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Mock Code

A 6-year-old male presented with respiratory distress, fever, and cough for 3 days. His condition deteriorated, requiring intubation. He then experienced ventricular fibrillation but was successfully resuscitated with defibrillation. Laboratory results showed signs of infection. The patient was stabilized and prepared for transfer to the PICU.

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KrezielDulosEscobar
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303 views

Mock Code

A 6-year-old male presented with respiratory distress, fever, and cough for 3 days. His condition deteriorated, requiring intubation. He then experienced ventricular fibrillation but was successfully resuscitated with defibrillation. Laboratory results showed signs of infection. The patient was stabilized and prepared for transfer to the PICU.

Uploaded by

KrezielDulosEscobar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Kreziel D.

Escobar
MOCK CODE
CASE: Respiratory distress(Disordered Control of breathing)- Respiratory FailureVentricular Fibrillation
Scenario:
A 6 years old male came to emergency with trouble breathing, lethargic, increase
effort upon breathing, pale skin with history of cough, shortness of breath and fever
for 3 days. Known case of Bronchial Asthma and Cerebral Palsy with seizure
disorder.
Part 1:
First responder came and assist patient, placed non- rebreathing mask 10 liters
/minute.
Resus team arrives: Identification of name and role in the team
Nurse 1: Secure airway-suction secretions
Nurse 2: Procedure- connects to cardiac monitor
-apply pulse oximeter , take weight(broselow),check
temperature
Nurse 3: Medication prepare ventolin and atrovent
Nurse 4:Documentation
Vital signs:
T 39.7/rectal, PR 130/MIN ,peripheral pulse normal, BP 102/50, SPO2: 80%, RR
62/min, sterna retraction, excess secretions, coarse breath sounds
Weight: 18 kg by broselow
Nurse 3: Paracetamol given 270mg per rectal(15mg/kg)
Part 2: Secondary Assessment
Patient is lethargic, weak, with fever, cough, shortness of breath for 3 days ,
unknown allergies, on medication: phenobarbitone, topamax, Last meal taken per
gastrostomy 3 hours ago, vomitted after feeding with acute onset of respiratory
distress
Please repeat vital signs:

T 38.2/rectal, HR 120/min, SPO2 92% (Oxygen), BP 90/50, RR 52 with secretions,


still labored breathing

Part3
Kreziel: Please insert IV line , get blood works (CBC, U/E, Calcium,Magnesium, VBG,
HGT, Blood culture and sensitivity, Drug level
Nurse 2: IV line inserted , blood works taken, HGT- 4.5 mmol/l
Kreziel: Start IV bolus of 0.9 NaCl 360 ml 0ver 30 minutes (20ml/kg)
Maintenance : D50.45NaCl 70ml per hour
Also give ventolin 5mg and atrovent 250 mcg for 3 doses back to back
Please request portable chest xray (Suspected : Aspiration Pnuemonia)
Prepare ceftriaxone 1350mg IV(75mg/kg) max:2 gram, wt:18 kg
Nurse3: Ceftriaxone 1350 m given IV over 30 minutes
Part 4:
Reassessment of the patient
Vitals Signs
T 38C/rectal ,PR 152, BP 103/58, SPO2 70% (oxygen) desaturating , RR 14
Kreziel: Prepare Intubation
Nurse 1: Equipments for intubation prepared
(ET TUBE size:

, laryngoscope, stylet, 10 cc syringe , ky jelly)

Nurse 3: Rapid Sequence Intubation Medication prepared


( succynlcholine3.6mg (0.2mg/kg), atropine1.8mg(0.1mg/kg),
midazolam1.8 mg(0.1mg/kg)
Doctor: Successfully intubation done
Kreziel: Please rechecked saturation
Nurse 1: Now, saturating 98%
Kreziel: Request portable chest x-ray for confirmation of ET tube

Chest xray technician came and chest xray done: ET tube was in place
Part 5
Suddenly patient deteriorates, HR 52, BP 49/39mmhg, Spo2 95%
NURSE 2: Notice Ventricullar Defibrillation
Doctor: Please start compression and continue bagging
Prepare for defibrillation
NURSE 2: Compression started
Kreziel: turn the knob give 36 joules (2 joules/kg)
Doctor: Clear the patient for defibrillation, I am clear,your clear, everybody clear,
oxygen away, shocked delivered.
Nurse2: resume compression
Nurse1: Secured airway( bagging)
Kreziel: Good job Nurse 2 , your doing right in way: push hard ang fast , Nurse 1:
securing airway
Nurse2:( 3 cycles of CPR)
Kreziel: 3 MINUTES over , Lets assess the rhythm
Doctor: Still showing Ventricular Fibrillation
Kreziel: Prepare for next defibrillation 140joules (4joules/kg)
Resume Compression
Nurse 4: 3 minutes over
Kreziel: Lets analyze rhythm( Normal sinus rhythm)
Please check pulse
Nurse 2: peripheral pulse is present and matching the monitor
Kreziel : any laboratory available
CBC RESULTS :WBC-6.3, HGB:12 , HCT: 35.9% , MCV:83.4 MCH:27.9 MCHC:334 ,
RDW: 12.5 %PLATELET:198 neutrophils:41.3% LYMPHOCYTES 48.2% basophils 0.7%

UREA &ELECTROLYTES: RBS: 22.5mmol/l Urea:4.1mmol/l, creatinine 62 umol/l,


sodium 132mmol/l,potassium 2.8mmol/l, chloride 95 mmol/l, bicarbonate 27 mmol/l,
osmolality 290.3 mosm/kg
VENOUS BLOOD GAS: pH: 7.20, PCO2:38.9, PO2:46, BICARBONATE 20, TOTAL
CO2 24.9,OXYGEN SATURATUION 81% , haemoglobin12.9
Kreziel: Please change fluid to D50.45NACl + 30 mmol/liter KCL at 70 ml/hr
Part 6 :TERTIARYASSESSMENT
Afebrile 37C/rectal
PR 128/min
SPO2: 98%( intubated)
Normal sinus rhythm , with IV fluid
Patient is stable .Please call PICU and we will shift the patient.

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