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Paeds Vivasacute-care-resuscitation-and-toxicology

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

Iron, salicylate and toxic alcohol poisoning — branching viva

A branching viva following one adolescent who presents with a high-anion-gap metabolic acidosis after a deliberate overdose, through the recognition of the poison-specific signature, the choice of decontamination, the weight-based antidote (desferrioxamine, urinary alkalinisation or fomepizole), the avoidance of the three lethal traps, and the escalation to dialysis and retrieval.

branching clinical structured oral6 min readSource-verified ·

Target exams

RACP General PaediatricsRACP DCERCPCH Progress+MRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics
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Target exams

RACP General PaediatricsRACP DCERCPCH Progress+MRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics
Prompt
A 14-year-old is brought to a rural emergency department after a deliberate overdose of unknown tablets and a mouthful of windscreen washer fluid. The examiner releases information in stages. The candidate must lead the resuscitation, read the poison-specific signature out of the shared high-anion-gap acidosis, give the correct weight-based antidote on its trigger, decontaminate by poison, avoid the three lethal traps, and arrange dialysis and retrieval before local support is exceeded.

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] [9]

Candidate brief

You are the senior paediatric clinician in a rural district emergency department. Speak as you would during resuscitation. Recognise the shared high-anion-gap acidosis and read the poison-specific signature; give the weight-based antidote on its trigger; decontaminate by poison; avoid the three lethal traps; and escalate to dialysis and retrieval before local support is exceeded. This is one continuous case. Each escalation branch leads to the next update. [9]

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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References5ShowHide
  1. [1]Chang TP, Rangan C Iron poisoning: a literature-based review of epidemiology, diagnosis, and management Pediatric Emergency Care, 2011.PMID 21975503
  2. [6]Snodgrass WR Salicylate toxicity Pediatric Clinics of North America, 1986.PMID 3960612
  3. [7]Juurlink DN, Gosselin S, Kielstein JT, et al. Extracorporeal treatment for salicylate poisoning: systematic review and recommendations from the EXTRIP workgroup Annals of Emergency Medicine, 2015.PMID 25986310
  4. [9]Brent J Fomepizole for ethylene glycol and methanol poisoning New England Journal of Medicine, 2009.PMID 19458366
  5. [10]Kraut JA, Mullins ME Toxic Alcohols New England Journal of Medicine, 2018.PMID 29342392
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