Paediatric trauma scenario
candidate brief
Pre-alert - 13yo e-scooter vs car RTC
you have 2 experienced resus nurses and a competent ED SHO
actor brief
examiner brief
13yo was riding e-scooter, crashed into car. Ambulance crew noted bulls-eye pattern on car windscreen
No PPE worn
Prehospital interventions: Intubated on scene by HEMS, currently on appropriate post-intubation infusions, pelvic binder in place
Have arrived at trauma unit due to distance from nearest MTC
Trauma team will take some time to arrive
Initial obs:
Intubated, good etCO2 trace, FiO2 80%, spO2 99%, TV 250ml RR 20
HR 100, BP 110/85
(est wt 46kg)
O/E
Chest NAD
Bruising over hip visible under pelvic binder
Patient gradually gets more tachycardic and hypotensive which is fluid responsive
Aim: recognise pelvic haemorrhage
- Wash hands, introduce self to team
- Confirms team competencies
- Facilitates primary survey
- Allocates roles
- Considers family
- Institutes neuroprotective critical care
- avoidance of tight tube ties
- 30 deg ramping of bed
- sets appropriate physiological targets
- Paediatric major haemorrhage call
- 10ml/kg fluid bolus, TXA, blood
- Requests appropriate investigations - trauma CT
- Handover to ICU to assist with transfer out
- Appropriate escalation to specialty - surgical (damage control surgery for pelvic bleed)
- Good use of competencies within team
- Leads team well
- Global mark from examiner