Diabetic Ketoacidosis – remember in paediatrics this may be the 1st presentation of diabetes.
DKA Management Flow Chart – HERE
Diabetic children sometimes attend ED with hyperglycaemia, but not in DKA (what should we do?)
Paeds have produced some advice to follow:
To clarify the immobilisation strategy for patients requiring Poly-Trauma CT Scans (anything more than an isolated CT Head)
As there are now no longer a paediatric clinical team at HRI, the paediatric surgical pathway is up-dating, this is the current provisional pathway, to ensure care falls inline with GIRFT report.
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 the reason for this clearly in the notes.
There is rapidly growing evidence, outcomes for children are improved by early attendance at specialist sites. As there is NO onsite paediatric speciality provision at HRI. It has been agreed that children likely to benefit from early Paediatric/Neonatal care move to CRH as swiftly as possible. This will be done using the agreed pathway, to reduce treatment and speciality input delay.
