Paediatric stroke is not something we see often in secondary paediatric units, but prompt diagnosis and consideration of transfer for treatment in a specialist centre is vital.
Click to access 20160314%20Key%20recommendations%20v1.0%20FINAL.pdf
Author: DrRobin
Paediatric FOAMed
Paediatric FOAMed Paediatric FOAMed stands for Free Open Access Medical Education _ an excellent collection of resources, a community and an ethos – aimed to better our practice of paediatric medicine through education and stirring our interest.
Has succinct write-ups, short video clips, 5 minute tips and so much more. Try the Neonatal Cardiology Quiz – great revision!
Paediatric pearls from the UK
This UK site Paediatric pearls is aimed at supporting the continuing professional development (CPD) of health professionals working with children. There are monthly updates/newletters on various paediatric topics. It is put together by a UK general paediatric consultant Dr Julia Thomson, ably assisted by an editorial team of doctors, GPS and nurse specialists.
The December 2017 edition suggests a mnemonic for recognising retinoblastoma and useful links discussing infantile spasms and labial adhesions – http://www.paediatricpearls.co.uk/wp-content/uploads/December-2017.pdf
Does CPR cause rib fractures in children?
In suspected NAI, which fractures should raise your concern?
This article from Paediatrics and Child Health outlines the current research concerning abusive fractures in children. It offers guidance on how to optimize radiological investigations and avoid common pitfalls in clinical practice.
http://www.paediatricsandchildhealthjournal.co.uk/article/S1751-7222(16)30183-4/fulltext#sec9
Child Protection Evidence
A series of systematic reviews by the RCPCH to help clinicians identify the signs of physical abuse and neglect.
The reviews include the latest evidence on a series of areas, including:
- Fractures
- Neurological injuries
- Bruises
- Burns
- Bites
- Spinal injuries
- Ear, nose and throat injuries
- Oral injuries
- Retinal findings
- Visceral injuries
- They also look at evidence on neglect and around particular age groups:
- Early years neglect
- School age neglect/emotional abuse
- Teenage abuse
- Dental neglect
- Parent-child interaction
http://www.rcpch.ac.uk/news/new-rcpch-child-protection-resource-now-available
You CAN use dilute povidine-iodine for mucky ears
Occasionally we manage children with chronic suppurative otitis media (CSOM). The link below, to the Clinical Care Guidelines for the Management of Otitis Media in Aboriginal and Torres Strait Islander Populations, is a comprehensive review of what to do for the variety of ear infections we see clinically.
You can safely use dilute (1:20) povidine-iodine (Betadine(R)) to perform ear toilet, for ears where there is perforation, in addition to treatment with a topical antibiotic (e.g. ciprofloxacin 2-5 drops 2-4 times a day after cleaning). Those of us with access to video-otoscopy should also photo-document the size of the perforation if possible.
Click to access Recommendation-for-clinical-guidelines-Otitis-Media.pdf
“Death is not a medical failure and hope is not a plan”
Death is the last step in the process of disease or ageing. Can we be both a source of truth and hope for our patients when death is approaching? Families want us to take the initiative for advanced care planning and parents “prioritise regular and sensitive conversations over written advanced directives” (Lotz et al, 2016, p.6). This is good bioethical practice aimed at alleviating suffering and preventing a prolonged death.
We might hesitate to explicitly discuss future health care decisions because the future is uncertain or we wish to maintain hope. Let’s face it, hypothetical discussions are difficult for physicians and families. But we must offer to plan for the best ending to each person’s story.
Balaban’s (2000) 4-step approach to advanced care planning is recommended and summarised in this resource.
Find the right words in the examples of other physicians and aspire to fearless healing.
Here are some resources to have a look at:
- The Royal Children’s Hospital (Melbourne) Bioethics Centre has a publication “Caring Decisions” for parents and families facing end of life decisions.
- The International Children’s Palliative Care Network has a list of resources and courses available for clinicians.
- The Initiative for Pediatric Palliative Care is a North American based organisation with a freely accessible curriculum for clinicians.
- Starship Child Health (NZ) also has a set of “Clinical Guidelines for End-Of-Life Care” – a very practical A-Z about day-to-day issues encountered in end-of-life care.
Credits to Dr Sherina Mubiru for this post!
Blogs we love…
Don’t forget the Bubbles is a great (Eastern) Australian based blog with a PEM focus run by Drs Tessa Davis, Henry Goldstein, Ben Lawton and Andrew Tagg, reviewing topics, curating resources, and more recently, reviewing recent literature in Bubble Wrap.
This seems to be an international collaboration with Damian Roland (rolobotrambles) and Sean Fox (pedemmorsels) both contributing.
From Death We Learn
The Western Australian Coroner’s Report, in conjunction with the HDWA Public Safety Surveillance Unit publish an annual report “From death we learn“. This makes for tragic, but meaningful reading, and there are cases relevant to paediatrics. In the current 2016 edition (the past nine years of editions can be found here), is a case of Kawasaki Disease resulting in death by myocarditis, a button battery causing an aorto-oesophageal fistula, and a collection of unfortunate neonatal deaths. The PSSU has made clear the learning points in each case.
There may be similar reports available elsewhere. The Cororner’s Court of Victoria is searchable using keywords and includes the recent experience of unpasteurised milk causing fatal HUS in a child, or you can read their Clinical Communiques. New South Wales reports coronial recommendations via their Department of Justice website. Queensland publishes governmental responses to coronial recommendations also, however paediatric content is not as easily discoverable – you need to do a manual search. New Zealand also publishes recommendations on their Coronial Services website – again you need to manually search for child health related recommendations.
Hypertension Guidelines – what to use – ED guide or comprehensive?
There are so many repositories of wisdom on the web, it can be difficult to sift through and find exactly what you need, quickly.
For comparison, compare the guidelines below. The first is from RCH and is great if you’re in the Emergency Department and want a quick read; the second is from the Royal Hospital for Children Glasgow and is comprehensive enough for our fellow renal physicians to refer to for refined management:
http://www.rch.org.au/clinicalguide/guideline_index/hypertension/
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