A: Optimal airway position for infants
Note how a rolled towel is placed under the baby’s shoulders to allow space for the occiput and avoid flexion of the neck and airway.
‘B’ assessment
Video links to examples of children with signs of respiratory distress:
‘D’ assessment
Example video showing a bulging fontanelle (excuse the slightly cheesy style!)
Non accidental injury
Sadly, NAI in under 2’s causes more than 10% of serious injuries to children.
Stigmata of possible NAI include:
- Bruising on the cheeks, neck, genitals, buttocks and back
- Pattern bruising from an implement including fingertip bruising
- Burns to hands, legs, feet and buttocks
- Subconjunctival haemorrhage
- Epistaxis in infants
Example of subconjunctival haemorrhage:
2017 NICE guidance: When to suspect maltreatment in under 18s.
Sepsis
Click for UK Sepsis Trust guidance for different clinical settings. Scroll down for the Screening and Action tool for under 5s for prehospital care and ambulance services.
References regarding IM benzylpenicillin that Tim mentions:
- Harnden A. Parenteral penicillin for children with meningococcal disease before hospital admission: case-control study. BMJ. 2006 Jun 3;332(7553):1295–8.
- Hahné SJM, Charlett A, Purcell B, Samuelsson S, Camaroni I, Ehrhard I, et al. Effectiveness of antibiotics given before admission in reducing mortality from meningococcal disease: systematic review. BMJ. 2006 Jun 3;332(7553):1299–303.
- Sörensen HT, Nielsen GL, Schönheyder HC, Steffensen FH, Hansen I, Sabroe S, Dahlerup JF, Hamburger H, Olsen J: Outcome of pre-hospital antibiotic treatment of meningococcal disease. J Clin Epidemiol 1998, 51:717–721.
Drug calculator
Example of a paediatric drug calculator from WATCh.
I think your language around child abuse was too cautious. It’s a serious widespread problem that our society does it’s best to ignore. Spell it out loud and clear other than using wishy washy language.
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Thanks for your comments, I’m sorry you felt we could have said more about this very important subject. We will consider doing a whole podcast on NAI in the near future.
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Hi Shayne,
Completely agree that this is a huge issue and needs due attention. I hope that the podcast has at least raised its significance as a differential for this patient group. more often than not warning signs are initially missed due to colleagues being unaware rather than deliberately dismissed.
I agree with @ClareBosanko that NAI in infants probably warrants its own podcast, as sadly it is often initially missed on presentation.
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Hi both Great series! How about for a future podcast management of acute general medical presentations – prolonged seizures, diabetic emergencies arrhythmias from a PHEM perspective? Thanks Ben
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Thanks for these suggestions, its good to have inspiration. We’ll get onto these.
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Hi @clare – a colleague just pointed out an important addendum in the talk, when discussing blood sugars.
Hypoglycaemia in the early neonatal stage (<72 hours old) = 2.0mmol/l, however, older infants the cut off is 2.6mmol/l. This is the widely agreed cut off in paediatric literature, and should prompt treatment and investigation.
I have attached a useful paper to this end: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5682370/
Some laboratories will not process hypo screens unless the plasma glucose is <2.0, but they are usually worth sending anyway if glucose <2.6mmol/l, as well as checking ketones response.
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