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Paeds Vivasacute-care-resuscitation-and-toxicology

Paeds Vivas · acute-care-resuscitation-and-toxicology

Altered conscious state in children — branching viva

A branching viva following one child with an altered conscious state from the doorway through airway security, AVPU and an age-adapted Glasgow Coma Scale, the bedside glucose and DEFG, convulsive status epilepticus at five minutes, recognition of raised intracranial pressure, and rural retrieval with a structured handover.

branching clinical structured oral6 min readVerification in progress

Target exams

RACP General PaediatricsRACP DCERCPCH Progress+MRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics
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Study tools

Target exams

RACP General PaediatricsRACP DCERCPCH Progress+MRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics
Prompt
A four-year-old is brought to a rural emergency department increasingly drowsy after a febrile illness, then begins to convulse. The examiner releases information in stages. The candidate must secure the airway and breathing, screen with AVPU and convert to an age-adapted Glasgow Coma Scale, check and correct the bedside glucose, treat the ongoing convulsion at five minutes, recognise raised intracranial pressure, escalate before local support is exceeded, and hand over safely.

Branching cross-examination

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. [1] [2]

Candidate brief

You are the senior paediatric clinician in a rural district emergency department. Speak as you would during resuscitation. Secure 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. [2]

Paediatrics Fellowship Pro

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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 library.

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References7ShowHide
  1. [1]Hoffmann F, Schmalhofer M, Lehner M, et al. Comparison of the AVPU Scale and the Pediatric GCS in Prehospital Setting Prehospital emergency care, 2016.PMID 26954262
  2. [2]Kirschen MP, Snyder M, Smith K, et al. Inter-Rater Reliability Between Critical Care Nurses Performing a Pediatric Modification to the Glasgow Coma Scale Pediatric critical care medicine, 2019.PMID 30946292
  3. [4]Faustino EV, Hirshberg EL, Bogue CW Hypoglycemia in critically ill children Journal of diabetes science and technology, 2012.PMID 22401322
  4. [6]Chamberlain JM, Kapur J, Shinnar S, et al. Efficacy of levetiracetam, fosphenytoin, and valproate for established status epilepticus by age group (ESETT): a double-blind, responsive-adaptive, randomised controlled trial Lancet (London, England), 2020.PMID 32203691
  5. [7]Appleton RE, Rainford NE, Gamble C, et al. Levetiracetam as an alternative to phenytoin for second-line emergency treatment of children with convulsive status epilepticus: the EcLiPSE RCT Health technology assessment (Winchester, England), 2020.PMID 33190679
  6. [9]Dunger DB, Edge JA Predicting cerebral edema during diabetic ketoacidosis The New England journal of medicine, 2001.PMID 11172161
  7. [10]Chávez-Bueno S, McCracken GH Jr Bacterial meningitis in children Pediatric clinics of North America, 2005.PMID 15925663
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