SIMULATION OSCE (FACEM) – DOUBLE STATION · PDF file Khanh Nguyen Scenario 3 SIMULATION...
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www.emergencypedia.com Khanh Nguyen Scenario 3 SIMULATION OSCE (FACEM) – DOUBLE STATION You are the consultant in a paediatric tertiary emergency department. A mother has brought in her 7-day old baby boy Joshua due to difficulty breathing and complaints of poor feeding. The mother tells you that the pregnancy was uncomplicated with normal vaginal delivery of a term baby weighing 3.2kg. Her child was feeding well on discharge but over the last 2 days has not been able to feed for longer than 5 mins and appears to be struggling to breathe. He has only had 2 wet nappies today. • The child has been brought directly into the resuscitation bay as the nursing staff were concerned that he looked cyanotic. You are to: 1) Team lead the resuscitation and manage the child accordingly 2) Hand over to inpatient admitting team There will be a registrar and 2 nurses in the room who are competent with clear instructions. Domains: Leadership and prioritisation Communication Medical expertise
Transcript of SIMULATION OSCE (FACEM) – DOUBLE STATION · PDF file Khanh Nguyen Scenario 3 SIMULATION...
www.emergencypedia.com KhanhNguyen Scenario3SIMULATIONOSCE(FACEM)–DOUBLESTATION
Youaretheconsultantinapaediatrictertiaryemergencydepartment.Amotherhasbroughtinher7-dayoldbabyboyJoshuaduetodifficultybreathingandcomplaintsofpoorfeeding.
Themothertellsyouthatthepregnancywasuncomplicatedwithnormalvaginaldeliveryofatermbabyweighing3.2kg.
Herchildwasfeedingwellondischargebutoverthelast2dayshasnotbeenabletofeedforlongerthan5minsandappearstobestrugglingtobreathe.Hehasonlyhad2wetnappiestoday.
• Thechildhasbeenbroughtdirectlyintotheresuscitationbayasthenursingstaffwereconcernedthathelookedcyanotic.
Youareto:
1) Teamleadtheresuscitationandmanagethechildaccordingly2) Handovertoinpatientadmittingteam
Therewillbearegistrarand2nursesintheroomwhoarecompetentwithclearinstructions.
Domains:
Leadershipandprioritisation
Communication
Medicalexpertise
www.emergencypedia.com KhanhNguyen Scenario3DUCTDEPENDANTCONGENTIALCARDIACDISEASE
PROGRESSOFTHESCENARIO
W:3kg
E:12J
T:size3.5/4ETT
F:60mLNS
M:0.5mgmidazolam
A:0.3mL1:10,000Adrenaline
G:6mL10%dextrose
0-2min:Assignroles
Briefdiscussionwithmother
PPE
Monitoring:RR50,sats75%RA(postductal),sats95%(preductal),HR160,SBP70,alert,36
deg
AchieveIV/IOaccess
2-7min:A-Eassessment
A:patent,notprotected.Nostridororsignsofobstruction.Positionshouldbeneutral
B:labouredbreathing,tachypneic,accessorymuscleuse,cyanotic
Applyhighflowoxygentherapyandplanforintubationbutacknowledginghighrisk
IfCXRperformed(attached)–lungfieldsareclear,cardiomegaly
C:tachycardic,borderlinehypotensive,caprefill6s,cooltotouch,peripherallyshutdown
Cardiacmurmurpresent
IVaccessandbloodscollected.VBG(attached)
IVFboluswithnilimprovementofhaemodynamics
IfongoingIVFbolusgiven,patientwillgetincreasinglybreathless/APO
ECGshowssinustachycardiaandRBBB(attached)
D:alertbutappearstired,PEARL3mm,BSL6
E:afebrile,nilevidenceofrash
www.emergencypedia.com KhanhNguyen Scenario3Recap:Unwellbabywithundifferentiatedshock–considerationforsepsis,cardiogenic,
metaboliccauses.
IVantibiotics–cefotaxime50mg/kg+ampicillin50mg/kg+gentamycin7mg/kg
7-12min:Ifnilconsiderationforprostaglandininfusionchildwillcontinuetodeteriorate
PGE1infusion:0.05mcg/kg/min.Maintenancedosemaybeaslowas0.01mcg/kg/min
Limitoxygentherapy
CautioususeofIVFascanworsecardiacfailure
Promptfromfacultyifnilconsiderationforcongenitalcardiacdisease
CancallNICUforadvice
Considerationofadrenalinsufficiency(highK,lowNa,lowBSL)andempiricalsteroids
12-15min:Ifprogressingwellthen:
Childcontinuestodeterioratedespiteaboveifinitiated–willneedtopreparetointubate
Highrisk–callforanaestheticssupportwhoarenotavailable
Atropinepremedication
PlanA,B,C
Size1blade,size4ETT,insert12cm
15-17min:Handovertocardiology/NICU
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www.emergencypedia.com KhanhNguyen Scenario3DUCTDEPENDENTLESIONS
- TetralogyofFallot
- Tricuspidatresia
- Pulmonaryatresiaorstenosis
HYPEROXIATEST
IfthecauseofcyanosisisnoncardiacthearterialPaO2willincreaseto>100mmHgonexposureto100%oxygen.Ifthereisacardiaccauseforcyanosis,thePaO2willremainbelow100mmHg
www.emergencypedia.com KhanhNguyen Scenario3DUCTINDEPENDENTLESIONS
- Truncusarteriosus
- Transpositionofthegreatarteries
- Totalanomalouspulmonaryvenousreturn
- Hypoplasticleftheartsyndrome
