In this simulation, a helmeted 5-year-old ATV rider hit a tree and flew off the vehicle, landing on a tree stump. A Mayo Clinic trauma team prepares for his arrival with a high heart rate, shock and potential transfusion. When the patient arrives, the team checks his bleeding status, airway and other vital signs while maintaining spinal stabilization for the patient. The team determines shock is present and provides treatment. Radiology technologists perform portable imaging on the patient. After the team provides a spinal check, it makes plans to take the patient to a CT scan, the operating room with orthopedics and then the pediatric intensive care unit.
Go ahead. Gold Cross 6 41. This is the trn for report this Gold cross we are en route with a five year old male helmeted writer on an A. T. V. Traveling 40 MPH when he struck a tree He flew about 15 ft landing on a tree stump. Highest heart rate 1 86, lowest blood pressure 78. Hi dr marjorie. This is Dana. Trn, yep. We have a five year old A T. V. Accident coming in E. T. A. Is in eight minutes. Child has bilateral thigh swelling and deformity is noted and also complains of abdominal pain. Patient is in our five. All right, thank you. Mike. Mm hmm. Video camera is on. I'm turning the Bair hugger on. Yeah. Mm hmm. Mhm. Hi, I'm Stephanie. I'm going to be the team leader. Stephanie. Thanks. Okay. Diana shoemaker airway. Okay, thank you Virginia is transmuted. Thank you. Yes. This is a Gold Cross ambulance. 6 41 is en route with five year old male who was riding a tv at about 40 miles an hour. He struck a tree flew off 15 ft off of hit the A T. V. Landing on a tree stump. Mm hmm mm hmm. Mhm. Okay. Mhm. Okay, let's go around the room and do introductions. I'm Stephanie. I'm gonna be the team leader. Dr more peace trauma consultant. I'm Eduardo. I'm going to be the primary assessment provider. I'm Robin on the transfusion service Virginia and transfusion service. I'm the cold nurse. Chris respiratory therapy. Dianna Airway. Cameron Ian consultant. Lori documenting nurse she added or charge dana side only pharmacists. Rochelle assisting provider steve pediatric ICU Fellow Dr Hira, pediatric anesthesia consult. I'm just gonna review the plan before the patient arrives. I'm concerned about the high heart rate and potential for shock. We may have to do a hard stop at sea and we may have to give some blood. We've got o negative blood and great. Thank you assisting provider. Could you contact pediatric orthopedics and ask them to come to the trauma bay? Thank you. Just so everyone's aware of the pediatric vital signs that will be up on the screen for reference. Could we make sure that we have the length based resuscitation tape available? The tape is in place. Great thank you. And does anyone have any questions or concerns? Yes. Can I get the pace of GCS Please? 15. OK. I'll prepare the appropriate labs if we could get the weight as soon as possible to be able to drop meds. Okay. Sounds good. All quiet for a report ready for a report. So this is adam He was involved in this accident. He was a writer going approximately just an hour past three when he flew he hit a stump. He has bilateral swelling to his thigh. Mhm. Asus two left for a quadrant of his abdomen, pain and tenderness of consciousness, paul's 87. It's apparently once pressure it was seven systolic restoration paid in their way. Uh huh mm hmm anybody. Can you tell me your name? Airway's patent. We're doing lots of stuff. There's a lot of people around. Okay. Have bilateral breath zones party. What is the heart rate? 1 74. Can we get a manual blood pressure? His extremely bizarre cool. Capillary refill is four seconds and he's failed. There's no signs of bleeding. We're going to do a hard stop at circulation. A child is in shock. What do we have for access? I have a right 18 gauge in the Ec. Could we obtain an estimated weight for the child? Why? Where? What? We're going to use 20 kg as a weight for this child. Could we please give a 400cc bolus of warm? Normal saline as rapidly as possible. Can I continue here? Okay, I see bilateral thigh deformities. He's moving all extremities, Manual pressure, 65/40. Could we please get the pediatric traction splints. Going to be putting some things on your legs to help with the pain. Okay, how are we doing with that bullet? We need to call for the traction splints. We'll do that now is orthopedics coming. Great. Thank you covering about parents. Yeah, my mom just arrived. Your mom's gonna be coming in. Did we get a pain score? What number would you give your pain? zero 10 worst thing you could imagine Paint six out of 10. Like to order some pain medications like to give them some fentaNYL, one microgram per kilogram of fentaNYL. 20 micrograms total for sure. I'll give you some pain medication in there, strong out of your arm and that do you think? Is it okay if mom comes out? Absolutely right here, funny mama 20 micrograms is ready. Oh, okay. How are we doing with education assessment? I'm doing the secondary survey right now. I'm starting with the head. There is no head lacerations and pupils are equal equal and round reactive. There's no blood and ears, no blood in the mouth. His face is non tender. His trachea is midline. Former fluid started. Great, thank you for this chest is non tender. Has some scrapes and abrasions in the left lower chest. Could we call for X ray to come to a portable chest and pelvis abdomen standard. There are some abrasions in the left upper abdomen. Thank you. We'll obtain portable chest and pelvis X rays and then we'll reassess. C'mon dynamics five minutes, folks, it's likely this guy's gonna need blood. It's likely he's also going to need to go to the O. R. So let's just keep things going here. Remember chest X. Right here. Okay, do you want to pelvis as well? Yes, please let's go for a lab and obtain level red labs please. What if you want to use the you know that's a great idea. Can you drop it? I've got one ready right here. Perfect. It's gonna be loud but it's not going to hurt when I do this kind of sound a little bit like a can opening. She'll tell you when she does all right. You're gonna hear that noise. Nice job adam you did great. The chest X ray looked normal. So I don't think we need a chest ct also. He didn't have a loss of consciousness and the GCS is 15. So I don't think we need a head ct but given his shock I think we should get a ct of the abdomen and pelvis. I totally agree. I think he's especially with that left upper quadrant abrasion and he's still talking Kartik. He's got some blood in there and then he may need to go to the O. R. For orthopedic repair. Depending on what else we find in ct. I think those femurs are probably broken and then eventually he will need a bed in the pick you okay? I'll prepare the hour. Let's reassess circulation. What are the vitals now? His current heart rate is 150 with the blood pressure of 80/50. Alright. His skin is still pale. Can we start a second? I've and give a second fluid bolus please and continue with the secondary survey. So his scapula refill is still three seconds and it's still pale and cold. Can we roll the patient and transfusion transfusion. Please prepare to give blood we made we will likely need blood after the second bolus once you've done that. Let's roll him and he will take a look at his back. Yes please we're gonna roll to the patients left second ideas and Got a 20 gauge left arm on the left arm. This is the second fluid bullets running. Okay. Yes please. You got his legs 123. All right adam. Tell me if you're feeling it. Tell me if you feel any pain here. No cervical heuristic step offs. There's no lumbar step ups. I don't see any abrasions in the back. Hi thanks for coming. So we think this patient has bilateral femur fractures. I think so what would your plan be? Probably going to go to new york. Great sounds good. So we're planning on taking him to the C. T. Scanner. He has an abrasion on his left upper quadrant So we'll get a ct scan of the abdomen and pelvis. Your temperature. Absolutely the bullets is done. Okay. What are the vitals now that the bullets is finished? The current set of vitals. His heart rate is 1 20 the blood pressure is 85. Over 50 patients responded to resuscitation so far. He's received 40 CC's per kilogram of crystal Lloyd and 10 CC's per kilogram of blood Given the bilateral femur fractures. I think he'll need another 10 CC's per kilogram of blood transfusion. Which we can get started now. But the plan will be for him to go to the C. T. Scanner for a ct scan of the abdomen and pelvis at this time after that he'll likely go to the operating room with orthopedics and then up to the pick. You don't worry. Okay. Mhm mm hmm.