Performing the newborn check

Cite this article as:
Taryn Miller. Performing the newborn check, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.25986

There are two situations in which you would examine a newborn:

  • As part of the newborn screening examination as a “baby check”
  • In the emergency department

Both situations are slightly different, but the same structured approach can be applied

 

Before you begin…gather what you might need

  • Examine the baby in a warm, well-lit environment- get a blanket if needs be, or examine in the neonatal resuscitaire if available
  • Preferably with parent/ guardian present (if newborn screening exam, if not call parent)
  • Tongue depressor
  • Ophthalmoscope that works!
  • Stethoscope – In NICU/SCBU usually each baby will have their own special stethoscope. If you are using your own, make sure to give it a good wipe before and after use
  • Measuring tape for head circumference and a set of weighing scales to examine the baby without the nappy!

 

  • Keep the baby warm by wrapping them in a blanket or rocking the baby
  • Auscultate the lungs and heart in mum’s arms or when the baby is settled
  • If a newborn is unsettled or crying, consider whether the examination needs to be done at that exact moment. Perhaps suggest that the baby has a feed or a cuddle with mum or dad.

 

Before you begin

  1. Introduce yourself with “Hello, my name is…
  2. Check the name and DOB on the name band
  3. Explain to parent/guardian why it is important and what the examination will involve
  4. Gain consent
  5. Wash your hands and don gloves!

PS – don’t forget to congratulate mum, it is a really nice touch and makes the parent or guardian feel at ease.

 

 

Before the baby cries – Perform these things first!

Assessment of breathing (0:17) – Respiratory rate, look for respiratory distress – intercostal and subcostal recession, tracheal tugging, nasal flaring

Assessment of circulation (0:36) – Auscultate the heart rate (all four areas), auscultate the lungs, feel the femoral pulses on both sides

Abdomen (0:48)- Palpate the abdomen for organomegaly, specifically the liver and the spleen. And look for any hernias

 

Structured assessment – Top to toe (1:14)

Head (1:14)

General inspection – Look for facial asymmetry and dysmorphic features.
Fontanelle –Palpate the anterior and posterior fontanelles
Ears- Look for skin tags or pits
Mouth – Assess the hard and soft palate. Ideally, you should use a tongue depressor and look directly with a light. Use a gloved finger in the mouth to look at the sucking reflex

*Chest and abdomen as before*

Extremities (1:50)

Hands – count the fingers, and look at the creases, assess the grasp reflex
Feet – count the toes, and look at the grasp reflex
Genitalia – Check for hypospadias and feel both testes
Bottom – make sure the anus is patent

STOP – warn parents- what you are going to do and not “I’m going to drop your baby”!!

Reflexes (2:24)

Head lag (2:30)
Moro reflex (2:42)
Stepping reflex (2:45)
Tone and ventral suspension (2:49)

Spine (2:30) – Look at the sacrum for birthmarks, hairy patches, or for any sacral dimples 

Hips (3:04) – Perform Barlow’s and Ortolani’s test to assess for developmental dysplasia of the hip

 

And finally

Pre-and post-ductal saturations (3:12)  – right hand for pre-ductal saturations and post-ductal saturations can be either foot

Eyes – Check for the red reflex

TOP TIP! Wrap the baby in a blanket and sit them upwards, the baby should open their eyes and let you get a good look with the ophthalmoscope.

Look at the baby book and plot previous weight measurements and today’s weight on an age-specific growth chart along with the head circumference

 

This video was created by Bec Packton, Aarani Somaskanthan, Alice Munro, and Izolda Biro with special thanks to Lisa Crouch and baby James. Check out our YouTube channel for more great teaching.

Selected references

American Academy of Pediatrics. Ear Pits, Skin Tags, and Hearing Loss. AAP Grand Rounds. 2009 Jan 1;21(1):2-.DOI: 10.1542/gr.21-1-2

Assessing for a patent anus in a neonate – Turowski, C., Dingemann, J. & Gillick, J. Delayed diagnosis of imperforate anus: an unacceptable morbidity. Pediatr Surg Int 26, 1083–1086 (2010). https://doi.org/10.1007/s00383-010-2691-5

Pre and post ductal saturations – Rüegger, C., Bucher, H.U. & Mieth, R.A. Pulse oximetry in the newborn: Is the left hand pre- or post-ductal?. BMC Pediatr 10, 35 (2010). https://doi.org/10.1186/1471-2431-10-35

Plotting growth chart UK – https://www.rcpch.ac.uk/resources/uk-who-growth-charts-guidance-health-professionals & Plotting growth charts Australia https://www.rch.org.au/childgrowth/Growth_Charts/

Immunisations –  DFTB – Immunisation Quick reference

 

Bibliography and some other approaches

Queensland Maternity and Neonatal Clinical Guidelines Program – Neonatal Examination

Davies, Cartwright & Inglis, Pocket Notes on Neonatology, 2nd Ed. 2008. Elsevier: Australia

Examination Adapted from; Examination of the Newborn: A Practical Guide. Helen Baston, Heather Durward Pg 3

Bronchiolitis: Ed Oakley at DFTB19

Cite this article as:
Team DFTB. Bronchiolitis: Ed Oakley at DFTB19, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.22370

When a medical student starts their paediatric ED rotation they need to know three key illnesses and that will cover the majority of patients that they see. To round out the ABC trifecta of asthma and crapping (acute gastroenteritis) we have bronchiolitis. At #DFTB19 Ed Oakley from PREDICT gave us the latest.

 

 

 

DoodleMedicine sketch by @char_durand-done live from Australia via the DFTB19 streaming video link!

 

 

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. 

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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Foreign bodies

Cite this article as:
Becky Platt. Foreign bodies, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.25947

This post is based on a talk I gave for the London School of Paediatrics in June 2020, and will focus on foreign bodies in the nose and ear.  If you’d like to read about ingested foreign bodies, please read this, from Andrew Tagg.

 

Foreign bodies in the ear or nose

Children often present to the emergency department with something alien in their ear or nose. They’re usually in the pre-school age group and have been experimenting by sticking things in their various orifices. Most children can be found with a finger up their nose on a fairly regular basis, but sometimes other objects too. These can be among the more light-hearted of ED attendances, but only if you have some strategies to deal with them.

4-year-old George comes into your ED with his exasperated mother.  She explains that he’s been telling her he has a phone in his ear for the last 2 days. “Obviously he hasn’t”, she says, “but please would you just have a quick look so I can tell him to stop going on about it”. You have a quick look in his ear, and you see something blue in there.* How will you proceed?

 

General considerations to aid success

Preparation is key. This means preparing the child, and yourself, for the procedure.

Think of foreign body removal as a one-time offer. You’ll generally have only one good go at it, so preparation is everything. This means getting the right people involved, ideally a play specialist or someone else who’s only role is to distract and calm the child. Make sure they know what is going to happen if they are old enough to understand. If they are unable to keep still, position them appropriately on their parent’s lap or maybe wrapped in a blanket. Foreign body removal is generally not painful (or shouldn’t be) but for children who are able, nitrous oxide can be a useful aid for its anxiolytic properties in addition to distraction.

Prepare yourself. Make sure you use the right technique and equipment for the job. There are several options:

  

Kissing technique

This is a useful technique for removing FBs from the nose and works especially well for solid objects such as beads. Getting the parent on board with it and briefing them about the technique is key:

  • Sit the child sideways on the parent’s lap with one of the child’s arms tucked away under the parent’s arm
  • Brief the parent that you want them to cover the child’s mouth with their own while you occlude the unaffected nostril
  • Get the parent to deliver a short sharp breath and, hopefully, the FB will shoot out!

 

 

For parents who either can’t master the technique, or can’t face it, the same effect can be achieved with a bag-valve-mask: choose a mask that only covers the child’s mouth, and occlude the pop-off valve to increase the pressure. Ask a colleague to hold the mask and the unaffected nostril, while you squeeze the bag sharply.

 

Other useful tools and techniques

Head torch – this is a game-changer in the world of foreign body removal. It prevents you from having to try to hold a torch in your mouth while holding an ear in one hand and tool in the other.

Yankauer suction – good for removing objects with a smooth surface e.g. beads, polystyrene balls. Warn the child it’ll be noisy and let them hear it before you start so they don’t jump away.

 

 

Syringe and water – good for items that will float or disintegrate e.g. tissue, play-doh, polystyrene beads. Add a cut-down NG tube on the end to make a smaller nozzle. Fill with warm water (for comfort) and irrigate generously. 

 

 

Jobson Horne probe – useful to get behind objects in the ear canal that won’t come out with suction. In this case, it will only work if there’s a little gap and you can actually get behind it.

Wax hook – can be used to get behind foreign bodies, as above, or to hook into softer objects such as bits of tissue or peas. Make sure you don’t leave some behind with this method.

Crocodile forceps – helpful with small or softer objects or those with an uneven surface where there’s something to grab.  

 

 

TOP TIP: magnetize the shaft to make it easier to pick up metal FBs

Magnets – can be used by rubbing them down the side of the nostril to work a foreign body down and out.

TOP TIP: the magnets on name badges are often useful for this if you don’t have a store of magnets specifically for the purpose.

Cotton bud and glue – can be used to remove foreign bodies from the ear canal if they’re difficult to get behind or to grab.  Apply a drop of whatever tissue adhesive you use to the end of a cotton bud and hold it on the offending item for 30 seconds or so then pull out.  This requires a steady hand and a reasonably still child. Be aware that this method can lead to adherence of the offending item to the ear canal.

 

 

Foley catheter – pass it behind a foreign body in either the nose or ear, inflate the balloon and then pull out, bringing the piece of corn with it.

 

If at first, you don’t succeed… stop

Complications can arise from failed attempts at removal, especially those involving the ear canal. These can range from pain, bleeding, distress, and the loss of trust to rare, but severe, complications including middle ear damage, hearing loss, vertigo, facial nerve paralysis and meningitis (Dance et al., 2009). If an attempt isn’t going well, stop, re-group, and consider the options. It may be that referral or a different approach is required.

 

Or maybe, don’t even start

If there is minimal chance of success, either because the FB is deep, impacted, or ungrabbable, or the child is unable to co-operate for whatever reason, think twice before starting. It may be better to bring them back when you have play specialist support or to refer to ENT for specialist assistance.

You involve the play specialist and prepare George for removal of the foreign body in his ear.  Wearing your headtorch, you gently pull on his pinna and gently insert a pair of crocodile forceps into his ear canal and pull out… a teeny tiny toy phone!  Vindicated, George squares up to his mum: “I told you!”.

 

*This is a true story (anonymized) from a long time ago, and one of my favourite ED presentations ever!

 

Selected references

Chan, T. C., Ufberg, J., Harrigan, R. A., & Vilke, G. M. (2004). Nasal foreign body removal. Journal of Emergency Medicine, 26(4), 441–445. https://doi.org/10.1016/j.jemermed.2003.12.024

Dance, D., Riley, M., & Ludemann, J. P. (2009). Removal of ear canal foreign bodies in children: What can go wrong and when to refer. British Columbia Medical Journal, 51(1), 20–24. https://www.bcmj.org/articles/removal-ear-canal-foreign-bodies-children-what-can-go-wrong-and-when-refer

https://www.aliem.com/trick-trade-nasal-foreign-body-removal-using-foley-catheter/

Approaching the paediatric ECG

Cite this article as:
Anna McCorquodale. Approaching the paediatric ECG, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.25928

The paediatric ECG is both a friend and foe to the general paediatrician. It can contain a wealth of direct information, but for most, creates an aura of uncertainty. I became interested in ECG interpretation as a junior registrar when I, on a post take ward round, was told to ‘send it across to cardiology for interpretation’. Now, whilst I do not disagree that ECGs can be tricky, and in those circumstances, paediatric cardiologists are invaluable, at that moment I wondered, why can’t a general paediatrician make a start? After all, in the adult arena ECGs are like paracetamol, you can barely make it over the hospital threshold without having one.  I firmly believe we as paediatricians are out of practice and therefore confidence, but that can be changed.

 

Understanding the trace

Let’s start at the start, what is an ECG? The electrocardiogram has been in use since the early 1900s and captures electrical activity emitted from the heart. Movement of ions across cell membranes is fundamentally responsible for this activity and it happened in a predictable and coordinated way in a normal heart.

P wave – represents atrial depolarization. The sinoatrial node is sited in the right atrium and as this discharges, electrical activity spreads from there across towards the left atrium. The P wave is therefore made up of two waves (RA and LA depolarization) but in time these are so close together that they become one on the trace

PR interval – a short lag as the electrical activity reaches the atrioventricular node

QRS complex – ventricular depolarisation

ST segment – an isoelectric phase immediately prior to the heart resetting itself

T wave – ventricular repolarisation

For the vast majority of children, this process will be repeated 60-150 times a minute, every minute of every day.

Having a good feel for what the trace means and where these waveforms are emitted from is key to figuring out what is going on when things aren’t normal and in what area to focus your attention if there has been a problem but things have resolved at the point of contact.

 

Take a systematic approach

The heart is systematic in the way it organises activity and the ECG trace produced reflects that, so we need to be systematic in our interpretation.

Information – we always check demographics. Here there is also a scale. The standard ECG should be set at 10mm/mV on the y-axis and 25mm/sec on the x-axis. All of the standard calculations depend on this so it needs to be checked. With those standardised values, one small square becomes 0.04s and a large square 0.2s.

Rate – this can be simply calculated using 300 divided by the number of large boxes between two R waves.

Rhythm – most ECGs will be normal sinus rhythm (NSR) so it important to be able to confidently characterise that. The standard criteria are:

  1. Normal rate for age
  2. Normal P wave axis (it should be upright in lead II, III and aVF). The axis of the wave gives you information about where in the RA it is situated.
  3. Normal P wave morphology (shape). This fundamentally means that the current is moving away from the sinus node in a normal pattern and over a normal time period. If the P wave looks broad and contains a notch it takes up a greater part of the x-axis/time it suggests left atrial enlargement. If it has a peaked/spiky appearance then the voltage  is high ie right atrial enlargement
  4. Normal PR interval
  5. P wave preceding every QRS complex

Note that most of the criteria for NSR, perhaps not unusually, focus on and around the P wave. If criteria 1-4 are met but the rate is abnormal then you would have sinus….tachycardia, bradycardia or arrhythmia.

Axis – here we are looking at where the bulk of the cardiac impulse is heading. Outside of early infancy, this should be towards the muscle bulk of the left ventricle. The axis is calculated by looking at leads I and aVF (but any two perpendicular leads could be used) and looking for the net deflection. This is then plotted along lead I (either in the positive or negative direction depending on whether the deflection is up or down), added to the end of the line along lead one is a similar line representing the overall deflection of aVF. A further line is then drawn from the base of the first line to the tip of the line along aVF the angle created is the cardiac axis.

Waveforms – the shape of each wave is important and the more you see the more familiar this will become, however, for me even more important that this is the return to basics. If you know WHAT the wave represents then you have identified where the issue is…

Intervals – there are reference tables for paediatrics  so remembering them is unnecessary. PR and QRS durations are straight calculations from the trace. Simply counting the number of boxes will suffice. The QT interval needs to be corrected for rate so takes a little more work.

QTc = QT/√ (RR) The machine will give you a reading, however, I advocate manual calculation for greater accuracy based on where the T wave truly ends.

Summary – I like to think of this as a case presentation, but about the child’s investigation. Given you have systematically looked through everything it should be a short process to pull this into a summary and if there are abnormalities being discussed with cardiology you will be able to succinctly highlight these, even if the diagnosis remains elusive.

 

Why are you looking at an ECG?

There are, of course, many reasons for performing an ECG but I’d argue this boils down to just a few important ones in acute general paediatrics. Consider what you are really looking for as some changes can be subtle and the primary complaint may have resolved to leave you with only a shadow to guide you to the underlying issue.

  • Chest pain – a common reason for ECG, but finding a cardiac problem is very unlikely – around the magnitude of 1%. How suspicious you are will depend a lot on the history but things such as pericarditis, myocarditis and myopathies might be in your differential. If they are in there then look HARD! These conditions irritate the ventricular pericardium and myocardium so changes will be seen in that latter part of the ECG.

Anomalous coronaries can also create exertional cardiac chest pain and may not have any ECG findings so again the history is key, is it convincing? Yes? Is there a better alternative explanation? No? Then you need an echocardiogram, and tell the operator what you are worried about!

  • Palpitations – you may find the arrhythmia and be in resus giving exciting drugs on a cardiac monitor. It is far more likely, and less frightening, to have a child back in normal sinus rhythm but describing something that might be an arrhythmia. So what could you look for? There might be nothing, but if the rhythm was SVT you could see an accessory pathway on the ECG – a delta wave leading from PR-QRS – it’s easy to miss. Thankfully, ventricular arrhythmias are far less common in children, especially those with structurally normal hearts, but there might be evidence of arrhythmic disorders such as LQTS. These disorders put children at higher risk of ventricular arrhythmias and fittingly, any clues are therefore found in this area so be suspicious.
  • Syncope – many adolescents have syncopal episodes due to autonomic BP control issues. The reason for the ECG is to weed out those where syncope has in fact been due to a short-lived cardiac arrhythmia.

So there you have my approach to ECGs. With a comprehensive system and one eye on what you might find they don’t have to be feared but should become part of your investigation battery and a fruitful discussion with cardiology when require.

 

Bottom line

  • Understand what the different areas of the trace represent
  • Be systematic and look at each area individually
  • In combination with the history be super critical of the areas where you could find a small clue to something bigger

 

 

 

 

The power (and pain) of the EMR

Cite this article as:
Henry Goldstein. The power (and pain) of the EMR, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.22306

My earliest years as a medical student and doctor were in a paper-based system, and over the last decade, I’ve been involved with a sequential introduction towards full EMR. For the last 16 months, I’ve had almost no use for a pen in my daily work. At the same time, the dynamics of medicine – and inpatient ward rounds, in particular – have changed.  How much of this change is just ‘societal’ or ‘generational’, and how much of it is due to the changing technology we use in our work?

 

(Editor’s note: This post was written before COVID-19. We’d love to hear of its impact on your use of technology)

I asked Twitter, and received some thought-provoking concepts, in addition to some things I’ve been observing over the last several years.

The more I thought things through, the changes occurred at many levels of the system, and I’ll try to dig into some of these changes within each part of our system.

 

Physicality

WoWs (Workstations on Wheels) are large and can be quite physically awkward to maneuver into a room or bed space whilst positioning the thing suitably to enter information, view the consult, make eye-contact with both patient & the doctor leading the review and still remaining socially acceptable. And, for that training doctor – they’re often looking at the screen instead of the clinical interaction. I’ve seen and heard of trainees writing notes from behind the curtain!

One hospital I’ve worked used, albeit infrequently, tablet computers in addition to the standard WoW. This provided a point of offset for results but was unsurprisingly unhelpful when it came to imaging or any data entry. I continue to advocate for their usage.

 

The challenge of wrangling a computer into the interaction with you patient is obvious, and with some strategies the affect can be reduced. But there’s more to the screen than doctor-patient blockade; the physicality of multiple handheld inputs (ie paper chart and bedside chart) usually meant that during a ward round there was some standing, well, around. Specifically, before entering a bed space, or in discussions afterwards, we stood in circles and looked at each other and listened.

Mobile computing requires that we stand side by side. This is either in order to read the screen, or because the computer is human-high, and we can’t pragmatically form a circle around it!

I think there’s something inherently powerful in this change – we no longer engage in routine confrontation. Standing in a circle means that you’re always opposite someone. The body dynamics are oppositional.

I acknowledge that these situations could, on occasion, be used negatively, but by the same token, standing opposite another human is not, in itself, shaming or humiliating. But these circles were the perfect opportunity to acknowledge all members of the team, to teach to level, to have a discussion. Micro-confrontations as a mode of education, learning, and accountability. Instead, mobile computing changes the dynamic – we stand next to each other, make eye contact less frequently, and can nod along to the words of the most powerful person in the group.

 

Because we are conflict and confrontation avoidant, and the text is there for all to see, we have nullified the ‘need’ to present a patient. Instead, we perch on one another’s elbows and read together.

Read what?! What does each doctor consider important? How do we know? What’s the framing? This is part of clinical reasoning. When we read in silence without the brief “Yes-no” questions like “Was there a trial of salbutamo?” or “Are they immunized?”, much more is lost in the thinking, learning and engagement of the ward round.

 

Infection control and accessibility of WoWs are inherently in tension. This was played out with medical charts not entering the bed space and the need to physically either put the notes into the chart afterwards or write on the move to the next patient.

The same pattern occurs with WoWs exists; either the machine is (appropriately) left outside the room and catching up occurs afterward, or if there’s a computer that remains at the patients’ bedside, then the operator must log in, invoking the Latency issue.

I have on occasion witnessed a mobile computer being wiped down, and not just because one of us has tipped over a cup of coffee! Folks, remember your 5 moments for hand hygiene!

 

But what other aspects of physicality of having a workstation the size of a small person on the round?

Rightly or wrongly, operating the mobile computer frequently falls to the most junior member of the team. Under a diffused system with multiple devices, or the classical paper charts for vital signs, medication charts and so on, much of the pressure was relieved from the person actually writing the notes.

Instead, a single operator system means that – latency notwithstanding – the rate-limiting step to all information and all documentation is through the same person. This can become quite stressful, quite quickly, and if not considered can exacerbate the load for junior staff.

 

Proximity

Sharing information via the same screen can lead to people almost standing on top of each other. Wanting to read the screen leads means that in the clamor to see, personal space is quickly eroded. My practice is now to show new staff how to MAKE THE TEXT BIGGER, so that I can see the information from a distance without the feeling of standing too close to their shoulder, especially as a male in a senior role.

Conversely, and also as a consequence of mobile computing, we spend less time in the immediate physical presence of our nursing and other medical colleagues. Proximity is part of forging a small professional community. It’s part of being in a team and if you spend your entire day behind shelves and screens rather than openly and effectively communicating with colleagues, well, I hope that’s not what being a doctor is.

 

Latency

When tech is slow, it can feel as though the entire ward round is covered in treacle. Time begins to stand still in response to simple questions. The clinicians believe the answer is contained in the machine, yet the machine is too stuttering, slow or confused to provide the information you need. Where and how you vent this frustration? Do your patients sense it? Do you look or feel incompetent? Almost all of the above pose a threat to professionalism.

 

Notes 

Copy+ paste digital vs analog. There’s something engaging with re-copying, by hand, text. That’s why monks spent many an hour laboriously lettering pages of Latin text. Many of us have even studied this way throughout our academic careers. The essential thoughts and actions required to process and idea leave, I suppose, a beautiful residual trace in our memories. We have the chance to identify and fix errors, lest we are blamed for recreating them with our own hand. Digital copy+paste is the opposite. It is unthinking, impersonal, disengaged. It can compound & perpetuate errors.

Diagrams and patient drawings were a feature of paper charts. A surgical note here or the old favourite of lungs and abdomen sketched side by side. In paediatrics, the ease of giving a child a page of clinical notes on which to draw has evaporated.

Demonstrate your reasoning. Clinical reasoning and the context in which we make decisions is what medicine is about. Whilst both EMR and written notes can use full sentences to articulate thinking, I have memories of marginalia, small diagrams, relational arrows of all different shapes, intensities, and directions. Variable intensities or shapes encircling words for emphasis help frame or direct clinical thinking that transcends written language as we know it. I miss seeing this in the work of others.

There is a litany of nuances in note-taking that are subsumed by electronic records. But I’ve never seen illegible or dangerous lookalike terms in the EMR; they’re always surrounded by logical context, be that medication chart or notes proper.

 

Boundaries 

Finally, mobile computing is a serious threat to professional boundaries. Many of us have work-related apps and email on our own devices. Beyond this, remote access to clinical information is growing. Ironically – and as I highlighted in this post  – we’ve all worked on MET teams. We know what critically urgent looks like, and yet, we are challenged by the need to step away from our work.

Mobile computing encourages us to just log in to find out how the patient went overnight, instead of reading the back of a cereal box or whatever you do in the morning. Likewise, reviewing results late at night – or whilst out to dinner – is a boundary failure.

We need to be better at defining the way we use our tech. Whilst at ACAH19, I thought of this framework: 

Using this diagram helps us to understand why it’s okay (awesome!!) to review the program for #DFTB20 during a loo break, but definitely not okay to reply to a parents’ email about their child’s asthma whilst in the toilet cubicle.

Here’s the larger point: We need to practice small scale, low risk confrontational clinical communication so that when we need to have big discussions, our discomfort is around the clinical challenge, not the awkwardness of professional communication.

 

In summary, mobile computing has profoundly changed the way we work. Everything from satisfying our impulses to know what is happening with a patient, to how we demonstrate clinical reasoning, to how we interact with each other & patients. I’m not saying it’s all good, nor all bad. Only that we must remain mindful and develop insight into how these changes influence our practice, our thinking and our relationship to patients and families.

I’m grateful to be able to work with some sophisticated, reliable technology on a daily basis. I want that tech to be able to bring out the best in doctors and medical care.

 

What kind of mobile computing does your hospital use? How does it improve care? How does it change it?

 

Concussion: Neha Raukar at DFTB19

Cite this article as:
Team DFTB. Concussion: Neha Raukar at DFTB19, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.22181

After spending 12 years as the Director of the Division of Sports Medicine in the Department of Emergency Medicine at the Warren Alpert Medical School at Brown University, Dr. Raukar joined the Department of Emergency Medicine at the Mayo Clinic in 2018 as full-time faculty.

In this fascinating talk she explores what happens to those children we see every weekend in the emergency department. Whether it is a clash of elbow versus head on the footy oval or a punch to the face at karate practice or something as innocuous as a simple fall from the monkey bars we don’t give these head injuries the attention they deserve.

 

 

©Ian Summers

 

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. 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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