PEM Review 007, June 2nd – PAIN // COMMUNICATION // BRONCHIOLITIS // P.O.C.U.S // LFTs // NORMAL VALUES // EXAMINATION TECHNIQUES

PEMgeek3

Hello,

Some solid journal article analysis featured this week (alongside some random factlets and mashup-diagnoses). There will definitely be at least one thing in this pick-and-mix to interest you:

specialk            1. PAINFUL FINDINGS How good are we at giving pain relief to paediatric trauma patients BEFORE they arrive in resus? Apparently not quite as good as we could be – this recent paper (Open access article from @PedCareonline) found that out of 1493 children who received prehospital care, analgesia was indicated in 489 cases, however only 32% of children actually got any. I highlight this European study as I know this blog has a few readers on the continent who might find this interesting (also – does anyone know of an equivalent UK based study for comparison?)

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nice   2. CALLING IN THE EXPERTS… I like to think that paediatricians are pretty good at communicating with colleagues from other specialities (if you can successfully negotiate with an angry five year old who doesn’t want you to look in his ears, then convincing the surgical reg to come down and review a patient shouldn’t be that hard… right?!) However – stress can sometimes mean manners go out the window… this post on @EMDidactic is a great reminder of the communication basics to remember when asking for a specialist opinion. The 5C model (Contact/Communicate/Core Question/Collaboration/Closing the loop) seems like a more healthcare appropriate version of SBAR (SBAR was first used in the nuclear submarine industry!)

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medical_urinary-tract-infec      3. BRONCHI-UTI-OLITIS? Here’s an interesting short summary of a study which found that over 6% of hospitalised febrile bronchiolitic infants (confirmed RSV positive) also had a UTI. Will this change your practice? (I’m copyrighting that double-diagnosis mash-up by the way). Journal article summary courtesy of dontforgetthebubbles/ @TessaRDavis

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VF01    4. HOCUS P.O.C.U.S. It’s prime ‘kids falling off things’ season. Our American colleagues are far ahead of us in the UK in bedside (ie point of care – P.O.C.) ultrasound – which can be used to check for a skull fracture, before you go ahead and irradiate with CT. Take a look at this video from Dr Charisse Kwan (@82CharK) giving some tips for performing a skull ultrasound, and once you’ve seen that check out  this playlist (thanks @POCUS4Peds)  showing various skull ultrasound findings.

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normal   5. WHAT IS NORMAL? Where did the ‘normal’ ranges for heart and respiratory ranges for children come from? Surprisingly, the quoted ‘normal’ ranges can vary and are sometimes based on consensus rather than evidence – which makes this recent paper in ADC(author @PEMdocSyd) a really important read. It looks at the heart and respiratory rates of over 100,000 well children attending the ED and compares the calculated centiles with the centiles used in APLS (there are some surprising differences). Since we place so much importance on numbers (for CEWS/PEWS scores etc), is it time for us (and APLS) to revise ‘normal’ values?

thinkingman   If you’re feeling philosophical here’s a loosely related blog post from @ADC_BMJ / @drbobphillips – what’s behind your thinking process when you use a number to decide whether or not to intervene?

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liver3   6. LFTs IN DETAIL Everything the EM doctor (probably) ever needs to know about LFTs:  A really detailed but succinct description of the clinical relevance of each component of the LFT panel is featured on @criticalPeds this week. Who knew that AST:ALT ratios could give you so much helpful information? (confession – not me :S )

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mexican-wrestling-7      7. HOLD TIGHT! This is a must-watch if you’re new to PEM – a little video demo of how to get a parent to hold their child so you can get a proper look into the throat.  An essential paediatric ED skill (shouldn’t this be a DOPS for RCPCH trainees..?!) No Mexican wrestling masks required. Thanks to @Damian_Roland for the video.

Yours in #FOAMed

@PEMgeek

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