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
Category: Paeds
Time Critical Medications
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.
Paediatric Flow at HRI
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.
Paediatric afebrile seizure pathway
C-Spine Injury
C-spine injury ranges from the obvious fracture-dislocation to the less obvious ligamentous injury, affecting about 2.5% of blunt trauma patients. However, ALL of them are serious and can lead to life changing injuries, that we obviously don’t want to miss. Unfortunately reported miss rates range from 4-30%. [IJO 2007]
Ingested Magnets
Ingestion of Strong Magnets is a TIME CRITICAL EMERGENCY
(Multiple Magnets OR a single Magnet and Metallic Objects)
If unsure if magnet classes as a strong magnet ask to see others from parents. If clearly not a strong magnet from the rest of the alphabet letters parents have provided please manage as per Ingestion of Foreign Body and avoid unnecessary radiation. If there is any uncertainty follow the policy below!
Strong magnets (such as Neodymium)
- Now common place around the house
- From; fridge magnets to toys and peicings
Ingested:
- Intestinal injury can occur within 8-24 hours
- However, symptoms may take weeks to develop
- Symptomatic patients are a SURGICAL emergency
Detection:
- 2 views – to determine number of magnets (if in doubt assume multiple)
RCEM recommendation (best practice)
Sore Throat and Group A Strep 2022
Due to the increased prevalence of Group A Strep (GAS) during winter 2022-23 national guidance on how we treat sore throats was updated (National advice to lower the threshold for antibiotics was rescinded 15ht Feb 2023)
Acute Flaccid Paralysis (AFP)/ Acute flaccid myelitis (AFM)
AFP/AFM is rare rare but serious neurological condition, which is associated with POLIO infection but has also been linked with other infections (and in the USA they have spikes every 2 yrs last 2020). AFP leads to weakness and paralysis affecting face and limbs but also the respiratory muscles and may lead to respiratory failure.
Paediatric Blast Injury
Save the Children, have published a used full guide on management on blast injuries in children. Taking you through pre-hospital, ED and inpatient care.
Although blast injury is rare in the UK it’s worth a read as an adjunct to APLS/ATLS training.
- Recognising “Blast Lung” – which may be subtle initially and develop over hours (p51)
- Prophylactic antibiotics
- Compartment syndrome and fasciotomy (p105)
- Burns Fluids and escharotomies (p112)
Paediatric Ketamine Sedation
RCEM 2022 Safe sedation in the ED and RCEM Ketamine for paediatric procedural sedation guideline. Please read these documents in full or participate in RCEM learning for further information.
