Unfortunately under 1 year olds are at a higher risk of NAI and this needs to be considered in ALL presentations. But remember if the child can’t Crawl/Stand/Cruise/Walk they shouldn’t injure themselves.
Category: Learning
iNFANT – user guide – normal development
the iNFANT is truly a design enigma, it is simple yet complicated, amazing yet frustrating, beautiful yet disgusting. And due to a unique production method, each iNFANT has its own variations and special features. Read more
EMBRACE & Paediatric Critical Care
In our trust we don’t have paediatric critical care beds. However, in our region we use EMBRACE (a paediatric critical care transport team), who can transfer critically ill children to specialist centers (in or out of region).
EMBRACE
- 0114 268 8180
- Guidance
Y&H Paed Critical Care
Drugs:
- Trust guide
- Remember: Midazolam 10mg/2ml is used(not the 5mg/5ml we have in ED)
- Found in theatres control drug cupboard (see trust guide)
Limping Child
This is a relatively common presentation within the ED that has a myriad of possible diagnoses ranging from sprain to malignancy. One thing to remember is that patients and relatives will look for a traumatic reason for limb pain, and may link it to minor injuries that would not have caused it. Read more
Alprostadil
To maintain or restore patency of the ductus arteriosus
Only to be used in infants who are ventilated or where ventilation is immediately available
Guideline-for-use-of-Dinoprostone-in-duct-dependent-CHD-1-8-3
DO NOT DELAY IN STARTING Alprostadil if: there is clinical
suspicion of duct dependent CHD while waiting for paediatric cardiology opinion OR echocardiogram, even when in-house echo facilities are present.
PDF: Alprostidil
Paediatric Hypoglycaemia
Paediatric Hypoglycaemia (BM <2.6) is a relatively common presentation in the Emergency Department. However, if we don’t do the BM it’s easy to miss.
Hypoglycaemia in paediatric diabetic patients is managed separately – see here
Hypoglycaemia in neonates (<72 hours of life) also has specific management – see here (Flowcharts A + B)
Hypoglycaemia is generally caused by disruption in one of the following:
- Carbohydrate intake
- Carbohydrate absorption
- Gluconeogenesis
- Glycogenolysis
DKA in Kids
Diabetic Ketoacidosis – remember in paediatrics this may be the 1st presentation of diabetes.
- Fluid – are more considered than adults due to the risk of cerebral oedema
- Insulin – WAIT – need 1hr of fluid first
- Paeds – involve them early
- USE the BSPED DKA Management flow charts, calculators and full guidelines for when electrolytes won’t play ball which are all linked below.
DKA Management Calculator (recommended by paediatrics)- HERE
DKA Management Flow Chart – HERE
Full CHT DKA Guideline – HERE
Diabetic Hyperglycaemia (Kids)
Diabetic children sometimes attend ED with hyperglycaemia, but not in DKA (what should we do?)
Paeds have produced some advice to follow:
- Ketones over 0.6?
- <0.6: Encourage fluids & food, may need an insulin correction
- >0.6: ask Question 2
- Are there clinical features of DKA?
- NO: Encourage fluids & food, decide Insulin correction, will need to be monitored
- YES: Will need Paeds admission
Wound Closure – Adhesive Strips
As part of a short series on very basic principles of wound closure we are going to discuss the use of adhesive strips. This practical advice is intended offer some guidance in the use of adhesive strips, assumes the full assessment of the wound has already occurred and the wound is suitable for this method of closure.
Read moreSagittal Band Rupture
Or Boxer’s Knuckle. This is a rupture of the sagittal band of the MCPJ joint, most commonly of the middle finger.
