A structured approach to care of critically ill children is thought to improve outcomes of patients admitted to the Paediatric Intensive Care Unit (PICU). In the process of learning, simulation plays an important part in acquiring knowledge and skills. Since 2012, a 2 day course on the basics of paediatric intensive care (Paediatric BASIC) was developed by an international group of experts in the field from Australia, Hong-Kong, Canada and USA. The course is comprised of lectures, skill stations and workshops and focuses on the practical approach to the management of critically ill children. Such courses have been run in more than 40 countries around the world. The sustainability of this course relies on local instructors who have been trained to continue the process in their own countries plus open access to all the teaching material including a 200+ page manual.
Our workshop is aimed at offering a glimpse into the Paediatric BASIC initiative and provide some of its essential elements in a much shorter timeframe. This three hours workshop will include lectures on Asessment of a seriously ill child, Shock and Life threatening arrrythmias, 2 skill stations in which the participants with acquire the necessary skills to perform safely and efficiently the insertion of an intraosseous needle and the use of a defibrillator for the treatment of life threatening arrhythmias in children. The participants will also participate in a clinical scenario – a simulated case that they will have to manage, followed by debriefing.
Intraosseous cannulation is a life saving procedure that can provide rapid vascular access in patients with shock in whom peripheral vascular access cannot be obtained in less than 90 s. It is the preferred route in patients in cardiac arrest who do not have a reliable vascular access. It has few contraindications – bone diseases such as osteogenesis imperfecta, osteopetrosis, fractures, previous attempts at intraosseous access in the same bone or, a relative one, skin infections at the site of access. The preferred sites for intraosseous cannulation in children are proximal and distal tibia, less commonly distal femur and proximal humerus. In recent years the procedure has been made much easier with autoinjecting devices – these are expensive, but provide a fast and secure access. Manual devices are still used successfully in locations with restricted financial resources.
Life-threatening arrythmias in children are less common than in adults, but are nevertheless just as deadly if treatment is not provided promptly. Patients with supraventricular tachycardia and ventricular tachycardia with pulse respond to cardioversion (a synchronised electrical shock), whilst pulseless ventricular tachycardia and ventricular fibrilation require defibrillation. If cardioversion/defibrillation are applied immediately after the onset of the life-threatening arrhythmia, survival can be improved. Nowadays, this aspect is included in the basic life support training – automated external defibrillators are available in many locations where large groups of people congregate – airports, undergound stations, malls etc. Acquiring the knowledge and skills necessary for applying correctly the electrical treatment are essential for the patient’s survival. For the initial response to be sustained by a return of spontaneous circulation, it is essential to continue with treating the cause of the arrhythmia.
In the process of learning, health care professionals need to acquire a structured approach to critically ill children. Participation in simulated clinical scenarios reinforces the important principles used to deal with such cases – early recognition of the deteriorating patient, initial confirmatory investigations, prompt initiating life-saving interventions, in addition to effective team work are important elements of this process. Debriefing at the end of the simulation is essential to allow the participants to reflect on their performance.
This simulation will undoubtedly provide the participants with a realistic experiential learning opportunity.