Initial stabilisation of major paediatric head injury — branching viva

A branching viva following one child with severe traumatic brain injury from first contact through the neuroprotective primary survey, airway threshold, ventilation target, fluid strategy, raised intracranial pressure management, hyperosmolar therapy evidence, neurosurgical escalation and rural retrieval.

branching clinical structured oral6 min readVerification in progress

Prompt

A six-year-old child is brought to a rural emergency department after being struck by a car at speed, with a brief loss of consciousness at the scene. The examiner releases information in stages. The candidate must lead the neuroprotective primary survey, justify the airway and ventilation decisions, manage raised intracranial pressure, interpret the hyperosmolar therapy evidence, and organise neurosurgical escalation and retrieval.

Branching cross-examination

Name: Initial stabilisation of major paediatric head injury — 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] ^[11]

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. ^[1]

References8Show

[1]Kochanek PM, Carney N, Adelson PD, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition Pediatric critical care medicine, 2012.PMID 22217782
[2]Kochanek PM, Adelson PD, Rosario BL, et al. Comparison of Intracranial Pressure Measurements Before and After Hypertonic Saline or Mannitol Treatment in Children With Severe Traumatic Brain Injury JAMA network open, 2022.PMID 35267036
[3]Chong SL, Zhu Y, Wang Q, et al. Clinical Outcomes of Hypertonic Saline vs Mannitol Treatment Among Children With Traumatic Brain Injury JAMA network open, 2025.PMID 40067302
[5]Laws JC, Vance EH, Betters KA, et al. Acute Effects of Ketamine on Intracranial Pressure in Children With Severe Traumatic Brain Injury Critical care medicine, 2023.PMID 36825892
[7]Erickson SL, Killien EY, Wainwright M, et al. Mean Arterial Pressure and Discharge Outcomes in Severe Pediatric Traumatic Brain Injury Neurocritical care, 2021.PMID 33108627
[8]Mai G, Lee JH, Caporal P, et al. Prehospital and emergency management of pediatric traumatic brain injury: a multicenter site survey Journal of neurosurgery Pediatrics, 2023.PMID 38716719
[9]Lele AV, Vavilala MS Cerebral Autoregulation-guided Management of Adult and Pediatric Traumatic Brain Injury Journal of neurosurgical anesthesiology, 2023.PMID 37523326
[11]de Carvalho Panzeri Carlotti AP, do Amaral VH, de Carvalho Canela Balzi AP, et al. Management of severe traumatic brain injury in pediatric patients: an evidence-based approach Neurological sciences, 2025.PMID 39476094

Initial stabilisation of major paediatric head injury — branching viva

branching clinical structured oral6 min readVerification in progress

Candidate brief

References8Show

[1]Kochanek PM, Carney N, Adelson PD, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition Pediatric critical care medicine, 2012.PMID 22217782
[2]Kochanek PM, Adelson PD, Rosario BL, et al. Comparison of Intracranial Pressure Measurements Before and After Hypertonic Saline or Mannitol Treatment in Children With Severe Traumatic Brain Injury JAMA network open, 2022.PMID 35267036
[3]Chong SL, Zhu Y, Wang Q, et al. Clinical Outcomes of Hypertonic Saline vs Mannitol Treatment Among Children With Traumatic Brain Injury JAMA network open, 2025.PMID 40067302
[5]Laws JC, Vance EH, Betters KA, et al. Acute Effects of Ketamine on Intracranial Pressure in Children With Severe Traumatic Brain Injury Critical care medicine, 2023.PMID 36825892
[7]Erickson SL, Killien EY, Wainwright M, et al. Mean Arterial Pressure and Discharge Outcomes in Severe Pediatric Traumatic Brain Injury Neurocritical care, 2021.PMID 33108627
[8]Mai G, Lee JH, Caporal P, et al. Prehospital and emergency management of pediatric traumatic brain injury: a multicenter site survey Journal of neurosurgery Pediatrics, 2023.PMID 38716719
[9]Lele AV, Vavilala MS Cerebral Autoregulation-guided Management of Adult and Pediatric Traumatic Brain Injury Journal of neurosurgical anesthesiology, 2023.PMID 37523326
[11]de Carvalho Panzeri Carlotti AP, do Amaral VH, de Carvalho Canela Balzi AP, et al. Management of severe traumatic brain injury in pediatric patients: an evidence-based approach Neurological sciences, 2025.PMID 39476094