Grace is a 6-year-old girl brought in by her father after inserting a small bead into her right nostril. She has no relevant past history, regular medications or allergies. Her observations are within normal limits for age and her weight is 20 kg. The parent-kiss technique has failed. The bead is visible, anterior and suitable for ED removal, but Grace is very anxious. You discuss a trial of midazolam with her father and reassure him that this approach does not require a needle.
Prescribe midazolam, including route and dose in milligrams, and state when peak sedative effect is expected.
(Marked out of 2.0)
/ 2
Midazolam produces only mild sedation and is not enough for safe removal. Her father is keen to proceed and you discuss ketamine. List three (3) benefits and three (3) risks that should be discussed for consent.
(Marked out of 6.0)
/ 6
Her father consents to ketamine. Despite the earlier midazolam, Grace remains too anxious and mobile for safe IV cannulation. Prescribe ketamine, including route and dose in milligrams, for procedural sedation.
(Marked out of 1.0)
/ 1
Before ketamine, the nurse prepares the airway trolley and asks for your guidance on sizing airway equipment for Grace. List three (3) appropriate options.
(Marked out of 3.0)
/ 3
After ketamine sedation, the bead is removed atraumatically and no further nasal or airway foreign body is found. Soon after, Grace develops stridor and her SpO2 falls to 92% despite oxygen via a non-rebreather mask. She is still sedated, the airway is not soiled and there is no allergic reaction. List four (4) steps in treating this condition, including drug doses where relevant.
(Marked out of 6.0)
/ 6
Total Score: 0 / 18
Percentage: 0%
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