ABCDE assessment and stabilisation of the acutely ill child — branching viva

A branching viva following one acutely ill child from the doorway through recognise-and-call, a hands-on ABCDE primary survey that treats each threat as found, age-appropriate oxygen, fluid, glucose and seizure decisions, recognising the tiring child, escalation to arrest doses, rural retrieval and structured handover.

branching clinical structured oral6 min readVerification in progress

Prompt

A four-year-old child is brought to a rural emergency department with worsening respiratory and then circulatory illness. The examiner releases information in stages. The candidate must lead the primary survey, treat each life threat as it is found, state the expected response to each action, reassess from A, escalate before local support is exceeded, and hand over safely.

Branching cross-examination

Name: ABCDE assessment and stabilisation of the acutely ill child — branching viva
Creator: MedVellum
Published: 2026-07-16

This is a MedVellum formative viva. It is not an official RACP, MRCPCH, ABP, ACGME or RCPSC station, mark scheme, duration or pass standard. Release each update only after the candidate states the failing system, the immediate action and the reassessment endpoint. [8] [9]

Candidate brief

You are the senior paediatric clinician in a rural district emergency department. Speak as you would during resuscitation. Treat immediate threats before the diagnosis is certain, state the change you expect from each action, and say what you will reassess. This is one continuous case. Each escalation branch leads to the next update. [9]

Paediatrics Fellowship Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References7Show ledger

[1]Fleming S, Thompson M, Stevens R, et al. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies Lancet (London, England), 2011.PMID 21411136
[3]Bjorklund A, Resch J, Slusher T Pediatric Shock Review Pediatrics in review, 2023.PMID 37777656
[4]Maitland K, Kiguli S, Opoka RO, et al. Mortality after fluid bolus in African children with severe infection The New England journal of medicine, 2011.PMID 21615299
[7]Faustino EV, Hirshberg EL, Bogue CW Hypoglycemia in critically ill children Journal of diabetes science and technology, 2012.PMID 22401322
[8]Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program The New England journal of medicine, 2014.PMID 25372088
[9]Topjian AA, Raymond TT, Atkins D, et al. Part 4: Pediatric Basic and Advanced Life Support 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Pediatrics, 2021.PMID 33087552
[10]Maconochie IK, Aickin R, Hazinski MF, et al. Pediatric Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Circulation, 2020.PMID 33084393