Fever and Seizure in a Young Infant: A Simulation Case

Abstract

Introduction: Fever in early infancy is a common problem for which management can be challenging. All residents need to be able to recognize critical illness such as meningitis in febrile infants and manage complications such as seizures. Many new residents are not competent performing bedside procedures as there is little opportunity to perform them while in medical school. This simulation case revolves around fever and subsequent seizures in an infant. Designed to last 2 hours, the case is specific for subinterns but is relevant for clerkship students and interns in pediatrics, family medicine, and emergency medicine.

Methods: In this case, a 5-week-old infant presents with fever and lethargy. He develops seizures with respiratory depression requiring antiseizure medication and respiratory support. His final diagnosis is bacterial meningitis. Major equipment required includes an infant mannequin and an infant lumbar puncture task trainer.

Results: A pilot study was conducted in 2015 with all subinterns on the pediatric service. Students' perceived competence in diagnosis/management, procedural skills, and managing complex pediatric cases rose sharply after completing the session. Critical actions include obtaining IV access, performing blood and urine cultures, considering lumbar puncture, recognizing respiratory depression, performing bag and mask ventilation, administering antiseizure medication, counseling parents, and starting appropriate anti-infective therapy.

Discussion: This clinical simulation case allows students to demonstrate clinical reasoning skills, procedural skills such as performing a lumbar puncture and bag-mask ventilation, and management skills. Materials are provided for students to perform self-assessments of perceived competency in procedural, diagnosis, and management skills related to the case.

Keywords: Fever; Lumbar Puncture; Meningitis; Pediatrics; Seizures; Simulation; Spinal Puncture; Subintern.