OSCE NAME: Paediatric Drowning
Single Length Station – 3 mins reading time, 7 min station
SUBJECT AND CURRICULUM REFERENCE
Prioritisation and Decision Making
Teamwork and Collaboration
CLINICAL SCENARIO STEM
A 4 yearold boy has been brought into the resuscitation bay in PEA cardiac arrest after being found submerged in the backyard pool for a maximum of 2-3 minutes. Effective CPR and administration of appropriate drugs is underway, but the team are having difficulty ventilating via a bag valve mask with a guedel airway in situ. The decision has been made to intubate the patient. The parents have chosen to leave the resus bay. The child weighs 20kg. There is copious vomitus and secretions gathering in the airway.
The team consist of:
- Candidate (assuming position of ED Consultant)
- Resus Registrar – directing ALS
- BVM/Cricoid Registrar
- Airway Nurse
- CPR Nurse
- Drug Nurse
- Your role is to manage the airway of this child, who is a high fidelity mannequin in this case. You will take over the airway from the BVM registrar when you enter the room. You must provide a definitive airway, BVM ventilation is ineffective.
- You will have an airway nurse who can be directed to prepare appropriate equipment, any drugs you wish to use for airway management. Remember doses and sizes. Note that there is no video largyngoscopy equipment/glidescope etc.
- There will be a CPR nurse, a registrar who is to continue leading the resus, another nurse to administer any drugs you may require and a registrar who is proficient in cricoid pressure/BVM only
- It is also your role to set ventilator parameters and manage the first few minutes of ventilation, including all post intubation checks and care.
- You do not need to manage any other aspect of the resus, you are solely responsible for securing the airway and managing the patients breathing.
- CPR will continue unless you ask the team to halt.