Resus Drills: Paeds Upper GI Bleed
Drill pre-brief (instructor to read out)
“Welcome to this Resus Drill. Drills are for situations which are not common, and need a time-critical response. This is not a Simulation. Drills are a rehearsal for practising teamwork and speed.
We will run a scenario for 5 minutes, chat and reflect on it, then run the same scenario again for another 5 minutes.”
Assurances
Learning, NOT assessment: drills are for practice and for learning. We’re concentrating on how fast you can think, and how well you work as a team.
Safe zone: lessons are shared here, not judged, not told as tales.
5-min reflection rules: please use the debrief to be positive about what you can all do better on the re-run. These are deliberately tough scenarios. That’s the point of a drill.
Pretend it’s real: although it’s not real, we need you to help us by acting as you’d do in real life, in your normal role, and we’ll try to run it in real time.
Take-away pack: there is some information that you can take away for further learning. We recommend “spaced repetition” for the best learning!
Make some reflective notes while it’s fresh in your mind
Make yourself read them again in a couple of weeks
How does it work?
Each Resus Drill pack follows a standard format.
The drill packs are laminated and available for teaching purposes. Printable copies can be downloaded HERE.
Our drills can also be EDITED to suit your local hospital needs (Google account required).
S.E.T.U.P. (before patient arrives)
SELF… physical readiness (stay calm) & cognitive readiness (accept the challenge)
ENVIRONMENT… lighting, crowd control, appropriate equipment?
TEAM… initial briefing, identify Team Leader, allocate team roles
UPDATE… if possible, recap for the team (and yourself) before patient’s arrival
PATIENT… the patient arrives
Location of Equipment
BloodTrack® devices (or similar) needed for requesting emergency bloods
A rapid fluid infuser will be needed for delivering requested blood products
Major Upper GI Bleed Decision Algorithm
Red Call Sheet
Scenario Script
“A 2-year-old boy suddenly vomited a large volume of fresh red blood. His mum called an ambulance. Here is the pre-alert sheet from the ambulance service…” (give Red Call sheet to Team Leader)
Minute One
Gloves, aprons, suction. Team Leader designates team members and uses S.E.T.U.P (Self, Environment, Team, Update, Patient arrives).
Minutes Two & Three
Child arrives: “The child is sitting up, looks anxious and quiet, and vomits blood again, filling 1/3rd of a bowl”
Team Leader to ask for primary survey, 2x IVs, verbally seek information of parameters of shock – including VBG. INFORM THEM: HR 140, BP 60/40, cold peripheries, Venous blood gas (VBG) is as shown below…
If anyone asks, there is no past medical history. Team Leader should be requesting MHP activation, ED consultant and paediatric help, senior anaesthetist.
Minute Four
IV access obtained (ideally two). Should start 10 ml/kg O-negative blood via warming device. Provide VBG, if requested.
Team Leader should be requesting more nurses, doctors, specialist help and using closed loop communication to check the multiple tasks are being done.
Minute Five
Haematemesis is ongoing. Team Leader should reassess all interventions, blood pressure, check help is arriving and consider diagnosis. If Team Leader suggests button battery and portable chest x-ray – diagnosis confirmed (show CXR below).
Debrief and Feedback
You should aim to cover the following points within 5 minutes, then re-run the scenario:
Did the Team Leader allocate roles and tasks in a way that was clearly understood? Was S.E.T.U.P utilised?
Did team members communicate as follows…
On patient arrival, did Team Leader ensure a good pre-hospital handover?
Did Team Leader show calm and clear speech? Body language?
Did Team Leader maintain good team control and communication throughout?
Was closed-loop communication used when assigning tasks?
Was IV access and the rapid infuser prioritised?
Did Team Leader accurately interpret gravity of situation and convey that?
Were the following all called correctly: ED consultant / ITU / Gastro? Was the massive haemorrhage protocol activated?
How did team members help the team pull together?
Were there any instances of…
Equipment issues?
Human factors negatively impacting communication or patient care?
Additional Resources
- Potential Button-Battery or Magnet Ingestion or Insertion (UHL local guideline)
- Management of Upper Gastrointestinal Bleeding in Children (UHL local guideline)
- Massive Haemorrhage guideline (UHL local guideline)
- Button Batteries Burn (EM3)
- Re-ACT Talks: Batteries, Burns and other Bombs (NHS England)
- Button Battery Update (LITFL)
- Lightning Learning: GI Bleeds (EM3)
