Trish Woods: Neonatal Retrieval at DFTB17

Cite this article as:
Team DFTB. Trish Woods: Neonatal Retrieval at DFTB17, Don't Forget the Bubbles, 2017. Available at:
https://doi.org/10.31440/DFTB.13131

This talk was recorded live at DFTB17 in Brisbane. We’ve got plenty more where this one came from so keep on checking in with us every week. If you think you’ve got the chops to pull it off next year then get in touch with us hello@dontforgetthebubbles.com

Simon Craig: Acute asthma at DFTB17

Cite this article as:
Team DFTB. Simon Craig: Acute asthma at DFTB17, Don't Forget the Bubbles, 2017. Available at:
https://doi.org/10.31440/DFTB.13122

This talk was recorded live at DFTB17 in Brisbane. We’ve got plenty more where this one came from so keep on checking in with us every week. If you think you’ve got the chops to pull it off next year then get in touch with us hello@dontforgetthebubbles.com.

DFTB go to Berlin – #SMACCmini

Cite this article as:
Tagg, A. DFTB go to Berlin – #SMACCmini, Don't Forget the Bubbles, 2017. Available at:
https://dontforgetthebubbles.com/dftb-go-to-berlin-smaccmini/

Having flown 16,893 kilometres to visit family, a short hop over the Berlin was nothing. This year Tessa and I were honoured to be able to help out with SMACCmini – the paediatric workshop before the main event.  DasSMACC is the second-most* anticipated conference of the year and we wanted to make sure the delegates left better able to look after critically unwell children.

Deciduous dental damage

Cite this article as:
Andrew Tagg. Deciduous dental damage, Don't Forget the Bubbles, 2017. Available at:
https://doi.org/10.31440/DFTB.12095

As my youngest daughter continues to her quest for her two front teeth, my eldest has lost two of hers. They came out naturally with minimal fuss though as they were hanging on by a (peri-odontal) thread she asked me lots of questions about teeth. Given that I was not trained as a dentist I thought I had better do a little more research on the matter.

Caring for children with disabilities

Cite this article as:
Lori Chait-Rubinek. Caring for children with disabilities, Don't Forget the Bubbles, 2017. Available at:
https://doi.org/10.31440/DFTB.12145

`I recently completed my first rotation as a doctor in the Emergency Department. Prior to entering the medical workforce, I had spent most of my employed life as a respite carer looking after and assisting children with developmental disabilities. I thought about these kids and how difficult an Emergency Department (ED) environment would be for them, as it is a place of hyper-sensory overload – noisy, bright lights and with constant movement. Yet when I looked at the literature I found limited qualitative data describing this patient groups experience in this setting.

The 7th Bubble Wrap

Cite this article as:
Grace Leo. The 7th Bubble Wrap, Don't Forget the Bubbles, 2017. Available at:
https://doi.org/10.31440/DFTB.11992

With millions upon millions of journal articles being published every year it is impossible to keep up.  Every month we ask some of our friends from PERUKI (Paediatric Emergency Research in UK and Ireland) to point out something that has caught their eye.

Trauma education at RCH

Cite this article as:
Andrew Tagg. Trauma education at RCH, Don't Forget the Bubbles, 2017. Available at:
https://doi.org/10.31440/DFTB.11996

If you are critically injured as a child in Victoria, Australia, the chances are that you will end up at the Royal Children’s Hospital in Melbourne. Every year they see approximately 320 severely injured children from all over Victoria.  177 of these are brought in by helicopter. #RCHTrauma2017 was a joint educational evening put on by the trauma service and the great team from Air Ambulance Victoria. As well as capacity crowd across two lecture theatres it was  live-streamed to 64 sites across Victoria and Tasmania.

 

Utilising a case based format the MICA (Mobile Intensive Care Ambulance) paramedics ran through a series of challenging cases.

Case 1

Ben Meadley went through  some of the challenges of extrication faced in rural Victoria. Winch rescues are some of the most dangerous performed by paramedics (and doctors). When advanced airway management is required there can be a trade off between intubating a critically unwell child in a precarious position with minimal staff and a short winch to a staging area with 360° access and more staff.

Ben was followed by clinical neuropsychologist, Debbie Houston, talking about the rarely mentioned sequelae of a traumatic brain injury. She spoke about the importance of cognitive rest in a low stimulus environment early in the recovery period – low light, low sound and minimal visitors. The RCH has a great resource for parents and health care providers alike. She reminded us that the the road to recovery is a long one that is only started in hospital. The harder work takes place later as the family and child come to terms with challenges in a number of cognitive domains including:-

  • Attention and concentration
  • Flexible thinking
  • Impulsive and inappropriate behaviour
  • Problem solving skills
  • Memory and learning

 

Case 2

Next Matt Shepherd presented a case of post-drowning cardiac arrest and some of the challenges experienced in the field. Even the most experienced amongst us can have challenges in obtaining intravenous access in the warm, brightly lit trauma bay. Ambulance Victoria Clinical Practice Guidelines allow MICA paramedics 90 seconds to obtain IV access before turning to the intraosseous route. Unfortunately, this route can still fail despite training. We can all have bad days and it is incumbent on all of us to be aware of our limitations.  If we are having a bad day when every cannula fails it is important to not let pride or ego take over and allow somebody else to have a go.  Just make sure you have not already tried both hands, both cubital fossae and tried IO’s in both legs first. You need to give others a fighting chance. MICA paramedics have recently introduced ultrasound into their skill set, initially for eFAST and now, with the introduction of a linear probe, vascular access.

Trauma fellow, Keith Amarakone, then reminded the audience of global, as well as the local, impact of drowning. Despite many public health appeals there were 43 drowning deaths in Victoria last year. The basic tenets of resuscitation hold true, with an emphasis on ventilation, but we can have just as big an impact if we focus on prevention and awareness. Instead of public pools most of the non-fatal drownings I have been involved with have been unsupervised toddlers in the bath.

 

Case 3

The final challenging case was presented by AAV poster boy, Darren Hodges. He discussed the medical details behind this case…

This case involved the first paediatric prehospital finger thoracostomy in Victoria coupled with a prehospital blood transfusion. Even with these life saving measures he still showed significant signs of shock when he arrived at RCH.

Warwick Teague, the Director of Trauma, took over the microphone to discuss Jordan’s in-hospital course. The main focus of his talk was that non-operative management is the mainstay of paediatric truncal trauma and the Royal Childrens experience. Despite a high incidence of severe chest injuries, less than 2% of severe thoracic injuries (with an AIS of 3 or more) required a thoracotomy and only 15% needed insertion of an intercostal drain.

He also showed the latest RCH data regarding management of solid organ injuries. Over a 10 year period they have had a 100% splenic preservation rate (n=185). Only 5 laparotomies for liver lacerations (n=172) occurred in a 10 year period and there have been just 3 angio-embolisations (n=499).

With so many patients arriving by helicopter, how do the paramedics deal with parents requesting to fly with their seriously injured child? Toby St Clair reinforced that it might not be in the patient or parents best interest. Even the AW-139 is not fitted out as an Uber of the sky and space in the back is limited.  The seriously ill child might deteriorate in transit and require further intervention. We know that parental presence can be beneficial in resuscitation so this often causes a degree of moral distress for all involved.

The evening ended with Kat Baulch, a senior emergency social worker, talking about the response to trauma and dealing with distressed families. She highlighted the importance of performing psychological first aid.

  • Promote safety
  • Promote calm
  • Promote connectedness
  • Promote self-efficacy
  • Promote hope

If you want to read more about this then read this guide from the Australian Red Cross.

For some more great #FOAMed resources on paediatric trauma check out the following links:-

Emergency Medicine Cases: Anton Helman chats with Dr Sue Beno and Dr Faud Alnaj about all things trauma related.

Pediatric Emergency Playbook: In this two part series, Tim Horeczko talks about massive transfusion and more besides.

The ideal paediatric resuscitation

Cite this article as:
Ben Lawton. The ideal paediatric resuscitation, Don't Forget the Bubbles, 2017. Available at:
https://doi.org/10.31440/DFTB.11246

The first few minutes of a paediatric resuscitation are intimidating and crucial. Every basic life support update we do drills the DRSABCD mnemonic.

Test yourself - What does DRSABCD stand for?

D – Danger – put on some PPE and think situational awareness.

R – Response – pinch the child’s trapezius while asking them to open their eyes..

S – Shout/Send for help – what is the number to call in your hospital?

A – Airway – open it and look for obstructions

B – Breathing – 2 rescue breaths

C – Compressions – 2:15 ratio with breaths, rate 100-120/min, depth 1/3 of the chest. N.B the two thumb technique is recommended in the current guidelines

D – Défibrillation – 4js/kg, manual defib if you have one, AED with attenuated leads next best, standard AED if no alternative.

The team from Princess Margaret in Perth have made this excellent video of what it ought to look like. Enjoy.

If you want to be able to run a calmer resuscitation come and listen to Tim Horeczko of the Pediatric Emergency Playbook at DFTB17