CICM SAQ 2010.2 Q28
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.
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
- 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
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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