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Virtual Reality Simulated Patient Encounters

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Altered Mental Status—MVA

Children's National

A 10-year-old male who presented after trauma with subdural hematoma who develops increased intracranial pressure.

Critical Care
Emergency Medicine
Pediatrics
Trauma

A 10-year-old male who presented after trauma with subdural hematoma who develops increased intracranial pressure.

Case Information:
Bundles:
Learner Population: Physician/Advanced Practice Provider
Specialty: Critical Care, Emergency Medicine, Pediatrics, Trauma
Author: Children's National
Language: English
Room size: 12x12
Setting: ICU
Patient ect:
Patient Gender: Male
Tags: abnormal neurological exam, altered mental status, brain herniation, emergency treatment, increased intracranial pressure, intubation, neurological assessment, neurological exam, neurosurgery, pediatric trauma, severe head injury, subdural hematoma, traumatic brain injury, VR medical training,

Virtual Manikin™ — Pediatric Respiratory

SimX

Patient is a pediatric patient in either a hospital or ambulance setting. There are no predetermined learning objectives, critical actions, states, or outcomes. The moderator will have the ability to select from several patients, and then adjust vital signs, lab/imaging results, and exam findings live during the case. In other...

Emergency Medicine
Pediatrics
Advanced EMT
EMT
Paramedic

Patient is a pediatric patient in either a hospital or ambulance setting. There are no predetermined learning objectives, critical actions, states, or outcomes. The moderator...

Case Information:
Bundles:
Learner Population: Nursing, EMS/Prehospital, Physician/Advanced Practice Provider
Specialty: Emergency Medicine, Pediatrics, Advanced EMT, EMT, Paramedic
Author: SimX
Language: English
Room size: 16x13
Setting: Ambulance, Emergency Department
Patient ect:
Patient Gender: Female, Male
Tags: anaphylaxis, anemia, asthma, bronchiolitis, cardiac arrest, Croup, DKA, Epiglottitis, foreign body, Manikin, Opiate overdose, pediatric, pneumonia, pneumothorax, respiratory,

EMS Pediatric Hypovolemic Shock

VALOR Program

Learner will arrive on-scene to find a 6-year-old female, listless and lying in bed. Learner will perform an initial assessment and identify that the patient is suffering from a respiratory illness with fever and vomiting. She recently passed out when trying to stand up. Current vitals are HR 150, BP...

Emergency Medicine
Pediatrics

EMS Pediatric Hypovolemic Shock

EMS Bundle

Learner will arrive on-scene to find a 6-year-old female, listless and lying in bed. Learner will perform an initial assessment and identify that the patient...

Case Information:
Bundles: EMS Bundle
Learner Population: EMS/Prehospital, Military, Physician/Advanced Practice Provider
Specialty: Emergency Medicine, Pediatrics
Author: VALOR Program
Language: English
Room size: 13x10
Setting: Ambulance, Home
Patient ect:
Patient Gender: Female
Tags: AEMT, als, bls, EMT, Febrile Illness, Hypovolemic shock, Military, Paramedic, pediatrics, prehospital, sepsis,

EMS Obstetrics Emergency

VALOR Program

Learner will arrive on-scene to find a 26-year-old female patient in the bathroom in the final stage of labor. Learner will perform an initial assessment and identify that delivery is imminent. The Learner will aid in delivery which will proceed in an uncomplicated fashion. The newborn will initially be blue...

Emergency Medicine
OB/GYN
Pediatrics
Family Medicine

EMS Obstetrics Emergency

EMS Bundle

Learner will arrive on-scene to find a 26-year-old female patient in the bathroom in the final stage of labor. Learner will perform an initial assessment...

Case Information:
Bundles: EMS Bundle
Learner Population: EMS/Prehospital, Military, Physician/Advanced Practice Provider
Specialty: Emergency Medicine, OB/GYN, Pediatrics, Family Medicine
Author: VALOR Program
Language: English
Room size: 12x12
Setting: Ambulance, Home
Patient ect:
Patient Gender: Female, Male
Tags: abdominal pain, AEMT, als, bls, ems, EMT, field delivery, Military, neonatal resuscitation, newborn, normal delivery, NRP, OB, OBGYN, Obstetrics, Paramedic, prehospital,

EMS Pediatric Overdose

VALOR Program

Learner will arrive on-scene to find a 4-year-old male patient with decreased responsiveness, pinpoint pupils, and shallow respirations. Learner will perform an initial assessment and identify that the patient ingested some hydrocodone-acetaminophen tablets that belonged to the parent, with an open bottle on the bathroom counter. Learner will recognize signs...

Critical Care
Emergency Medicine
Pediatrics
Toxicology

EMS Pediatric Overdose

EMS Bundle

Learner will arrive on-scene to find a 4-year-old male patient with decreased responsiveness, pinpoint pupils, and shallow respirations. Learner will perform an initial assessment and...

Case Information:
Bundles: EMS Bundle
Learner Population: EMS/Prehospital, Military, Physician/Advanced Practice Provider
Specialty: Critical Care, Emergency Medicine, Pediatrics, Toxicology
Author: VALOR Program
Language: English
Room size: 12x12
Setting: Ambulance, Home
Patient ect:
Patient Gender: Male
Tags: AEMT, altered mental status, bls, ems, EMT, Military, Opiate overdose, pals, Paramedic, pediatrics, prehospital, toxicology,

Unstable SVT in the ED

Children's National

A 5 day old infant is brought to the emergency department with irritability, decreased oral intake, hypoactivity, and tachycardia. He was intubated for transport here. He has given adenosine twice for supraventricular tachycardia and now requires further intervention.  

Cardiology
Critical Care
Emergency Medicine
Pediatrics

A 5 day old infant is brought to the emergency department with irritability, decreased oral intake, hypoactivity, and tachycardia. He was intubated for transport here....

Case Information:
Bundles:
Learner Population: Physician/Advanced Practice Provider
Specialty: Cardiology, Critical Care, Emergency Medicine, Pediatrics
Author: Children's National
Language: English
Room size: 12x12
Setting: Emergency Department
Patient ect:
Patient Gender: Male
Tags: cardiac ICU, cardioversion, pals, supraventricular tachycardia, torsades,

EMS Prehospital Pediatric Trauma

Servicio Nacional de Aprendizaje (SENA)

In a car accident, a pediatric patient suffers trauma, head injury, fracture of one of his arms with deformity and bruises in thorax. He is confused with recent amnesia, but responds to orders. Two EMS must secure the area, give him first attention, and take him in their ambulance to...

Emergency Medicine
Pediatrics
Advanced EMT
EMT
Paramedic
Trauma

In a car accident, a pediatric patient suffers trauma, head injury, fracture of one of his arms with deformity and bruises in thorax. He is...

Case Information:
Bundles:
Learner Population: EMS/Prehospital, Physician/Advanced Practice Provider
Specialty: Emergency Medicine, Pediatrics, Advanced EMT, EMT, Paramedic, Trauma
Author: Servicio Nacional de Aprendizaje (SENA)
Language: English, Spanish
Room size: 12x12
Setting: Hospital, Outdoor, Ambulance
Patient ect:
Patient Gender: Male
Tags: ambulance transport, car accident simulation, emergency care protocols, EMS training, first response, fracture management, head injury, medical VR scenario, pediatric emergency, pediatric trauma,

Coarctation of the Aorta

Children's National

2-week-old baby girl otherwise healthy, born at 38 weeks presenting with respiratory distress. Her parents have noted that she has been breathing faster and feeding less. She has an older brother (3-year-old who is in daycare). Symptoms have been getting worse over the last couple days. She was seen at...

Cardiology
Pediatrics
Cardiac/Telemetry
Interprofessional

2-week-old baby girl otherwise healthy, born at 38 weeks presenting with respiratory distress. Her parents have noted that she has been breathing faster and feeding...

Case Information:
Bundles:
Learner Population: Nursing, Physician/Advanced Practice Provider
Specialty: Cardiology, Pediatrics, Cardiac/Telemetry, Interprofessional
Author: Children's National
Language: English
Room size: 16x13
Setting: Hospital
Patient ect:
Patient Gender: Female
Tags: CXR, ED, icu, pediatrics, PGE, respiratory distress,

BTT Shunt Occlusion in Interstage Patient with HLHS

Children's National

The patient is a 5-week-old baby girl with a prenatal diagnosis of hypoplastic left heart syndrome, status post-Norwood with a 3.5mm BTT shunt at DOL5. Her intraoperative and postoperative course was relatively unremarkable, and she had been in the hospital for two weeks post-op, working on feeding issues. She has...

Cardiology
Pediatrics
Cardiac/Telemetry
Interprofessional

The patient is a 5-week-old baby girl with a prenatal diagnosis of hypoplastic left heart syndrome, status post-Norwood with a 3.5mm BTT shunt at DOL5....

Case Information:
Bundles:
Learner Population: Nursing, Physician/Advanced Practice Provider
Specialty: Cardiology, Pediatrics, Cardiac/Telemetry, Interprofessional
Author: Children's National
Language: English
Room size: 16x13
Setting: Hospital
Patient ect:
Patient Gender: Female
Tags: emesis, hypoplastic, infant, norwood, pediatrics, postoperative, shunt,

Social Determinants of Health Bundle

SimX

This bundle focuses on the holistic approach to patient care, concentrating on the social determinants of health and health equity. Through these virtual patient encounters, learners experience various scenarios that highlight the complex social, environmental, and psychological factors affecting patient health. Each scenario is meticulously crafted to challenge the learner...

Cardiology
Critical Care
Emergency Medicine
Internal Medicine
Neurology
OB/GYN
Pediatrics
Cardiac/Telemetry
Community/Public Health
Psychiatry/Mental Health
SDOH
Surgery
Trauma

Social Determinants of Health Bundle

Social Determinants of Health

This bundle focuses on the holistic approach to patient care, concentrating on the social determinants of health and health equity. Through these virtual patient encounters,...

Case Information:
Bundles: Social Determinants of Health
Learner Population: Nursing, Chiropractor, EMS/Prehospital, Physician/Advanced Practice Provider
Specialty: Cardiology, Critical Care, Emergency Medicine, Internal Medicine, Neurology, OB/GYN, Pediatrics, Cardiac/Telemetry, Community/Public Health, Psychiatry/Mental Health, SDOH, Surgery, Trauma
Author: SimX
Language:
Room size:
Setting:
Patient ect:
Patient Gender:
Tags:

Pediatric Asthma Requiring Airway in a Rural ED

Air Methods

A 5-year-old male with a history of asthma presents to a small community hospital ED with three days of worsening shortness of breath that requires transfer to a pediatric capable facility. Learners must recognize severe asthma and initiate usual asthma treatment, but the child does not respond to these basic...

Critical Care
Emergency Medicine
Pediatrics
Emergency
Interprofessional
Paramedic

A 5-year-old male with a history of asthma presents to a small community hospital ED with three days of worsening shortness of breath that requires...

Case Information:
Bundles:
Learner Population: Nursing, EMS/Prehospital, Physician/Advanced Practice Provider
Specialty: Critical Care, Emergency Medicine, Pediatrics, Emergency, Interprofessional, Paramedic
Author: Air Methods
Language: English
Room size: 17x13
Setting: Hospital
Patient ect:
Patient Gender: Male
Tags: asthma, ED, hypotension, intubation, pediatrics, refractory asthma, severe asthma, shortness of breath,

Pediatric Asthma Exacerbation

Southeastern Illinois College

The patient is a fifteen-year-old teenage male that presents to the medical clinic with asthma exacerbation. He is attended by his parent. The patient reports having played a football game earlier this week in cold, damp weather. He has a two-day history of a non-productive cough, shortness of breath, and...

Pediatrics

The patient is a fifteen-year-old teenage male that presents to the medical clinic with asthma exacerbation. He is attended by his parent. The patient reports...

Case Information:
Bundles:
Learner Population: Nursing
Specialty: Pediatrics
Author: Southeastern Illinois College
Language: English
Room size: 16x16
Setting: Hospital
Patient ect:
Patient Gender: Male
Tags: asthma, asthma exacerbation, cough, pediatric asthma, respiratory distress, sbar, shortness of breath, therapeutic communication,

Precipitous Labor & Neonatal Resuscitation

SimX

This scenario starts in the emergency department. There is an obviously pregnant mom who is screaming in pain. The OB/GYN cannot arrive at the hospital in time, even if they are paged. Delivery becomes imminent, and the mom gives birth to a baby with a poor tone and low heart...

Emergency Medicine
OB/GYN
Pediatrics
Emergency
Interprofessional
Maternal and Child Health (MCH)
Resuscitation

This scenario starts in the emergency department. There is an obviously pregnant mom who is screaming in pain. The OB/GYN cannot arrive at the hospital...

Case Information:
Bundles:
Learner Population: Nursing, EMS/Prehospital, Physician/Advanced Practice Provider
Specialty: Emergency Medicine, OB/GYN, Pediatrics, Emergency, Interprofessional, Maternal and Child Health (MCH), Resuscitation
Author: SimX
Language: English, Spanish
Room size: 20x13
Setting: Hospital
Patient ect:
Patient Gender: Female, Male
Tags: emergency department, imminent birth, labor and delivery, neonatal, NRP, ob/gyn, ppv,

Tetralogy of Fallot with Hypercyanotic Spell

Children's National

The patient is a 2 week-old baby boy with prenatal diagnosis of Tetralogy of Fallot. An IV was placed when the patient was in the triage area and the saturations since the arrival to the ED have been in the 60s. This scenario begins with a notably cyanotic infant with...

Cardiology
Emergency Medicine
Pediatrics
Cardiac/Telemetry
Interprofessional

The patient is a 2 week-old baby boy with prenatal diagnosis of Tetralogy of Fallot. An IV was placed when the patient was in the...

Case Information:
Bundles:
Learner Population: Nursing, Physician/Advanced Practice Provider
Specialty: Cardiology, Emergency Medicine, Pediatrics, Cardiac/Telemetry, Interprofessional
Author: Children's National
Language: English
Room size: 16x13
Setting: Hospital
Patient ect:
Patient Gender: Male
Tags: baby, CICU, cyanotic, emergency, hypercyanotic spell, infant, nasal cannula, neonatal, pediatrics, tetralogy of fallout, triage,

Pediatric Dysrhythmia (Resuscitation)

SimX

In this scenario, a 9-year-old Hispanic male without any prior known medical history is brought in by EMS after collapsing during physical education class. The patient was transported to the emergency department by the emergency medical providers. During the assessment, the patient goes into ventricular tachycardia and the learner must...

Cardiology
Emergency Medicine
Internal Medicine
Pediatrics
Emergency
Paramedic
Resuscitation

In this scenario, a 9-year-old Hispanic male without any prior known medical history is brought in by EMS after collapsing during physical education class. The...

Case Information:
Bundles:
Learner Population: Nursing, EMS/Prehospital, Physician/Advanced Practice Provider
Specialty: Cardiology, Emergency Medicine, Internal Medicine, Pediatrics, Emergency, Paramedic, Resuscitation
Author: SimX
Language: English, Spanish
Room size: 16x13
Setting: Hospital
Patient ect:
Patient Gender: Male
Tags: broselow tape, cpr, defibrillation, pals, pediatric defibrillation, pediatric syncope, pediatrics, syncope, ventricular tachycardia,

Violent Adolescent Drug Abuse

Indiana University East School of Nursing and Health Sciences

Samuel is a 15-year-old male arriving on a Wednesday evening to the Anger and Substance Abuse Clinic. Samuel has been in the foster care system for thirteen years and with his current family for a year. The learner will have the chance to speak to the foster parents alone and...

Pediatrics
Psychiatry/Mental Health
SDOH

Violent Adolescent Drug Abuse

Social Determinants of Health

Samuel is a 15-year-old male arriving on a Wednesday evening to the Anger and Substance Abuse Clinic. Samuel has been in the foster care system...

Case Information:
Bundles: Social Determinants of Health
Learner Population: Nursing
Specialty: Pediatrics, Psychiatry/Mental Health, SDOH
Author: Indiana University East School of Nursing and Health Sciences
Language: English
Room size: 16x16
Setting: Hospital
Patient ect:
Patient Gender: Male
Tags: adolescent anger, adolescent drug abuse, marijuana, patient violence, security, violent adolescent,

Pediatric Tonsil and Adenoid

Indiana University East School of Nursing and Health Sciences

Ricky Stone is an 8-year-old African American male that arrived at the emergency department with his mom. He is seven days postoperative from a tonsil and adenoidectomy. Today, he vomited at home and filled a bowl of clotted blood. After the initial examination, learners are expected to articulate pertinent findings...

Pediatrics
Emergency
Interprofessional

Pediatric Tonsil and Adenoid

SimX Nursing Bundle

Ricky Stone is an 8-year-old African American male that arrived at the emergency department with his mom. He is seven days postoperative from a tonsil...

Case Information:
Bundles: SimX Nursing Bundle
Learner Population: Nursing
Specialty: Pediatrics, Emergency, Interprofessional
Author: Indiana University East School of Nursing and Health Sciences
Language: English
Room size: 16x13
Setting: Hospital
Patient ect:
Patient Gender: Male
Tags: dizziness, hematemesis, post operative complications, post operative hemorrhage, post t&a bleed, post tonsillectomy bleed,

Infant with Bronchiolitis

Queensland Health Service

A 4-month-old is admitted with RSV and bronchiolitis by their mother who is concerned her baby is deteriorating. The Learner(s) must assess the patient, recognize respiratory distress, and escalate oxygen. The patient will decompensate, which requires the learner(s) to call a code blue, support the patient’s airway, suction the airway,...

Critical Care
Emergency Medicine
Pediatrics
Interprofessional
Resuscitation

A 4-month-old is admitted with RSV and bronchiolitis by their mother who is concerned her baby is deteriorating. The Learner(s) must assess the patient, recognize...

Case Information:
Bundles:
Learner Population: Nursing, Physician/Advanced Practice Provider
Specialty: Critical Care, Emergency Medicine, Pediatrics, Interprofessional, Resuscitation
Author: Queensland Health Service
Language: English
Room size: 15x15
Setting: Hospital
Patient ect:
Patient Gender: Male
Tags: airway emergencies, bronchiolitis, pals, pediatrics, respiratory distress, shortness of breath,

PED 33 – Kyle Reeves – Cystic Fibrosis, Adolescent, Management of Respiratory Arrest

Elsevier

This Simulated Patient Encounter maps to Scenario PED 33 - Kyle Reeves - Cystic Fibrosis Pulmonary Exacerbation - Adolescent - Management of Respiratory Arrest on the Elsevier Evolve Platform Kyle Reeves, a 16-year-old Caucasian male with a history of cystic fibrosis, was admitted with fever, shortness of breath, and wheezing....

Pediatrics

PED 33 – Kyle Reeves – Cystic Fibrosis, Adolescent, Management of Respiratory Arrest

SLS for RN Bundle

This Simulated Patient Encounter maps to Scenario PED 33 - Kyle Reeves - Cystic Fibrosis Pulmonary Exacerbation - Adolescent - Management of Respiratory Arrest on...

Case Information:
Bundles: SLS for RN Bundle
Learner Population: Nursing
Specialty: Pediatrics
Author: Elsevier
Language: English
Room size: 17x13
Setting: Hospital
Patient ect:
Patient Gender: Male
Tags: adolescent, contact isolation, cystic fibrosis, management of respiratory arrest, pediatrics, pseudomonas, pulmonary exacerbation,

PED 32 – Ricky Alvarez – Diabetes Mellitus, Hyperglycemia Management

Elsevier

This Simulated Patient Encounter maps to Scenario PED 32 - Ricky Alvarez - Hyperglycemia Diabetes Mellitus - Adolescent - Management of Hyperglycemia on the Elsevier Evolve Platform Ricky Alvarez, a 13-year-old Native American male with poorly managed type 1 diabetes, presented to the emergency department with a foot wound infection...

Pediatrics

PED 32 – Ricky Alvarez – Diabetes Mellitus, Hyperglycemia Management

SLS for RN Bundle

This Simulated Patient Encounter maps to Scenario PED 32 - Ricky Alvarez - Hyperglycemia Diabetes Mellitus - Adolescent - Management of Hyperglycemia on the Elsevier...

Case Information:
Bundles: SLS for RN Bundle
Learner Population: Nursing
Specialty: Pediatrics
Author: Elsevier
Language: English
Room size: 16x16
Setting: Hospital
Patient ect:
Patient Gender: Male
Tags: adolescent, diabetes mellitus, foot wound infection, hyperglycemia, insulin, management of hyperglycemia, pediatrics, type 1 diabetes,

PED 31 – Abdullah Yusuf – Acute Appendicitis / Adolescent / Post-operative Care

Elsevier

This Simulated Patient Encounter maps to Scenario PED 31 - Abdullah Yusuf - Acute Appendicitis - Adolescent - Preoperative Care on the Elsevier Evolve Platform Abdullah Yusuf, a 12-year-old Arab American male, was admitted for a perforated appendix and a successful appendectomy was performed. Abdullah has a naso-gastric tube and...

Pediatrics
Perioperative

PED 31 – Abdullah Yusuf – Acute Appendicitis / Adolescent / Post-operative Care

SLS for RN Bundle

This Simulated Patient Encounter maps to Scenario PED 31 - Abdullah Yusuf - Acute Appendicitis - Adolescent - Preoperative Care on the Elsevier Evolve Platform...

Case Information:
Bundles: SLS for RN Bundle
Learner Population: Nursing
Specialty: Pediatrics, Perioperative
Author: Elsevier
Language: English
Room size: 16x16
Setting: Hospital
Patient ect:
Patient Gender: Male
Tags: acute appendicitis, adolescent, appendectomy, naso-gastric tube, pain management, penrose drain, perforated appendix, peritonitis, postoperative care, postoperative pain,

PED 30 – Abdullah Yusuf – Acute Appendicitis, Preoperative

Elsevier

This Simulated Patient Encounter maps to Scenario PED 30 - Abdullah Yusuf - Acute Appendicitis - Adolescent - Preoperative Care on the Elsevier Evolve Platform Abdullah Yusuf, a 12-year-old Arab American male, was brought to the emergency department with complaints of abdominal pain, vomiting, and low-grade fever. Emergency surgery for...

Pediatrics
Perioperative

PED 30 – Abdullah Yusuf – Acute Appendicitis, Preoperative

SLS for RN Bundle

This Simulated Patient Encounter maps to Scenario PED 30 - Abdullah Yusuf - Acute Appendicitis - Adolescent - Preoperative Care on the Elsevier Evolve Platform...

Case Information:
Bundles: SLS for RN Bundle
Learner Population: Nursing
Specialty: Pediatrics, Perioperative
Author: Elsevier
Language: English
Room size: 16x16
Setting: Hospital
Patient ect:
Patient Gender: Male
Tags: abdominal pain, acute appendicitis, adolescent, pediatrics, preoperative care, sbar, surgery prep,

PED 27 – Annabell Flaherty – Gunshot Wound, Management of Hypovolemic Shock

Elsevier

This Simulated Patient Encounter maps to Scenario PED 27 - Annabell Flaherty - Gunshot Wound - School Age - Management of Hypovolemic Shock on the Elsevier Evolve Platform Annabell Flaherty, a 10-year-old Caucasian female, presented to the emergency department with a gunshot wound to the right shoulder. An IV was...

Pediatrics

PED 27 – Annabell Flaherty – Gunshot Wound, Management of Hypovolemic Shock

SLS for RN Bundle

This Simulated Patient Encounter maps to Scenario PED 27 - Annabell Flaherty - Gunshot Wound - School Age - Management of Hypovolemic Shock on the...

Case Information:
Bundles: SLS for RN Bundle
Learner Population: Nursing
Specialty: Pediatrics
Author: Elsevier
Language: English
Room size: 16x16
Setting: Hospital
Patient ect:
Patient Gender: Female
Tags: domestic quarrel, emergency, gunshot wound, management of hypovolemic shock, pain medication, prbc transfusion, school age, surgical repair,

PED 26 – Monique Jones – Sickle Cell Anemia, Management of Sickle Cell Crisis

Elsevier

This Simulated Patient Encounter maps to Scenario PED 26 - Monique Jones - Sickle Cell Anemia - School Age - Management of Sickle Cell Crisis on the Elsevier Evolve Platform Monique Jones is a 9-year-old African American female with sickle cell anemia. She was directly admitted to the pediatric unit...

Pediatrics

PED 26 – Monique Jones – Sickle Cell Anemia, Management of Sickle Cell Crisis

SLS for RN Bundle

This Simulated Patient Encounter maps to Scenario PED 26 - Monique Jones - Sickle Cell Anemia - School Age - Management of Sickle Cell Crisis...

Case Information:
Bundles: SLS for RN Bundle
Learner Population: Nursing
Specialty: Pediatrics
Author: Elsevier
Language: English
Room size: 16x16
Setting: Hospital
Patient ect:
Patient Gender: Female
Tags: iv, management of sickle cell crisis, pain medication, pediatrics, school age, sickle cell anemia, sickle cell crisis, symptomatic management,