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Paeds Vivasacute-care-resuscitation-and-toxicology

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

Major trauma and paediatric trauma systems — branching viva

A branching viva following one injured child from pre-alert through team-led primary survey that controls catastrophic haemorrhage first, protects the cervical spine, weight-based fluid with early blood for haemorrhagic shock, avoiding the lethal triad, applying paediatric imaging rules, escalating to a paediatric trauma centre before local support is exceeded, and 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 nine-year-old is brought to a regional emergency department after a high-speed motor-vehicle crash. The examiner releases information in stages. The candidate must lead the trauma team, run a primary survey that treats each threat as found, state the expected response to each action, reassess from the top, apply imaging rules, escalate to retrieval 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. [6] [11]

Candidate brief

You are the senior paediatric clinician leading a regional trauma team. Speak as you would during resuscitation. Control catastrophic haemorrhage before airway work, protect the cervical spine, treat each threat as you find it, 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. [6]

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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References6ShowHide
  1. [1]Kuppermann N, Holmes JF, Dayan PS, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study Lancet (London, England), 2009.PMID 19758692
  2. [2]Leonard JC, Harding M, Cook LJ, et al. PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study The Lancet Child and Adolescent Health, 2024.PMID 38843852
  3. [5]Russell, Russell T Damage-control resuscitation in pediatric trauma: What you need to know The journal of trauma and acute care surgery, 2023.PMID 37314396
  4. [6]Galvagno SM Jr, Nahmias JT, Young DA Advanced Trauma Life Support Update 2019: Management and Applications for Adults and Special Populations Anesthesiology clinics, 2019.PMID 30711226
  5. [8]Leeper CM, McKenna C, Gaines BA Too little too late: Hypotension and blood transfusion in the trauma bay are independent predictors of death in injured children The journal of trauma and acute care surgery, 2018.PMID 29389838
  6. [11]Ciorba MC, Maegele M Polytrauma in Children—Epidemiology, Acute Diagnostic Evaluation, and Treatment Deutsches Arzteblatt international, 2024.PMID 38471125
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