Stabilisation with limited paediatric resources — branching viva · Paeds Vivas

Prompt

A two-year-old with septic shock arrives at a small rural emergency department with one paediatric-experienced nurse and no on-site paediatrician overnight.

Opening question

A two-year-old with septic shock arrives at a small rural emergency department with one paediatric-experienced nurse and no on-site paediatrician overnight. Give the one-sentence definition and first safety moves. [1]

Branch 1 — classification and red flags

Classify urgency, setting and equity risks, and name red flags for escalation. [1][2]

Branch 2 — stepwise plan

Walk through assessment, call for help, stabilisation and documentation. [1]

Branch 3 — stay versus go

Explain the local-care versus retrieval decision and packaging priorities. [1][2]

Branch 4 — equity and family

Describe cultural safety, family logistics and closed-loop follow-up. [3]

References

[1]Haynes SC et al. The Use of Telemedicine for Stabilization of Neonates Transferred from Rural Community Hospitals. Telemed J E Health, 2021.PMID 33691080
[2]Klionsky DJ et al. Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition). Autophagy, 2016.PMID 26799652
[3]Sanddal TL et al. Analysis of preventable trauma deaths and opportunities for trauma care improvement in utah. J Trauma, 2011.PMID 21206286
[4]Gava F et al. Overcoming challenges in the implementation of chimeric antigen receptor (CAR) T-cell therapy in resource-constrained settings: Lessons from Brazil and India. Cytotherapy, 2026.PMID 42462591

Prompt

A two-year-old with septic shock arrives at a small rural emergency department with one paediatric-experienced nurse and no on-site paediatrician overnight.

Opening question

Branch 1 — classification and red flags

Classify urgency, setting and equity risks, and name red flags for escalation. [1][2]

Branch 2 — stepwise plan

Walk through assessment, call for help, stabilisation and documentation. [1]

Branch 3 — stay versus go

Explain the local-care versus retrieval decision and packaging priorities. [1][2]

Branch 4 — equity and family

Describe cultural safety, family logistics and closed-loop follow-up. [3]

References

[1]Haynes SC et al. The Use of Telemedicine for Stabilization of Neonates Transferred from Rural Community Hospitals. Telemed J E Health, 2021.PMID 33691080
[2]Klionsky DJ et al. Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition). Autophagy, 2016.PMID 26799652
[3]Sanddal TL et al. Analysis of preventable trauma deaths and opportunities for trauma care improvement in utah. J Trauma, 2011.PMID 21206286
[4]Gava F et al. Overcoming challenges in the implementation of chimeric antigen receptor (CAR) T-cell therapy in resource-constrained settings: Lessons from Brazil and India. Cytotherapy, 2026.PMID 42462591