CICM SAQ 2010.2 Q28
Questions
You have been asked to review a three year old child who was trapped in a house fire and is now in the Paediatric Emergency Department. There is no history available from the child’s carer and you observe that the child is drowsy and confused and has a persistent cough. His heart rate is 140 beats per minute, blood pressure 70/40 mmHg. Respiratory rate is 54 breaths per minute and oxygen saturations are 94 % on high flow oxygen via a non re- breather mask.
- a. Briefly outline the initial priorities in management.
- b. List the features from the history and your examination of this child which would suggest a significant airway injury.
- c. List 4 likely causes for his altered conscious state.
Answers
Answer and interpretation
a. Briefly outline the initial priorities in management.
- Resuscitation including primary and secondary survey
- Assessment and management of potential airway burn injury – mention consideration of early intubation
- Obtain large bore iv access and administration of fluid bolus (20mls/kg) for probable hypovolaemic shock- mention that groins are usually spared in burns and are a good site for clean skin vas cath access.
- Look for signs of traumatic injury and assess extent of body surface area and depth of burn
- Awareness of risk of hypothermia
- Seek collateral history for past medical history and medication history and history of acute events
b. List the features from the history and your examination of this child which would suggest a significant airway injury.
- Burns occurring in a closed space
- Cough, stridor, hoarseness of voice
- Burns to face, lips, mouth, pharynx or nasal mucosa
- Soot in sputum, nose or mouth
- Hypoxaemia
- Dyspnoea
- Carboxyhaemoglobin levels > 2%
- Acute confusional state or depressed level of consciousness
c. List 4 likely causes for his altered conscious state.
- Traumatic brain injury
- Carbon monoxide / CN – poisoning
- Hypoxic insult
- Other pathology precipitating loss of consciousness eg seizure-related, hypoglycaemia, drug ingestion
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CICM
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
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