OSCE_SIM_Paed Drowning

 

OSCE NAME: Paediatric Drowning

Single Length Station – 3 mins reading time, 7 min station

 

SUBJECT AND CURRICULUM REFERENCE

Medical Expertise

Prioritisation and Decision Making

Communication

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

 

INSTRUCTIONS

  • Candidate
    • 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.

 

 

2 thoughts on “OSCE_SIM_Paed Drowning

  1. I’m curious why you’ve asked for volume cycled ventilator setting (100-140 ml x 20-40/min) rather than pressure cycled which might be a better option for this scenario. I’d have gone with pressure cycled.

    1. Very fair point Brendon.
      I guess whether you start with pressure or volume is really a matter of personal preference. I think as long as there is an understanding that the patient may have wet and poorly compliant lungs, and that calculated volumes may generate inappropriately high/dangerous pressures.
      And that if you start with pressure, you may get such low MVs that you end up with a hideous resp acidosis

      I think its where understanding resp physiology, knowing what pressures are safe, and realising that sometime you have to accept a little bit of acidosis is important. Also that you cant just set a vent with what you think is an appropriate bunch of settings and walk away. You need to stay and play, get used to tinkering and knowing what the tinkering will likely do to your resp physiology..

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