In this episode, we delve into the critical role of neuroprotection in pre-hospital care, particularly in pediatric head injuries. Through a real-life case study of a 13-year-old boy who suffered a traumatic brain injury after being hit by a car, we explore the steps taken by paramedics and critical care teams to stabilize him and prevent further neurological damage. From airway management to advanced interventions, this episode highlights the challenges of pre-hospital neuroprotection and the incredible teamwork that led to the patient’s remarkable recovery.

There is more detail on the full blogpost here.

This podcast was recorded live at the Hope Church in Winchester as part of the PREMIER conference. We are grateful to the organizing team for hosting us and allowing us to use the audio. The PIER and PREMIER websites are full of amazing resources for anyone working in Paediatric Emergency Medicine, and we highly recommend them.

Ed is a Speciality Trainee in Emergency Medicine in Wessex and a trainee Critical Care Practitioner with Dorset and Somerset Air Ambulance. Ed is also the co-founder and Managing Director of Enhanced Care Services, a Southampton-based company delivering enhanced and critical care to the event medical sector, providing frontline ambulance services across Hampshire and clinical education at all levels, employing over 200 clinicians. Ed holds the Diploma in Immediate Medical Care (RCSEd) and, having promised to not take on any more work, is currently undertaking a Masters in Resuscitation, Pre-hospital and Emergency Medicine at QMUL.

Enhanced Care Services' mission is to provide and influence excellent patient care, irrespective of injury, illness or location, through the delivery of high-quality clinical operations and education. Founded in 2015, ECS now provide frontline ambulance operations across the South, delivers extensive medical cover to some of the most prestigious events across the UK and provides education from its bespoke education centre in Southampton and beyond.

In this episode, Dr Tim Warlow, a consultant in Paediatric Palliative Care, explores the complexities of caring for children with life-limiting conditions in the emergency department (ED). The discussion highlights the increasing prevalence of paediatric life-limiting conditions and the growing medical complexity of these cases, which pose significant challenges for ED staff.

The episode begins by clarifying what paediatric palliative care truly involves. Contrary to common misconceptions, palliative care is not about withdrawing care but rather enhancing the quality of life for children from the point of diagnosis, whether the condition is present from birth or develops as the child deteriorates. This proactive approach often involves increasing the level of care and support as the child’s needs evolve.

As the number of children with life-limiting conditions continues to rise, EDs are encountering more medically complex cases, including children who are technology-dependent and require high levels of care at home. These challenges are compounded by the evolving expectations of parents, who are often better informed and more involved in their child's care decisions. Post-COVID, community services have struggled to recover, particularly in nursing support, making the role of the ED even more critical.

The episode provides practical tips for ED professionals to better manage these cases. Key strategies include:

1. Recognising Life-Limiting Conditions: With over 400 recognized life-limiting conditions and many more undiagnosed, it’s crucial to assess whether a child might have palliative care needs.

2. Listening to Families: Families often have an intimate understanding of their child’s unique medical baseline. Listening deeply to their insights, even when they seem unusual, is essential for providing appropriate care.

3. Building Rapid Rapport: Quickly establishing a connection with the family is vital, as these children can deteriorate rapidly. Acknowledging the child’s presence, summarizing the situation, and validating the family’s experience can help build trust.

4. Understanding the Child Beyond Their Illness: Families worry that healthcare professionals only see their child when they are unwell. Taking the time to learn about the child’s life outside of the hospital can lead to better care decisions.

5. Reading the Advanced Care Plan: If available, review the child’s advanced care plan before discussing the case with the family. This ensures that the family doesn’t have to recount their entire journey and that care decisions are based on the most current information.

The episode also addresses the importance of being aware of unconscious prejudice. Healthcare professionals must ensure that decisions are based on the child’s specific needs rather than assumptions about their quality of life due to their disability.

In conclusion, the episode emphasizes that while caring for children with life-limiting conditions in the ED is challenging, it is also deeply rewarding. The key to providing excellent care lies not just in medical interventions but in being present, listening, and supporting the family through difficult times. Whether things go as planned or not, your presence and compassion are what families remember most.

This episode is a must-listen for anyone involved in pediatric care, offering valuable insights into the critical role of the ED in supporting children with life-limiting conditions and their families. There is more detail on the blogpost here.

As the UK enjoys its unpredictable summer, with everything from sunshine to hailstorms, we bring you a mix of updates and discussions on emergency medicine, blog content, upcoming conferences, and insightful research reviews. So, whether you're basking in the sun or sheltering from the rain, sit back and enjoy our latest insights into the world of emergency medicine.

In this round-up of Month Year, we talk about a wide range of issues relating to emergency medicine, including nebulised ketamine for analgesia in the ED, risky intubations, presentation skills, more about the DOSE VF trial and analysis of the much-hyped PREOXI trial about preoxygenation before tracheal intubation.

We're excited to announce our participation in two upcoming conferences. The Tactical Trauma Conference in Sweden this October promises to delve into pre-hospital emergency medicine, offering sessions from renowned speakers. It's a fantastic opportunity to learn and network, with flights to Sweden being relatively affordable. The event takes place just north of Stockholm, providing a chance to explore the beautiful city.

In March next year, we look forward to the Incrementum Conference in Murcia, Spain. This is a significant event as emergency medicine has recently been recognized as a specialty in Spain. The conference will feature an impressive lineup of speakers from the FOMED world, including Scott Weingart, Ken Milne, Hany Malamatt, and Slim Resie , among others. Our very own Simon Carly will also be presenting. We'll be there to conduct interviews and gather exclusive content for our listeners.

Thank you for joining us, please do like and subscribe wherever you get our podcasts.

In this podcast from the PREMIER conference 2024, Francesca Stedman, a consultant paediatric surgeon from Southampton Children's Hospital discusses the care of the child who has ingested a button battery.

Button batteries are ubiquitous and come in various types and sizes. There are about 85 different kinds available or in use in the UK alone, found in everything from toys to hearing aids. The most notorious is the CR2032, which is about 20 millimeters in diameter and 3.2 millimeters thick. It contains lithium manganese oxide, and while its small size makes it convenient for electronics, it poses a significant risk if ingested.

The danger with button batteries lies in their potential to cause severe injuries when lodged in the esophagus. They can cause necrosis, which is essentially tissue death, due to a strong alkaline substance produced by the battery. This substance acts like a potent oven cleaner, rapidly causing damage. The esophagus has three natural narrowing points where these batteries often get stuck, increasing the likelihood of injury. The situation becomes critical very quickly, often within two hours of ingestion.

One of the most concerning aspects of these incidents is that button battery ingestions are rarely witnessed. Children might present with vague symptoms like drooling, difficulty swallowing, or even just being generally unwell. These can easily be mistaken for other common illnesses, leading to delays in diagnosis. In one particularly harrowing case, a child presented multiple times with symptoms of a respiratory infection, only for an x-ray to reveal a button battery lodged in the esophagus. By then, the damage was extensive.

When ingestion is suspected, immediate action is crucial. Getting a chest x-ray is the first step, and if necessary, a lateral x-ray can confirm the presence of a button battery by revealing a characteristic double rim or halo sign. Pre-hospital measures can include giving honey or jam, depending on the child’s age, to help mitigate the damage. However, these should never delay getting the child to the hospital.

Once at the hospital, the primary goal is to remove the battery as quickly as possible to prevent further injury. Depending on the location of the battery and available specialists, either ENT surgeons or paediatric surgeons may perform the removal. Post-removal care involves monitoring for complications like perforations or fistulas, which can develop days or even weeks later. In severe cases, these injuries can lead to life-threatening conditions, such as aorto-esophageal fistulas, which require immediate surgical intervention.

In summary, button battery ingestion is a serious and often underappreciated risk. Even in homes where precautions are taken, accidents can happen. The key is quick recognition and action. As parents and caregivers, we need to be vigilant about keeping these small, dangerous objects out of children's reach. And if an accident does occur, immediate medical attention is essential to minimize the risk of serious injury.

More details are available on the blogpost here.

In this St. Emlyn's podcast, Rick Body and Greg Yates, continue our exploration of diagnostic test accuracy, shifting our focus to positive predictive value (PPV) and negative predictive value (NPV). These concepts are vital for anyone preparing for exams or looking to enhance their application of diagnostic tests in clinical practice. While our last podcast discussion centred on sensitivity and specificity, PPV and NPV offer a different, arguably more clinically practical perspective on interpreting test results.

Positive predictive value (PPV) and negative predictive value (NPV) are essential tools for understanding the effectiveness of diagnostic tests. PPV helps us determine the likelihood that a patient with a positive test result actually has the condition, whereas NPV helps us gauge the probability that a patient with a negative test result does not have the disease. These values are crucial for making informed clinical decisions, particularly when considering the prevalence of a condition in the population. Today, we’ll delve into these concepts, their practical applications, and why it's important to consider both PPV and NPV alongside sensitivity and specificity.

You can find more about this on the St Emlyn's Blog and please don't forget to like and subscribe.

In today's episode, taken from live recordings at PREMIER 2024, we dive into an increasingly common treatment for type 1 diabetes: hybrid closed loop insulin pumps. We'll begin with a brief overview of traditional insulin pumps and explain how hybrid closed loops are different. The core of our discussion will be centered around three case studies, illustrating potential scenarios you might encounter in a pediatric emergency department and how to manage them effectively.

With NICE's recent technology appraisal advocating for universal access to hybrid closed loop systems for all type 1 diabetes patients, it's crucial to understand these devices. Over the next few years, you'll likely encounter these systems frequently. We'll cover the essentials of how these pumps work, their benefits, and potential issues that might arise, such as connectivity problems, cannula issues, and handling intercurrent illnesses.

Join us as we explore the revolutionary impact of hybrid closed-loop systems, which offer better glucose control and significantly improve the quality of life for those with type 1 diabetes.

Dr Nicola Trevelyan has been the Clinical Lead for the Paediatric Diabetes Service in Southampton for the last 20 years. During this time, she has seen huge changes in the management of CYP with diabetes. She has been involved in several large multicentre trials for paediatric diabetes, helping to better our understanding of how best to use new technologies in diabetes management in children and move forward access to new treatment technologies. She was one of the founding committee members for the Assoc of Children's Diabetes Clinicians (ACDC) in 2006 and has been on working parties for BSPED helping evidence base and re-write the national DKA guidelines in 2020 and for the National Paediatric Diabetes Audit. For the last 4 years, she has been on the Clinical Advisory Group for the RCPCH Quality Improvement Programme for Paediatric Diabetes.

It was a huge pleasure to sit down with Steve Smith, a name synonymous with ECG expertise. Steve, renowned worldwide for his influential ECG blog, has been a pivotal figure in advancing our understanding of ECGs. Many of us have honed our ECG skills thanks to Steve’s insights. I had the opportunity to meet Steve about a decade ago at one of the SMACC conferences. Today, we delve into the fascinating world of occlusive myocardial infarction (OMI) and its comparison to STEMI (ST-elevation myocardial infarction), and explore the promising future of artificial intelligence in ECG interpretation.

A comprehensive blog post with references is available here

Eating disorders are a critical health concern that tragically lead to numerous deaths, especially among young women during their transition age. Anorexia nervosa, in particular, is the most deadly psychiatric condition with a 10% lifetime mortality risk. Recent coroner reports highlight significant medical failings and a dire lack of knowledge among healthcare providers. Given the 90% increase in eating disorder admissions over the last five years, this issue demands urgent attention.

In this podcast Anna Kyle, a consultant paediatrician, covers all you need to know when looking after a young person or young adult with an eating disorder in the Emergency Department.

Comprehensive notes can be found here