Hypovolaemic and haemorrhagic shock — branching viva

A branching viva following one bleeding child from the doorway through recognition of compensated shock, bleeding control, activation of the paediatric massive transfusion protocol, tranexamic acid dosing and timing, prevention of the lethal triad, damage control resuscitation, early surgical and retrieval escalation, and structured handover.

branching clinical structured oral7 min readVerification in progress

Prompt

An eight-year-old is brought to a regional emergency department after a motor vehicle collision with abdominal pain and signs of shock. The examiner releases information in stages. The candidate must recognise shock before hypotension, decide between bleeding and non-bleeding pathways, control the bleeding, run a massive transfusion protocol, give tranexamic acid within the correct window, prevent the lethal triad, escalate to surgery and retrieval early, and hand over safely.

Branching cross-examination

Name: Hypovolaemic and haemorrhagic shock — 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. [1] [5]

Candidate brief

You are the senior paediatric clinician in a regional emergency department. Speak as you would during resuscitation. Recognise shock before the blood pressure falls, decide whether the child is bleeding, treat immediate threats, 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. [5]

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.

References6Show ledger

[1]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
[2]Bjorklund A, Resch J, Slusher T Pediatric Shock Review Pediatrics in review, 2023.PMID 37777656
[5]Russell, Russell T Pediatric traumatic hemorrhagic shock consensus conference recommendations The journal of trauma and acute care surgery, 2023.PMID 36245074
[6]Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial Lancet (London, England), 2010.PMID 20554319
[7]Borgman MA, Nishijima DK Tranexamic acid in pediatric hemorrhagic trauma The journal of trauma and acute care surgery, 2023.PMID 36044459
[9]Neff LP, Beckwith MA, Russell RT, et al. Massive Transfusion in Pediatric Patients Clinics in laboratory medicine, 2021.PMID 33494884