ALiEM Sim Case Series: Pediatric WPW 1. ABEM Milestone: Emergency Stabilization (PC1) Scenario: 10 yo boy s/p syncope with exertion found to have irregularly irregular wide complex tachycardia and undiagnosed WPW, if pt is not cardioverted, or if given AV nodal blocking agent, pt decompensates into VF cardiac arrest. Prioritizes critical initial stabilization action and mobilizes hospital support services in the resuscitation of a critically ill or injured patient and reassesses after stabilizing intervention. Milestone Level 1 2 2

Milestone to be Assessed Recognizes abnormal vital signs Recognizes when a pt is unstable requiring immediate intervention Discerns a primary assessment on a critically ill or injured pt

Specific Behavior o o o o o

3

3

Prioritizes critical initial stabilization actions in the resuscitations of a critically ill or injured pt Reassess after implementing a stabilizing intervention

o

o o o o o

4

Integrates hospital support services into a management strategy for a problematic stabilization situation

o o

Places pt on cardiorespiratory monitor upon arrival in the ED Places cardiac pacer pads upon the chest of the pt Discusses management of irregularly irregular wide complex tachycardia with the medical team Prioritizes focused history to questions limited to syncope and family history related to syncope Uses broselow tape to obtain approximate weight to provide weight based dosing and joules for pt resuscitation Assess ABCs by: 1. talks to the pt 2. places pt on supplemental oxygen 3. obtains IV or IO access Cardioverts or defibrillates the pt in a timely manner Repeats primary survey after each administration of medication or cardioversion/defibrillation Obtains new set of vitals after each administration of medication or cardioversion/defibrillation Obtains repeat EKG after each administration of medication or cardioversion/defibrillation If given procainamide, team recognizes stability and places pt on procainamide drip Obtains stats PICU consult for disposition of critically ill pt Obtains stat Pediatric Cardiology consult for evaluation of pt with dysrhythmia