Mock Code # 1

A 2-year-old girl who was brought to the ED by his mother for lethargy and a seizure at
home.
The mother states that earlier that day the child had been fussier than usual, then he had a
seizure lasting about 30 minutes.Baby is Ex- preterm . Mother & father is of young parents; 1
older brother.

Initial Vitals: TEMP: A/FEBRILE ; HR= 160 bpm ; RR= 55 breaths/min ; BP = 60/40

A. seize B. increased C. pale

PLEASE FOLLOW PALS APPROACH ACORDINGLY

1. Intractable Seizures
2. Airway: recognize early intubation. (ETT; LMA)
3. For circulation: Shock secondary to subdural hemorrhage.
4. CNS: pupils mid-dilated sluggish to light; AVPU: Unconscious, seizing: RBS: 89MG/DL
(follow EPILEPTICUS algorithm)
5. Exposure: bruises behind ears; hemorrhages conjunctival;
Candidates must know
1. Metabolic screening while putting canula
2. Look for algorithm for Status epilepticus (benzodiazepine (dose; twice), Phenytoin/
phenobarbitone wait for 30 min and look for response [deterioration , GCS ; BP or
improvement ] WAIT HERE ; AND STOP SEIZURES SENERIO. ; 2nd line lerace ( dose ,
response] ; epival [loading doses ] ; wait for 30 min and look for response
(deteriorate) ; midazolam infusion.
SECONDARY EXAMINATION
History : The mother states that earlier that day the child had been fussier than usual, then
he had a seizure.
What is on your differential for this patient?
What are the next steps in management?

Examination: Case of Non-Accidental Injury (NAI)

Findings
1. Abdominal & Neck Brisures; and petechias; ecchymoses; behind the ear multiple (red
; yellow ; blue)
Ask for differentials diagnosis and relevant lab workup (don’t waste time on discussion; give
time on de-briefing)