- Consent from mother - Intubation with paralytic - IV Fluid bolus (20mL/kg) 6. Resolution - Push-dose Epi at bedside (give - No intubation 4 min into state 1mcg/kg bolus q2-3 min) OR 4. Laryngospasm increase infusion rate 4. Laryngospasm High pitched Learner Actions Modifiers HR to 110 over 1 stridor noise, - BVM ventilation with PEEP - 1 min of BVM O2SAT to 75% min followed by no valve (difficult to bag with O2SAT 65% over visible chest poor chest rise) 60 sec. movement. - Update team RR 0 - Apply pressure to Larson’s Triggers BP 80 /60 point with jaw thrust - Paralytic given - Administer deeper sedation 6. Resolution - Administer paralytic - 2 min of laryngospasm - Intubate paralytic 5. Bradycardia 5. Bradycardia Learner Actions Modifiers O2SAT 95% over 1 - Give atropine 0.02mg/kg iv min of bagging (0.56mg) Triggers HR 35 over 1 min - Continue bagging patient if not - Atropine given yet intubated 6. Resolution - 13 minutes 6. Resolution 6. Resolution Learner Actions Modifier HR: 100/min - Post-intubation sedation - Mother not updated gets very BP: 90/50 - ICU Consult upset. Questions care. Threatens RR: 10 (vented) - Update mother to sue. O2SAT: 100% Triggers - ICU consult END CASE Section VII: Supporting Documents, Laboratory Results, & Multimedia Laboratory Results No blood work required. Images (ECGs, CXRs, etc.) Initial CXR - normal pediatric CXR Post-intubation - normal CXR source: CXR source: http://jetem.org/ettcxr/ Section VIII: Debriefing Guide
- Consent from mother - IV Fluid bolus (20mL/kg) - Push-dose Epi at bedside (give 1mcg/kg bolus q2-3 min) OR increase infusion rate - Intubation with paralytic 6. Resolution - No intubation 4 min into state 4. Laryngospasm 4. Laryngospasm HR to 110 over 1 min O2SAT 65% over 60 sec. RR 0 BP 80 /60 High pitched stridor noise, followed by no visible chest movement. Learner Actions - BVM ventilation with PEEP valve (difficult to bag with poor chest rise) - Update team - Apply pressure to Larson’s point with jaw thrust - Administer deeper sedation - Administer paralytic - Intubate paralytic Modifiers - 1 min of BVM O2SAT to 75% Triggers - Paralytic given 6. Resolution - 2 min of laryngospasm 5. Bradycardia 5. Bradycardia O2SAT 95% over 1 min of bagging HR 35 over 1 min Learner Actions - Give atropine 0.02mg/kg iv (0.56mg) - Continue bagging patient if not yet intubated Modifiers Triggers - Atropine given 6. Resolution - 13 minutes 6. Resolution 6. Resolution HR: 100/min BP: 90/50 RR: 10 (vented) O2SAT: 100% Learner Actions - Post-intubation sedation - ICU Consult - Update mother Modifier - Mother not updated gets very upset. Questions care. Threatens to sue. Triggers - ICU consult END CASE Section VII: Supporting Documents, Laboratory Results, & Multimedia Laboratory Results No blood work required. Images (ECGs, CXRs, etc.) Initial CXR - normal pediatric CXR CXR source: Post-intubation - normal CXR source: http://jetem.org/ettcxr/ Section VIII: Debriefing Guide
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