1. While children are not simply small adults, many resuscitation skills are transferable between adult and pediatric populations.
2. Unplanned transfers of sicker and younger patients from one hospital to another revealed they experienced more complications and higher mortality, suggesting delays or errors in initial treatment.
3. Resuscitation of pediatric patients requires age-appropriate consideration of factors like fluid administration, ventilation settings, and therapeutic endpoints to restore physiology while drawing on experience from adult resuscitation.
Mark Little builds a framework for the clinical approach to patients with suspected poisoning or envenomation. Particularly useful in a country where everything is trying to kill you.
Mark Little builds a framework for the clinical approach to patients with suspected poisoning or envenomation. Particularly useful in a country where everything is trying to kill you.
Critical Care physiology in resuscitation: Rinaldo BellomoSMACC Conference
Rinaldo Bellomo is here to cause some trouble! He says that critical care physiology in resuscitation has problems! Whilst the rest of the medical field has advanced and evolved over time (we no longer routinely prescribe oxygen for an acute myocardial infarction), critical care resuscitation still relies on malfunctioning physiological paradigms.
Critical care clinicians can change physiology with a number of tools. They can repeatedly, often, and mercilessly change physiological variables. Blood pressure, cardiac output, cardiac filling pressures, glucose levels, positive fluid balance and countless other physiological parameters can be increased and decreased at will.
This kind of “numerology” is attractive because the outcomes can be immediate, and clinicians feel powerful and effective. However, outside the obvious situations where physiology is so dangerously abnormal as to threaten life, such physiological manipulations have an unproven relationship with outcome.
Importantly, patients do not care whether their cardiac output has been increased from 5L/min to 6 L/min. They only care whether they live or die, get out of hospital intact and return to their previous life. Thus, physiological gain is not patient centred.
Moreover, all research focusing of the physiology of a specific intervention inevitably deals with the effect on a specific set of variables. For example, a fluid bolus may or may not increase cardiac output in the short term. However this effect is not sustained much past 20 minutes. Similarly, no studies examine the effect of such fluid bolus on anything other than haemodynamics. No one measures what the effect is on the immune system, cerebral oedema, the glycocalyx, interstitial oxygen gradient, pulmonary congestion, body temperature, haemoglobin, or white cell function. Thus, all physiological studies are “blind” to the broader effects of their intervention.
Rinaldo claims that in critical care resuscitation physiology, the measurable is made important but the important may not be measured. Clinicians need to reflect on this before they become seduced by physiological manipulation.
Rinaldo’s challenge to you? Look at the literature, consider biological plausibility, follow evaluated evidence, balanced, accept doubt with a smile and practice known medicine of the time whilst understanding that today’s medicine will be the source of derision in the future.
This presentation discusses the various presentation of inborn error of metabolism to pediatric ICU and basic management of such cases. Also discusses the basic evaluation and iagnostic appraoch to various inborn of error of metabolism with consideration to pediatric critical care
Fran Lockie is a Paediatric Emergency and Retrieval physician currently based in Adelaide. He is quickly becoming a leading expert in paediatric TBI and so was the perfect person to give this talk. The audio that goes with these slides is on Intensive Care Network (www.intensivecarenetwork.com). If you like these sorts of presentations, come to Cairns Bedside Critical care this September where we've got a great line up of speakers and we're doing it all again.
Neonatal and Pediatric Critical Care - Mostafa QalavandWang Lang
Neonatal and pediatric critical care is markedly different from adult critical care because of the physiologic and hemodynamic dissimilarities between immature and adult animals. Clinicians are often wary of treating these patients because of their small size and the presumptive limitations in diagnostic and therapeutic interventions. Nevertheless, we have the ability to treat these young animals aggressively. In doing so, however, we must be cognizant of the unique distinctions among pediatric patients with regard to normal physiologic variables that affect physical examination findings and diagnostic test results.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
12. Anecdotally.....
Errors of Omission and delay
Wait for help
Failure to intervene
Cliff drop of kids pathology
Benjamin Ellis CCL
http://www.flickr.com/photos/jamin2/3191895921/
44. Pressure control more popularPressure control more popular
Tidal volume reasonable (5-8 ml/kg)Tidal volume reasonable (5-8 ml/kg)
or maybe better to look at chest wall excursion with pressure controlor maybe better to look at chest wall excursion with pressure control
Aim for lower FiOAim for lower FiO22 albeit with higher PEEPalbeit with higher PEEP
4-6 to start4-6 to start
6-8 if bad lung disease6-8 if bad lung disease
8-10 if wet lungs8-10 if wet lungs
SpO2 = 88-96%SpO2 = 88-96%
Chest tubesChest tubes
49. Fluid requirements
• Sepsis -
• Adequate volume important within 1-2 hours
• Reduced mortality
• less persistent hypovolaemia
• no increase in ARDS
• each additional hour of shock doubles odds of death.
• reduced PICU stay
Role of early fluid resuscitation in pediatric shock. Carcillo JA, Davis AL, Zaritsky A. JAMA 1991;266: 1242-1245.
Early reversal of Pediatric - Neonatal septic shock by Community Physicians is associated with improved outcome. Han
YY, Carcillo JA, Dragotta M et al. Peds 2003;112: 793-799.
58. 53 patients in 15 months
No improvement in mortality
Feasibility proven
59. Therapeutic end points
• Titrate to effect
• Normal pulses with no difference central/peripheral
• Warm extremities
• Return of Urine output (>0.5-1ml/Kg/Hr), HR, Cap refill,
LOC
• SVC or mixed venous gas
• Normalising base deficit and lactate
60. Today...
•Fire up the simulator
• Kids & Adults in the past
• Kids & Adults in the future
66. End points
• It’s you
• There is specialism here
• but not that much in the beginning
• Beware the neonate - they are not human
• If you did adult resus on kids how often would it
go badly wrong?
• Crack on with it
One thought is around drug doses - for most drugs it is not as exact a science as paediatric formularies would have you believe - ie if child about 20% / half the size of an adult draw up an adult dose give about 20% / half but round up. They don't (or at least didn't when I worked in OZ both times) have the equivalent of BNF / BNFC you had to use a MIMS book and the childrens hospitals produced their own formularies (presume there are apps now but might be worth checking)
As I mentioned before teenagers probably better from a physiological perspective being looked after by adult nurses / docs who recognise the abnormal HR.
Paediatric major trauma so rare in UK / Oz that only way to be a specialist in managing paed major trauma is to manage adult major trauma and kids with non trauma emergencies.
Neonates - scary even for PEM specialists - if you don't know what is going on treat the treatable stuff (infection / dehydration / jaundice / hypoglycaemia) as not going to do any harm while trying to diagnose rarer stuff like metabolic/cardiac (and even in metabolic babies acute episode often precipitated by infection).
Worth mentioning that APLS 20ml/kg fluid boluses may be over generous (I go 5ml/kg if they don't look too bad 10ml/kg if they look awful) can always keep giving. FEAST study has introduced debate / doubt about massive fluid volumes in resus for kids. Drawing fluid boluses up in 20ml not 50ml syringes much easier to push in babies.
Will let you know if any more gems occur to me.
Rachel
Really good Simon. It all makes total sense what you've pulled together. I think it's worth re iterating that in kids you see probably a higher proportion of 'well' patients compared to adults. Most of the time I feel in adults you expect to find something, whereas in kids you don't. So when you've seen tons of well kids, the really sick ones pop out at you. If not its so engrained in your head to run through a head-toe examination that you'll pick stuff up if its there. Does that make sense?
The other scarey bit with kids for many is all the syndromes and other weird stuff that can change, and get in the way of just seeing the patient in front of you.
More common sense needed in kids sometimes.
Adult practice gives you way more exposure to practical skills so when you get to do them on kids it's not so scarey apart from their size.
They are my thoughts so far. In kids all this week so may be enlightened some more!
K
Easy when you are here
new hospital
all specialities on site
dedicated ped
all medical and surgical on site
does this give me credibility or not?
NOt so easy when you are here
EMS get scared
parents transport directly
secondary transfers in more common
most likely to see a non-specialist PEM physician
Frequency of critically ill kids distributed in geography and in time
Cliff of physiology
The case.
Let’s give you an example of what can and does happen as we see the effect of
The case.
The case.
The case.
The case.
The case.
Good people
Good knowledge
Good process
but no action.
Not an isolated event
Still takes place.
Where are we scared?
1. Unfamiliarity
2. High stakes
3. Unhelpful paediatricians
What’s our starting point and why are we talking about this?
Even the World Health Organisation thinks they are not little adults
Because we all know that.........
But this is SMACC2013
& it’s different
Is the approach still going to be the same for the resuscitation of sick and injured kids?
So what worries you here?
Is it really just a size issue OR
are we looking at something that looks the small and similar
but in reality is actually quite different and requires a whole new strategy.
Perhaps we need to clarify a few things first.
First there is a continuum of ages from birth through to adulthood. That’s fine and the differences change at a gradual rate, and change in different ways. Psychologically children extend to an age well in to teens, but physiologically we are pretty much adults from
So what is that we are really that interested in?
Still have lots of similarities
A, B, C,
Change of mindset. Look for similarities not look for difference.
Where is the expertise in the management of the sick and injured child
Have worked in lots of different setting where you either get people thinking someone else is the expert or in settings where they think they are the only people with the expertise. In reality it is a mixed picture.
But in the acute and severe setting what we are looking for is the ability to deal with a group of undifferentiated, sick/injured kids for whom the picture is uncertain, where teams are required and where good overall management is needed.
In a situation that is stressful for all.
So if there was ever a time for the resuscitationist, then this is it & that perhaps more than anything else is what defines expertise in our specialities.
But maybe they are in many ways, but a lot of the differences in EM management are about when children are fairly well.
That’s not why we are here.
So why does this matter to us?
RSI Ket and Sux - follow up with Midaz and Morphine as propofol not used in children (though many people do)
Airways are usually OK in normal kids.
Other than that same process for getting out of trouble.
Video laryngoscopes - no-one I know using them. Not usually needed.
Same rescue process
Last place for needle cric - know your kit.
force required to open the mouth
teeth
tumour
arthritis
jaw opening
HOW WILL YOUR APPROACH BE DIFFERENT?
Take FB as an example as that is perhaps one of the scarier aspects
What happens when it goes wrong? What would be your strategy for failure be?
Need appropiate kit - but.....
DL - LMA - Surgical appropriate speciality
6ml/Kg is just fine.
Set the vent as you would an adult or squeeze the bag.
Use ETCO2 to guide
Chest tubes a great example of a very rare event in children where the expertise will lie within the EM adult community.
6ml/Kg is just fine.
Set the vent as you would an adult or squeeze the bag.
Use ETCO2 to guide
Top area for failure and preventable death, delay in therapy, chicken bombs etc.
What are our rules for cannulation?
What are our rules for IO?
Who administers these rules - the nurses are good with this.
Data on trauma resuscitation models predominantly from young adults. therefore probably applicable to kids as well.
TXA used in paed cardiac surgery
End points for resuscitation
I put it to you that in the resus room children are a size issue and not an entirely different job.
I put it to you that what a child needs in the resus room is a skilled resuscitationist who can use their adult transferrable skills and knowledge to save lives.
I put it to you that we are the group of people who can lead that process (with appropriate help).
I put it to you that in the resus room children are more likely to survive if we engage with them as little adults.