SimFridays - paediatric head injury

For our first month of SimFridays we’re looking at paediatrics, and if you couldn’t join us for 18th September this blog covers some of the learning points. We will be aiming to run simulations every Friday at 11am - go to derriforded.com/sim, particularly if you have suggestions of what we should cover! Some of the sessions will be moved to Thursdays (!) but the gmail calendar is up-to-date.

The simulated case: 
James is a 14 year old child brought in by older teenagers. He has been drinking with them and has apparently fallen and hit his head. One of his parents is on their way in.

What are your immediate thoughts? What might the challenges be in looking after this patient?

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What happened?
The nurse assessed James and noted he’d been out drinking with older teenagers and had an injury to his head. They noted normal observations, GCS14 (E4V4M6), and no serious concerns at this point. 

The doctor’s assessment was interrupted by the arrival of James’ mother. She was unhappy and keen to remove James from the ED. The team attempted to engage with her on the importance of staying with James while he is assessed and treated. 

It was noted that James met the criteria for a CT of his head. 


What did we think? 
In debrief we discussed:

• Safeguarding: use the Salus referral but also if very concerned can phone too.
• Parent should stay, encourage but if they do insist on leaving include on Salus referral.
• Discussed the NICE CT pathway, but sometimes deviation needed -> speak to a senior.
• Consent in children: see “guideline” below. 

Feedback from the participants noted that greater staffing might make the care of patients like this easier. It was noted that this sim being in the Stewart room rather than in situ meant a reduction in realism. For the next sim we will ensure the room is better kitted out with the equipment necessary.

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The guidelines:
Consent in children:

The mental capacity act doesn’t apply to children under 16. Children under 16 can give affirmative consent if they are deemed “Gillick competent” - see link.

If the parents disagree with treatment like they did in this sim:

“Where such a disagreement arises, further discussion should take place and a second opinion offered, but it may be necessary to seek legal advice. In the interim, only emergency treatment that is essential to preserve life or prevent serious deterioration should be provided.” from this link.

The NICE guidance on deciding whether to use CT for head/neck injuries gives advice both for adults and children. See here.


To do:
If it’s been a while since you worked in the paeds area, ask someone who is regularly there to show you where key items are   [  ]

Find where the head injury guidelines and advice leaflets are on EDIS   [  ]

Consider a past situation where you have looked after a child and the parents have been involved in the decision making process about their care. What do you do if there is disagreement between child/parent/medical team?  [  ]

If you took part in the sim, you can use this blog as a starter to reflect on your own experience of it   [  ]


James Keitley - ED Sim Fellow

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For clinical decisions please refer directly to the guidance. This blog will not be updated.