By the product, not the symptom — household chemical exposure station

Station status

This is one MedVellum formative structured clinical encounter. The scoring, prompts and performance descriptions are educational feedback tools. They are not an official college station, timing, mark allocation, pass score or reproduced examination format. The encounter assesses first-impression recognition, identification of the product from the container, application of the contraindications, running the six-hour hydrocarbon observation, arranging timed endoscopy for a caustic comparator, communication, escalation, and a structured handover. [1] [8]

Candidate instructions

You are the paediatric registrar called to the acute assessment room. Assess the child from the doorway and say aloud what you see. Identify the product from the container, read the label yourself, and apply the contraindications: never induce emesis, never lavage a hydrocarbon, never neutralise a caustic. Run the six-hour observation pathway for a hydrocarbon, with oxygen-saturation monitoring and a chest X-ray if symptomatic. Speak directly to the child and parent. Reassess after every action. Call the poisons information centre and senior or toxicology support early. Finish with a structured handover and disposition plan, including a contrast statement on what you would change if the product had been a caustic. Say what you would assess or do; do not perform painful or distressing manoeuvres on the actor. [1]

Room setup and observable starting state

The encounter. Maya is two and is sitting on the assessment trolley beside a parent. The parent holds an open bottle of lamp oil and says, "She's drunk some of this about forty minutes ago. She coughed a lot but she hasn't been sick." Maya is alert, slightly clingy, with no obvious respiratory distress. The candidate should describe the scene objectively, declare the suspected hydrocarbon exposure, identify the product from the container, and apply the contraindications before starting the six-hour observation. [8]

Simulation safety. Maya remains on the trolley and is never forcibly positioned. Cards or the assessor supply vital signs, monitor readings and laboratory values. The parent does not obstruct urgent care. [1]

Actor cues

Parent actor

• Begin with "She's drunk some of this about forty minutes ago. She coughed a lot but she hasn't been sick." If asked what has changed, answer: "She found the bottle on the low shelf in the laundry. I don't think it was much, maybe a mouthful. She's been a bit quiet since but she's breathing fine now." [11]

Child actor

• Respond to questions appropriately early in the encounter; remain stable and alert unless the assessor's cue card specifies a change. [8]

Assessor cues and clinical data

Release findings as the candidate reaches each step. Reward product identification from the container, application of the contraindications, and a correctly run six-hour observation; penalise induced emesis, gastric lavage, neutralisation, or early discharge before six hours. [1]

A and B — Airway and breathing

Airway is patent. Respiratory rate 28, oxygen saturation 98 per cent on air, no recession. Expected strong behaviour: confirm a safe airway and adequate breathing; declare this is a hydrocarbon exposure where the dominant threat is aspiration, so the contraindications (no emesis, no lavage) apply and the six-hour observation begins. [8]

Product identification and decontamination

The parent hands over the lamp-oil bottle. Expected strong behaviour: read the label yourself, confirm lamp oil as a very low-viscosity petroleum distillate, state that activated charcoal is not indicated, and call the poisons information centre with the product in hand to confirm the observation period and any product-specific rule. [8] [9]

The observation pathway and chest X-ray

Over the next hours the child is monitored. Expected strong behaviour: state the six-hour observation with continuous saturation monitoring, a baseline chest X-ray and a repeat film if symptomatic; explain that a normal early film does not exclude evolving pneumonitis because radiographic changes can lag symptoms. [8]

Escalation event — evolving pneumonitis at four hours

At four hours the respiratory rate is 44 and the oxygen saturation is 92 per cent on air, with bilateral crackles. Expected strong behaviour: recognise evolving hydrocarbon pneumonitis, admit and begin supportive respiratory care with supplemental oxygen, escalate to high-flow or non-invasive support as needed, and state that corticosteroids and prophylactic antibiotics are not routine. [8]

Caustic comparator — what would change

The assessor asks: "If the bottle had been drain cleaner, what would change?" Expected strong behaviour: state that the child would be kept nil by mouth, never neutralised, never given emesis, and endoscoped between six and twenty-four hours, with the Zargar grade driving the surgical and surveillance plan; note that the absence of oral burns would not exclude oesophageal injury. [1] [3]

Marking domains

Debrief prompts

• What made you confident the contraindications applied here, and when would a different product have changed them?
• If the chest X-ray had been normal at two hours, would you have discharged her? Why or why not?
• If the product had been a laundry detergent capsule, how would your monitoring have differed? [9] [11]