Category: Paeds

Rape & Sexual Assault

Don’t

Preform intimate examinations on Sexual assault/Rape patients

  • Unless life-threatening injuries are suspected e.g Haemorrhage.
  • As our examination will inevitably destroy evidence that may aid this patient’s case

Do’s

  • Consider contamination injury (HIV, HepB, HepC) – Guide
  • Consider emergency contraception
  • Children must have police referral for safeguarding
  • Refer to The Sexual Assault Referral Centre, either via Police or Self referral

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Sore Throat

Background

Acute sore throats are often caused by a virus, last about a week and get better without antibiotics. withholding antibiotics rarely causes complications. Antibiotic stewardship is everyone’s responsibility to prevent resistance developing.

Assessment

Are there any concerns regarding airway compromise?  – If yes – transfer to resus, give high flow Oxygen, IV steroids, IV antibiotics, Nebulised adrenaline 1:1000, IV fluids, take bloods and refer to both anaesthetics and ENT registrar.

Otherwise:

Assess all under 5s  with a temperature as per the NICE fever guidelines

Assess the patient for signs of severe sepsis – if present use the severe sepsis guidelines

If no signs of sepsis assess patient, exclude Quinsey (unilateral swelling, paina nd trismus) and calculate the FeverPAIN score and Centor score

FeverPAIN = 1 point for each of –

  • Fever
  • Purulent tonsillar exudate
  • Attendance within 3 days of onset
  • severely Inflamed tonsils
  • No cough/coryza

Centor = 1 point for each of –

  • Tonsillar exudate
  • Tender anterior cervical lymphadenopathy or lymphadenititis
  • History of fever >38
  • No cough

Treatment

Can the aptient swallow fluids and medication – if not give a stat dose of IV Dexametasone, IV antibiotics, IV fluids and analgesia – review in 2 hours. If they can swallow at this time then you can consider discharge with a patient information leaflet.

  • FeverPAIN = 0 or 1/ Centor = 0,1 or 2 – no antibiotics, self care advice
  • FeverPAIN = 2 or3 – no antibiotics or a script for 3-5 days time if no better, self care advice
  • FeverPAIN = 4 or 5 / Centor 3 or 4 = give Antibiotics immediately, self care advice

Patients to seek medical advice if become more unwell or not improving after 1 week

Self care advice – Paracetamol, Ibuporfen, Adequate fluids, Medicated lozenges

 

Antibiotics –

Phenoxymethylpenicillin 5-10 days

If Penicillin allergy – Clarithromycin or Erythromycin 5 days

Tonsillitis Patient Information Leaflet

Full NICE Guidance

 

Search: tonsillitis

Asthma – Paeds

Quick Ref Guide

Full What0-18 Guide

Asthma is common and potentially fatal.

  • Severity -Inital
    • Life Threatening:
      • Move to Resus
      • Senior Dr
      • Oxygen
      • Back-Back Neb – Salbutamol & Ipratroprium
      • Steroids
    • Severe:
      • Nebuliser – Salbutamol & Ipratroprium
      • Oxygen – to maintain SaO2 >94%
      • Review 15min
    • Mild-Mod:
      • Inhaler with Spacer
      • Review 15min

  • Treatment within 30 min – bronchodilators and steroids should bee given within 30min
  • 2hrs Observation after Neb – better after a neb don’t just send home they may deteriorate when it wears off.
  • Discharge advice sheet – print off from this guide, remember to check inhaler technique and consider a spacer

 

PDF:asthma pead

Paediatric Mental Health

The provision of out of hours mental health services for Children and young people (under the age of 18) is changing: –

Between 8pm and 9am the onsite Mental Health Liason team (RAID) will see these patients initally and help with the mental health aspects of their care. Between 9am and 8pm contact CAMHS via switchboard as normal.

Afebrile Seizure (Paed)

Child (<16) presents with PAROXSYMAL EVENT – episode of loss of consciousness, blank starring or other brief unusual behaviour

History

  • Detailed description of event
  • Before (trigger? Concurrent illness? Behaviour change? Cessation of activity?)
  • During (collapse? Colour change? Altered consciousness? Body stiff or floppy?, limb movements?)
  • After (sleepy?, unusual behaviour? Unsteady?, limb weakness?)
  • Copy and paste YAS EPR entry
  • Can child be distracted at any point
  • Does the event occur during exercise
  • Developmental history
  • Family History
  • Assess for red flags below

Examination

  • Documented neurological examination including gait – observe eye movement, look for a new squint
  • Cardiac Examination including blood pressure (esp if associated with exercise / colour change)

Investigations

  • Ask parents to video events and keep detailed, descriptive diary (day, time, event-before, during and after)
  • ECG
  • Routine bloods are NOT required unless clinically indicated

RED Flags

  • Age < 1year
  • Acute confusion
  • Pervasive behaviour change / lethargy
  • New onset, recurrent convulsive seizures (>1 per week)
  • Abnormal cardiac examination or ECG findings
  • Abnormal neurological examination findings
  • Symptoms of raised intracranial pressure (blurred / double vision, headache at night or on waking, persistent nausea / vomiting)
  • Signs of sepsis / meningitis

Referral

  • RED Flag– Ref to PAU (Paeds Reg)
  • Non Urgent Referral –
    • Document history and examination (esp. neuro)
    • Ask parents to video events
    • Send message to Salim Uka and Matthew Taylor through EPR “Communicate”  to request appointment (usually within a few weeks)
  • No Referral Required –
    • The following are examples of benign paroxysmal episodes that do not require a referral to paediatrics if the diagnosis is secure:
      • Breath holding attackes
      • Simple Faint
      • Reflex Anoxic Seizures (document normal ECG)
      • Sleep Myoclonus
      • Night Terrors

Paediatric – Time Critical Transfers (non-trauma)

Definition of a time critical transfer 

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. 

Principles 

  1. Acceptance by the regional centre is NOT dependent on bed availability. 
  2. Time critical transfer should normally be provided by the referring hospital team NOT Embrace. 

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