Dr. Damian Roland (@damian_roland) - #FOAMed supporter

The ice bucket challenge: The best solution to SVT

In FOAMed, Medical Education on August 31, 2014 at 8:21 pm

Not one to waste an educational opportunity I used my ‘ice-bucket’ challenge video to talk about another use of ice-buckets…

SVT

Children in Supra-ventricular Tachycardia (SVT) are not uncommon presentations to Emergency Departments. It’s worth remembering that infants won’t present complaining of palpitations and may just be brought in by parents with poor feeding, irritability or just not being ‘right’. There is a really nice blog post about SVT  from Paediatric EM Morsels but I want to focus on one form of treatment – ice-water. I have yet not to have a child present who I have been unable to revert by this technique (It will happen I am sure…).

The key mistakes people make are:

1) Not holding properly. Young infants must be completely swaddled and have their face held in the water. This looks dreadful – so a lot of pre-warning to the parents is necessary.

2) They don’t complete immerse the face. It is not a slight ‘dab’ – the whole face must be immersed

3) They panic at 3 seconds.

In my experience you need a good 5s (sometimes slightly longer). This feels like a very long time (and is worse than the swaddled hold!) so you must brief parents (and other staff!) extensively about it.  Another approach is to basically hold longer than comfortable, and then hold a bit a more, if you don’t feel like counting in your head.

My ice-bucket challenge was to demonstrate what 5s feels like. Believe me if you can revert this way it is A LOT better than adenosine….

(Would have been better if I had thought through in advance what I was going to say but the light was running out fast…!)

[I have donated to the MND association]

What I learnt this week: #doctorwho would have no difficulty adopting a more managerial role #WILTW

In Uncategorized on August 29, 2014 at 6:01 pm

This is the fifteenth #WILTW

The new series of #DoctorWho started in the UK last weekend. For those who aren’t aware, every so often the Doctor re-generates, taking on a new appearance and personality although keeping previous memories and skills. It’s a brilliant concept which in some part is the reason for the shows continued success.

Doctor Who

(photo via copyright free site http://www.fanpop.com/clubs/doctor-who/images/37459545/title/coleman-capaldi-photo)

In this new series a new doctor is with us, and more time than most, is spent on the doctor reflecting on his new body:

“You know I never know where the faces come from, they just pop up. It’s covered in lines. But I didn’t do the frowning… Who frowned with this face?”

For the doctor’s companion the change can be hard to take, especially when a fanciable young man is replaced by a somewhat older model. The Doctor is the same person inside and pleads at the end of the episode to be considered no different from his predecessor:

“You can’t see me can you? You look at me and you can’t see me. Have you any idea what that is like. I’m right here. Please just see me…”

So what does this have to do with healthcare I hear you ask? Well at any given moment there will be a professional somewhere adopting a new role. Maybe involving more managerial or leadership responsibility, perhaps a step up a band level, or a move off a clinical rota. Often this person will be working with their peers, perhaps in exactly the same environment, but now have a ‘hierarchical’ responsibility for them. The person they are is no different, same skills and memories, but perhaps they might have to adopt a different personality. The buck, in management terms, now stops with them. This new ‘face’ is not always an easy mantle to take on. Whereas the doctor’s face changes completely – it is easy to think of them as a different person – for us non-Gallifreyans this isn’t an option. We should remember however the doctor finds the transition just as challenging.

hierarchy

It is worth both the doctor, and the newly promoted staff member, contemplating at the end of the day you are still the same person. It’s the characteristics of YOU that got you into this position and that will be your greatest strength.

“Have you seen this face before? No? Are you sure? It’s funny because I’m sure that I have…”

What have you learnt this week? #WILTW

EM isn’t child’s play when it’s Emergency Maths

In FOAMed, Medical Education on August 27, 2014 at 6:10 pm

New starters to paediatric wards, emergency departments and general practices around the country are faced with a huge array of formulas and equations to navigate. Most are relatively simple and require only a basic revision of multiplication tables. However some calculations are required in a time critical manner and anyone experienced in treating children knows how easy it is to make mistakes. In resucitation situations there may be many drug doses to calculate using some medications which may not be frequently used by the person prescribing them.

Given paediatric pharmacy is a very ‘mass’ based subject prompt calculation of weight is an essential first step. The traditional approach taken is that advised by APLS courses:

Weight 0 -1 = (Age/2)+4

Weight 1 -5 = (Age x2)+8

Weight 6 -12 = (Age x3)+7

There is a great blog from Simon Carley on the introduction of three equations rather than just one and the problems this may cause. The key point being does having three forumula increase complexity, and therefore risk of error, especially given we aren’t really sure what amount of difference in weight is clinically significant?  Other mechanisms of calcuating weight do exist, the broselow tape for example, but I especially like this one via Dilshad Marikar

(2010 APLS weight estimation) – Talking to the hand from Paediatric Tools on Vimeo.

The Leicester Hospitals Emergency Department have been working for sometime on a drug calculator for use in Emergency Situations. I’m very grateful to Dr. Mike Pearce, Dr. Mark Williams and Dr. Steve Corry for their hard work on bringing this to fruition. In the spirit of ‘FOAM’ we are sharing our efforts, not because we think it is any better than other systems out there, but because we are sure improvements can be made.

Drug Calculator

It can be downloaded by clicking LRI Paeds Drug Calculator v1.4. It’s been extensively tested and has the approval of our senior paediatric pharmacist. As with all such calculators we can not accept responsibility for its accuracy or ensure its currency.

Please let us know what you think via comments, @damian_roland or @em3foamed

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