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.
In anybody who there is suspicion of a non-traumatic haemorrhage arrange an urgent CT Head.
All patients need IV access and U&E, FBC, Coag
If CT confirms PICH (not traumatic, not SAH): –
If anticoagulated with warfarin or NOAC discuss with stroke consultant and Haematologist regarding reversal
If not anticoagulated give Tranexamic acid – 1g in 100mls Saline/Glucose over 10 mins followed by 1g in 250mls Saline over 6 hours.
BP needs to be <150/80 – use labetalol (max 400mg – until BP <160 or HR <50) and GTN infusion
Not all patients with intracerebral bleeds need referral to neurosurgery – you could save yourself and your patient a lot of time and effort!
Those to refer:
Nose bleeds are a bloody common problem (bad pun intended) – most originating at the front to the nose where there is a cluster of blood vessels – Little’s Area.
In the young the bleeding often starts after trauma (e.g. picking or punching noses). In the elderly however, it is commonly a manifestation of underlying vascular disease. Read more
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
Time Critical Medication (TCM) is scheduled medication that the patient is already on when they present to the Emergency Department (ED).
The medications are “time critical” because a
delayed or missed dose can result in harm with exacerbation of symptoms and the development of complications leading to an increased mortality.
Movement disorders – Parkinson’s / Myasthenia medication
Immunomodulators including HIV medication
Sugar (Insulin)
Steroids – Addison’s and adrenal insufficiency
Epilepsy – anticonvulsants
DOACs and warfarin
Its really important for our patients that these medications are prescribed and given while in ED/uSDEC/fSDEC.
If you are withholding these medication (which may be necessary) -please document the reason for this clearly in the notes.
In hours speak to pharmacy if you require any support with these patients.
