Decompensated Toxic Shock in a Gender-Diverse Adolescent: A Pediatric Emergency Medicine Simulation Case.

Introduction: Gender-diverse patients frequently encounter health care discrimination, contributing to delayed care and worse outcomes. Simulation offers a safe environment to integrate trauma-informed, gender-affirming care into high-acuity training. We developed a 1-hour simulation for pediatric emergency medicine (PEM) fellows combining management of toxic shock with affirming communication and trauma-informed practices. Methods: The case features a 13-year-old nonbinary patient presenting with abdominal pain, ultimately diagnosed with toxic shock from a retained tampon. A high-fidelity mannequin capable of intubation and genitourinary exams was used, with a standardized actor voicing the patient. Learners diagnosed and managed toxic shock including progression to decompensated shock requiring intraosseous access and endotracheal intubation. Performance was assessed using a 10-item critical actions checklist. Learners completed a postsimulation survey assessing confidence in providing gender-affirming care, use of trauma-informed communication, and perceived case effectiveness. The simulation was piloted with PEM fellows and is adaptable to pediatric or emergency medicine residents, attendings, and interprofessional teams. Results: Ten PEM fellows piloted the case. Across 2 sessions, learners completed 9/10 critical actions, with consistent omission of asking pronouns until prompted. All participants correctly diagnosed and managed toxic shock, with surveys indicating increased confidence in providing affirming, trauma-informed care. Seventy percent rated the case Discussion: This case demonstrates how high-stakes resuscitation training can incorporate equity-focused communication objectives. We offer a complete, educator-facing resource with case materials, script, debriefing guidance, and assessment tools to support adoption.