PAC Conference 2015 – Morris on the difficult adolescent patient

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We have teamed up with APLS to share the videos from their Paediatric Acute Care Conferences. These videos have never been open access before, so if you weren’t able to attend the conferences, then now’s your chance to catch up.

The PAC Conference is run each year by APLS and consists of presentations on a range of topics relevant to paediatric acute and critical care.

Joanne is a General Paediatrician at Wollongong Hospital with an interest in adolescent medicine and weight management. She also works as a VMO with the Adolescent Medicine Unit at the Children’s Hospital Westmead. In this fabulous talk, Joanne addresses an important topic that we aren’t always great at – managing the difficult adolescent patient.

Key points:
The agitated adolescent

  • Think about the location and environment for seeing an agitated adolescent, and try to speak calmly to them on their level
  • Think about drugs for sedation but aim for oral if possible
  • Ensure adequate monitoring if parenteral sedation is used
  • Use physical restraint safely if necessary

The adolescent with medically unexplained symptoms

  • Can present with a broad range of symptoms
  • Patients can have a long history of seemingly alarming symptoms but look very healthy
  • Think carefully about the words you use when speaking to parents and adolescents – do not dismiss then or suggest they are faking it
  • Try to find the time to take a good psychosocial history
  • Encourage a good routine, sleep hygiene, and a graded return to normal activities
  • Give patients a face-saver so there is a way out of their current symptoms
  • Find the balance between doing enough tests but not too many

Adolescents with medically unstable anorexia nervosa

  • HR<40, T<35.5, SBP<80 or DBP<40
  • The management is food – will probably need a nasogastric tube – continuous Ensure at 100ml/hr
  • Monitor their electrolytes, and give regular phosphate
  • Need to be on strict bedrest

About the authors

  • Tessa Davis is a Consultant in Paediatric Emergency Medicine at the Royal London Hospital and a Senior Lecturer at Queen Mary University of London.

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