ConSEPT – the reveal: Stuart Dalziel at DFTB18

Cite this article as:
Team DFTB. ConSEPT – the reveal: Stuart Dalziel at DFTB18, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.20055

Given that DFTB18 was held in Melbourne it was important to highlight the work of PREDICT (the Paediatric Research In Emergency Department International Collaborative)* This talk, by Stuart Dalziel, centred around ConSEPT and the management of convulsive status epilepticus.

Fluid assessment in sepsis: Elliot Long at DFTB18

Cite this article as:
Team DFTB. Fluid assessment in sepsis: Elliot Long at DFTB18, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.19912

Given that DFTB18 was held in Melbourne it was important to highlight the work of PREDICT (the Paediatric Research In Emergency Department International Collaborative)* This talk, by Elliot Long, centred around his work on the role of fluids in the septic child.

The missing component of clinical practice

Cite this article as:
Damian Roland. The missing component of clinical practice, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.19685

This is an extract of the talk I gave at #DFTB19 highlighting an important research ethos – the full talk will be released via the Don’t Forget the Bubbles at a later date.

The Doctor” is a painting by Luke Fildes and was first exhibited in 1891.

The Doctor exhibited 1891 Sir Luke Fildes 1843-1927 Presented by Sir Henry Tate 1894 https://www.tate.org.uk/art/work/N01522

The artist had lost his son Philip at the age of one and the scenes reflects the admiration that he had had for the doctor who had looked out for him. 

For some the painting may represent a stereotypical view of medicine in the past – the doctor rubbing his chin in a wise fashion, the child prostrate on a make-shift bed. And there is a parent figure in the background, watching on anxiously. 

This painting has had a revival recently despite being over 100 years old. It highlights the triad of care we all know exists in paediatrics – the child, the parents and carers, and ourselves.

This triad has received increased attention recently. The need for child centered care in respect of their engagement and involvement in their care. The need for positive communication with families; we remember the cases where parents haven’t acted as their child’s advocates but forget the vast majority of cases when they have. We so often let parents down when we should have been, not just listening to them, but honestly hearing what they were saying. And most recently the doctors themselves. An understanding of the importance of wellbeing and the shackles of rudeness. 

There is a fourth component, as well. One which perhaps will never get the attention it deserves because it isn’t a visceral part of our clinical care. It’s something we know exists but are quite willing to ignore. It’s something that perhaps has more impact on our practice than we would like to admit. It’s the variability in the actual care or treatment we provide or the fact that it might not be necessary at all.

When I became chair of PERUKI, Paediatric Emergency Research United Kingdom and Ireland, the international sibling of PREDICT and daughter of PERN I’d a personal vision that I would drive the organization forward in delivering ground-breaking new research highlighting novel interventions that would really make a difference to patients. What actually occurred is that I have realised that perhaps PERUKI has an even more important roll. One that does obviously include the need to develop, innovate and implement but one also that highlights where we could, and should do, better. It’s some examples of variation and the need for no treatment I would like to share. 

So this is an original selection of PERUKI members and those who helped us get PERUKI off the ground. I’d like a chance to pay particular tribute to Mark Lyttle at this point who has worked tirelessly at the outset to drive forward many early projects and is consistently named checked by our research partners for his ceaseless enthusiasm at collaborating and engaging. PERUKI took part in a prioritisation process published in 2015 with members putting forward their preferred research agendas and PERUKI publishing the top 20 via a Delphi process.

Number 4 on this list was: what is the best IV medication for Acute Asthma. PERUKI started on this work with essentially a two phase examination of the management of wheeze in March 2013. In the first phase a written questionnaire was undertaken. PERUKI sites responded as departments and 183 consultants responded individually on their wheeze management.

In study 99 (54.1%) use salbutamol as first-line intravenous therapy, 52(28.4%) magnesium sulfate and 27 (14.8%) aminophylline; 87 (47.5%) give these sequentially depending on response and 30 (16.4%) give them concurrently. Overall, 146 (79.8%) continue inhaled bronchodilators while on intravenous therapy.

When commencing on intravenous bronchodilators there were 10 different infusion rates with over 10-fold variation between the lowest and highest.

Everyone tends to have their little foibles about which treatment they prefer. And given the range of phenotypes and genotypes that exist in our wheezy cohort in can’t be the case that there is only going to be one best fit treatment for all patients. But a 10-fold difference probably pushes the bounds of flexibility.

What makes this more interesting is the second study. Also completed at the time (March 2013) was a prospective observational study. Data was screened from all patients presenting with wheeze and a detailed proforma completed for those who received intravenous therapies.Of 3238 children, 101 received intravenous therapies. Intravenous magnesium sulfate (MgSO4) was used in 67 (60.9%), salbutamol in 61 (55.5%) and aminophylline in 52 (47.3%) of cases. 

In 35 cases (31.8%), two drugs were used together, and in 18 cases (16.4%), all three drugs were administered.

More than half used salbutamol as the first-line intravenous agent, while fewer preferred magnesium sulfate or aminophylline, suggesting equipoise regarding which is most efficacious. To investigate this, participants were asked whether they would enrol patients to a randomised controlled trial allocating salbutamol, aminophylline or magnesium sulfate as the first-line intravenous agent, to which 148 (80.9%) responded positively. Asking clinicians who are regularly prescribing acute medications is vital for study design and subsequent implementation of study findings. With all due respect to respiratory paediatricians the question that they may be interested in, or want to explore, may well be completely out of keeping with the practice habits of emergency and acute paediatricians. PERUKI have welcomed increased engagement with our specialty colleagues in the last year and we hope we will reap the benefits of this. 

So a clear example of variation. I feel uncomfortable. Is there any reason to believe this variation has improved 6 years on? We have a challenge as the evidence base is not as strong as we would like. We look to Simon Craig and his work on developing asthma outcomes here – a PERN study I am very proud that PERUKI is part of. 

So what about where we think there is only a small amount of variation (a nationally agreed algorithm for example). DO we need to improve practice and CAN we improve practice? The EcLIPSE study was published a mere month ago and I am proud of the Don’t Forget the Bubbles team  for being part of the process of sharing this information widely. The Eclipse study compared levetiracetam and phenytoin in the treatment of status epilepticus. It was published on exactly the same day as the ConSEPT trial a similar study from our PREDICT friends. The EcLIPSE paper is available open access and there is a Don’t Forget the Bubbles summary. I also recommend the reviews by Justin Morgenstein and Casey Parker 

The primary outcome was time from randomisation to cessation of all visible signs of convulsive activity, defined as cessation of all continuous rhythmic clonic activity, as judged by the treating clinician.

Much debate has centred on what EcLIPSE and ConSEPT showed and at the heart of this is the difference between superiority and non-inferiority.

If these studies do nothing else it will to be to have spread the word about this construct. Because it is really important that people don’t glaze over or think because this terminology is used it’s someones else’s problem to analyse. I think this undue deference to academics probably perpetuates variation in care. I am not saying the theory is easy but neither is managing a sick neonate with congenital heart disease and we completely commit ourselves to doing that. 

Superiority trials aim to demonstrate that one intervention is better than other. The statistics, by convention, dictate that a difference between the interventions needs to be defined. In the case of EcLIPSE because phenytoin stopped status 60% of time and it was felt Levetiracetam may terminate seizures at a 75% rate the statistics calculated that 140 patients would be needed in each group. IF a difference exists this difference is likely to be a difference that is real and not by chance alone.

If they had wanted to show that levetiracetam was only 1% better then 1000s of patients would probably have been needed as if there was no difference by chance it would easily be possible that levetiracetam happened to be 1% better in that cohort of patients. 

A few interesting facts come out of EcLIPSE.

The first is that the while this wasn’t a perfect observational study – i.e not all patients presenting were recruited across a wide range of hospitals over 1400 patients were screened. This is a good cohort of children with seizures. About 10% of those who needed second line treatment for status were first presentations of afebrile convulsions and 5% were as a result of CNS infection.

Median time from randomisation to start of infusion was 11 min (IQR 8–15) for levetiracetam and 12 min (8–17) for phenytoin

But median time from randomisation to seizure cessation was 35 min (IQR 20 to not assessable) in the levetiracetam group and 45 min (IQR 24 to not assessable) in the phenytoin group.

These interventions take time! 

In EcLIPSE convulsive status epilepticus was terminated by levetiracetam in 106 (70%) participants, and by phenytoin in 86 (64%) participants. Therefore by the statistics LEVETIRACETAM is NOT better

Because the results are broadly the same it doesn’t mean they are equal – a non-inferiority study looks at two drugs and aims to calculate what is the minimum number of patients needed to be recruited into each intervention arm to demonstrate that one drug is not more than a certain % worse than another. By convention that number is normally 10%. The reason why 10% is important is that in EcLIPSE while it appears levetiracetam may have passed this test if the study had been designed as a non-inferiority in the ConSEPT study levetiracetam only terminated seizures (albeit as different end point) 50% of time; 10% worse than phenytoin. We don’t know yet what the meta-analysis may show us but this is planned.

A further suggestion is should we consider adding in levetiracetam with phenytoin; we could but that might delay some RSI intervention even further without overall benefit in seizure termination further. This is messy area where the complexity of clinical practice hints the required precision of research head on.

It might well be that you are happy for others to research novel drugs and techniques. You may well be content in supporting research through signposting or perhaps recruiting patients yourself. I would ask though that research itself is not scary. There is false divide between the ivory tower academic and jobbing clinician. Both these terms probably tribal and derogatory in their own way. We should all care about how effective our treatments are and where variability in practice is not in the patient’s interest. It is no more or less important than the three figures in Luke Fildes picture but perhaps it is less visible. 

Through PERUKI I’d like to champion this cause to make research feel more accessible. We are not doing research because we like to, we are doing it because we have to. 

Mirror Mirror

Cite this article as:
Andrew Tagg. Mirror Mirror, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.19303

This blog post complements the talk I gave in the closing session of DFTB19. It has been recorded and will be released as FOAMed later in the year.

As part of my ongoing professional development I decided to volunteer for an experiment the Australasian College for Emergency Medicine were running. As a consultant it is really hard to get feedback on how you are doing, both clinically and professionally. You could ask your colleagues face-to-face but how honest an answer are you really going to get? So I enrolled in a pilot multi-source feedback program. Unlike traditional peer feedback and yearly assessments where you receive one-on-one feedback from the head of department, this was was something different.

I had to nominate 15 colleagues to complete an online survey about my professional behaviours. Anonymized to makes sure that things would not be seen as personal. I chose colleagues from all levels of my work life – from interns, registrars, peers, my immediate bosses and the Chief Medical Officer of the hospital. I chose doctors from specialities that I refer to on a regular basis and I chose non-clinical staff too. And in order to increase the actual worth of the project I included some people that I feel that I don’t get on with as well as I could (yes, they do exist!).

The findings were…interesting. There were the usual comments about drinking less coffee and learning to say no, both of which I fail at miserably on a regular basis. And then there was this one.

Now clearly this says more about the author than it does about me, but it did get me thinking about the impact we have in the workplace.

Emotional contagion

Human beings are social animals. We thrive in groups and, despite having had language for approximately 100,000 years, we rely on non-verbal communications to let members of our tribe know how we are feeling.

Charles Darwin, in his three-quel to The Origin of the Species, wrote that, despite their fleeting nature, our emotions are written large on our faces and this process is far beyond our control. But what is more fascinating is what happens when someone witnesses that unbidden display of emotions. Watch someone smile, genuinely smile, a mirror neurons light up in your brain. In a series of fMRI studies Rizzolatti et al. showed that the same are of the brain fires up when you witness an emotional display as if you had experienced it yourself. This reflexive, sub-thalamic response is emotional contagion.

Whilst our emotions influence our physiological state the reverse is also true. If I smile (more on that later) I feel happier. If I frown I feel more sad. And if I cannot frown – perhaps I have succumbed and finally got some botox to rid me of these troublesome wrinkles – then I will actually feel happier. Well, that is what some scientists have found.

Negative states

The problem is that negative states – fear, anger, boredom – are much more readily transmitted than positive ones – kindness, compassion, calm. Perhaps because they often come unbidden and out-of-control they are more likely to leak out before they can be contained.

This can cause major problems in the workplace as a doctor infects all those around them.

The work we do has a high level of emotional labour, moving from high intensity states such as dealing with life-affecting resuscitations to low intensity states of chronic constipation, without pause.

Some people are more susceptible to emotional contagion than others. Take a look at Docherty’s 15 part emotional contagion susceptibility scale and see where you might fall.

Doherty, R. W. (1997). The Emotional contagion scale: A measure of individual differences. Journal of Nonverbal Behavior, 21, pp. 131-154

And if you are the sort of person that finds themselves crying at the movies then you are not alone. I’ve left a little something for you on our YouTube channel for the next time you want to cut loose.

There are some highly infectious people that we can find in any department.

We’ve all met the MAVERICK – the hot shot doctor that thinks they know everything. They don’t need to follow the guidelines because they know better. They can send home the febrile 28 day old because they look fine to them. They can make the half-baked referrals because it’s the end of their shift and they have to get to their beach volleyball game. Besides the team will sort it out.

They make us fearful, nervous, a little afraid. Their arrogance spreads as they achieve more success, until…. They make a mistake. And they will.

So how can we help them? How can we protect ourselves and the department from their contagion? They need to be reminded, gently, that even Tom Cruise wears a safety harness. Guidelines are there for a reason. It’s okay not to agree with them but you have to be able to defend your actions. If you want to go your own way you need the evidence to back you up. Rather than ignore the MAVERICK and allow the worry to fester it’s important to head them off (whilst allowing them to save face). You set the tone!

What about the MOANER? You only have to go into the staff room of an y department in the hospital to spot one of these creatures. They are the ones drawing everyone into their spiral of doom as they complain about so-and-so from X (insert particular out-group here). Before long the rest of the group has been infected but their particular brand of emotional catharsis and everyone begins to moan.

It’s easier to not become one of them than it is to change their mind. This is the time for herd immunity. The more positive people there are in the room the better. Rather than joining in it is time to point out the dangers of stereotypes and labels. And should the opportunity to moan about your lot at work arise then it is time to take the higher ground. Remember, you set the tone!

And finally there is the MAGNET. Years of bad experience has led to a degree of learned helplessness. The more times they have been crushed by the chaos of the system the more they feel it is pointless to do something about it. At the mention of the Q word – the-word-that-should-not-be-named – they predict an apocalypse worse than any Private Frazer could dream up. Equipment will fail, stock will be missing or fall apart and there will be nobody around to help at the critical juncture – all because you said the word q.u.i.e.t.(shhhhh!)

So what can you do? It is time to role model the desired behaviour. You cannot control what is happening outside of your department but you can claw back a little control from the chaos within. At the beginning of every shift I check the key equipment that I might need to make sure it is working, I make sure that nothing is missing and I make sure roles have been allocated before the inevitable happens. I set the tone!

Manipulation?

All of this behaviour, including the examples I give in my talk, could be seen as manipulative, perhaps even a little sly? Teams that have a happier outlook, with members that embrace positive emotional contagion are safer and more efficient. Whereas when experimental psychologists have planted a MOANER as a confederate they found that teams became much less efficient.

Which sort of team would you rather work in?

Selected References

Doherty, R. W. (1997). The Emotional contagion scale: A measure of individual differences. Journal of Nonverbal Behavior, 21, pp. 131-154.

Vicarious Trauma : It’s ok to not be ok

Cite this article as:
Jasmine Antoine. Vicarious Trauma : It’s ok to not be ok, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.19256

One afternoon my team broke the news to three different families that their children had a non survivable condition. That same week I was involved with a patient transitioning to a palliative pathway focused on comfort. I returned home to utter the words, “She is so sweet, I hope she dies soon.

For many of us, days like these, occur commonly.

Being a doctor is a privilege, an honour, a calling. Our jobs are stressful, diagnostically challenging, involve managing team members, and effectively communicating and engaging with different families whom have different needs. We are reliant on our knowledge and skills. What sets our job apart from other high stress environments is that any given day can involve death and dying. We see distressing conditions. Our day includes the uncommon, the unlucky and the unfortunate events of life. To the public these events occur few and far between, but for us it may be a daily occurrence -a relentless barrage of traumatic events, poor outcomes and sad stories.

The intensive care environment is difficult to navigate. The rates of burnout, mental health issues and self medication are high amongst our peers. 70% of junior doctors feel burnt out following a neonatal rotation. Strikingly, their (our) rates of suicide are twice that of the general population. Most of us have heard the words compassion fatigue. Some of us may even be familiar with vicarious trauma – the negative experience of working directly with traumatised populations. Compassion fatigue and vicarious trauma are on a spectrum. We initially may feel overwhelmed by our interaction but this can develop into symptoms of post traumatic stress.

At DFTB18, I spoke about some of the things we can do to reduce this happening to us, and the events above reinforced that message;

  • Seek the support of those around you.
  • Reflect with your supervisor.
  • Get together with your team to debrief.
  • Seek professional psychological support.
  • Foster a culture in your workplace that is supportive and open, whilst also taking time for yourself.
  • Make a regular appointment to see you GP.

And remember, it’s ok not to be ok

For more on this topic of the difficulties of dealing with death and burn out hit up DFTB at:

Burning out by Mark Garcia

A short story about death by Andy Tagg

Selected References

Boss RD, Geller G, Donohue PK. Conflicts in Learning to Care for Critically Ill Newborns: “It makes me question my own morals”, Bioethical Inquiry. 2015;12:437-448

Hauser N, Natalucci G, Ulrich H, Sabine K, Fauchere JC. Work related burden on physicians and nurses working in neonatal intensive care units: a survey, Journal of Neonatology and Clinical Pediatrics. 2015;2:2:0013.

Nimmo A, Huggard, P. A systematic review of the measurement of compassion fatigue, vicarious trauma and secondary traumatic stress in physicians. Australian Journal of Disaster and Trauma Studies. 2013;1:37-44.

Stress, burnout and vicarious trauma: looking after yourself. RACGP Webinar Series.

Weight estimation guidelines – Part 1

Cite this article as:
Mieke Foster. Weight estimation guidelines – Part 1, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.18165

When a child is picked up by paramedics or brought into an emergency department, their weight is not always known and cannot always be formally measured. Many research teams across the globe are trying to find the best method to estimate a child’s weight, so medication can be dosed and equipment sized appropriately. Traditionally, age-based formulae have been used, but these are known to be very inaccurate. More reliable methods are available, however all require input of more information than just age, whether that be height, mid-arm circumference, a parent estimate or a smartphone image. You can find a summary of weight estimation techniques in this post from Andy Tagg. The question is, what method is sufficiently accurate and will work best in practice?

At the moment, Australian guidelines still use age-based formulae (namely the original APLS formula, weight = 2 x (age+4)). Even though they are very inaccurate, they have a number of advantages:

  • They are very quick. Most prescribers use these formulae in conjunction with resuscitation aids, emergency manuals or clinical practice guidelines which mean they do not need to remember the formula or do the calculation themselves as they are given a table with corresponding weight to age.

  • Given age-to-weight conversions are often provided, staff do not need to be trained on how to gather the estimate.
  • They do not require any additional equipment, which may be hard to find if an ambulance or emergency department rarely sees paediatric critical cases.
  • An emergency department can predict the weight of the child that is about to arrive by ambulance if they have the child’s age, and can therefore start drawing up medications in advance.
  • Stress and cognitive load have been shown to be the key precipitating factors of human error in paediatric critical events. Human errors in these scenarios include significant medication errors, such as ten-fold errors (where 10x the medication is prescribed or administered because the decimal point is moved or the concentration incorrectly calculated). These have been shown to cause significant patient morbidity and mortality. Efforts to gather the further information needed to make the weight estimate more accurate (e.g. measuring the child, taking a sufficient quality image, finding a parent) increase the complexity of the weight estimation phase. Increased complexity is likely to increase cognitive load, and thus increase the risk of human error at all phases in the dosing process.

    We need to find a weight estimation tool that can be used by anyone who might need to manage a paediatric critical event. This includes paramedics, junior medical staff and adult emergency department personnel that may need to manage patients before they reach a tertiary children’s hospital or paediatric emergency department. This means we need clear, easy-to-follow guidelines and associated training that can be rolled out broadly. It also emphasises the need to ensure we keep the cognitive burden as low as possible, as many prescribers will be in an unfamiliar, stressful situation, both of which further precipitate human error. Future protocols may also differ based on the paediatric emergency expertise and training available in that setting, for example, a paediatric emergency department may choose a more accurate method with higher cognitive load than an ambulance service.

    Another important consideration is the time delay involved in each weight estimation strategy. Most events requiring weight estimation are time-critical in nature. It is important to not only consider the time involved in getting the estimate, but also the time needed to find the appropriate equipment, make subsequent dose calculations and prepare the dose for administration. This highlights the significant advantage of emergency departments being able to draw up medications prior to the child’s arrival, as having doses pre-calculated and pre-prepared would significantly reduce the time delay in drug administration.

    Given rising rates of childhood obesity, we need to find a weight estimation strategy that will work for all body types and medication types. Some drugs should be dosed based on ideal body weight (IBW) whilst others should be dosed based on total body weight (TBW), depending on their pharmacokinetic properties. Similarly, dosing medication by TBW in obese children can lead to overdose. Sydney Children’s Hospital has given a nice overview to some of the adjustments which should be made for specific medications. However, adjusting weights for specific medications in a paediatric emergency may further add to the cognitive load.

    Overall, the pros and cons of each group of techniques can be summarised in a table:

    So, how important is it that we have an accurate weight estimate? And how important are other considerations such as reducing cognitive load and practicality (eg. speed, equipment and staff training requirements)?

    Unfortunately, there is very limited data on patient outcomes available to help guide us. The small number of studies into the impact of weight errors look at incorrectly documented weights, such as where the wrong weight unit was recorded (pounds instead of kilograms) or where a decimal point was moved (6). No study has looked specifically at the harms caused by weight estimation error in paediatric emergencies. There is no suggestion that using the original APLS formula in Australia is currently causing harm to patients, but there is also no evidence that proves that it is not. Reducing error should always be the goal, however increasing the complexity of generating a weight estimate could increase the cognitive load, and thus increase the risk of more significant errors. When deciding on which weight estimation technique to use, we need to find a middle ground between accuracy and practicality with an emphasis on reducing overall cognitive load.

    Selected References

    Wells M, Goldstein LN, Bentley A. The accuracy of emergency weight estimation systems in children – a systematic review and meta-analysis. Int J Emerg Med. 2017;1:1. Available from: https://intjem.biomedcentral.com/articles/10.1186/s12245-017-0156-5

    Sutherland A, Ashcroft DM, Phipps DL. Exploring the human factors of prescribing errors in paediatric intensive care units. Arch Dis Child. 2019;0:1-8. Available from: https://adc.bmj.com/content/104/6/588.long

    Khoo TB, Tan JW, Ng HP, Choo CM, bt Abdul Shukor INC, Teh SH. Paediatric in-patient prescribing errors in Malaysia: a cross-sectional multicentre study. Int J Clin Pharm. 2017;39(3):551-9.

    Doherty C, McDonnell C. Tenfold medication errors: 5 years’ experience at a university-affiliated pediatric hospital. Pediatrics. 2012;129(5):916-24. Available from: https://pediatrics.aappublications.org/content/129/5/916.long

    Foster M, Tagg A, Klim S, Kelly AM. Accuracy of parental estimate of child’s weight in a paediatric emergency department. Emerg Med Australas. 2019; in press.

    Shaw KN, Lillis KA, Ruddy RM, Mahajan PV, Lichenstein R, Olsen CS, et al. Reported medication events in a paediatric emergency research network: sharing to improve patient safety. Emerg Med J. 2013;30(10):815-9. Available from: https://emj.bmj.com/content/30/10/815.long

    Catch 22

    Cite this article as:
    Ana Waddington. Catch 22, Don't Forget the Bubbles, 2019. Available at:
    https://doi.org/10.31440/DFTB.19122

    James was 13 the first time I treated him in A&E. He was rushed in after being hit on the head with a metal bar, but he wouldn’t tell us what had happened. Some others had seen him, rushed him, started beating him with bats and bars – that was all he said he remembered. It was clear that James was already deeply involved in the world of gang violence, and it was equally clear that if he wasn’t saved from it soon this world would destroy him. We tried to get James to stay in A&E long enough to hear the results of his scan, but as soon as he got a chance he slipped out and back onto the streets. My fear was that before long the streets would deliver him back to us, only this time he wouldn’t be able to walk out again.

    The Collapsed Cardiac Child: Kath Browning Carmo at DFTB18

    Cite this article as:
    Team DFTB. The Collapsed Cardiac Child: Kath Browning Carmo at DFTB18, Don't Forget the Bubbles, 2019. Available at:
    https://doi.org/10.31440/DFTB.18978

    There is nothing like the thought of dealing with a shocked neonate to strike the fear of the almighty into the most experienced doctor. If you are lucky enough to have Kath Browning Carmo on speed dial then you may be a little more relaxed but if you don’t here she is to offer some words of comfort.

    (Kath has chosen Moonlight Sonata as her ringtone so she gets woken gently rather than in a fluster – what a great idea: Ed)

    Here’s a sketch note from the talk by @char_durand

    If you want to get a better idea of some of the congenital abnormalities that can occur then take a look at these animations from Cincinatti Children’s.

    This talk was recorded live at DFTB18 in Melbourne, Australia. With the theme of ‘Science and Story‘ we pushed our speakers to step out of their comfort zones and consider why we do what we do. Caring for children is not just about acquiring the scientific knowhow but also about taking a look beyond a diagnosis or clinical conundrum at the patient and their families.

    DFTB19 has already sold out but there are still spots for some of the pre-conference workshops.

    If you want our podcasts delivered straight to your listening device then subscribe to our iTunes feed or check out the RSS feed. If you are more a fan of the visual medium then subscribe to our YouTube channel. Please embrace the spirit of FOAMed and spread the word.

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    Selected References

    Evans NJ, Archer LN. Postnatal circulatory adaptation in healthy term and preterm neonates. Archives of disease in childhood. 1990 Jan 1;65(1 Spec No):24-6.

    Legal and Ethical Quandaries: Ian Summers at DFTB18

    Cite this article as:
    Team DFTB. Legal and Ethical Quandaries: Ian Summers at DFTB18, Don't Forget the Bubbles, 2019. Available at:
    https://doi.org/10.31440/DFTB.18919

    When most of us think of ethics and law our eyes roll and we picture Rumpole of the Bailey and quiet Sunday afternoons in front of the television. But his time Ian Summers came up with something unique. Pushing the boundaries of simulation as an educational medium he introduced us to a series of hypotheticals. Take your time to watch rather than just listen to your iDevice. You’ll learn about ethical practice in paediatrics but if you pause, take a step back, and press play again, you’ll see a masterclass of simulation in action.

     

     

     

    This talk was recorded live at DFTB18 in Melbourne, Australia. With the theme of ‘Science and Story‘ we pushed our speakers to step out of their comfort zones and consider why we do what we do. Caring for children is not just about acquiring the scientific knowhow but also about taking a look beyond a diagnosis or clinical conundrum at the patient and their families.

     

    If you want our podcasts delivered straight to your listening device then subscribe to our iTunes feed or check out the RSS feed. If you are more a fan of the visual medium then subscribe to our YouTube channel. Please embrace the spirit of FOAMed and spread the word.

     

    iTunes Button

     

    The Paediatric Assessment Triangle

    Cite this article as:
    Andrew Tagg. The Paediatric Assessment Triangle, Don't Forget the Bubbles, 2019. Available at:
    https://doi.org/10.31440/DFTB.18616

    This post accompanies the talk I was asked to give to a fantastic group of Ambulance Victoria paramedics. I was given the title “Everything you NEED to know about paediatrics”  but given that I don’t know everything I need to know yet I thought I would drill down and focus on doing one thing well.

    pHirst Aid – Management of Chemical Attacks in Children

    Cite this article as:
    Anna Dobbie. pHirst Aid – Management of Chemical Attacks in Children, Don't Forget the Bubbles, 2019. Available at:
    https://doi.org/10.31440/DFTB.18552

    Chemical attacks (or acid attacks as they are colloquially known) are increasing. The latest numbers show the UK has one of the highest rates of violent acid attacks per capita in the world. The latest figures released report 601 attacks in the UK in 2016 but 400 in first 6 months of 2017. London has emerged as a hot-spot for acid attacks in recent years and it is thought that many attacks still go unreported.

    ConSEPT and EcLiPSE – Levetiracetam versus Phenytoin for Status Epilepticus

    Cite this article as:
    Roland D, Davis T. ConSEPT and EcLiPSE – Levetiracetam versus Phenytoin for Status Epilepticus, Don't Forget the Bubbles, 2019. Available at:
    https://doi.org/10.31440/DFTB.18696

    This week sees the publication of two hugely anticipated randomised controlled trials both published in the Lancet simultaneously which DFTB have been given exclusive access to.