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Paeds Vivasclinical-assessment-and-reasoning

Paeds Vivas · clinical-assessment-and-reasoning

Recognising the seriously ill child and paediatric assessment triangle — branching viva

A branching viva following one seriously ill child from the doorway through PAT, age-adapted ABCDE, reassessment, retrieval, safeguarding, handover and disposition, with evidence and regional boundaries tested throughout.

branching clinical structured oral23 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 four-year-old child presents to a rural district emergency department with worsening respiratory, circulatory and neurological illness. The examiner releases information in stages. The candidate must describe the physiology before naming a cause, treat threats during age-adapted ABCDE, define the expected response, reassess, escalate 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 severity, immediate action and reassessment endpoint. [18] [21]

Candidate brief

You are the senior paediatric clinician supporting a rural district emergency department. Speak as you would during resuscitation. Treat immediate threats before the diagnosis is certain, and say what you will reassess. This is one continuous case. Each escalation branch leads to the next update. [1] [12] [21]

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References22ShowHide
  1. [1]Dieckmann RA, Brownstein D, Gausche-Hill M The pediatric assessment triangle: a novel approach for the rapid evaluation of children. Pediatric emergency care, 2010.PMID 20386420
  2. [2]Horeczko T, Enriquez B, McGrath NE, et al. The Pediatric Assessment Triangle: accuracy of its application by nurses in the triage of children. Journal of emergency nursing, 2013.PMID 22831826
  3. [3]Tørisen TAG, Glanville JM, Loaiza AF, et al. Emergency pediatric patients and use of the pediatric assessment triangle tool (PAT): a scoping review. BMC emergency medicine, 2024.PMID 39227775
  4. [4]Gomez B, Hernandez-Bou S, Garcia-Garcia JJ, et al. Bacteremia in previously healthy children in emergency departments: clinical and microbiological characteristics and outcome. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2015.PMID 25252630
  5. [5]Fleming S, Thompson M, Stevens R, et al. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet (London, England), 2011.PMID 21411136
  6. [6]Fleming S, Gill P, Jones C, et al. Validity and reliability of measurement of capillary refill time in children: a systematic review. Archives of disease in childhood, 2015.PMID 25260515
  7. [7]Fleming S, Gill P, Jones C, et al. The Diagnostic Value of Capillary Refill Time for Detecting Serious Illness in Children: A Systematic Review and Meta-Analysis. PloS one, 2015.PMID 26375953
  8. [8]Trubey R, Huang C, Lugg-Widger FV, et al. Validity and effectiveness of paediatric early warning systems and track and trigger tools for identifying and reducing clinical deterioration in hospitalised children: a systematic review. BMJ open, 2019.PMID 31061010
  9. [9]Parshuram CS, Dryden-Palmer K, Farrell C, et al. Effect of a Pediatric Early Warning System on All-Cause Mortality in Hospitalized Pediatric Patients: The EPOCH Randomized Clinical Trial. JAMA, 2018.PMID 29486493
  10. [11]Sharma M, Brown AW, Powell NM, et al. Racial and skin color mediated disparities in pulse oximetry in infants and young children. Paediatric respiratory reviews, 2024.PMID 38233229
  11. [12]Bjorklund A, Resch J, Slusher T Pediatric Shock Review. Pediatrics in review, 2023.PMID 37777656
  12. [13]Weiss, Scott L Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2026.PMID 41869844
  13. [14]Maitland K, Kiguli S, Opoka RO, et al. Mortality after fluid bolus in African children with severe infection. The New England journal of medicine, 2011.PMID 21615299
  14. [15]Mills E, Lin P, Asghari-Jafarabadi M, et al. Association between caregiver concern for clinical deterioration and critical illness in children presenting to hospital: a prospective cohort study. The Lancet. Child & adolescent health, 2025.PMID 40451224
  15. [16]Kuo DZ, Houtrow AJ Recognition and Management of Medical Complexity. Pediatrics, 2016.PMID 27940731
  16. [17]Boylen S, Cherian S, Gill FJ, et al. Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review. JBI evidence synthesis, 2020.PMID 32813387
  17. [18]Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program. The New England journal of medicine, 2014.PMID 25372088
  18. [19]Burvenich R, Bos DA, Lowie L, et al. Effectiveness of safety-netting approaches for acutely ill children: a network meta-analysis. The British journal of general practice : the journal of the Royal College of General Practitioners, 2025.PMID 39117428
  19. [20]Bragança-Souza KK, Lopes de Lisboa J, Silva-Oliveira F, et al. Health Professionals: Identifying and Reporting Child Physical Abuse-a Scoping Review. Trauma, violence & abuse, 2024.PMID 36747372
  20. [21]Chaichotjinda K, Chantra M, Pandee U Assessment of interhospital transport care for pediatric patients. Clinical and experimental pediatrics, 2020.PMID 31477679
  21. [22]Shah SN, Bachur RG, Simel DL, et al. Does This Child Have Pneumonia?: The Rational Clinical Examination Systematic Review. JAMA, 2017.PMID 28763554
  22. [23]Faustino EV, Hirshberg EL, Bogue CW Hypoglycemia in critically ill children. Journal of diabetes science and technology, 2012.PMID 22401322
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