An 18 month old presents with signs of an allergic reaction. He develops symptoms that are refractory to initial management and ultimately will require IV epinephrine and potentially intubation.

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Case By: The Hospital for Sick Children Simulation Team. Virtual Room created by HSC Sim Team, modified by Dr. Sarah Foohey.

A nine year old male presents with severe asthma.

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Case By: Dr. Alex Aliferis (2021). Reviewed by Sarah Foohey.

A 10 year old admitted for respiratory insufficiency in the setting of a viral infection with a superimposed pneumonia. He develops bradycardia with worsening hypoxia/septic shock and then asystole. After intubating and completing several rounds of CPR and epinephrine, patient will ROSC and be transferred to PICU for telemetry monitoring and ventilation management.

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Case and Room By: Dr. Alexandra Moseanko

A 6 year old with viral URI presenting with lethargy and altered mental status to peds ED. Initial ECG showing sinus bradycardia. After initiation of ventilation, respiratory status improves, but remains altered with bradycardia not responding to fluid management. Requires initiation of CPR and 2x dose of epinephrine to improve hemodynamics. At end of case, patient should be admitted to PICU and parents updated.

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Case and Room By: Dr. Alexandra Moseanko

A 4 month old boy presents with a respiratory distress secondary to bronchiolitis and progressing to respiratory failure prompting intubation.

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Case By: The Hospital for Sick Children Simulation Team. Virtual Room created by HSC Sim Team, modified by Dr. Sarah Foohey.

10-day-old male brought in by EMS with tachypnea and poor feeding. The team should work to diagnose a PDA-dependent congenital heart disease requiring alprostadil (PGE1) infusion. The PGE1 infusion will result in a brief apneic period corrected by BVM.

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Case By: Case modified from ALIEM EMReSCu Sim curriculum by Dr. James Leung and Dr. Rebekah Burns. Virtual Room created by Sarah Foohey.

A 6 month old girl presents with symptoms of croup. She has progressive hypoxia and respiratory distress, and ultimately requires intubation. Attempts at intubation are unsuccessful. She will ultimately require a surgical airway (needle cricothyrotomy) to secure her airway.

This virtual room includes audio of a croupy cough, gifs of respiratory distress, and a procedural model with integrated of the needle cric procedure.

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Case By: The Hospital for Sick Children Simulation Team. Virtual Room created by HSC Sim Team, modified by Dr. Sarah Foohey.

4 year old boy who has been unwell for a week with vomiting. He is found to have severe DKA. He subsequently develops cerebral edema. Due to ongoing vomiting, aspiration, and hypoxia he then requires intubation. Challenges include managing the protected intubation and optimizing peri-intubation course for the acidotic child.

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Case By: Dr. Robyn Shafer & Dr. Sarah Foohey, modified from a case written by Dr. Nick Clarridge.

A 5 year old boy is brought to the ED with infectious symptoms. He is found to be in shock. He then progresses into a ventricular tachycardia arrest and requires Defibrillation.

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Case By: The Hospital for Sick Children Simulation Team. Virtual Room created by HSC Sim Team, modified by Dr. Sarah Foohey.

After the precipitous delivery of a term pregnancy in the emergency department, learners should care for this neonate using the NRP algorithm.

Our team used the rapid cycle deliberate practice technique to review the NRP management steps. This case could be delivered in sequence after the resuscitative hysterotomy case.

Multimedia includes a photo and video of a floppy neonate. The virtual room includes a “warmer” where learners will have to select the appropriate settings and a slide that models the steps involved in placing a UVC:

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Case By: SimSinai. Updated Jan 2021 by Dr. Maria Ivankovic.

Evelyn is an 18 month old female admitted to pediatric wards with viral bronchiolitis that develops worsening hypoxia and transitions into PEA requiring deep compressions and 3 rounds of epinephrine. Team should be able to identify PEA and hypoxia as root cause to correct PEA.

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Case and Room By: Dr. Alexandra Moseanko

3 year old boy came inside from playing around the campsite, holding his arm, and crying inconsolably. Exam will show tachycardia, mild hypotension, right arm swelling and two small puncture wounds to the extremity concerning for a snake envenomation. Edema will progress and the learners will need to recognize that antivenom is indicated, order it, and administer in conjunction with toxicology/poison control and a pharmacist. For junior learners, the case ends with disposition to the PICU. For senior learners, the patient goes on to have an anaphylactoid reaction to the antivenom, necessitating treatment with epinephrine, slowed infusion rate, and/or cessation of infusion in conjunction with discussion with poison control.

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Case By: Melissa Joseph MD, Elizabeth Sanseau MD, MS, Anita Thomas MD MPH, Nick Brandehoff MD, Julie Augenstein MD, Megan Shuster PharmD, Gunjan Tiyyagura MD MHS, Marc Auerbach MD. Virtual Room developed by Melissa Joseph and Sarah Foohey.

A 4 year old boy appearing unwell with respiratory distress is brought to the resuscitation bay. He is found to be septic secondary to pneumonia. He will require resuscitation with supplemental oxygen, fluids, pressors, and early antibiotics. He will eventually require intubation. 

This case integrates the following multimedia: video of child with work of breathing, video of delayed cap refill, video demonstrating use of 3-way stopcock, and audio clip of crackles. It also includes a procedural model where learners will have to walk through the steps involved with placing an IO.

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Case By: Dr. James Leung, McMaster

10 year old male with complex medical history (cerebral palsy) and tracheostomy with pneumonia is seen in a community ED with pneumonia. The child presents in respiratory distress and is hypoxic. He acutely worsens with a tracheal mucus plug and requires a tracheostomy tube change to improve. After tracheostomy change, his work of breathing improves, but he remains in cold septic shock. Sepsis improves with 40cc/kg IV fluids and antibiotics.

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Case By: Case modified from ALIEM EMReSCu Sim curriculum by Dr. James Leung and Dr. Rebekah Burns. Virtual Room created by Sarah Foohey.

A 6 year old boy presents to the emergency department seizing. He has been seizing for 45 minutes. Learners will have to recognize this as status epilepticus, consider reversible causes, and manage him appropriately (with particular attention to medications and airway).

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Case By: Dr. James Leung, McMaster Children’s Hospital

A 5 year old girl presents to the ED feeling unwell with a URTI and is found to be in SVT. She is initially stable and learners can trial vagal maneuvers and medications. She then becomes hypotensive and learners should proceed with cardioversion. Learners will be expected to use the Broselow tape and/or her age to determine the appropriate dosing.

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Case By: Dr. Quang Ngo, McMaster.

6-month-old female with presents with crying and poor oral intake, but is otherwise alert. When placed on monitors, the patient is revealed to be in stable SVT. Vagal maneuvers and 2x attempts adenosine are provided without arrhythmia reversal. The patient’s oxygenation, ventilation and circulation decline and the patient develops unstable SVT. With BVM (patient will have PEA arrest if intubated), SVT terminates with 1J/kg synchronized cardioversion.

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Case By: modified from ALIEM EMReSCu Sim curriculum by Dr. James Leung and Dr. Rebekah Burns. Virtual Room created by Sarah Foohey.

A 12 year old girl, recently diagnosed with hyperthyroidism, presents in thyroid storm. She is acutely unwell. She is found to have pulmonary edema, and ultimately will require intubation.

This virtual room contains images of physical exam findings consistent with hyperthyroidism, models of BiPAP + vent machines, and a video of intubation being done.

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Case By: The Hospital for Sick Children Simulation Team. Virtual Room created by HSC Sim Team, modified by Dr. Sarah Foohey.

An 8 year old boy was admitted to the PICU for myocarditis that resulted in pVT and required resuscitation. He will go into Vfib and participants will need to recognize that the patient requires CPR and epinephrine. Ultimately the patient will re-enter sinus rhythm.

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Case and Room By: Dr. Alexandra Moseanko