Paediatric presentations account for approximately 5 million ED attendances each year in the U.K. and in Western Sussex contribute about 20-25% of our yearly attendances. Children may present with injury or illness, and frequently the E.D. is used for primary care presentations.
One of the biggest challenges for staff working in the E.D. is that of being able to identify the critically unwell child, and the child at risk of deterioration. It can at times feel like trying to identify the needle in the haystack! Normal physiological responses to injury and illness in the paediatric population can mean that recorded physical observations can remain in normal limits until a sudden deterioration, and because of this differentiating between the child early in the course of a life threatening condition and one with a self limiting illness can be tricky.
The following podcasts and blog posts give some useful tips for approaching the paediatric patient in the E.D.
1. Listen to the following podcasts
2. Work through the Remit project - This educational package on the NICE traffic light system for Children with Fever has been designed by Dr Damian Roland who is an EM consultant in Leicester.
To login: Username: damian Password: remit
3. Try to spend some of your next clinical shift in paeds and if possible ask a senior to complete a miniCex or equivalent when you are assessing a child.
This 'Top Tip' list was put together by Natalie May following giving the above talk at SMACC Gold. It's a great list - much of which can be applied to adult practice as well.
1. Train/Prepare well for critical illness so the emotions don’t weigh in
2. Kids generally don’t feign illness
3. Address pain, fever, fatigue, fear – makes your job easier in every respect
4. Engage the parents, the nurses (RN and MO cannot be interchanged for assistance) and the patient
5. Never lie to / mislead a kid (affects later consults)
6. Let the kid speak first (it builds rapport and understanding)
7. Toddlers want parents, teenagers want space
8. Treat the parent, not just the kid. Let them vent. See how they are managing. Empathise with their efforts and anxieties
9. Two attempts for IV then IO if sick
10. Get help early if sick
11. Manage and prevent pain (including neonates) – intranasal opiates, sucrose, nerve blocks, topical anaesthetics
12. Always check sugar esp in perplexing presentations
13. Beware of persistent, unexplained tachycardia
14. Check for testicular torsion in abdo pain
15. Umbilical hernia rarely obstruct < 4 y.o
16. Rectal prolapse + sick = ?colonic intussuception
17. Undress all kids for rash and NAI
18. Double check your drug/fluid doses
19. Remember child protection laws
20. Good discharge advice is your safety net