Faculty Collaboration Database

Pediatric Toxidrome Simulation Curriculum: Lidocaine-Induced Methemoglobinemia. MedEdPORTAL 2021 Jan 28;17:11089

Date

02/05/2021

Pubmed ID

33537407

Pubmed Central ID

PMC7842087

DOI

10.15766/mep_2374-8265.11089

Scopus ID

2-s2.0-85101256512 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

INTRODUCTION: Lidocaine is a common local anesthetic used during minor procedures performed on pediatric patients. A rare but toxic and life-threatening side effect of lidocaine is methemoglobinemia. It should be considered in children who are hypoxic after exposure to an oxidizing agent.

METHODS: We developed this simulation case for pediatric emergency medicine (PEM) fellows, but it can be adapted for interprofessional simulation. The case involved a 1-month-old male with hypoxia and resulting central cyanosis after exposure to lidocaine. The team performed an initial evaluation and intervention, collected a history, and developed a differential diagnosis for hypoxia and central cyanosis in an infant. Methemoglobinemia was confirmed by CO-oximetry. Preparatory materials, a debriefing guide, and scenario evaluation forms assisted with facilitation.

RESULTS: Fifty-six participants (including 18 PEM fellows) completed this simulation across four institutions. Participants rated the scenario on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree), finding it to be relevant to their work (median = 5) and realistic (median = 5). After participation in the simulation, learners felt confident in their ability to recognize methemoglobinemia (median = 4) and implement a plan to stabilize an infant with hypoxia (median = 4).

DISCUSSION: This simulation represents a resource for learners in the pediatric emergency department. It teaches the recognition and management of an infant with lidocaine toxicity and resultant methemoglobinemia. It uses experiential learning to teach and reinforce a systematic approach to the evaluation and management of a critically ill infant with acquired methemoglobinemia.

Author List

Rosso CD, Thomas A, Hardy N, Connelly S, Davila U, Pearce J, Mazor S, Burns R

Author

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

Computer Simulation
Curriculum
Humans
Infant
Lidocaine
Male
Methemoglobinemia
Pediatric Emergency Medicine