Gastric volvulus is fortunately a rare pathology where the stomach rotates 180°. This causes a foregut obstruction but also strangulation of the stomach wall. This rapidly leads to necrosis, perforation and sepsis, and a mortality rate 42-56%.
Making Gastric Volvulus a surgical emergency! However it is easy to misdiagnosed especially as an upper GI bleed (UGIB).
Transfer of a patient for life, limb or organ saving treatment when the time taken to provide this treatment is a critical factor in outcome.
See separate post for more resources and education if desired.
Occasionally children (<18 yrs) unfortunately will either die in ED or be brought in dead, this is obviously a terrible time for the child’s family and for staff. Despite this there are several important things we must do. Read more
There is was a national shortage of Intranasal Diamorphine therefore many departments are now more comfortable using Intranasal Fentanyl as a replacement for rapid provision of opioid analgesia in children.
Dose is 1.5micrograms/Kg for the initial dose and 0.75micrograms/kg 10 minutes later if required.
Draw up the appropriate dose plus 0.1ml to allow for the dead space in the Mucosal Atomizer Device
Attach the MAD to the syringe
Sit the child at 45 degrees insert MAD loosely into the nostril and press the plunger
Doses greater than 0.5ml should be split between 2 nostrils
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).
Seizures are a common neurological emergency in the neonatal period, occurring in 1–5 per 1000 live births.1 The majority of neonatal seizures are provoked by an acute illness or brain insult with an underlying aetiology either documented or suspected, that is, these are acute provoked seizures (as opposed to epilepsy). They are also invariably focal in nature.
Clinical diagnosis of neonatal seizures is difficult. This is in part because there may be no, or very subtle, clinical features, and also because neonates frequently exhibit non-epileptic movements that can be mistaken for epileptic seizures.
If interested the full guideline pan Yorkshire Neonatal Seizure Guideline can be found here
Tips:
Information from APLS Aide-Memoire
The Yorkshire & Humber Paediatric Critical Care ODN, has released some useful guidance about the Post-ROSC phase of care 
PUT OUT A NEONATAL CRASH CALL
CRH – will result in at least a Neonatal SpR, SHO +/- a neonatal nurse.
HRI – may not generate a response. Consider a crash bleep to anaesthetics
CALL NEONATAL CONSULTANT (WILL ONLY GIVE ADVICE AS AT CRH)
CALL THE ED CONSULTANT
***Remember Grab Box***
Unless within the first few hours of life using the APLS algorithm is equally if not more appropriate
