Paeds Vivas · acute-care-resuscitation-and-toxicology
Paracetamol poisoning — branching viva
A branching viva following one child from the recognition of a significant paracetamol ingestion through the ingestion history, the four-hour nomogram decision, activated charcoal, the intravenous N-acetylcysteine regimen, an anaphylactoid reaction, the monitoring of hepatotoxicity, and escalation when King's College criteria appear.
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Study tools
Target exams
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 or the decision rule, the immediate action and the reassessment endpoint. [1]
Candidate brief
You are the senior paediatric clinician in the emergency department. Speak as you would during a poisoning assessment. State the ingestion history you need, the nomogram decision, the antidote you will start and what you will reassess. This is one continuous case. Each escalation branch leads to the next update. [1]
References5ShowHide
- [1]Rumack BH Acetaminophen hepatotoxicity: the first 35 years Journal of toxicology. Clinical toxicology, 2002.PMID 11990202
- [4]Sivilotti MLA, Yarema MC, Juurlink DN Treating acetaminophen overdose CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2022.PMID 35440504
- [9]Daoud A, Dalhoff KP, Christensen MB, et al. Two-bag intravenous N-acetylcysteine, antihistamine pretreatment and high plasma paracetamol levels are associated with a lower incidence of anaphylactoid reactions to N-acetylcysteine Clinical toxicology (Philadelphia, Pa.), 2020.PMID 31601129
- [10]Harrison PM, O'Grady JG, Keays RT, et al. Serial prothrombin time as prognostic indicator in paracetamol induced fulminant hepatic failure BMJ (Clinical research ed.), 1990.PMID 2249026
- [11]Karabacak B, Özaydın E Clinical characteristics and outcomes of pediatric paracetamol poisoning presenting to the emergency department BMC pediatrics, 2026.PMID 41998668