Simulation/Emergencies Flashcards
You have walked into a scenario in which you see a child with a barking cough, following a 2 day history of a coryzal illness. They appear to have expiratory wheeze and stridor. Using an ABC approach, describe how you will deal with this situation.
A: Do NOT try putting anything in the mouth. they will often have found a position in which they are coping - work with this, don’t start moving them around.
B: Only assess if it doesn’t cause them further distress.
***At this point aim for either oral dexamathesone 0.15mg/kg or nebulised bumetanide. If not improving, aim for nebulised adrenalin. If you think there is need for ABX, Amoxicillin is a good choice. **
C: This is often improved once nebs given. Lines etc may upset child to state of respiratory arrest so be CAREFUL.
A child that is known to suffer from Asthma is admitted to PAU with a tightness in the chest, expiratory wheeze, tachypnoea and SOB. Describe how you will manage this situation.
A: High flow oxygen, ensure airway isn’t closed, fast Hx
B: Nebulised Salbutamol first line (5 years old = 5mg).
- Ipratropium (Atrovent) is second line (anticholinergic). This can be given x3 in the first hour, then every 4-6 hours. (This seems to be most effective on
You are the F1 on nights and have been called to a crash in one of the main corridors. The patient is a 5 year old boy. The resuscitation team have just arrived with the trolley, but you are the first doctor on scene. Nurse says that child is not breathing and can’t feel pulse. What do you do?
Check areas is safe.
Response. AVPU?
ABC.
Administer high flow oxygen via Ambu bag and give 5 rescue breaths. Commence CPR 15:2 ratio. Get monitoring on ASAP.
After first cycle assess rhythm.
If shockable, shock at 4j/kg (ensure all stood clear) and re-commence CPR asap.
Review.
AT THIS POINT:
If no change, continue with shocks, and add adrenalin 10mg 1:10,000 after 3 minutes with amiodarone. Then use Adrenalin 10mg 1:10,000 every other cycle of CPR.
If non-shockable, administer 10mg 1:10,000 Adrenalin ASAP and continue CPR. Repeat adrenalin dose each 3-5 minutes.
If return to spontaneous circulation, ensure adequate airway and oxygen support, fluid therapy to maintain BP and get to Paeds HDU.
(of course, seniors should be with you within minutes)
You attend a child with suspected meningococcal septicaemia. What do you do?
Pre-hosp = IM Ben-Pen and Blue light.
Hospital:
A: Ensure airway is patent
B: Check RR SPO2 and Breath sounds, administer high flow O2 via non-rebreather mask
C: Get venous access, check BP, Check CRT, get bloods, cultures and venous gas BEFORE administering IV ceftriaxone/cephotaxime. If BP low, administer fluid bolus of 20ml/kg IV 0.9% Saline solution.
D: check BM. If Low, can administer 2ml/kg IV 10% dextrose.
E: Look for petechial rash, and do a brief top to toe review.
If in doubt, call help. If concerned, call help. If no BP
You are called to see a 5 year old boy, who’s mother says has been generally unwell for the past day. On inspection he has a patent airway, and a clear chest. His CRT is >5 seconds, and he looks unwell, mildly cyanotic and irritable. As you listen to the chest he produces bilious vomit. You note that he is drawing his knees up towards his chest, and that his abdomen is distended. On inspection of the nappy, you see a stool that looks like cranberry jelly. What do you suspect is going on here? What can you do in the short term? What are the definitive treatments?
This is likely a case of intersucception, a rare cause of acute abdomen in children, caused by telescoping of the small bowel.
In the short term:
STABILISE
ABC Approach
Get access, get NG tube in, give fluid bolus to manage BP @ 20ml/kg 0.9% saline.
IV morphine is an approp. painkiller in this instance (check dosage on BNF).
IVX:
Gas, bloods, culture, AXR, abdominal ultrasound.
If mild, can watch and wait. OR Refer to surgeons for:
- Inflation of bowel, which may prevent need for lap
OR
- Laparotomy to repair.
If someone has an IO in their leg, what risk is associated with misplacement into muscle?
Compartment syndrome
With children, what is a rapid approximation you can use to work out their weight from their age?
(Age+4) x2 = Approx weight (KG).
You see a 3 year old child that is having a convulsion. It doesn’t appear status, they have no history of epilepsy or previous seizures, they have a temperature of 40C and their mother said they had a cold for the last couple of days. What is this likely to be, and how would you manage it?
This is likely to be febrile convulsion.
Treatment is protection of airway, monitoring, and cooling down.
If
