Upload
trinhphuc
View
221
Download
0
Embed Size (px)
Citation preview
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
www.emergencypedia.com KhanhNguyen Scenario3
www.emergencypedia.com KhanhNguyen Scenario3
www.emergencypedia.com KhanhNguyen Scenario3
www.emergencypedia.com KhanhNguyen Scenario3DUCTDEPENDENTLESIONS
- TetralogyofFallot
- Tricuspidatresia
- Pulmonaryatresiaorstenosis
HYPEROXIATEST
IfthecauseofcyanosisisnoncardiacthearterialPaO2willincreaseto>100mmHgonexposureto100%oxygen.Ifthereisacardiaccauseforcyanosis,thePaO2willremainbelow100mmHg
www.emergencypedia.com KhanhNguyen Scenario3DUCTINDEPENDENTLESIONS
- Truncusarteriosus
- Transpositionofthegreatarteries
- Totalanomalouspulmonaryvenousreturn
- Hypoplasticleftheartsyndrome