This month’s newsletter is all about epilepsy, with thanks to one of the senior registrars working at Homerton currently who has a special interest in epilepsy. Useful updates and links. Please do leave comments below.
This month‘s newsletter has 2 updates on the new anaphylaxis guideline for people working in EDs, and a rethink about the amount of salbutamol we send children home from hospital with. A bit about the role of the educational psychologist and a reminder that, although usually benign, not all premature thelarche is transient. Do leave comments below:
With thanks to Dr Cate Luce:
Here is a systematic approach to burns using an ABCDE approach.
- Facial burns
- Smoke Inhalation
- Stridor, wheeze, crepitations
- Increase work of breathing
For more information: https://dontforgetthebubbles.com/picu-qa-airway-injuries-due-burns/ 1
B: Basic first aid
Adequate pain relief is essential in burns. You should use something fast-acting such as intranasal diamorphine or follow your local policy. This will allow for a better assessment of the extent of the burns and delivery of basic first aid. Don’t forget running cold water on the affected area for at least 20 minutes, which may be effective up to 3 hours after the burn. First aid steps at https://cks.nice.org.uk/burns-and-scalds.
C: Calculate the percentage of total body surface area (TBSA)
There are several methods to calculate the percentage of TBSA. The palmar aspect of a child’s hand is 1% of a child’s surface area. You can use the Lund and Browder charts.
People often overestimate the percentage of TBSA affected; remember to only include partial and full thickness burns as defined at www.cks.nhs.uk/burns_and_scalds3.
Why not make it easy for yourself and download the Mersey Burns App4, which calculates the percentage of burns for you?
Children with more than 10% of TBSA will need intravenous fluids. The app also calculates the fluid required using the Parkland Formula (3-4ml x (%TBSA) x (weight kg)). You should give half in the first 8 hours followed by the rest within the next 16hours.
D: Discussion with burns centre
- >1% TBSA in children, >3% in adults (London and South East Burns Network)
- Chemical/electrical/high pressure steam
- Serious co-morbidity
- Non accidental
D: Disabilities– what are the complications?
- Toxic shock syndrome https://www.nhs.uk/conditions/toxic-shock-syndrome/5
E: External factors
Burns can be a result of neglect or physical abuse therefore safeguarding should always be considered. All children should be referred to their Health Visitor who is responsible for talking to the family about safety in the home – even if you feel it was an accident. Use the Child Protection Companion as a guide. https://www.rcpch.ac.uk/sites/default/files/2019-09/child_protection_evidence_-_burns.pdf 6
Always check the child’s immunisation status, especially tetanus, as burns can act as a tetanus-prone wound.
- Davis, T. PICU Q+A: airway injuries due to burns, Don’t Forget the Bubbles, 2013.https://dontforgetthebubbles.com/picu-qa-airway-injuries-due-burns/
- Sillett, Remember, Remember Burns and Scalds, https://em3.org.uk/foamed/25/10/2015/remember-remember-burns-and-blasts
- NICE, Burns and Scalds 2019, cks.nhs.uk/burns_and_scalds.
- Toxic Shock Syndrome 2019, https://www.nhs.uk/conditions/toxic-shock-syndrome/
- Child Protection Evidence, Systemic review of burns, July 2019, https://www.rcpch.ac.uk/sites/default/files/2019-09/child_protection_evidence_-_burns.pdf
The 2nd Paediatric and Neonatal Cardiac Emergencies Course is being run at Homerton University Hospital in London again this April. The expert faculty come from Great Ormond Street Hospital, Evelina, Homerton and Barts Health. Paediatric cardiologists, simulation trainers, neonatologists and paediatricians with expertise in cardiology and life support instructors. Do come along for a fun if somewhat intensive couple of days of defibrillation, terrifying talks on QT intervals, enlightening workshops and – acting on feedback from candidates who just couldn’t get enough last year – no less than 6 full immersion simulations. Application forms from the e-mail address on the flyer.
Flyer available to download from http://www.paediatricpearls.co.uk/wp-content/uploads/2020/01/Cardiology-Course-Flyer-April-2020.pdf . You’ll need lots of blue ink in your colour printer – sorry.
Causes of chest pain in children this month (hint: it’s not the heart), causes of tachycardia, nosebleeds, Down Syndrome annual reviews, causes of erythema nodosum and a link to a fantastic document on the top 20 paediatric outpatient referrals. Read this document from Birmingham Women and Children’s Hospital and cut your referrals by at least 50%!
Local anaesthetic cream this month (why do some places not use it in the under 1’s?), a link to useful “flash card” learning in the paediatric ED from Leicester, new Movicol doses, diphtheria and the last instalment of urinalysis with bilirubin and urobilinogen. A reminder also to please discuss children with glycosuria and a high BM with a paediatrician – most children have type 1 diabetes and are at risk of DKA at diagnosis. Do leave comments below: