Isoniazid Overdose: A Pediatric Simulation Case.

Abstract

Unintentional toxic ingestions are a common occurrence in the pediatric population, and it is therefore important for resident physicians to learn to both recognize and effectively manage these events. Seizures caused by isoniazid overdose are a well-described clinical entity for which pyridoxine serves as an effective antidote. We developed a pediatric simulation case using a high-fidelity patient simulator to engage learners in a case of status epilepticus in a toddler caused by accidental isoniazid ingestion. The learning objectives of this activity are for participants to recognize that toxic ingestion has occurred, execute appropriate initial management of status epilepticus, and administer pyridoxine as an antidote. Equipment and personnel needed for this activity include a high-fidelity patient simulator, simulated medical supplies, a patient simulator operator, and one actor. This simulated case debuted among resident physicians at a simulation competition event within the emergency medicine residency program of an academic medical center. Feedback elicited after the event included a high proportion of respondents agreeing that the cases used were "sufficiently complex" and "relevant for my clinical practice." Despite some barriers to effective implementation, this simulation case was well received and may serve as a valuable educational tool for training resident physicians to effectively manage toxic ingestions. The effectiveness of this simulation in accomplishing its specific learning objectives was not formally assessed, but participant evaluations suggest that it was well received by its target audience.