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Paeds Vivasacute-care-resuscitation-and-toxicology

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

Poisoned child: structured assessment and decontamination — branching viva

A branching viva following one poisoned child from the doorway through resuscitation before decontamination, the four-question ingestion history, reading the toxidrome, calling the Poisons Information Centre, deciding on activated charcoal within the first hour, escalating to whole bowel irrigation for a sustained-release ingestion, and a structured handover with safeguarding in parallel.

branching clinical structured oral5 min readVerification in progress

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 three-year-old is brought to a rural emergency department forty minutes after swallowing an unknown number of sustained-release tablets from a grandparent's medication. The examiner releases information in stages. The candidate must resuscitate before any decontamination, take the four-question ingestion history, read the toxidrome, call the Poisons Information Centre, decide on activated charcoal, escalate to whole bowel irrigation for the sustained-release ingestion, observe for delayed toxicity, and hand over safely with safeguarding in parallel.

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. Secure immediate threats before any decontamination, 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. [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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References6ShowHide
  1. [1]Hoffman RJ, Nillas A Toxidromes and a general approach to poisoning Archives of disease in childhood, 2025.PMID 39978865
  2. [3]Hoegberg LCG, Shepherd G, Wood DM, et al. Systematic review on the use of activated charcoal for gastrointestinal decontamination following acute oral overdose Clinical toxicology (Philadelphia, Pa.), 2021.PMID 34424785
  3. [5]Zhao X, Dughly O, Simpson J Decontamination of the pediatric patient Current opinion in pediatrics, 2016.PMID 27031659
  4. [7]Tenenbein M Position statement: whole bowel irrigation. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists Journal of toxicology. Clinical toxicology, 1997.PMID 9482429
  5. [9]Berg SE, McCann SD Pediatric Toxicology: An Updated Review Pediatric annals, 2023.PMID 37036778
  6. [12]Bond GR The role of activated charcoal and gastric emptying in gastrointestinal decontamination: a state-of-the-art review Annals of emergency medicine, 2002.PMID 11867980
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