Simulation Debrief 13/5/13 – Difficult Decisions

Scenario – Night mission. Raining. 6 year old with burns to the face and potentially airway. Child was with parents at the grandparents’ house near gas fire place which has somehow resulted in them sustaining burns to the face.  The house is located 5 mins drive from a regional hospital. Rescue crew decide to meet road crew with patient at regional hospital. Due to time of day, weather and age of patient team decided to assess child inside emergency department.

simem2 simem3

Scene
Emergency department of a small regional hospital. Coinciding with arrival of team and patient.

Patient
25kg 6year old. Sitting of dad’s knee. 22g IVC in right cubital fossa. 3mg morphine given. Relatively calm if left alone. Right periorbital burns and left lower cheek and around lips (red with some developing blisters), involvement of lip. Currently speaking without a hoarse voice.
Deteriorates with onset of hoarseness of voice if approached by staff (e.g. when monitoring placed). Resolves if left alone.

Challenges
– Airway planning in a small child with
potentially evolving airway burns.

– Human factors involving management of distressed family.

Learning points from
debrief for clinical practice
:

– Difficult airway planning, including planning
for potential surgical airway

– Review of rapid sequence induction in a small child

Thanks to Chioma (doc),  Lindsay(para),  Lucas(actors), Cliff (SRC), Emily (STAR)

 

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