Category: Resus

Hip Dislocation – Flowchart

Dislocation of a Native Hip

  • Uncommon – High-Energy injury
  • All patients presenting with a suspected native hip dislocation following trauma (including falls from standing) must have a primary survey done to assess for other injuries.
  • Early Senior input (if not trauma team) and Resus
  • Neurovascular status of the affected limb must be assessed and documented. 

Dislocation of Prosthetic Hip

  • Relatively common and frequently low energy
  • All patients should be assessed with low threshold to treat as trauma
    • Remember the biggest cause of ISS >15 Major Trauma in UK is older patients falling from standing height
  • Neurovascular status of the affected limb must be assessed and documented. 
  • If there is neurovascular compromise then move to Resus and inform ED senior 
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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

Intranasal Fentanyl

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.

  1. Intranasal (IN) fentanyl is a safe, non-invasive and effective analgesic for children with moderate to severe pain
  2. Fentanyl should be used in combination with non-pharmacological and other pharmacological pain management
  3. It can be used in conjunction with nitrous oxide for procedural sedation or prior to procedural sedation with ketamine

Dose is 1.5micrograms/Kg for the initial dose and 0.75micrograms/kg 10 minutes later if required.

Drug Delivery

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

 

Contraindications

  • Blocked nose due to upper respiratory illness or epistaxis
  • Respiratory depression
  •  Hypovolaemia
  • Altered consciousness
  • Hypersensitivity to fentanyl
  •  Children below 1 year old

Full Intranasal Fentanyl SOP

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

Y&H Paed Critical Care

Drugs:

  • Trust guide
  • Remember: Midazolam 10mg/2ml is used(not the 5mg/5ml we have  in ED)

 

Neonatal Seizures

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

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