A Lecture to Teach an Approach and Improve Resident Comfort in Leading Resuscitation of Young Infants in the Emergency Department

AUDIENCE: The intended audience of this lecture is emergency medicine residents at all levels of training. It is also appropriate for practicing emergency physicians interested in improving comfort in resuscitating sick young infants, ages 0–60 days. INTRODUCTION: The majority of sick and injured children in the United States are seen and treated in general emergency departments.1 This includes very young infants (0–60 days old) in need of immediate resuscitation. Resuscitation of children in this age group involves use of specific knowledge and skills that residents and emergency physicians in general have fewer opportunities to practice.2,3 Emergency medicine residents and practicing emergency physicians often report this as an area of particular discomfort in practice.4,5 It is important that the inconsistent and infrequent opportunities to resuscitate young infants during emergency medicine residency and beyond are supplemented by residency didactics that focus on improving comfort and skills with this population of sick children. This lecture focuses on a practical approach intended to improve the relevant knowledge, skills, and confidence required to stabilize a critically ill young infant in a general emergency department. EDUCATIONAL OBJECTIVES: By the end of this lecture, participants should be able to: 1. Apply a consistent approach to the initial resuscitation of a critically ill young infant in the emergency department. 2. Select appropriate medications and equipment for use in resuscitation of critically ill young infants. 3. Describe the components of the Pediatric Assessment Triangle,6 which can be used to identify critically ill infants and children. 4. Improve comfort in resuscitating young infants in the emergency department. EDUCATIONAL METHODS: This is a live lecture format using PowerPoint slides. The lecture emphasizes a practical approach to improve the skills and knowledge required for successful young infant resuscitation. It utilizes a case-based approach, and encourages the audience to determine next steps in care to mimic the real time decision-making required for care of critically ill young infants in the ED. RESEARCH METHODS: Learners were asked to fill out anonymous pre- and post quizzes immediately prior to and directly after the lecture was given. These surveys included questions to assess resident knowledge as well as resident comfort as it pertained to resuscitation of critically ill young infants. RESULTS: Resident comfort with resuscitation of young infants improved with a mean Standard Deviation (SD) pre-lecture rating of 23.1(14.9) on a 100-point visual analog scale and a mean (SD) post lecture rating of 46.7(14.6). Resident performance on all knowledge base questions improved on the post-lecture quiz for all four questions asked. DISCUSSION: This lecture was effective in improving emergency medicine resident comfort and practical knowledge pertaining to resuscitation of young infants in the emergency department. The emphasis on a practical approach was well received by the resident audience, and they engaged well with audience participation portions of the lecture. The impact of the lecture can be enhanced by having the lecturer share their own real-world experience of resuscitation of young infants in the emergency department during the discussion portions of the lecture. TOPICS: Neonatal resuscitation, infant resuscitation, pediatric assessment triangle, neonatal sepsis, congenital heart disease, congenital adrenal hyperplasia, non-accidental trauma, malrotation.