Nastily Exhausting Wizarding Test(NEWT)
2025 Pediatric Service Line Annual Competency Session
Welcome Wizards!
Pediatric Assessments
Pediatric Assessment Competence Validation
Review the validation forms, discuss what you missed in your assessment. Read the assessment validation to ensure you understand how to complete a thorough pediatric head to toe assessment.
Pediatric Post Op Case Study
Review the case study. Respond to the prompts as a group and enter your answers. After, discuss as a whole class.
Setting: Pediatric recovery unit, post-appendectomy
Background: Daniel Sanchez, an 8-year-old boy weighing 25.8 kg, underwent an uneventful laparoscopic appendectomy. He received succinylcholine and propofol during anesthesia. Initial Post-op Vitals: •
Temp: 99.0°F (37.2°C) •
HR: 100 bpm •
RR: 24 •
BP: 105/60 mmHg •
SpO₂: 100% Intervention: Daniel is given IV morphine 0.1 mg/kg for pain. 5 Minutes Later: •
Temp: 102.5°F (39.2°C) •
HR: 130 bpm •
RR: 30 •
BP: 120/80 mmHg •
Skin: Warm, moist •
Muscle rigidity noted in jaw and facial muscles •
Increased end-tidal CO₂ •
Dark urine observed
Pediatric Malignant Hyperthermia
Review the case again. Respond to the prompts as a group and enter your answers. After, discuss as a whole class.
Setting: Pediatric recovery unit, post-appendectomy
Background: Daniel Sanchez, an 8-year-old boy weighing 25.8 kg, underwent an uneventful laparoscopic appendectomy. He received succinylcholine and propofol during anesthesia. Initial Post-op Vitals: •
Temp: 99.0°F (37.2°C) •
HR: 100 bpm •
RR: 24 •
BP: 105/60 mmHg •
SpO₂: 100% Intervention: Daniel is given IV morphine 0.1 mg/kg for pain. 5 Minutes Later: •
Temp: 102.5°F (39.2°C) •
HR: 130 bpm •
RR: 30 •
BP: 120/80 mmHg •
Skin: Warm, moist •
Muscle rigidity noted in jaw and facial muscles •
Increased end-tidal CO₂ •
Dark urine observed
Pediatric Malignant Hyperthermia Discussion
PALS Case Review
- What is our first approach, assessment findings and interventions?
PALS Case Review
Initial Interventions: Attempted vagal maneuvers (ice pack to face, knees to chest). NO CHANGE.... What is next?
PALS Case Review
Initial Interventions: Attempted adenosine• First dose: 0.1 mg/kg IV rapid push (max 6 mg) • Second dose: 0.2 mg/kg IV rapid push (max 12 mg) • Administer adenosine using stop-cock method • Rhythm remains unchanged NO CHANGE.... What is next?
PALS Case Review
Decompensation• Patient becomes unresponsive • HR: 280, BP: 60/38, RR: 4, SpO₂: 80% NO CHANGE.... What is next?
PALS Case Review
Decompensation• Prepare for synchronized cardioversion
• First shock: 0.5 J/kg → no change
• Second shock: 1–2 J/kg → conversion to sinus rhythm if not, proceed to next steps.
You see a change back sinus, but the patient keeps having runs of SVT .... What is next?
Refractory SVT
Expert Consultation, Drip and/or other Pharmacological Interventions• Expert consult obtained- peds cardiology Esmolol drip: Loading dose: 100–500 mcg/kg IV once Infusion: Start at 50–100 mcg/kg/min Titrate: Increase by 25–50 mcg/kg/min every 10–20 min Usual range: 100–300 mcg/kg/min (max 1000 mcg/kg/min)2 Monitor for: hypotension and bradycardia Procainamide drip: Loading Dose: 15 mg/kg IV over 30–60 minutes Monitor: ECG and blood pressure Stop infusion if: Hypotension occurs or QRS complex widens >50% from baseline Maintenance Infusion: 20–80 mcg/kg/min by continuous IV infusion / Maximum: 2 g/day
Refractory SVT
Expert Consultation, Drip and/or other Pharmacological Interventions• Expert consult obtained- peds cardiology Esmolol drip: Loading dose: 100–500 mcg/kg IV once Infusion: Start at 50–100 mcg/kg/min Titrate: Increase by 25–50 mcg/kg/min every 10–20 min Usual range: 100–300 mcg/kg/min (max 1000 mcg/kg/min)2 Monitor for: hypotension and bradycardia Procainamide drip: Loading Dose: 15 mg/kg IV over 30–60 minutes Monitor: ECG and blood pressure Stop infusion if: Hypotension occurs or QRS complex widens >50% from baseline Maintenance Infusion: 20–80 mcg/kg/min by continuous IV infusion / Maximum: 2 g/day
SVT Knowledge Check
SVT Knowledge Check
SVT Knowledge Check
SVT Knowledge Check
Euipment Stations
Go to each station and complete the activity/instructions.
- Bair Hugger
- Transport warming matress
- Radiant Warmer
- Bili Lights
- temp probes: esophageal, foley, baby, rectal
- Ranger Fluid Warmer
- Surgical Drains (JP and hemovac)
- PCA
- Defibrillator
- Tracheostomies
- Restrains: violent and non-violent
- C-collars and C-spine
End of Session for Peds M/S RNs
Time to get competency signed, then you are dismissed.
Ventilator/Unplanned Extubation Simulation Debrief
- Vent Alarms and actions to take
- vent buttons- what RNs can utilize vs RT only
- DOPE algorithm
- response for unplanned extubation
- important of volumes and volume trends
- PIP increase- meaning
Patient Profile: •Name: Simone Phillips • Age: 4 months • Weight: 6 kg • Diagnosis: Post-pneumonia, intubated for respiratory support
Ventilator/Unplanned Extubation Knowledge Check
Ventilator/Unplanned Extubation Knowledge Check
Ventilator/Unplanned Extubation Knowledge Check
Pediatric Procedural Sedation Safety and Interventions
Debrief Topics:
- Airway management sequence
- Jaw thrust techniques and sniffing position importance
- PEEP and PIP on the Resuscatee
- LMAs
- Reversal Review
- ETCO2 review
- Bronchospasm recognition and treatment
- Sedation risk factors and monitoring
Pediatric IOs
Femur has a HIGH success rate on first attempt.
Pediatric IOs
Humeral in young children can be difficult to find the landmark. ONLY insert if the landmarks are clear and present.
Pediatric IOs
Pediatric IOs- Time to Practice
REMINDER: you may not always get blood return, BUT STILL CONFIRM PLACEMENT USING THE GUIDANCE BELOW.
ALWAYS ASSESS FOR SIGN OF INFILTRATION!
End of Session
Time to get competency signed, then you are dismissed.
2025 Pediatric Service Line Annual Competency Session
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Transcript
Nastily Exhausting Wizarding Test(NEWT)
2025 Pediatric Service Line Annual Competency Session
Welcome Wizards!
Pediatric Assessments
Pediatric Assessment Competence Validation
Review the validation forms, discuss what you missed in your assessment. Read the assessment validation to ensure you understand how to complete a thorough pediatric head to toe assessment.
Pediatric Post Op Case Study
Review the case study. Respond to the prompts as a group and enter your answers. After, discuss as a whole class.
Setting: Pediatric recovery unit, post-appendectomy Background: Daniel Sanchez, an 8-year-old boy weighing 25.8 kg, underwent an uneventful laparoscopic appendectomy. He received succinylcholine and propofol during anesthesia. Initial Post-op Vitals: • Temp: 99.0°F (37.2°C) • HR: 100 bpm • RR: 24 • BP: 105/60 mmHg • SpO₂: 100% Intervention: Daniel is given IV morphine 0.1 mg/kg for pain. 5 Minutes Later: • Temp: 102.5°F (39.2°C) • HR: 130 bpm • RR: 30 • BP: 120/80 mmHg • Skin: Warm, moist • Muscle rigidity noted in jaw and facial muscles • Increased end-tidal CO₂ • Dark urine observed
Pediatric Malignant Hyperthermia
Review the case again. Respond to the prompts as a group and enter your answers. After, discuss as a whole class.
Setting: Pediatric recovery unit, post-appendectomy Background: Daniel Sanchez, an 8-year-old boy weighing 25.8 kg, underwent an uneventful laparoscopic appendectomy. He received succinylcholine and propofol during anesthesia. Initial Post-op Vitals: • Temp: 99.0°F (37.2°C) • HR: 100 bpm • RR: 24 • BP: 105/60 mmHg • SpO₂: 100% Intervention: Daniel is given IV morphine 0.1 mg/kg for pain. 5 Minutes Later: • Temp: 102.5°F (39.2°C) • HR: 130 bpm • RR: 30 • BP: 120/80 mmHg • Skin: Warm, moist • Muscle rigidity noted in jaw and facial muscles • Increased end-tidal CO₂ • Dark urine observed
Pediatric Malignant Hyperthermia Discussion
PALS Case Review
PALS Case Review
Initial Interventions: Attempted vagal maneuvers (ice pack to face, knees to chest). NO CHANGE.... What is next?
PALS Case Review
Initial Interventions: Attempted adenosine• First dose: 0.1 mg/kg IV rapid push (max 6 mg) • Second dose: 0.2 mg/kg IV rapid push (max 12 mg) • Administer adenosine using stop-cock method • Rhythm remains unchanged NO CHANGE.... What is next?
PALS Case Review
Decompensation• Patient becomes unresponsive • HR: 280, BP: 60/38, RR: 4, SpO₂: 80% NO CHANGE.... What is next?
PALS Case Review
Decompensation• Prepare for synchronized cardioversion • First shock: 0.5 J/kg → no change • Second shock: 1–2 J/kg → conversion to sinus rhythm if not, proceed to next steps. You see a change back sinus, but the patient keeps having runs of SVT .... What is next?
Refractory SVT
Expert Consultation, Drip and/or other Pharmacological Interventions• Expert consult obtained- peds cardiology Esmolol drip: Loading dose: 100–500 mcg/kg IV once Infusion: Start at 50–100 mcg/kg/min Titrate: Increase by 25–50 mcg/kg/min every 10–20 min Usual range: 100–300 mcg/kg/min (max 1000 mcg/kg/min)2 Monitor for: hypotension and bradycardia Procainamide drip: Loading Dose: 15 mg/kg IV over 30–60 minutes Monitor: ECG and blood pressure Stop infusion if: Hypotension occurs or QRS complex widens >50% from baseline Maintenance Infusion: 20–80 mcg/kg/min by continuous IV infusion / Maximum: 2 g/day
Refractory SVT
Expert Consultation, Drip and/or other Pharmacological Interventions• Expert consult obtained- peds cardiology Esmolol drip: Loading dose: 100–500 mcg/kg IV once Infusion: Start at 50–100 mcg/kg/min Titrate: Increase by 25–50 mcg/kg/min every 10–20 min Usual range: 100–300 mcg/kg/min (max 1000 mcg/kg/min)2 Monitor for: hypotension and bradycardia Procainamide drip: Loading Dose: 15 mg/kg IV over 30–60 minutes Monitor: ECG and blood pressure Stop infusion if: Hypotension occurs or QRS complex widens >50% from baseline Maintenance Infusion: 20–80 mcg/kg/min by continuous IV infusion / Maximum: 2 g/day
SVT Knowledge Check
SVT Knowledge Check
SVT Knowledge Check
SVT Knowledge Check
Euipment Stations
Go to each station and complete the activity/instructions.
End of Session for Peds M/S RNs
Time to get competency signed, then you are dismissed.
Ventilator/Unplanned Extubation Simulation Debrief
Patient Profile: •Name: Simone Phillips • Age: 4 months • Weight: 6 kg • Diagnosis: Post-pneumonia, intubated for respiratory support
Ventilator/Unplanned Extubation Knowledge Check
Ventilator/Unplanned Extubation Knowledge Check
Ventilator/Unplanned Extubation Knowledge Check
Pediatric Procedural Sedation Safety and Interventions
Debrief Topics:
Pediatric IOs
Femur has a HIGH success rate on first attempt.
Pediatric IOs
Humeral in young children can be difficult to find the landmark. ONLY insert if the landmarks are clear and present.
Pediatric IOs
Pediatric IOs- Time to Practice
REMINDER: you may not always get blood return, BUT STILL CONFIRM PLACEMENT USING THE GUIDANCE BELOW.
ALWAYS ASSESS FOR SIGN OF INFILTRATION!
End of Session
Time to get competency signed, then you are dismissed.