PICU CASE SCENARIO SIMULATION, KSH, May 23 2024

PICU Simulation Case

Number: 1

May, 23th, 2024

PICU UNIT

1. Attendance :

Function Name Remarks/Note

Senior physicians

Junior Physicians

Senior Nursing Staff

Junior Nursing Staff

Other

Organizer

2. Plan :
a. Checklist of Necessary, ventilator, monitor, bed, mannequin…: By Head Nurse
(………………………………….) and Case Scenario Organizer (…………………………), 10
mn
b. Case Presentation: Verbal Endorsement by Organizer, Responding to questions
of the staff by designated parent, 10 mn
c. Assessment, brief summary, plan of Care to be done by Junior then Senior
Physician (………………………….../…………………………………), 10 mn
d. Dispatching functions by Senior Physician, 3 mn
e. 3-Staged-Case Scenario development:
i. First Presentation 15 mn
ii. A major/Classical complication 15 mn
iii. CPR/Life threatening complication 20 mn
f. Debriefing/ Take Home Messages

1
 PICU CASE SCENARIO SIMULATION, KSH, May 23 2024

Case Scenario

1. Presentation: 5 years old boy, known case of frequent

wheezing episodes since age of 2 years, admitted once to PICU
for 1 week, ventilated, no medication at home, poor
compliance to medical education, vaccinated. Weight: 16 kg
- Treated in ER for 90 mn with 4 nebs ventoline, 1
atrovent, 1 pulmicort, 1 iv HSHC, 1 dose of
Cefotaxime
- Actually: increased work of breathing, Vitals (look to
Monitor), CNS: looking agitated, auscultation: no
wheeze at all, low air entry
- VBG on demand
- X-ray ondemand (after 20 mn)
2. Major/Classical Complications:
- More agitation, Confusion, Tachycardia, Hypertension
- Hyperglycemia
- Hypokaliemia
- metabolic acidosis with high lactates
- Decision to Intubation, RSI, ETT, Sedation plan, Ventilator
Setting
- Parent Endorsment
3. CPR/life threatening Complication:
- Bradycardia
- Hypoxemic Cardiac Arrest
- ROSC after 15 mn, post resus plan (in brief)
- Endorsment to parents