In the case of patient with Massive Haemorrhage weather that be from Trauma, Surgical, O&G, UGIB, you can activate the MHP
Aortic Dissection (AD), is uncommon (1 AD:200 ACS) but is…Rapidly FATAL! Unfortunately recognising aortic dissection is difficult with a clinician pickup rate of 15-43%. Read more
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)
Anyone with one or more RED’s is high risk and should be considered for admission MEED
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).
If anybody is symptomatic after button battery ingestion they need referral to the Surgical team for urgent endoscopic removal. Liase immediately with our local surgical/ENT teams but be aware this may end up as a time critical transfer to Leeds especially if child <2years. Read more
Most children with sickle have direct access to the paediatric ward and team and will not present to ED.
On the rare occassions children and young people do present we need to get it right. The Paediatric Team use the Leeds Hospital Guideline to guide this. Our primary role in PED is to manage pain while we ask for help.
An adapted version of the LTHT Painful Crisis Flowchart follows but the key is to involve the paediatric team for support early. If patients attend with a personalised analgesia plan from a recognised NHS organisation please ensure this is followed where possible.
Quick access to the Fentanyl guideline and SORTT tool mentioned below.
To maintain or restore patency of the ductus arteriosus
Only to be used in infants who are ventilated or where ventilation is immediately available
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
Faltering growth and poor weight gain in neonates are handled very differently.
Fortunately for us our paediatric colleagues have developed a very robust (read long) guideline to help us understand what we may need to do for these children.
They also appreciated we aren’t so good in PED at reading long guidelines so please refer to the bottom of the linked document for the appendices – one for babies and one for children.
Enjoy
Working out what your patient might have been vaccinated for can be tricky, and more so if they were raised outside of the UK. Luckily there are a couple of tools online you can use to make this easier.
There are approximately 20'000 strangulation victims each year in the UK
1:11 sexual assault victims
Strangulation/Hanging/Suffocation are the most common suicide method in Wales and England
