Naughty kids burn OSCE added anonymously 

 
You have 3 minutes reading time. This OSCE will run for a maximum of 17 minutes. DOUBLE

Scenario:

You are the duty Consultant in your rural ED at 6.30pm. You receive ambulance notification regarding 2 paediatric patients with burn injuries. Estimated time of arrival is 5 minutes. Both children were playing in the kitchen. One of them grabbed the handle of a large pot of boiling oil, tipping its contents over both of them.

PATIENT ONE : 2 year old girl. Burns to head, chest, abdomen, back and legs
PATIENT TWO : 4 year old boy. Burns to same areas but apparently less severe

Both patients have cold saline soaks over the injuries. Neither have intravenous access; no observations are known

Instructions for the candidate

Preparation for the arrival of these 2 patients with your nurse in charge

After 2 minutes the patients will arrive and you will need to manage them

Domains being examined

  • Medical Expertise
  • Prioritisation And Decision Making
  • Communication
  • Teamwork and Collaboration
 
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 17 minutes. DOUBLE

For the actor

INSTRUCTIONS FOR NURSE IN CHARGE :

Rural ED resources :
1 resus bay, 4 cubicles and fast track x 2 procedure rooms
junior registrar, an intern and 4 nurses in the department currently
another 2 ED consultants in the town who are at home
on call paediatrician and GP anaesthetist at home
surg reg is in the hospital currently
on call radiographer

Current ED patients :
Mrs Jones 82 with pneumonia waiting to go to ward, not on supports
Mr Singh 45 with probable renal colic, waiting for the radiographer to arrive to perform CT KUB
Miss Simpson 32 with RIF pain, waiting for surg reg to review, she is well
In waiting room : 4 year old with “gastro”, hasn’t been seen yet


INSTRUCTION FOR PARENT :

Both children were playing in the kitchen. One of them grabbed the handle of a large pot of boiling oil, tipping its contents over both of them.

You were in kitchen at the time but not quick enough to stop the older one grabbing the pot

You are distressed and appropriately concerned but will not interfere with the resus

You have put both kids in shower for 20 mins waiting for the ambulance

Your kids have no medical problems and have been fully immunised

For the examiner

Domains Assessment Objectives

Medical Expertise

Prioritisation And Decision Making

Communication

Teamwork and Collaboration

Other Assessment Notes

Preparation

Issues
- critically injured children
- resources : staff, equipment, drugs, fluids (may be limited in rural ED)
- care of parent / caregiver
- departmental management

Staff
- organise the department
- assemble team and allocate roles
- brief team - key objectives and requirements
- enlist assistance (on call staff)
- non clinical support staff
- staff to care for parents

Space / Equipment
- resus areas
- monitoring, IV/IO access

Drugs
- IV crystalloid, narcotics

Supplies
- dressings, emollients, bandages, IV cannulae

Disposition
- anticipate need for possible transfer ?PETS


PATIENT ARRIVAL :

READ TO CANDIDATE :
" The 4 yr old boy has minor injuries is ably managed by your registrar. The 2 yr old girl has 30% TBSA burns, and no other injuries. Proceed to manage this child, her parent is in attendance"

Resus :
- Not required (vitals normal except tachycardia)
- Child is distressed but alert
- No facial burns / airway issues

Supportive care :
- IO access (no success with IV)
- analgesia
- cooling (need to mention, but parents placed child in shower at home for 20 mins whilst waiting for ambulance)
- thermoregulartion
- distraction therapy / involve parents

Dressings
- assists analgesia and minimises fluid and heat loss

Fluid resuscitation
- formulae to guide initial therapy
- parklands 3-4ml/kg/% burned from time of incident, 1/2 in first 8 hrs, 1/2 in next 16h
- weight (calculate 12kg)
- gauge clinical response - IDC for uo measurement

- ADT prophylaxis
- No ABx indicated

Disposition
- plastics, paed critical care, burns centre, retrieval service
- social work to support parents
- debrief staff


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