Výsledková listina a přehled úkolů Rallye Rejvíz 2010

Házená D RLP Rozhodčí:
D RZP Rozhodčí:
Handball D INT Judges:
Time limit for task:
max. 12 min.
Daniel Csomor, Barbora Zuchová RALLYE REJVÍZ 2010
Branislav Podhoranský, Dana Nosovská
Christoph Redelsteiner, Simona Slezáková
Story get to team at task start.
•
•
•
•
A
B
C
D
Story for team:
Dispatch centre received emergency call:
Emergency call is received by the dispatcher at 15.35. The troubled mum of Juraj/Katka complains that she is not able to get her son/daughter from the bed. The patient vomited once earlier and
then went to sleep. At the moment the patient Is laying in the bed, breathing normally but refusing any bodily contact or any change in body position. The worried mother insists on immediate
medical help (she is worried that her child has eaten "something" in the school earlier that day). As the GP cannot come earlier than 30 minutes the dispatcher is sending out an ambulance with
a crew.
Your task:
examine and evaluate condition of patient
determine operative diagnosis and differential diagnosis,
administer the therapy,
when hospitalization needed, set up patient for a transport, define direction and next procedure
Local situation:
Nearest hospital is 20 km by ground transport with surgery, internal medicine (neurologists on duty nonstop),gynecology and obstetric and biochemistry.
Higher level hospital 42 km by ground transport, dept. as A + ED, anaesthesia and General Intensive Care, ENT, CT, neurologic dept. with ICU, psychiatry, infectious diseases and pediatric dept.
Specialized centre 55 km by ground. Depts. as B + traumacentre, burn unit, cardiocentre, stroke unit, NMR.
Helicopter rescue available at 15 mins.
Situation:
8-years-old Jurko/Katka is laying covered by his/her blanket on the bed. The patient is not responding to greetings, opens eyes in response to painful stimuli but closes them immediately afterwards
(photophobia). Patient's speech is slurred (words cannot be understood), physically defends and protects him/herself, (GCS 10-11 bb.) and falls straight to sleep. Body temperature is 37.2 °C(99F), limbs are
cold, blood pressure is 90/50, heart beat rate is 110/min, oxygen saturation is 96 %. Isocoria is present, moderate nuchal rigidity, ptechial rash at the inner side of the thighs. Box of opened Paracetamol with 2
empty blister packages is on the bedside table. Bottle of mineral water is standing next to the bed. After the 4th minute patient suffers grand-mal lasting 30 seconds followed by unconsciousness, GCS 6-7. The
mother tells the crew that after coming home from school Jurko/Katka had a headache, vomited once and had a fever which wasn't checked with thermometer. To a question if the patient have eaten all the
missing pills from the box the Mother answered that she gave him/her only two tablets which left from before and that these were the only pills left in the package. This was two hours ago. Then he/she had a drink and fell asleep.
He/she is not treated for any illnesses. However, in his/her childhood he/she used to suffer from Febrile Seizures. He/She plays Handball for a local village Handball club. Today he/she was supposed to have
training and this is why they are trying to get him/her from the bed. During the patient's seizures she non-aggressively tries to persuade the crew not to intervene because she knows this situation from before.
She thinks he/she will get better shortly, everything will be fine and Jurko/Katka can go to handball training. After crew's kind approach she understands and cooperates.
Correct decisions:
Examination the patient's condition with nuchal rigidity and with petechial rash, obtaining of consistent medical history from mother, treatment of seizures, estimation of correct diagnosis and differential diagnosis
(paracetamol intoxication, epileptic seizure, blunt head trauma (Handball) and consecutive bleeding, spontaneus subarachnoidal bleeding etc.), patients management (airway management in sedation, fluid
therapy, antibiotic and ev. corticosteroid treatment). Set up Patient for a transport - analgosedation, monitoring, thermo foil. Psychological support of mother. Transport into the pediatric ICU, if needed also by air
- transport time 45 min.
Team scoring
1 Primary survey
2 History from mother
1 2
Consciousness
(GCS), breathing,
pulsation, capillary
refill
Body temperature,
oxygen saturation,
blood pressure
Nuchal rigidity or
other meningeal
signs, pupils
Petechial rash
glycemia
80 30 50 50 50
Past medical
history - febrile
seizures
amout of applied
požitého
Parcetamol
3 4
vaccination and
epidemiological
anamnesis
chief complaint
50 60 50 100
5
Max. points
1 200
240
260
Correct decision + performance
Primary survey of unconscious patient in attempt to find
out differential diagnosis and the cause of the present
condition. Assess level of consciousness , evaluate
and determine the GCS, evaluate basic vital bodily
functions including glycemia, Intentionally examine the
patient to find out if there are any meningeal signs.
Because this is the febrile child, detailed examination
of whole body is necessary.
Take detailed and sufficient patient's medical history by
questioning the mother. Determinate previous Febrile
Seizures in the patient anamnesis. Give detailed report
about patient's current condition (time when the
symptoms have begun, vomiting, headache, problems
with consciousness, fever). Eliminate possibility of
Paralen (Paracetamol) poisoning. Medical history of
febrile patient should also include date of the last
vaccination and epidemiological anamnesis.
3 Diagnose and differential dg
Meningitis
Subarachnoid
hemorrhage
Traumatic
intracranial
hemorrhage
Intoxication
100 25 25 25
175
On base of patient's examination, his/her clinical
condition and medical history provided by his/her
mother determine correct diagnoses. Establish
diagnoses as Meningitis and indicate possible
complications and conditions in differential diagnosis.
4 Therapy
i.v. access, i.o.
access, oxygen,
treatment of
seizures
Medication for
intubation
Correct airway
management
Analgosedation
and fluid
management
Antibiotic and
corticosteroid
treatment
50 50 50 50 50
250
Basic therapeutic procedure in case of
Unconsciousness: Deliver Oxygen via Oxygen mask,
i.v. access,which will be not possible to successfully
secure and due to the patient’s deteriorating conditions
an alternative vascular access has to be chosen
(intraoseal access). Patient will fall into deep
unconsciousness, therefore his/her airways have to be
secured by intubation. - RSI (short-acting hypnotic
agent, SHCJ, Sellick's Maneuver, endotracheal tube
5,5, continue with analgosedation). Fluid therapy -
crystalloids or colloids 20ml/kg. Consider administration
of antibiotics and corticosteroids according to duration
of transport.
5 Next procedures
6 Players
Secondary survey
after intubation
Patient set up for
transport
Directing in to the
PICU
Antibiotic
prophylaxis of
crew/mother
50 25 50 50
Mother
Jurko/Katka
50 50
175
100
After intubation check visually, with auscultation and
with help of EtCO2 correct position of endotracheal
tube. Before transportation patient's vital functions are
monitored: EKG, oxygen saturation , Blood pressure
every 5 minutes (noninvasive), Patient is covered by
thermal foil blanket. Taking into account patient's age
he/she should be transported right in to the children's
centre (hospital). This has to be reported to dispatcher
. Personal protective equipment must be worn on the
site. Full report of the case and prophylaxis wit
antibiotic after returning to the base.
Accent on communication with the patient, warning
before any change of body position, polite introducing
of the crew to the mother, good manners and language
and permanent psychological reassurance.