Paediatric Fluid Management, Electrolyte Imbalances, Metabolic Derangements, and Massive Transfusion — WACS Viva & Clinical Scenarios (Paediatrics & Day Care)

Exam-style paediatric fluid management, electrolyte imbalances, metabolic derangements, and massive transfusion viva scenarios with examiner probes and model…

Scenarios covered

• SCENARIO 1: A 4-week-old infant weighing 3.2 kg presents with persistent projectile vomiting, sunken eyes, dry mucous membranes, and a palpable olive mass in the epigastrium. Laboratory results reveal Na⁺ 130 mmol/L, K⁺ 2.8 mmol/L, Cl⁻ 80 mmol/L, and HCO₃⁻ 38 mmol/L. The surgeon wants to perform an emergency pyloromyotomy tonight. How do you assess, correct, and justify the timing and anaesthetic management of this infant?
• SCENARIO 2: A 3-year-old child weighing 14 kg is involved in a road traffic crash and sustains a Grade IV splenic laceration with free haemoperitoneum. Heart rate is 175 bpm, blood pressure is 65/38 mmHg, capillary refill time is 4 seconds, and haemoglobin is 6.2 g/dL. Formulate a complete resuscitation, massive transfusion, and intraoperative anaesthetic strategy.
• SCENARIO 3: An 18-month-old child undergoing major craniofacial reconstruction has received 60 mL/kg of packed red cells and 40 mL/kg of fresh frozen plasma over 3 hours. The ECG suddenly shows peaked T waves, widening of the QRS complex, and progressive bradycardia, with an unrecordable blood pressure. How do you identify the cause and manage this intraoperative arrest?
• SCENARIO 4: A 6-year-old child admitted with severe burns involving 35% total body surface area at 18 hours post-injury requires surgical debridement and grafting. Describe your fluid resuscitation calculation using the Parkland or Galveston formula, your choice of intraoperative fluids, and your precautions regarding electrolyte shifts, blood loss, and neuromuscular blockers.