Medical College of Wisconsin
CTSICores SearchResearch InformaticsREDCap

Pediatric Emergency Medicine Didactics and Simulation (PEMDAS): Serotonin Syndrome. MedEdPORTAL 2020 Jul 28;16:10928



Pubmed ID


Pubmed Central ID




Scopus ID

2-s2.0-85088884557   1 Citation


INTRODUCTION: Serotonin syndrome is caused by an accumulation of serotonin in the body from drug interactions or overdose of serotonergic medications, including commonly used antidepressants. Symptoms can be life-threatening and encompass both neurologic and cardiovascular toxicity, including agitation, seizure, tachycardia, rhabdomyolysis, and hyperthermia.

METHODS: This simulation case was developed for pediatric emergency medicine fellows and emergency medicine residents in the pediatric emergency department and can be altered to accommodate other learners. The case involved a 16-year-old male, represented by a low- or high-fidelity manikin, who presented with altered mental status/agitation after an overdose of antidepressant medication. The team of learners was required to perform a primary and a secondary assessment; manage airway, breathing, and circulation; and recognize and initiate treatment for serotonin syndrome. The patient had a seizure resulting in airway compromise requiring advanced airway support, as well as developed rhabdomyolysis requiring aggressive fluid hydration. We created a debriefing guide and a participant evaluation form.

RESULTS: Fifty-seven participants across five institutions completed this simulation, which included residents, fellows, faculty, and students. The scenario was rated by participants using a 5-point Likert scale and was generally well received. Participants rated the simulation case as effective in learning how to both recognize (M = 4.9) and manage (M = 4.8) serotonin syndrome.

DISCUSSION: This pediatric emergency simulation scenario can be tailored for a range of learner backgrounds and simulation environments. We used the participant evaluation form to improve future iterations of the simulation.

Author List

Shubin C, Iyer S, Pearce J, Lang B, Gross I, Ciener D, Mazor S, Keilman A, Thomas A


Jean Pearce MD Assistant Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Clinical Competence
Emergency Medicine
Pediatric Emergency Medicine
Serotonin Syndrome
Simulation Training