Tag Archives: ENT

October 2015 newsletter

We have seen a lot of cases of scarlet fever this year so thanks to Dr Lock for his text box this month on recognising and managing this strep infection.  Comprehensive information on paediatric dizziness from Mr Sharma, ENT registrar, and a bit about asthma in schools and some of my own CPD on birthmarks caused by a Mum whose view that the internet knew more than me was a little unsettling – for a while.  We have all been there, I’m sure.

Do leave comments below.

September 2015 uploaded

September 2015: ENT feature this month – quinsy, Part 2 of the NICE guideline summary on bronchiolitis, information about a domestic violence campaign, self help books for children and a round up of topics to get you started if you are new to paediatric practice.  Do leave comments below.

August 2015

August 2015: ENT feature this month – acute mastoiditis, PVL producing staph from the dermatology team, Henoch Schonlein purpura – long term management and follow up and Part 1 of the NICE guideline summary on bronchiolitis.  Just in time for the RSV season….

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July 2015 being uploaded on a Sunday in honour of the Right Honourable Jeremy Hunt

Chest pain this month – which is very rarely cardiac in the paediatric population, early recognition of various childhood cancers, links to some drug and alcohol support groups, paediatric drooling.  Do leave comments.

June 2015 published

Gianotti Crosti this month, updated “Working Together” safeguarding document, epistaxis and malaria.  Also links to a few other useful documents recently uploaded to the Primary Care Guidelines part of the website, with thanks to Redbridge and West Suffolk.  All comments welcome.

April and May!

I seem to have forgotten to put a blog post up when I published April’s newsletter which contains information on: tonsillectomy for parents, erythema infectiosum (which I think my son had this week), a safety alert about bath seats, tranexamic acid in paediatric trauma and how to make a nasal douche for rhinitis sufferers.

May is now also published and features dangerous dogs, knee pain, dental caries and continuations of both the dermatology and ENT features.  Do leave comments below.

March 2015 published

March 2015: the first post of the new ENT feature this month – glue ear, more help with viral exanthems, important safeguarding information on the UK government’s Prevent Strategy, breastfeeding for mums and research in the paediatric ED. 

February 2013 uploaded!

A timely reminder of an albeit old guideline on otitis media this month, continuation of our minor injuries series and introduction to a new series on sleep disorders.  Also a link to a new Whipps “1st afebrile fit” guideline and a bit of background on hypospadias.

Foreign body ingestion

The information for this topic is taken from a recent comprehensive review (August 2012) that appeared in www.UpToDate.com.  Bartshealth employees can access the full text via a link from the intranet.

Ingested foreign bodies (UptoDate.com article, August 2012)

Coins — Coins are by far the most common foreign body ingested by children. Approximately two-thirds of ingested coins are in the stomach by the time of x-ray but those that lodge in the oesophagus for 24 hours after ingestion may need to be removed endoscopically as only 20-30% of these will pass into the stomach on their own.  Coins that reach the stomach can be managed expectantly, and most will be passed within one to two weeks. A child who develops any signs or symptoms of obstruction, abdominal pain, vomiting, or fever, needs to come back to the ED urgently.

Button batteries — ingestions of “button” batteries are increasing and are associated with significant morbidity. Animal studies have demonstrated mucosal necrosis within one hour of ingestion and ulceration within two hours, with perforation as early as eight hours after ingestion.  It may be difficult to differentiate between a disk battery and a coin on a radiograph. This distinction is most important when the foreign body is in the oesophagus, since batteries require immediate removal whereas coins may not.

Magnets — also increasing. Many of the children with complications from multiple magnet ingestion had underlying developmental delay or autism. In one case, an older child inadvertently swallowed these magnets while using them to imitate a pierced tongue.  Two or more strong magnets, especially if ingested at different times, may attract across layers of bowel leading to pressure necrosis, fistula, volvulus, perforation, infection, or obstruction. Radiographs of the neck and abdomen should be performed, including a lateral view. X-rays cannot usually determine whether bowel wall is compressed between the magnets, although the finding of magnets that appear to be stacked but are slightly separated is suggestive. Management depends on the number, location and type of magnets, and on the timing of the ingestion.  Ingestion of a single magnet can generally be managed conservatively with serial radiographs while multiple magnets need removing.  Laxatives may help with faster bowel emptying if they are not in a place easily accessible with the endoscope.

References at www.uptodate.com.

 

ED May 2011

The ED version of May 2011’s “Pearls” is available here!  NICE on otitis media with effusion, inguinal hernias, measles, the child with a limp and the significance of a high anion gap.  Do leave comments below.