Lethargic Infant

Publication ID Published Volume
755 December 26, 2007 3


A ten-month old male presents via Emergency Medical Services (EMS) with an altered mental status. His mother went to check on him this morning and found him in his crib lethargic, hot to the touch, and difficult to arouse. She tried putting him in a cool bath, but "he wouldn't stay awake." Paramedics found the child to be lethargic and minimally responsive. They are unable to establish intravenous therapy (IV) and transported him to the hospital. Shortly after arrival in the emergency room and the primary survey, he has a generalized seizure. The case progresses through a series of decisions including seizure management, airway management, septic shock, and cardiac arrest. When this case was used in our simulation center, it was found to be an effective tool to teach and evaluate emergency medicine (EM) residents in pediatric resuscitation techniques and septic shock management. It uses a high-fidelity simulation mannequin to create a realistic atmosphere, placing residents in a high-pressure situation without risk. Standardized forms were used to successfully evaluate residents in the core competencies. Using an anonymous electronic evaluation system, excellent feedback was received from the residents who found the case to be highly educational. The case tends to flow naturally, but faculty/preceptor prompting and manual transitions on the simulator may be necessary to ensure realism and smooth flow. At the end of the resuscitation, the faculty/preceptor will need to make it obvious that all further resuscitative efforts fail.


Noeller T, Smith M. Lethargic infant. MedEdPORTAL Publications. 2007;3:755. http://doi.org/10.15766/mep_2374-8265.755

Educational Objectives

  1. To be able to gain recognition and management of altered mental status in infants.
  2. To be able to gain recognition and management of seizures in infants.
  3. To be able to gain recognition and management of septic shock and cardiovascular collapse in infants.
  4. To be able to gain involvement of family in termination of resuscitation efforts.


  • Pulmonary Ventilation, Shock, Septic, Heart Arrest, SAEM, Infant, Seizures, Resuscitation

Prior Scholarly Dissemination

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ISSN 2374-8265