GEMS March 2016 - WDWLT?

Session 1: Audit presentation / Case Presentation

RCEM audit - Vital signs in Children
Sets of vital signs consist of: temperature, respiratory rate, heart rate, blood oxygen saturation measured by pulse oximetry, level of consciousness expressed as Glasgow Coma Scale (GCS) or AVPU (alert, response to voice, responsive to pain or unresponsive) scale, and capillary refill time.

Vital signs are frequently recorded in children presenting at Emergency Departments because, if abnormal, they indicate that a patient has deranged physiology. This derangement is often indicative of a disease process and associated with an increased risk of morbidity and mortality. The detection of abnormal vital signs, appropriate escalation and response can avoid the patients' deterioration and improve patient outcomes. 

LEARNING POINT: we should encourage vital sings to be documented on dedicated paediatric observation charts, which will help calculate the PEWS and spot the sick child.

Case Presentation: scrotal pain in a young boy
​"I am always asking myself: “Why is it NOT testicular torsion?” If I can’t answer that satisfactorily, that boy is going to theatre." ... so refer to the surgeons from ED!

Differential diagnosis of acute testicular pain in a boy
Torsion of:

• spermatic cord (testicular torsion)
• testicular appendage
• epididymis

Infection:

• epididymitis (viral or bacterial)
• orchitis
• cellulitis

Trauma:

• blunt (e.g., sports injury)
• sexual abuse

Other:

• hernia
• hydrocele
• testicular tumour
• vasculitis (e.g., Henoch–Schönlein purpura)
• noninfectious/chemical epididymitis
• abnormality in vas deferens or ejaculatory duct
• idiopathic scrotal oedema

Links to further reading
Painful testicle in a young boy
Saving balls: the acute scrotum
Testicular Torsion: Pearls and Pitfalls - (emdocs)

Session 2: Decompensated liver disease

There is now a care bundle for patients who present with decompensated liver disease - please print this and follow treatment guidelines.
Diagnostic ascitic tap technique

Session 3: Major incident refresher

This topic is part of the FRCEM curriculum ( HAP 20)

Definition: 
- any incident that requires an extraordinary response from health services – ambulance services, primary care, community services and hospital Trusts
Classification:
- Natural or manmade
- Simple or compound
- Compensated or uncompensated.
All hazards approach : every incident is different, but the solution are the same
Major incident response principles : CSCATTT
Triage

​Terminology:
- Major incident standby
- Major incident declared
- Major incident stand down


Know where your department's plan is (or at least a summary that you can access quickly)

​
Read your action card from time to time

Links to further reading
​Major incidents part 1
​Major incidents part 2
Take home points from a HMIMMS course

Nanette