Original Publication
Open Access

Pediatric Emergency Medicine Simulation: Hyperkalemia Due to Congenital Adrenal Hyperplasia

Published: October 29, 2015 | 10.15766/mep_2374-8265.10250

Included in this publication:

  • Pediatric Emergency Medicine Curriculum-CAH.pdf
  • CAH Slide Presentation.ppt

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Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.

Abstract

Congenital adrenal hyperplasia is a group of autosomal recessive diseases marked by mutation of the genes involved in steroidogenesis. There are many types of the disease with 21-hydroxylase deficiency comprising 90-95% of cases. Medical providers must be able to identify the signs and symptoms of salt-wasting, specifically related to hyperkalemia and hyponatremia. When presented with a critical potassium level, medical providers must rapidly stabilize the cardiac membranes to prevent ventricular arrhythmias. The goal of this scenario is to provide the learner with an opportunity to manage life-threatening pediatric hyperkalemia due to adrenal crisis, where both electrolyte abnormalities and the underlying etiology must be addressed. We include extensive preparatory material to help the instructor prepare the environment and learners. The debriefing tools have been tailored specifically for this scenario, with advice on how the instructor can edit them for different learners. The suggested debriefing comments/questions in the Skill Training section are written in the advocacy-inquiry debriefing style that would best be supported by formative assessment with adequate time for learners to reflect. These are the debriefing questions we use the most in our ongoing educational curriculum. The Medical Management and Teamwork Evaluations/Debriefing Forms are written in the plus/delta debriefing style and are a better fit for summative assessment. We use these less frequently, often as part of our quality improvement work. Because not all the material will be applicable to every instructor and every set of learners, we recommend instructors spend at least 30 minutes of preparatory time with all the materials to ensure familiarity, confidence, and maximal efficacy.


Educational Objectives

By the end of this module, the learner will be able to:

  1. Recognize and manage undiagnosed congenital adrenal hyperplasia in a pediatric patient.
  2. Recognize hyperkalemia in a pediatric patient and initiate prompt treatment.
  3. Demonstrate efficient, effective teamwork and communication skills.

Author Information

  • Abigail Schuh, MD: Seattle Children's Hospital
  • Rebekah Burns, MD: Seattle Children's Hospital
  • Jennifer Reid, MD: Seattle Children's Hospital
  • Kimberly Stone, MD, MA, MS: Seattle Children's Hospital

Disclosures
None to report.

Funding/Support
None to report.


References

  1. Agus MSD. Endocrine emergencies. In: Fleisher GR, Ludwig S, eds. Textbook of Pediatric Emergency Medicine. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010:768-771.
  2. American Heart Association. Pediatric Advanced Life Support: Provider Manual. Dallas, TX: American Heart Association; 2011.
  3. Hegenbarth MA; Committee on Drugs. Preparing for pediatric emergencies: drugs to consider. Pediatrics. 2008;121(2):433-443. http://dx.doi.org/10.1542/peds.2007-3284
  4. Joint LWPES/ESPE CAH Working Group. Consensus statement on 21-hydroxylase deficiency from the Lawson Wilkins Pediatric Endocrine Society and the European Society for Paediatric Endocrinology. J Clin Endocrinol Metab. 2002;87(9):4048-4053. http://dx.doi.org/10.1210/jc.2002-020611
  5. Masilamani K, van der Voort J. The management of acute hyperkalaemia in neonates and children. Arch Dis Child. 2012; 97(4):376-380. http://dx.doi.org/10.1136/archdischild-2011-300623
  6. Simon R, Raemer DB, Rudolph JW. Debriefing Assessment for Simulation in Healthcare—Rater’s Handbook. Cambridge, MA: Center for Medical Simulation; 2009.
  7. TeamSTEPPS: national implementation. Agency for Healthcare Research and Quality Web site. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/about-teamstepps/index.html. Updated August 2015.


Citation

Schuh A, Burns R, Reid J, Stone K. Pediatric emergency medicine simulation: hyperkalemia due to congenital adrenal hyperplasia. MedEdPORTAL. 2015;11:10250. https://doi.org/10.15766/mep_2374-8265.10250

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