Paediatric Enhanced Life Support Scenarios

Transcription

1 Paediatric Enhanced Life Support Scenarios These scenarios should be used to assess staff undertaking the Paediatric Enhanced Life Support course within the Black Country Partnership NHS Foundation Trust. The scenarios can be adapted to make them relevant to the clinical areas in which individual candidates work but the vital signs and clinical features should not be changed to ensure consistency of assessment. Candidates should be reminded that in case of a medical emergency they may be required to assess the siblings of a patient as well as the patient themselves and so participation in and observation of scenarios relating to medical emergencies that they perceive to be outside their normal field of practice is relevant and necessary.

2 SBAR Asthma S- Rhys is a four-year-old boy with difficulty breathing B- His mother states that he is increasingly wheezy over the past few hours A- The receptionist in clinic has asked you to review him as she is worried about him He is able to talk and to maintain his own airway Breathing Respiratory Rate 48 per minute SpO2 90% in air Respiratory Signs He has an audible wheeze. You note intercostal recession and tracheal tug Circulation Pulse 152 Blood Pressure- 93/52 Capillary Refill Time 2 seconds Disability He is alert Blood Glucose 4.9 mmols Drugs/Access to Drugs- Normally takes a salbutamol inhaler as required Exposure There is no rash, no bleeding and no signs of Dehydration S- Farida is a 2 year old girl who has had diarrhea and vomiting for three days B- She has an inherited metabolic disorder and has complex care needs including a requirement for PEG feeding. A- Her mother is worried about her because she seems listless and has not had a wet nappy for over 12 hours She is grizzly and starts to cry as you approach her Respiratory rate 38 per minute SpO2 97% in air Respiratory Signs Her breathing is rapid but her chest is rising and falling normally and there are no abnormal sounds Pulse 144 Blood Pressure 74/22 Capillary Refill Time 4 seconds She is alert Pupils Equal and reacting to light 6mm Blood Glucose 3.1 mmols Drugs/Access to Drugs she is prescribed a number of medications including PEG feed There is no rash, no bleeding and no sign of. Her eyes appear sunken Her lips and tongue are dry

3 Bleeding SBAR S- Lucy is a nine-year-old girl who feels shaky and unwell B- She had her tonsils out yesterday and was discharged from hospital this morning. A- Her mother is worried about her because she is as white as a sheet She is able to talk and to maintain his own airway Breathing Respiratory Rate 32 per minute SpO2 97% in air Respiratory Signs Her chest is rising and falling normally and you can hear no abnormal sounds Circulation Pulse 148 Blood Pressure- 62/22 Capillary Refill Time 5 seconds Disability She is alert Blood Glucose 4.9 mmols Drugs/Access to Drugs- She does not take Exposure Her lips and tongue are dry She complains that her throat is very sore and that she has a nasty taste in her mouth Anaphylaxis S- Jordan is a ten-year-old boy who suddenly complains of being unable to breathe and that his lips are tingling B- He is known to have a nut allergy A- He is with his grandmother who is scared and does not know what to do R- She has asked you to help her He is currently able to speak to you. He states that his tongue and lips are tingly Respiratory rate 38 per minute SpO2 94% in air Respiratory Signs He is very wheezy and is using his accessory muscles to breathe. He has subcostal recession and marked tracheal tug. Pulse 128 Blood Pressure 84/39 Capillary Refill Time 4 seconds He is alert Pupils Equal and reacting to light 6mm Blood Glucose 5.9 mmols Drugs/Access to Drugs He carries and adrenaline pen and has this with him There is a widespread urticarial rash on his trunk and limbs. His eyelids appear swollen now.

4 Sepsis Drug Overdose SBAR S- Ellie is a 15 year old girl who has been feverish since this morning B- She has global developmental delay and uses a wheelchair. She is fully dependent for all daily living activities. A- Her mother tells you that she is worried because her urine has smelt offensive for the S- Ben is an 18-month old boy. You visit him at home where you find him asleep on the sofa B- He is normally fit and well. A- His mother worries because she is unable to wake him R- She shouts at you to see what is wrong with him past 24 hours She is able to say drink to her mother He is making snoring noises as he breathes Breathing Respiratory Rate 28 per minute SpO2 92% in air Respiratory Signs Her chest rises and falls normally. There are no abnormal sounds. Respiratory rate 8 per minute SpO2 87% in air Respiratory Signs His breathing is shallow but both sides of his chest are moving and there are Circulation Pulse 118 Blood Pressure- 89/52 Capillary Refill Time 4 seconds Disability She is alert Blood Glucose 4.9 mmols Drugs/Access to Drugs- She does not take Exposure There is no rash, no bleeding and no signs of She feels very hot to the touch no abnormal sounds Pulse 94 Blood Pressure 74/22 Capillary Refill Time 1 seconds He stirs to painful stimulus but does not open his eyes Pupils Pinpoint 1mm Blood Glucose 4.2 mmols Drugs/Access to Drugs his mother is on a subutex programme as she was an iv drug user in the past. There is no rash, no bleeding and no sign of.

5 SBAR Breathing Choking Hypoglycaemia S- Ajay is a 2-year old boy who has been S- Selina is a 10-year-old girl who has become eating grapes in the waiting room drowsy and unwell B- He is normally fit and well and does not B- She has recently been diagnosed with Type I take. diabetes A- His mother is with him and shouting for A- Her grandmother is with her but does not know help and that he is dying what is the matter with her R- Reception staff request you to help immediately He is unable to speak or to cry and is drooling She is able to speak and says that she feels really poorly Respiratory Rate he is trying to breathe at a Respiratory rate 22 per minute rate of 30 per minute SpO2 97% in air SpO2 90% in air Respiratory Signs Her breathing looks and Respiratory Signs He has a see saw sounds normal respiratory pattern Circulation Pulse 161 Blood Pressure- You are unable to record a blood pressure as he cannot keep still Capillary Refill Time 1 seconds Disability Exposure He is alert but very distressed Blood Glucose 6.1 mmols Drugs/Access to Drugs- He does not take There is no rash, no bleeding and no signs of Pulse 124 Blood Pressure 90/48 Capillary Refill Time 2 seconds She opens her eyes when you speak to her Pupils Equal and reacting to light 6mm Blood Glucose 2.1 mmols Drugs/Access to Drugs she takes insulin but her grandmother does not know the name of this or how much she takes There is no rash, no bleeding and no sign of.

6 Fitting SBAR S- Jake is a 3-year-old-boy who is fitting B- He is normally fit and well but had had cough and cold symptoms for the past two to three days A- He is actively fitting in the waiting room. As you approach you notice that he is well wrapped up in multiple layers of clothing. When you comment on this his mother states that she had to wrap him up as he kept complaining of feeling cold. R- You are first on scene and his mother asks you to help him He is making snoring and grunting noises as he fits Breathing Respiratory Rate 38 per minute SpO2 90% in air Respiratory Signs His breathing appears shallow and erratic Circulation Pulse 168 Blood Pressure- 70/30 Capillary Refill Time 1 second Disability He is unresponsive Blood Glucose 4.3 mmols Drugs/Access to Drugs- He does not take Exposure There is no rash, no bleeding and no signs of When you touch his skin he feels very hot to the touch His temperature is 39.9

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