One of the challenges of paediatrics is how to distil a life of experience down to something more tangible. When you are asked “How did you know s/he was sick?” you need to be able to give a better answer than “I just know”. In this session from DFTB19Â we challenged three clinicians to explain just why they think the way they do.
In this final session that was designed to challenge up and coming paediatricians to be a little better Dr Alan Grayson brought up the boogie-monster in the paediatric emergency department – sepsis.
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The Complexity of Paediatric Cases
Children are complex, with children presenting a myriad of symptoms that can range from a simple viral infection to a serious bacterial infection. The challenge lies in distinguishing between the two, given the overlap in symptomatology.
The Three Worst Words in Clinical Practice
For paediatricians, the three worst words in clinical practice are “Remember that child.” This phrase often precedes a discussion about a misdiagnosed case, a situation every paediatrician is likely to encounter at some point. It serves as a reminder of the difficulties in emergency care.
Overcoming Diagnostic Challenges
Building a Strong Index of Suspicion
Dr. Grayson emphasizes the importance of building a strong index of suspicion, especially when dealing with sick children. He encourages paediatricians to rely on their clinical skills and use a systematic approach in assessing each child, considering factors such as history, clinical examination, and the patient’s overall presentation.
The Impact of Guidelines and Targets
Four hour targets, while well-intentioned, can create pressure and affect the diagnostic process, leading to potential pitfalls in identifying sepsis in a timely manner.
The Role of Nurses and Communication
Importance of Nurse-Physician Collaboration
Nurses play a crucial role in paediatric emergency care. To bridge communication gaps, nurses should assertively communicate their concerns to physicians, ensuring that physicians understand the urgency of the situation. Creating a culture of mutual respect and flattening the hierarchy can contribute to a more effective and patient-centered approach.
Investigations and Evidence-Based Medicine
Challenges with Blood Tests
We over-rely on blood tests. Consider the routine use of tests like CRP (C-reactive protein) and emphasizes the importance of understanding the limitations of these tests in diagnosing serious bacterial infections.
The Role of Evidence-Based Medicine
Highlighting the need for evidence-based medicine in paediatric sepsis, Dr. Grayson references the Sprout study, a point prevalence study in pediatric intensive care units. The study reveals valuable insights into the prevalence and nature of pediatric sepsis, emphasizing the importance of ongoing research in this field.he importance of a compassionate and collaborative approach in caring for sick children.
This talk was recorded live at DFTB19 in London, England. With the theme of “The Journey” we wanted to consider the journeys our patients and their families go on, both metaphorical and literal. DFTB20 will be held in Brisbane, Australia.
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