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Background Paediatric emergencies can be challenging, time critical and often stressful situations. Recall of protocols and treatments from memory, including correct drug dosages, is fraught by human error. Although paediatric guidelines are available in printed or web-based format, quite frequently these are not available immediately. Consequently, there can be treatment delays, sub-optimal protocol adherence and drug errors, leading to patient harm. Studies have shown that in a simulated environment, the accuracy of emergency drug dosing is Mobile applications commonly used in emergency departments has been showed to reduce the drug preparation time and time to delivery.2 But this is dependent on internet signal and availability or restrictions placed by hospitals.3 The use of convenient portable cards has been useful in both paediatric and adult medicine settings 4,5,6. Objectives Develop 6 lanyard flashcards featuring common paediatric life support protocols and emergency drug calculations. Describe clinicians’ views on the potential benefit of using flashcards for accessing paediatric life support guidelines quickly and accurately. Methods A pre implementation survey was conducted in the paediatric emergency department. Using a Likert scale, staff ranked emergency topics in order of importance for inclusion on the flashcards. Cards were designed based on these suggestions, and approved by senior paediatricians and the pharmacy team. These featured emergency algorithms, common emergency drug dosages in cardiac arrests, endotracheal intubation and maintaining cardiovascular support, age-based vital sign ranges and WETFLAG calculations. These flashcards could be worn conveniently on lanyards together with identity badges. These were distributed within the paediatric emergency department and wards to act as aide-memoire cards during emergencies. A post implementation survey was completed 1 month after distribution. Both surveys were completed by a range of junior and senior doctors and paediatric nurses. Results The pre-implementation survey (responders=36) showed that staff accessed local guidelines from a variety of sources: memory (n=10), the internet (n=7), the trust intranet (n=21), printed booklet guidelines (n=12), other (n=6); with many using more than one of these. Prior to introducing the flashcards, only 9% of participants (n=3) were able to locate guidelines in 3 minutes. After implementation of the flashcards 69% of participants (n=39) were able to access guidelines in Conclusions The flashcards improved the time to access paediatric life support guidelines, with good acceptance across a range of doctors and nurses in the emergency department and wards. Following this project these flashcards have been distributed to non-emergency staff redeployed during the Covid-19 pandemic.

Summary Drilling horizontal infill wells in the Pierce field in the UK Central North Sea (UKCNS) is challenging because of the narrow drilling window caused by depletion in a highly fractured reservoir, which is complicated further by water injection and the proximity of other production wells. Wellbore strengthening was attempted in the reservoir section of Pierce B5 (B5), although, when a pre-existing fracture weakened further by depletion was encountered, losses occurred. During the next 10 days more than 5,000 bbl of nonaqueous fluid (NAF) was lost downhole. During the recovery from the losses event, 15 individual treatments with lost-circulation materials (LCMs) were made. More than 50 t of LCM was used without success; however, the well was stabilized enough to secure the drilled footage and to complete the well. Two additional horizontal wells in the same field were successfully drilled with a low-equivalent-circulating-density (ECD) management strategy combined with the development of a low-ECD drilling-fluid system and the use of a high-fluid-loss, high-strength (HFHS) pill. The dual problems of barite sag and poor hole cleaning, which can be problematic when reducing ECD through a reduction in fluid rheology, were successfully managed. This low-ECD technique can be applied in other subsea depleted wells in which a narrow drilling window exists. This paper describes how a detailed analysis of the losses event on Pierce B5 provided an improved understanding of the loss mechanism that resulted in a revised ECD-management strategy. An engineered low-ECD NAF with an HFHS pill, combined with learnings on ECD awareness in the planning and execution phases, mitigated the drilling risks on subsequent wells. This has implications when encountering very large fractures that are difficult to overcome, not only on future Central North Sea wells, but also globally for wells drilled in similar geological settings.

Abstract Globally, lost circulation is a major contributor to non-productive time. The types of products available to address this problem are many and varied, ranging from simple fibres and particulates to more complex cements, chemical gels, engineered particulates, and high-solids de-fluidizing treatments. Some are designed to be used in the drilling fluid continuously, whilst others are tailored to be placed independently as discrete pills, subject to the loss situation and, in many cases, the economics. In scenarios where relatively high levels of losses occur, operational decision trees invariably dictate the use of simpler options where possible. However, these are not always suitable. A positive outcome to the difficulties of one challenging Brownfield location is described. The application of a bespoke multi-fibre high-shear strength lost circulation treatment, when combined with sound contingency planning, has made a significant difference to the continuation of the field. Situated in the Central North Sea, the site depicted is an established infill development centred around a number of existing wells drilled on the flanks of two complex salt diapirs. Given the physical nature of the field, radial faults and fractures are a major concern. To compound the challenge, depletion effects over time have resulted in changes in the stress regime and a weakening of pre-existing natural fractures. Drilling windows consequently are tight (and not always easily predicted) and large volume drilling fluid losses are commonly experienced. To mitigate the problem, a revised loss management strategy was developed to include the integration of a high-fluid-loss, high-strength (HFHS) lost circulation product capable of dealing with dynamic loss situations involving fractures of at least 3,000 microns. This paper will describe the development, application, and differentiating benefits for the industry of this treatment and detail its ultimate acceptance as a key element of the operator's lost circulation decision tree. Introduction The field detailed in this paper is an established Brownfield site located in the Central Graben, UK Central North Sea. This infill development consists of a mix of both producing and water injection wells constructed on the flanks of two salt diapirs, predominant features of the site referred to as 'north' and 'south' reservoir zones respectively. The reservoir is both oil- and gas-producing Paleocene Forties sandstone combined with fractured chalk. For reservoir management reasons, the gas is currently re-injected and, until the introduction of pressure support, oil production was depletion driven. Based upon data from a nearby producing well differential depletion pressures have fluctuated from historical peaks of around 1,850 psi to less than 30 percent of that value today, with reservoir temperatures of up to 133°C (271°F) being recorded (Murray et al., 2014). Three specific wells will be discussed in this paper, identified here as A1, B1, and C1 (Figure 1). All three are essentially horizontal wells in design. Given the physical nature of the field, radial faults and fractures are of major concern, particularly when drilling horizontally. To compound the problem, the depletion effects experienced over time have resulted in changes to the stress regime and a weakening of pre-existing natural fractures. Drilling windows, the operational drilling pressure enveloped between pore and formation fracture pressures, as a consequence are tight and not always easily predicted. Much higher mud losses have been commonly experienced in recent years and for this reason a better managed equivalent circulating density (ECD) and lost circulation (LC) strategy was required for continued infill drilling programs. A relatively new high-fluid-loss, high-shear strength (HFHS) LC treatment was a major component of this revised management strategy, the inclusion of which ultimately proved highly successful for the operator. This paper will highlight major challenges associated with the infill development, describe key aspects of the renewed ECD and LC management strategies and will discuss HFHS, its function and the part it played in the success of more recent wells.

Drilling horizontal infill wells in the Pierce field in the UK Central North Sea is challenging due to the narrow drilling window caused by depletion in a highly fractured reservoir, which is further complicated by water injection and the proximity of other production wells. Wellbore strengthening was attempted in the reservoir section of Pierce B5, although, when a pre-existing fracture further weakened by depletion was encountered, losses occurred. During the next ten days over 5,000 barrels of non-aqueous fluid (NAF) were lost downhole. During the recovery from the losses event, 15 individual treatments with loss circulation materials (LCM) were made. More than 50MT of LCM was used without success, however, the well was stabilised enough to secure the drilled footage and complete the well. Two additional horizontal wells in the same field were successfully drilled using a low-equivalent circulating density (ECD)-management strategy combined with the development of a low-ECD drilling fluid system and the use of a high-fluid-loss, high-strength (HFHS) pill. The dual problems of barite sag and poor hole cleaning, that can be problematic when reducing ECD, were successfully managed. This low-ECD technique can be applied in other subsea depleted wells where narrow drilling windows exist. This paper describes how a detailed analysis of the losses event on Pierce B5 provided an improved understanding of the loss mechanism resulting in a revised ECD management strategy. An engineered low-ECD NAF with a HFHS pill combined with learnings on ECD awareness in the planning and execution phases mitigated the drilling risks on subsequent wells. This has implications when encountering very large fractures that are difficult to overcome, not only on future Central North Sea wells, but also has wider global significance for wells drilled in similar geological settings.