Septic shock resuscitation and vasoactive support — branching viva

A branching viva following one child from the recognition of septic shock through the first-hour bundle of oxygen, access, reassessed fluid aliquots and antibiotics, the choice of adrenaline for cold shock, recognition of fluid accumulation injury, escalation to catecholamine-resistant management, and rural retrieval and handover.

branching clinical structured oral6 min readVerification in progress

Prompt

A five-year-old child is brought to a rural emergency department with worsening fever, poor perfusion and altered consciousness. The examiner releases information in stages. The candidate must recognise shock from the whole circulation, run the first-hour bundle, choose the vasoactive agent by phenotype, recognise fluid accumulation injury, manage catecholamine-resistant shock, and arrange retrieval before local support is exceeded.

Branching cross-examination

Name: Septic shock resuscitation and vasoactive support — branching viva
Creator: MedVellum
Published: 2026-07-16

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]

Candidate brief

You are the senior paediatric clinician in a rural district emergency department. Speak as you would during resuscitation. Recognise shock from the whole circulation, 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. [1]

Paediatrics Fellowship Pro

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 atlas.

References6Show ledger

[1]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
[3]Sanchez-Pinto LN, Bennett TD, DeWitt PE, et al. Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock JAMA, 2024.PMID 38245897
[4]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
[5]Bjorklund A, Resch J, Slusher T Pediatric Shock Review Pediatrics in review, 2023.PMID 37777656
[6]Wen L, Xu L The efficacy of dopamine versus epinephrine for pediatric or neonatal septic shock: a meta-analysis of randomized controlled studies Italian journal of pediatrics, 2020.PMID 31937353
[9]Ali AO, Kordi HAA, Alhag MHSA, et al. Restrictive Versus Liberal Fluid Strategy for Initial Resuscitation in Sepsis and Septic Shock: A Systematic Review and Meta Analysis Journal of clinical medicine research, 2026.PMID 41953594