Archives of disease in childhood. Education and practice edition
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Arch Dis Child Educ Pract Ed · Jun 2021
Fifteen-minute consultation: Point of care ultrasound in the management of paediatric shock.
The use of point of care ultrasound (POCUS) in the assessment of the acutely shocked adult patient has been well established for over a decade. Comparatively, its use in paediatrics has been limited, but this is starting to change with the recent introduction of Children's Acute Ultrasound training. This article highlights the pathophysiology of shock in children and demonstrates how bedside ultrasound can be used to assist decision making in the clinical assessment of the neonate, infant or older child presenting with undifferentiated shock. We discuss a structured protocol to use when performing the POCUS examination and explain how this could lead to a more rapid correlation of the ultrasound findings with the underlying cause of shock.
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Arch Dis Child Educ Pract Ed · Mar 2021
Addressing recruitment and retention in paediatrics: a pipeline to a brighter future.
In the UK, the number of junior doctors completing foundation programme, and the number of trainees applying to paediatrics has been in decline in recent years. The NHS is at 'breaking point', exacerbated by workforce shortages, chronic underfunding, increasing service demand and poor job satisfaction within healthcare workers. Issues in recruitment and retention of paediatricians 'threaten the safety of our children's health', according to the Royal College of Paediatrics and Child Health. ⋯ While some issues share similarities with other specialties in difficulty, much of the context and potential remedies within paediatrics are distinct. A strategic, multi-agency collaborative approach is required urgently to address the significant issues that face both paediatrics and the healthcare system.
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Two previously well Caucasian teenage girls with no significant travel or family history were admitted with sinusitis refractory to treatment with antibiotics. Both had progressive symptoms despite broad-spectrum antibiotics and developed involvement of other systems, ultimately requiring admission to the paediatric intensive care unit (PICU). They were subsequently diagnosed with the same condition and made an excellent recovery. ⋯ Immunodeficiency. What investigations should be performed in a child presenting with symptoms of sinusitis?edpract;archdischild-2020-319887v1/F1F1F1Figure 1The chest X-ray for case 1, 1 week into her hospital admission.edpract;archdischild-2020-319887v1/F2F2F2Figure 2The chest CT for case 2 at her local hospital, prior to transfer. Answers can be found on page XX.
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Arch Dis Child Educ Pract Ed · Feb 2020
ReviewFifteen-minute consultation: Prevention and treatment of chickenpox in newborns.
There are inconsistencies in how newborns are managed following exposure to varicella, ranging from reassurance and observation to administration of varicella zoster immunoglobulin (VZIG) and admission to hospital for varying length courses of intravenous aciclovir. Hospitalised preterm babies exposed to varicella should receive VZIG. ⋯ The use of VZIG may not prevent varicella but may reduce severity of disease. In this article, we review the evidence for risk to non-immune mothers, the fetus and newborns who had different types of exposure to varicella, with recommendations for management and treatment of confirmed neonatal chickenpox.
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Arch Dis Child Educ Pract Ed · Apr 2019
Fifteen-minute consultation: Childhood burns: inflicted, neglect or accidental.
Burns are a relatively common injury in children accounting for over 50 000 emergency department attendances each year. An estimated 1 in 10 of these are due to maltreatment. These may present in the form of physical abuse or neglect with a reported ratio of 1:9. ⋯ In this review, key variables that may aid in differentiating maltreatment from accidental burns are discussed in a case-based format, utilising up-to-date evidence to support the recommendations. Despite a proportion of burns resulting from physical abuse, the rate of child protection investigations in these patients are significantly lower than for children who present with other forms of physical injuries despite a similar proportion of positive findings. Our objective is to review the available evidence to support the safe assessment and management of children presenting with scalds or contact burns.