Volume depletion is commonly reported in pediatrics. Interns must identify critical illnesses like hypovolemic shock, acquire access, and handle complications. A simulation case describes a child with hypovolemic shock who needs intraosseous (IO) needle placement. Designed for subinterns in pediatrics, it is also applicable for clerkship students and interns in family medicine and emergency medicine.

A 3-year-old child presents with vomiting, diarrhea, and lethargy, and was in a state of hypovolemic shock. Since IV access wasnt feasible, IO access was required. Laboratory results showed hypoglycemia, hypernatremia, and acute kidney injury. Equipment required was an IV arm task trainer and a child mannequin with IO capacity (or a child mannequin plus a separate IO task trainer). Identifying and managing hypovolemic shock, hypoglycemia, and electrolyte disturbances; obtaining IO access; and communicating with a distraught parent were the Learning objectives. Attempting IO access, requesting labs, and administering fluids were the critical actions required. Students were to fill out a self-assessment survey after the case.

16 subinterns in the pediatric service were included in this pilot study. Their perceived competence in assessing and managing volume depletion and procedural skills like IO placement was high after the session, and they rated the case as a highly beneficial learning experience.

This clinical simulation case permits students to display clinical reasoning skills, procedural skills, and management skills regarding hypovolemic shock. It may be included in the curriculum for fourth-year students entering pediatric residency.

Source: Rideout M, Raszka W. Hypovolemic Shock in a Child: A Pediatric Simulation Case. MedEdPORTAL. 2018 Mar 16;14:10694. doi: 10.15766/mep_2374-8265.10694. PMID: 30800894; PMCID: PMC6342355.