#RCEMasc 2019 – Day 1

For those back home its been an interesting 1st day at the conference  – and the top 5 are

1. Learning from Child Death

Great session, presented by both clinical staff and parents, around the death of a 3yo with Down’s syndrome, from sepsis. Highlighted some key points that we can all do better:

  • Communication:
    • Listen to the Carers: the parents could see the patient wasn’t his normal self but staff didn’t head the warnings, and his parents felt ignored.
    • Let Carers know whats happening: The patient was moved to Resus, we might think the parents know what that means, but they thought it was just because everywhere else was busy.
  • Unrecognised deterioration:
    • The child deteriorated through the ED stay of >8hrs, and the sepsis was only picked up and treated on paediatric ward, after a fresh set of eyes. Remember if you put a frog in boiling water it jumps, but if you turn the heat up slowly its dinner. Always be alert to the slow change!
  • Responsibility:
    • The patient remained in Resus after being seen by PICU who had then referred to Paeds – Who was looking after him? We are ALL responsible for that patient – ED and the specialities!

2. Non-blanching rash & fever in children

There are many sets of guidance out there with 100% sensitivity, however, specificity varies. NICE has a specificity of approx 1%, while the best performing Newcastle, Birmingham, Liverpool (NBL) algorithm performs at about 44%. And Purpura (defined as being between 3 milimeters and 1 centimeter in size) is a BAD sign!!!

The NBL algorithm

 

3. STEMI – de Winter is coming!

The de Winter T wave is an important ECG sign of MI, that can develop quickly into the classic STEMI. Its present in 2% of cases so learn it.

  • LITFL

    Tall, prominent, symmetric T waves in the precordial leads

  • Upsloping ST segment depression >1mm at the J-point in the precordial leads
  • Absence of ST elevation in the precordial leads
  • ST segment elevation (0.5mm-1mm) in aVR

 

4. Toxbase Pearls

  • Severe Ca/β blocker overdose – move through the treatments relatively quickly in a step wise manner as Toxbase (i.e. dont wait for ages to see if it works it either does or doesn’t). To get to High Dose Insulin Euglycaemia Regime, this seems to be one of the best therapies
  • Charcoal: Evidence coming out suggesting it is useful beyond the 1hr period, and higher doses seem better (watch this space)
  • Whole Bowel Lavage: Really difficult but good in body-packers, Iron & Lithium as well as Sustained release compounds.

5. Malaria

  • Rapid antigen test and thick and thin film – good but not 100% (esp with ovalae)
  • 5-10/yr patients die in UK from malaria – Mainly as unrecognised (travel to malaria region and unsure why they are unwell test)
  • Is it Ebola or Malaria? – if you can’t get malaria screen done (?ebola can slow the labs down) – Assume Ebola & treat as severe malaria concurrently

 

 

 

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