Paeds Cases · mental-behavioural-and-psychosomatic
Explain paediatric delirium and the ABCDEF plan to parents — OSCE
OSCE communication and shared-planning station: explaining the diagnosis of paediatric delirium in a post-cardiac surgery child, the cause-first approach, the ABCDEF prevention bundle, why benzodiazepines are being changed, and the honest role of antipsychotics as last resort.
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You are the paediatric registrar in the cardiac ICU. The parents of a four-year-old boy who is delirious on day three after cardiac surgery have ten minutes with you. They are frightened because he does not recognise them and keeps pulling at his lines, and they wonder whether he has brain damage. Explain, in plain language: (1) what delirium is and that it is usually reversible; (2) what the team is doing to find and treat the cause; (3) why his sedation is being changed from midazolam to a different medicine; and (4) what the ABCDEF care bundle is and how they can help. Invite their questions and check understanding throughout. Do not use jargon; do not lecture. [4]
References4ShowHide
- [1]Smith HAB, Besunder JB, Betters KA, et al. 2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility. Pediatr Crit Care Med, 2022.PMID 35119438
- [2]Traube C, Silver G, Kearney J, et al. Cornell Assessment of Pediatric Delirium: a valid, rapid, observational tool for screening delirium in the PICU*. Crit Care Med, 2014.PMID 24145848
- [3]Lin JC, Srivastava A, Malone S, et al. Caring for Critically Ill Children With the ICU Liberation Bundle (ABCDEF): Results of the Pediatric Collaborative. Pediatr Crit Care Med, 2023.PMID 37125798
- [4]Dechnik A, Traube C, et al. Delirium in hospitalised children. Lancet Child Adolesc Health, 2020.PMID 32087768