S: Cassius is 4 months old. His mother and father have brought him to A&E following a 2 day history of cough, coryza And reduced feeding.
B: Cassius was born at term. He has previously been well and has no known allergies.
A: Cassius is asleep in mum’s arms on entering triage. You can see he is headbobbing.
R: Please complete an initial assessment and discuss appropriate treatment
Q1: “Please describe your initial approach to Cassius.” (approx. 100 words)
Cassius is bubbling at the mouth and has congested nasal passages.
Q2: “How would you assess the airway. Describe the actions you would take for Cassius?” (approx.. 100 words)
Q3. In accordance with the guidelines when is suctioning indicated?
Q4: “Describe respiratory assessment you would perform on Cassius?” (approx. 250 words)
Q5: “Describe how you would auscultate the chest, the sounds you are looking for and what they indicate’’ (approx. 75 words)
You record the following vital signs under ‘B’
RR 60, Saturations 88% in air. Headbobbing. Nasal flaring. Mild tracheal tug. Intercostal and subcostal recession. On auscultation you hear wheeze and crackles.
Q6: “Please provide a brief summary of your conclusions regarding Cassius’s breathing status, and the appropriate actions required” (approx.. 100 words)
Q7: “What is normal respiratory rate in a baby of 4 months?”
Q8: “Please discuss your options to provide supplementary oxygen. Indicate which you would select and provide a rationale for your choice.” (approx. 150 words)
Q9. “Describe the circulatory assessment you would perform on Cassius” (approx. 75 words)
You record the following vital signs under ‘C’
Pulse 160, normal rhythm. CRT less than 3 seconds, BP 80/60. Pale but no mottling. Reduced urine output today.
Q10: “What is normal HR for a 4 month old baby?”
Q11: “Please provide a summary of your conclusions regarding Cassius’s circulation status.” (approx. 50 words)
Q12: “Describe the disability assessment you would perform on Cassius” (approx. 50 words)
You record the following vital signs under ‘D’
Alert. GCS: 14/15. Pupils equal and reacting to light, size 2mm. Blood glucose 4.0mmol/l
Q13: “Please provide a summary of your conclusions regarding Cassius’s disability status.” (approx. 100 words)
Q14.“Describe what you will check under ‘E’ Exposure.’’ (approx.. 50 words)
You record the following under ‘E’
Cassius has a temperature of 38.0 degrees celcius. He has no rash’s, bruises or signs of injury. He has no known drug allergies. Previously fit and well. Born at term.
Q15: “Please provide a summary of your conclusions following your assessment of ‘E’.” (approx. 50 words)
Q16: “What do you suspect is the cause of Cassius’s symptoms?’’ (approx.. 150 words)
Q17: “What treatments do clinical guidelines say should NOT be used in the treatment of bronchiolitis?’’ (approx. 150 words)
Cassius is unsettled when awake. He is prescribed paracetamol
Please note: You are permitted to refer to the British National Formulary (BNF) or a similar resource to assist you in answering the following questions.
Q18: “When are antipyretics indicated (in accordance with NICE) ?”
Q19: “What type of drug is paracetamol?”
Q20: “What is the recommended dose of paracetamol for Cassius?
Q21: “What is the recommended frequency and maximum dose?”
Q22: ‘’You have a bottle of 120mg/5ml Paracetamol suspension. What volume would you administer?’’