Respiratory Distress in Infants

Building on my last post, I’ve found this youtube playlist of some short videos of infants in respiratory distress. From my year, so far(!), in Paeds ED, sepsis and respiratory problems have been the two most common medical reasons for admitting kids to PICU (ie the reasons why kids are big sick). And as winter comes round, there’ll be more and more bronchi kids

It’s really important to be able to recognise the seriously ill child, and if you can pick up on on these respiratory signs you’ll be doing pretty well. Before I add the links, just a quick point; we in the UK call the sucking in of various bits of the chest ‘recession’, but in the US they call it ‘retraction’.

So, here goes:

This is a really good example of ‘tracheal tug’; where there’s a big sucking in around the trachea. Really pronounced tracheal tug can be a sign of very severe respiratory distress. In adults with respiratory distress something you look for is someone who can’t speak in full sentences – this baby clearly cannot ‘speak’ in full sentences either.

In really small infants they ‘head bob’ because their neck extensor muscles are weaker than older kids.

This one’s particularly grim; it shows a small infant with horrendous sternal recession and tracheal tug. Sternal recession generally shows respiratory distress at a more advanced stage than intercostal and subcostal recession alone. These kids are often pretty sick. You can really hear the stridor as well

This video’s similarly unpleasant; it shows an older child with pretty much his whole chest sucking in (you can see this better at 00:14). This video appears to show the child being bagged.

None of these videos are particularly nice to watch, but they are very informative for any students doing paediatric placements.

And to make you feel better, here’s a video of a happy infant with puppies 🙂 

Cannulation

With all that goes on in A&E, cannulation doesn’t excite many people, but I find it really satisfying.

Knowing that your efforts in getting a cannula in can make a big difference is someone’s life is a very rewarding feeling. Just today, my patients have been able to have medications for life-threatening conditions and strong pain relief because they were successfully cannulated 🙂

Hannah and her mum

Hannah had had a good day and was driving home with a smile on her face. Today she’d finalised the most time consuming contract of her fledgling legal career. She was planning her celebratory evening in her head when she felt her pocket vibrate, she looked down at her boyfriend’s text. This is where Hannah’s story ends.

About 90 minutes later Hannah’s mum walked into the hospital reception desperate for information. She’d raced to A&E after she’d received the call.

‘Hello, Mrs Green? I’m calling from the hospital, your daughter’s been involved in an accident and she’s had to be airlifted in. Please come as soon as you can.’

When she went to the reception desk, not wanting to be rude, she waited her turn. When she told the receptionist her story, his world weary expression softened and he walked her to the relatives’ room. After what seemed like an eternity there was a knock at the door and a little Indian man walked in. Mr Patel took the seat next to Mrs Green and began to talk, ‘Mrs Green, your daughter suffered extensive brain injuries and is very unwell, she’s going up to intensive care now, but I must warn you that she’s unlikely to wake up.’

Hannah’s mum’s face crumpled.

Paeds Major Trauma

Generally isn’t that major.

The vast majority of incidents that trigger the ‘trauma tree’ in paediatrics are discharged within 24 hours.

The first paeds major trauma I saw sounded pretty serious on the way in: a hypotensive 12 year old boy involved in an RTC with part of his jaw missing. When he came in he was conscious, talking and haemodynamically stable…it turned out that the bit of his jaw missing was a couple of teeth. This boy had snapped the steel bar connecting the wing mirror to a minivan with his head and he had no brain bleed at all!

Other kids have fallen down tens of stairs and seemingly just bounced. Because of the mechanism of injury they are classified as ‘major trauma’ but many of these kids don’t have a scratch on them!

Even the girl who had to be intubated and sent to neurointensive care after a very high speed car accident was discharged four days later.

Saying that, whenever the ‘blue call’ alarm goes off in A&E I still stop talking to find out if it’s for us.

Offer Received

Finally! I have my offer, so I should be able to look through all the material soon.

Offer!

I interviewed for a healthcare assistant position last week, and they said that although I couldn’t have the advertised job due to being unavailable one day a week because of my MSc they think they’ll be able to find me a job on a different ward!

A&E Waiting Times

Just a brief one.

I’ve just watched a video about paramedics/A&E support having to wait for hours outside A&E departments to handover (http://www.bbc.co.uk/news/health-25298066). The lady from the NHS was talking about pumping more money into the NHS – good idea – but putting it into the ambulance service to prevent the waits. To me, the obvious primary limiting factor is A&E capacity, and one  solution (rather than changing the mindsets of people calling 999 unnecessarily) would be to increase the capacity of A&E departments, both numbers of staff and space, rather than increasing the queue of ambulances. By decreasing waiting times outside A&E, ambulances would spend more time on the road anyway.