nialldurrant.bsky.social

Lots of advancements coming in this field - some a little more critical care than ED but hugely interesting! #premier2025 @rcpch.bsky.social

Paediatric specific TBIs:
Prone to diffuse axonal injury
More prone to extradural with skull fractures.
Can accommodate more swelling in young children - soft skull/fontanelle
Conversely lower margins means a small rise in ICP or small drop in BP can have big effect on perfusion

Diffuse axonal injury is also heavily implicated in TBI. Shearing forces cause shearing of axons, particularly in the corpus callosum and brainstem. Brainstem involvement is associated with worse long term outcomes. Look with an MRI.

Did you know that globally injury/trauma is the leading cause of death in the under 40s? (Importantly almost all children are under 40 years old)
Primary brain injury - subarachnoid patients do worse in terms of outcomes #premier2025

Spotlighting on paediatric pre hospital care and traumatic brain injury is Dr Katie Crewdson - who has one of the coolest jobs around.

The main principle of chemical incident treatment is REMOVAL - dry and wet. Where is the equipment for this in your ED? How would you decontaminate patients? #premier2025

Major incidents have become a major part of my role, helping to develop our ED response plan and training program. Are you familiar with the METHANE tool? Do you know the difference between CBRN/hazardous incident? What is exposure and what is contamination? Check out @rcemlearning.bsky.social

We move onto Chemical Major Incidents with Jon Lang - who makes chemistry interesting, something my A-Level made me think was impossible. Always think own/staff safety first - you cannot help patients if you are contaminated or harmed! #premier2025

Also watch for the physical displacement effects of tumours - including spinal cord compression and mediastinal masses. Even intubation does not guarantee your patient is safe - I've had an ET tube block off after placement when a child was moved. Beware. #premier2025

Moment of silence over! After lunch we've got fantastic topics, starting with oncology pts in the CED. Key messages - high risk sepsis, always use their central access. Tumour lysis CAN happen before starting treatment, be aware and watch for deranged electrolytes!

Lunch was some excellent curry, I got distracted playing with vascular access models and missed out on the brownie desserts though. Moment of silence please. #premier2025 #chocolateislife

We had some spotlights on poster presentations including penthrox use (good but be aware of cost), and extubating Status Epilepticus in ED - this was my favourite, there's definitely scope to improve and change the use of PICU/Transport teams!

ARFID can be a terribly distressing condition, not just for the patient but for the family, and family therapy can be really beneficial. Treatment needs to be tailored to each patient, and moving from one food to another is a VERY gradual process - use very similar foods and take baby steps!

ARFID - diagnosis requires one of "clinically significant" nutritional deficiency (most commonly used criteria), psychosocial impact (common but harder to specify), or dependence on supplements #premier2025 @rcpch.bsky.social @rcemlearning.bsky.social

A PREMIER branded coffee cup and notebook

Side note good stash this year I love me a notebook

Moving down to the abdomen and haemolytic uraemic syndrome - diagnosis and careful fluid management is key to CED treatment, look out for these complications #premier2025

Lovely break where I met some legends of PEM and the awesome team from Sonosite who are our partners on the #DVAC course - if you want to improve vascular access in children, get in touch! dreeam.ac.uk/courses/diffic…

Tryptase is helpful if positive, but a negative result doesn't exclude allergy/anaphylaxis! Don't allow it to delay treatment. Takes a while to come back so this is very much 'not helpful in CED helpful' imo.

Next up Anaphylaxis - remember the guidelines now says NOT to give steroids, they don't help in the acute phase and the evidence they prevent biphasic responses is poor. MAYBE use in refractory anaphylaxis...

Paediatric ECG: Stepwise approach Stepwise assessment of the paediatric ECG, including rhythm, rate, axis, intervals, ST segments and Q/P/T/U waves

We move on to the thorax theme with a review of paediatric ECGs. Take a structured approach especially if you are used to adults - like everyone else I use the Life in the Fast Lane guide on a regular basis litfl.com/paediatric-e... #premier2025

Continuing the head theme, Dr Kim Sykes talks safe intubations. Understand your equipment! Different (age based) sizing for tubes with video scopes, adult (orange) bougies will hold a bend, paeds ones less so. Consider using VAFI for those tricky neonates with subglottic stenosis.

Dr Carl Van Heyningen reminds us that it is not our role to put risk personal harm to prevent people absconding - even if they are themselves at risk. However legal advice says common law will protect you if you do intervene and restrain with minimal reasonable force.

Acute behavioural disturbance tips - listen, think underlying triggers, try to optimise environment, address what is distressing the patient!
Physical restraint is a last resort and only to prevent harm - are your staff trained? Never restrain someone on their front.

YouTube video by TSC Alliance Signs of Infantile Spasms

youtu.be/kRt8muFfUQo?...

An EEG showing hypsarrythmia

First up was infantile spasms - will link a video below. Remember these are easily missed, and EEG (hypsarrythmia) helps differentiate the mimics. Short term seizure resolution (with steroids +/- vigabatrin) 70%, long term 30. Early recognition improves our outcomes! (I know, shock) #PREMIER

Hey friends! I've resurrected social media in honour of the PIER network Paediatric emergency conference PREMIER. A lovely run around Winchester this morning followed by some excellent sausages, and we are ready to learn!! #PREMIER

Doing an experiment - which will taste better?

Protip book friends: If you buy second hand books from charity shops you are saving money, the environment and giving to charity all in one go so your partner (or in my case my 4yr old?!) can't tell you off for buying yet more books.

How does one correctly eat this? Delicious though.

Okay lesson learned. Even an ADHD brain can't read Lyndon Hardy's Riddle of the Seven Realms and watch Loki season two, simultaneously.