If one twin suddenly passes away, what should be done for the second twin
Admitted to a paediatric ward for monitoring
Prior to a SUDIC body being taken to the morturary
Should be examined by an experienced paediatrician
What must happen 48hrs after a SUDIC
Multi agency meeting
Where to refer concerns about a child’s welfare
Local authority children’s social care
Section 47 enquiries
Child’s social worker leads a multi agency enquiry to be completed within 45 days - will often include a medical assessment
What follows a section 47 enquiry
Initial child protection conference -> child protection plan
Emergency protection order
Obtained by a judge at family court
To remove the child into care for a max of 8 days (up to a further 7)
Usually made by social services or NSPCC
Local authority takes on limited parental responsibility
Police protection order
Gives a police officer to power to take a child into police protection for 72hrs if they are felt to be at immediate risk.
CAN be used to present children’s removal from ED - quicker than EPO
BRUE is defined as …
An episode in an infant less than 12 months of age characterised by:
<1 minute duration (typically 20-30s)
A return to baseline state
Not explained by any identifiable medical condition (i.e. medically well)
Includes one or more of the following features:
- Central cyanosis/pallor
- Absent, decreased or irregular breathing
- Marked change in tone (hyper- or hypotonia)
- Altered level of consciousness
Apnoea of prematurity is of high prevalence in which set of patients?
Those born at 34 weeks or less
The commonest causes of symptoms similar to a BRUE presentation
GORD
Detailed social paediatric hx includes:
Cohabiting family members, whether there is smoking/drug use at home, any mental illness at home and any social work involvement with the family.
Examination in a child with ? BRUE
Full ABCDE assessment – consider differential diagnoses. Remember to test a capillary blood glucose.
Fully expose the child to check for bruising, bleeding from nose/mouth, torn frenulum and subconjunctival haemorrhage
Plot weight, length and head circumference
Note any dysmorphic features that might indicate underlying congenital abnormalities
BRUE low risk features
No concerning features in hx / exam AND
> 60 days of age
Born >32 weeks’ gestation and have a corrected age of >45 weeks (or approximately >2 months)
No CPR given by trained practitioner
<1 minute duration
First event
Corrected Age=
Chronological Age−Weeks of Prematurity
High risk BRUE patients investigations
ECG is to assess QT interval
Capillary gas is to assess blood glucose, bicarbonate and lactate to evaluate for metabolic disease
NPA is to assess for pertussis +/- RSV
Management of low risk BRUE patients
High risk
In practice, often are admitted for a period of cardio-vascular monitoring and to enable education and advice on BRUE for caregivers.
HIGH risk patients need referral to Paediatrics for a 24-hour period of monitoring +/- investigations.
Categorising asthma in children
Most common age for perthes disease
5-8yrs old
XR views for SUFE
AP and frog leg lateral views
Most common metabolic condition in neonates
Urea cycle disorders
which congenital lesions present in then neonatal period
duct dependant
5 categories for newborn emergencies
Sepsis
Metabolic
Cardiac
NAI
Surgical
organ involvement to consider in HSP
renal - do a urine dip
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Urogynae7
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Vascular13
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Mental health4
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Paediatrics46
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Medicolegal11
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Environmental23
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Respiratory30
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Orthopaedics / plastics61
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Trauma46
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Cardiology25
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Haematology16
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Toxicology25
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Ophthalmology28
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Endocrine and metabolic13
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Obstetric and gynaecology5
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Renal2
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Neurology23
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Maxfax7
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Upper limb / axilla90
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Gastroenterology / General surgery14
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Lower limb105
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Environmental8
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ENT4
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Procedures78
