Critical Coarctation of the Aorta - 10-day old Neonate Scenario - Team Simulation

Sep 23, 2026

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Scenario-based clinical simulation for emergency providers managing a 10-day old neonate with critical coarctation of the aorta presenting with decompensated shock. The module emphasizes rapid recognition of ductal-dependent congenital heart disease, prioritization of ABCs with continuous reassessment, shock differential diagnosis, timely IV/IO or UVC access, and glucose treatment. Learners practice RSI in cardiogenic shock, initiation of PGE infusion, and administration of empiric antibiotics, supported by high-fidelity simulation and structured debriefing.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Emergency Providers Goals and Objectives

Learner Strategy and Assessment

Scenario Flow and Preparation

Medical Setting and EMS Call

Preparation and Critical Actions

Patient Evaluation and Critical Actions

Airway, Breathing, Circulation

Glucose Management and Fluid Boluses

Antibiotics and PGE Infusion

RSI, Access, and Confirmation Steps

Intubation and ETCO2 Confirmation

NG Tube Placement

Team Roles and Debriefing

Team Leader Prompts

Other Team Members Prompts

Scenario: 10-day old Neonate with Critical Coarctation of the Aorta | Learners | Goals | Objectives | Strategy | Assessment | | --- | --- | --- | --- | --- | | Emergency
Providers | Review and practice recognition of:
1. Ductal-dependent congenital heart disease | 1. Identify cardiogenic shock in the neonate
2. Demonstrate prioritization ofABCs with continued reassessment
3. Verbalize the differential diagnosis of shock in the newborn period
4. Obtain rapid IV/IO or UV access
5. Perform RSI in the context of cardiogenic shock in an infant
6. Recognize and treat hypoglycemia in the infant in shock
7. CCEMTP: Administer PGE to the infant with shock
8. CCEMTP: Administer empiric antibiotics to the infant in shock. | 1. High fidelity simulation
2. Structured debriefing | 1. Critical action checklist
2. Global Assessment Scale | Defined Team Roles: • Team leader: • Airway /Breathing: • Circulation/IV Access/Monitor/Fluids: • Medications • Family member (parent): • Debriefing: • Simulator: Scenario Flow • Medical Setting: Home • • EMS Call: Parents noted that the baby had been feeding poorly for 3-4 days, decreased urination, and today has been “breathing fast” and has become “lethargic.”Fire arrives and describes pale, limp infant with cold extremities, tachypnea, and tachycardia. Unable to obtain a BP, unable to obtain IV access. VS: HR 180, RR 40s, Pox – not picking up. • Preparation: Roles and expectations verbalized, including potential need for: IV/IO access, RSI Estimates weight at 3 kg, Consider call for additional transport/flight depending on where you are ▪ Critical Actions: Anticipates airway equipment, RSI meds, IO, umbilical line equipment • Patient eval: Pale, intermittent grunting with rapid respiratory rate, poor tone. • VS: HR 180, RR 48, BP unable to obtain, POX unable to obtain, if obtains temp = 36oC • Physical Exam: ▪ Critical Actions: Applies high-flow oxygen via non-rebreather, attaches monitors, calls for IV access with 10cc/kg NS bolus. Closed loop communication: 10cc/kg = 30cc NS bolus; repeats back. Exposes infant o Airway: Patent o Breathing: Intermittent grunting, clear BS bilaterally, tachypneic o Circulation: Palpable brachial pulses, very weak femoral pulses, unable to appreciate distal pulses in feet. ▪ Critical Actions: Limits attempts at PIV to 3 attempts or 90 seconds (CCEMTP Prepares umbilical stump with wet saline), or calls for EZ-IO drill. Recognition of shock. Verbalizes differential diagnosis: “We have a critically ill 10-day old infant in decompensated shock with poor perfusion. This could be overwhelming sepsis or congenital heart disease.” Calls for glucose. Places UVC or IO. Administers IVF bolus: 10cc/kg = 30cc. ▪ Disability (GCS): Eyes closed at rest, grunting, ▪ Head: Atraumatic, sunken fontanelle. {PERRL: 4mm to 2mm, if checked} Nares patent, dry lips/tongue, normal TMs. ▪ Thorax: Tachycardic with possible gallop, harsh murmur. ▪ Abdomen: Non-distended, non-tender, no organomegally ▪ Critical Actions: IF team is CCEMTP, they can begin empiric antibiotics: Ampicillin 50mg/kg = 150 mg UV/IO and Gentamicin 4mg/kg = 12mg. Requests STAT PGE drip from pharmacy at 0.05mcg/kg/min (0.1mcg/kg/min OK) . ▪ Pelvis / Extremities: Cold extremities, mottled, 10sec capillary refill. ▪ Includes parent in resuscitation room. • Frightened teenage parent reveals uncomplicated pregnancy with no pre-natal care, uncomplicated NSVD, discharged DOL 2, bottle feeding well until 3-days ago. Has not checked temperature, noted “fast breathing” and “hard to wake up to feed.” • Explains critical condition of infant, need for intubation • Reassess VS, ABCs: HR 185, RR 46, BP unable to obtain, POX unable to obtain. Patent airway, clear BS, occasional grunting, cold extremities with extremely delayed capillary refill. o Bedside glucose: 32 o Critical Actions: Orders D10 bolus: 4cc/kg (2-5 acceptable) = 12cc UV/IO

FAQs

What should emergency providers focus on first in this neonate scenario?

They review and practice recognition of ductal-dependent congenital heart disease and identify cardiogenic shock, while prioritizing ABCs with continued reassessment.

How is IV/IO or UVC access handled when standard access fails?

The scenario limits PIV attempts, prepares an approach for IO (including EZ-IO), or places a UVC/IO access to deliver rapid boluses and medications.

What key treatments are included for shock and suspected ductal-dependent disease?

They administer high-flow oxygen, give fluid boluses and dextrose for hypoglycemia, start empiric antibiotics, and request PGE infusion (PGE drip) as part of shock management.

Sep 23, 2026

Uploaded by Ivy