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Introduction Chronic salicylate toxicity is an uncommon, potentially life-threatening poisoning that requires high clinical suspicion in order to make the diagnosis. We created a simulation case that challenges learners to analyze case information, construct a differential diagnosis of an elevated anion gap metabolic acidosis with respiratory alkalosis, and initiate treatment for this toxicity. Methods The simulation case was designed for emergency medicine residents and pediatric emergency medicine fellows. The activity began with a brief overview of the monitors, equipment, and simulation experience. For interns, a team of two learners comanaged the case; for senior learners, the case was managed solo. The learners had 15 minutes to complete a focused history and physical exam, request and interpret labs and studies, and initiate specific treatments. The simulation was followed by a 15-minute facilitated debrief session that included an overview of key learning points and learner performance based on an evaluation checklist. Results Residents completed a postparticipation questionnaire consisting of six questions rated on a 5-point Likert scale. Overall, residents reported a high degree of satisfaction with the simulation experience. The case and debrief were effective in meeting the educational objectives and proved to be an effective modality to fill this educational gap. Discussion This simulation exercise was effective in showing residents the uncommon presentation of chronic salicylate toxicity. Learners reported increased confidence in recognizing and managing this ingestion. The simulation experience closed an identified education gap and provided an experiential learning opportunity that accomplished the targeted learning objectives.

Abstract Acute iron overdose is an uncommon but life-threatening ingestion that requires basic knowledge of clinical effects to evaluate and manage. This case requires residents to critically think about numerous tests and interventions to manage the case, including required laboratory studies, utility of radiographic studies, decontamination efforts, and antidote administration. Secondary to unfamiliarity with this ingestion, this case offers residents an opportunity to test their knowledge base and critically self-assess their approach to patient care for this ingestion. Included in the resource is the patient information (laboratory, EKG, and radiographic imaging) as well as a PowerPoint presentation.

Abstract This educational resource provides the information and materials for a high-fidelity simulation case suitable for resident physicians in emergency medicine. This case is currently in use at Wake Forest University in North Carolina and Wright State University in Ohio for emergency medicine residents completing educational time in emergency department simulation programs. This case has been used for the past 3 years and has recently been edited and expanded to its existing form. The resource contains a high-fidelity patient simulation case involving a patient presenting with fatigue and weakness. Evaluation in the emergency department demonstrates bradycardia and worsening hemodynamic status from beta-adrenergic antagonist toxicity. Appropriate treatment with glucagon and vasopressors will allow stabilization of the patient. Debriefing materials are provided to illustrate and stimulate discussion of the important concepts for diagnosing and treating patients with beta-blocker toxicity. This case is currently in use for emergency medicine residents completing required educational time in an emergency medicine simulation program. This scenario has been presented for small groups of three to four participants, and has been field-tested approximately eight times over the past 3 years. All participants have been PGY1, PGY2, and PGY3 emergency medicine residents.