Category: Paeds

Toddlers Fracture

Toddlers Fractures

  • Typically occur between 9months and 4yrs of age.
  • After a low energy twisting injury, such as;
    • Slipping and twisting while walking/running/jumping
    • Leg caught when sliding off parent/chair/toy
  • Clinical Features:
    • Wont put foot down
    • Not walking
    • Often little tenderness
    • Gentle twist of ankle and knee will be painful
  • Xray features:
    • Spiral fracture tibia (often seen best on lateral view
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Major Haemorrhage Protocol

In the case of patient with Massive Haemorrhage weather that be from Trauma, Surgical, O&G, UGIB, you can activate the MHP

Remember:

  • Do the Basics – don’t forget ABCD
  • Inform Transfusion and get someone to run a G&S sample down
  • FFP can take up to 45min and platelets come from Leeds
  • If you no longer need the MTP – inform transfusion and return products ASAP
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Medical Emergencies in Eating Disorders

Eating disorders* are relatively common and unfortunately patients who “look well” can have a significant mortality risk. MEED.org.uk have national risk tools to recognise those that would benefit from admission, which fit with our local mental health teams, and agreed by both acute medicine and paediatrics

(*anorexia nervosa, bulimia nervosa, binge eating or avoidant restrictive food intake disorder)

Risk Assessment

RED indicators

Anyone with one or more RED’s is high risk and should be considered for admission MEED

  • BMI <13/<70% mBMI
  • Recent weight loss >1 kg/week for 2 weeks in an underweight patient
  • HR (awake) <40
  • Recurrent syncope with standing BP <90 systolic (<0.4th percentile for age) and postural drop >20 mmHg (or increase HR >30 [>35 if <16])
  • Fluid refusal or signs of dehydration
  • Temperature <35.5°C tympanic/35°C axillary
  • Long Qt or other ECG abnormalities
  • Low Glu/Na/K/Ca/PO4/Alb
  • Low WCC, Hb <10
  • Acute food refusal/very low calorie intake per day
  • Physical struggles with carers over nutrition
  • High levels of uncontrolled exercise (>2 hours/day)
  • Daily purging behaviours
  • Self-harm
  • Moderate–high risk suicidal ideas.
MEED Check list

Swallowed Foriegn Body

The ingestion of a foreign body or multiple foreign bodies (FB) is a common presenting complaint in paediatric surgery, with a peak incidence from 12-24 months however, can occur at any age. Ingested foreign bodies rarely cause problems; almost 80% of patients pass the foreign body without intervention – in seven days2 (only 1% require surgical removal). However, occasionally foreign bodies can cause significant morbidity (for example, oesophageal rupture) and 1% require surgical removal.

The presenting symptoms and outcomes of an ingested foreign body is highly dependent on the swallowed object, and for this reason, the guidance for hazardous and non-hazardous foreign body ingestion has been divided accordingly.

Using the Metal Detector

Non-Hazardous Objects

Button Battery

Ingestion of Button Battery = POTENTIAL EMERGENCY

See separate post for more resources and education if desired.

Magnets

 

Sharp Objects

PDF copy – HERE

Paediatric Mental Health

Paediatric Mental Health Concerns

The provision of out of hours mental health services for Children and young people (under the age of 18) and in hours services are different.

In-Hours (9am – 8pm) – contact CAMHS via switchboard

OOH (8pm – 9am) – contact the Mental Health Liason team (RAID) via switchboard (they will see/telephone review these patients initally and help with the mental health aspects including levels of risk and follow up plans with further mental health services)

Most, if not all, primary presentations to the ED with mental health concerns will meet the threshold for discussion with these services even if they decide same day review isn’t appropriate/they direct you elsewhere.

All self-harm and any overdose must be discussed!

Acute behavioural disturbance in children and young people has no nationally approved guideline and should be discussed with senior ED (ST4+), paediatric and mental health colleagues.

In young people for whom a HEADSSS assessment has been performed and you have low level concerns but for whom formal mental health/safeguarding thresholds have not been reached there are local resources which it may be useful to direct young people towards.

BLOSM colleagues are also a great resource repository even if children don’t meet formal referral criteria

Night OWLS – confidential emotional support line open between 8pm and 8am

Openminds Calderdale – repository of multiple sources of well-being support for children in Calderdale

Kirklees Keep in Mind – repository of multiple sources of well-being support for children in Kirklees