514 - Airway Foreign Body: Difficult Airway Simulation for Pediatric Trainees

Poster Number: 514
Publication Number: 514.3153

Background: Airway foreign body obstruction (FBO) can be a challenge to recognize and manage even for the experienced clinician and poses a significant risk to affected patients. The presentation of FBO can be life threatening and as such a high index of suspicion should be held by providers. Additionally, adequate preparation and instrumentation is crucial for successful recognition and management of patients with FBO. While simulations exist for otolaryngology providers, currently pediatric foreign airway body simulations for PEM fellows and other pediatric trainees in the literature are lacking.

Objective: To evaluate perceived skill and comfort with managing airway foreign body obstruction in the pediatric patient using simulation curriculum.

Design/Methods: A simulation case was created for PEM fellows and other learners in the pediatric emergency department. Participants included PEM fellows, physician assistants, and a respiratory therapist. The case was a 2-year-old male presenting with acute onset difficulty breathing brought to ED by ambulance from daycare. Learner actions included preparing equipment for desired intervention and setting up emergency airway equipment, recognizing unsuccessful pharmacologic intervention, recognizing complete airway obstruction and attempting visualization with correct instrumentation, attempt to perform rapid sequence intubation (RSI) to secure airway, and to recognize failed intubation due to foreign body obstruction and attempt to appropriately secure airway by emergency cricothyrotomy.

Results: The simulation was rated by 30 participants across two sites on a 5-point Likert scale for both simulation and debrief. Learners rated perceived skills after simulation including escalation of oxygen supplementation (M=4.6), evaluating airway for signs of difficult airway (M=4.4), preparing advanced airway equipment for difficult airway (M=4.6), and understanding indications and contraindications for intubation (M=4.7). The simulation scenario was rated realistic (M= 4.5), clinically relevant (M=4.7), and self-reported improved comfort level in caring for critically ill children (M=4.86). Learners rated the debrief as providing valuable learning (M=4.93), and felt debrief was a safe, supportive environment (M=4.9) (Figure 1).

Conclusion(s): This pediatric airway foreign body obstruction simulation case can be utilized by pediatric trainees and other learners in the pediatric emergency department caring for children with suspected FBO. To improve the learning experience of subsequent simulation sessions, we have integrated learner feedback.