Here at St.Emlyn’s we like a bit of #dogmalysis. We like to challenge established thinking and perhaps to look again at what we all know to be true.
One such dogma is that ‘Children are not little adults’.
This is embedded into our training from undergraduate level, through postgraduate training and it’s one of the most common (and quite frankly the laziest) lines to appear at the beginning of any paediatric text.
Now, there is much to be said for paediatrics and paediatricians. I work with some absolutely amazing paediatricians on a regular basis and frequently use their skills, knowledge and experience for kids in the ED. In my current hospitals it’s a great symbiotic relationship that works well, but in my training and travels this has not always been the case. When we stop and think about sick kids, and I mean really sick kids we might perhaps need to think again about whether the expertise lies in a job title, or in a skills set. In terms of resuscitation should we ask ourselves a dogmalysis type question….
In the resus room are children really just little adults?
The following talk was delivered at SMACC 2013. A great conference that excelled at getting clinicians to think and challenge what we think we already know. My contribution is designed to be the antidote to the established dogma around children and as such I’ve designed the talk to be delivered as a challenge to established thinking.
I wanted to do this talk from the perspective of a general emergency physicians who deals with kids as I believe this to be the norm in the UK. Most sick kids will initially be seen by a general EP and whilst I think some paediatric specialists in the UK believe that this should change and that adult and child emergency medicine should split apart, that’s not my belief and for much of the country it will not be practically possible. So, for the foreseeable future we need to ensure that our EPs are mentally prepared to engage with paediatric resuscitation in the same way that they do for adults. That, I hope, will be the outcome of this talk.
All the cases are illustrative and not real cases. For confidentiality reasons I’ve made the main case up based on an amalgam of past events and experiences over many years. The docs mentioned are essentially hypothetical (see note on cases on St.Emlyn’s below). They are included to illustrate the principles discussed and show a chain of events that can take place through procrastination resulting from a fear of intervening in sick kids. I should also clarify that when I say (in the talk) that cases such as these are not uncommon – that refers to the delay in intervention. I don’t want to give the impression that children are dying on a regular basis! The vast majority of kids are treated well in the UK, but it is not infrequent to see delays manifested in the resuscitation process that we would not expect to see in adults.
The views are designed to promote debate and are based on my personal thoughts and experiences. They do not represent the opinions of my colleagues, my employer or students. In fact I may be the only person in the world who thinks this……but I don’t think so. We recently met Joe Lex here in Virchester and he attributed the following (I think) to Rosen (previously said Tintinalli – thanks to Chris Nickson for correction) ‘the last thing a sick kid needs to see is a paediatrician’, and whilst that is a far more provocative statement than anything in my presentation there may be some truth in the statement. Let’s go for an amendment ‘a sick kid should not ONLY see a paediatrician’. Hopefully that statement will make more sense after listening to the podcast.
If you like this I would strongly recommend that you also listen to the talks given in the same session. Matt O’Meara doing a great job on the FEAST trial, the very impressive Mary McCaskill on neonatal nightmares, and Andrew Numa on futility in paediatric care.
Finally, I have always worked in hospitals that see kids and I think it’s a really exciting and rewarding part of practice. Like everyone else I am not immune to errors and many of the lessons in this presentation are…., as Casey Parker might say Hard Learned.