Cases in paediatric critical care transfer and retrieval medicine / edited by Shelley Riphagen, Sam Fosker.

Format:

Book

Contributor:

Riphagen, Shelley, editor.

Fosker, Sam, editor.

Language:

English

Subjects (All):

Pediatric emergencies.

Physical Description:

1 online resource (xviii, 323 pages) : digital, PDF file(s).

Edition:

1st ed.

Place of Publication:

Cambridge : Cambridge University Press, 2022.

Summary:

Critically ill paediatric transfers have expanded rapidly over the past ten years and, as such, the need for transfer teams to recognise, understand and treat the various illnesses that they encounter is greater than ever. This highly illustrated book covers a multitude of clinical presentations in a case-based format to allow an authentic feel to the transfer process. Written by clinicians with experience in thousands of transfers, it brings together many years of experience from a world-renowned hospital. Following the case from initial presentation, to resuscitation and referral and finally with the transfer itself; the book explores the clinical stabilisation, human factors decisions and logistical challenges that are encountered every day by these teams. Following the entire journey, this is an ideal resource for all professionals who may be involved in critical care transfer and retrieval medicine, particularly those working in paediatrics, emergency medicine, anaesthesiology, intensive care, or pre-hospital settings.

Contents:

Cover

Half-title

Title Page

Copyright Information

Contents

List of Contributors

Preface

The Service

The Book

List of Abbreviations

Chapter 1 Models of Care

Paediatric Critical Care Retrieval Services

Integrated or Independent

Choosing the Best Model

Chapter 2 Logistics and Organisation

Organisation

Logistics

Checklists

Data Quality and Audit

Chapter 3 Air Retrieval

Tasking an Air Retrieval

Rotary Transfer

Fixed Wing

Other Considerations

Landing Sites

Team

Parents

Flight Equipment

Extra Considerations

Pre-departure Checks

Patient Safety during Flight

Further Reading

Chapter 4 Improving Team Performance

The Retrieval Team

Medications Used on Transfer

Team Training

Retrieval Team

Local Referring Team

Chapter 5 I Like Children, but I Don't Fancy Intubating One . . .

Introduction

Prepare Equipment

Oxygenation

Intubation

Blades

Suction

Preparing for Difficulty

Monitoring

Prepare Drugs

Intubation Drugs

Ketamine

Propofol

Fentanyl

Rocuronium

Emergency Drugs

Post intubation Sedation

Prepare the Patient

Assess

IV Access

Optimisation

Position

Prepare the Team

Location

Assign Roles

Team Briefing

Checklist

Parental Presence

Post Intubation

Before Transfer

Debrief

Improving Safety

Chapter 6 Upper Airway Obstruction

1. What is the most likely underlying pathology and why is it important to consider this?

2. How would you anaesthetise this patient in order to safely secure her airway prior to transport?.

3. Following induction of anaesthesia, the infant becomes apnoeic. Direct laryngoscopy is attempted, but reveals no view of the glottis (Cormack and Lehane grade 4). Attempts at bag mask ventilation are unsuccessful. The infant begins to desaturate. How do you proceed?

Chapter 7 Just Bronchiolitis?

1. What management plan should you suggest to the referring team?

2. Before leaving to retrieve the child, you receive a call saying the child has been intubated but they are having difficulty with ventilation. How would you assess and manage this? What specific interventions should be carried out based on the X-rays sent to you?

3. When you arrive, the mother says she has two other children currently at nursery but needs to arrange care for them and can't the baby be treated locally? What would you explain to the mother?

Outcome

Chapter 8 Foreign Body Aspiration

1. What are the common issues around ingested/aspirated foreign bodies?

Chemical/Burn

Chronic Infective Foreign Body

2. Should this child be intubated prior to transfer and, if so, how should the intubation be undertaken?

Aspirated Foreign Body

Swallowed Foreign Body

Novel Techniques and Extra Considerations for Removal of Foreign Bodies

Non-pharmacological Methods of Keeping a Child Calm

3. Are there any child safeguarding issues to consider?

Management

Chapter 9 A Child with Facial Swelling

1. What are your primary concerns for the cause of this child's symptoms and radiological findings?

2. What are the potential respiratory and cardiovascular emergencies that arise due to mediastinal masses?

3. What are the prime considerations of management of children with this problem, including during transfer?

Summary

Chapter 10 Pneumonia and Empyema

Retrieval Call.

1. What is the background of pneumonia +/- empyema in this clinical context?

Complications of Pneumonia (including Para-pneumonic Effusion and Empyema)

2. What advice would you give the local team regarding the ongoing low blood pressure prior to intubating the child?

3. What issues on transfer might you face regarding ventilating this child?

Chapter 11 The Child with a Cough and Concerning White Cell Count

1. Given the above information, what concerns would you have with the child's current diagnosis and management?

2. Thirty minutes later, the referring team call to say the baby is now having significant colour changes when coughing. What would be your advice to the local team?

3. The parents have asked to speak to you. They are concerned as they overheard someone speaking about organ support and their other child also has a cough. What information do you need to communicate with parents?

Chapter 12 Worsening Stridor, to Intubate . . . or Not to Intubate

1. What advice would you give to the referring team about the management of the baby's airway as a forewarning call at 1 o'clock?

2. What advice would you give to the referring team about the management of the baby's airway in case of further deterioration?

3. If, as a retrieval team, you arrive at the above clinical scenario with a marginally improved clinical picture in an unintubated child, would you proceed with transfer and under what conditions?

Chapter 13 Difficult Asthma

1. What advice would you give to the referring team regarding this child's stabilisation?

2. What are the possible complications that may occur at stabilisation?

3. What approach would you take to mechanical ventilation in this patient on retrieval?.

4. What precautions would you take and what possible rescue measures might you consider/employ during retrieval?

Chapter 14 Transfer of Child with Pulmonary Hypertension

1. How might this patient's condition affect where you choose to transfer him and what treatment options might there be in PICU?

Pulmonary Hypertension

Treatment of Pulmonary Hypertension

2. What advice would you give the local team regarding the intubation of this baby, both from a clinical and human factor standpoint?

Preparing the Patient

Gather All Necessary Resources

Personnel and Anticipation of Problems

Intubation Plan

Chapter 15 A Blue Baby

1. What tests could be easily performed to help establish whether this baby is likely to have congenital heart disease (CHD)?

2. If CHD is suspected, what management principles should be applied?

3. When dealing with a baby with this condition what are the transport priorities?

Congenital Heart Disease

Chapter 16 A Shocked Blue Baby Who Won't Improve

1. What is the most likely diagnosis for this baby?

2. What measures can be taken prior to transfer to optimise the condition of this baby?

3. What information are you going to give to the parents?

Chapter 17 Under a Spell

1. What causes 'spelling' in Tetralogy of Fallot?

2. What would you advise the local team regarding the further management of the child?

3. When should the child be transferred to a paediatric cardiac centre?

Chapter 18 A Decline in Function

1. Is this an emergency and if so, what would you advise as initial management of this child?

2. What features are unusual in this setting and how would it alter your decision making?

Arrival of the Retrieval Team.

3. Based on the echo performed locally by the adult intensive care consultant, what advice would you give in terms of transfer, and what is said to the child and parents?

Chapter 19 Rash, Tachycardia and Irritability

1. The district general hospital team was seeking advice. They were unsure of how to proceed. How would you manage this referral?

2. Having clarified the situation, how would your structure your advice?

3. Following admission to PICU an ECG and echo performed shows small voltage complexes with some non-specific ST changes. Echocardiogram demonstrated significant globally reduced function with normal intracardiac anatomy and a small rim of pericardial fluid.' How would you tailor your therapy and investigations?

Chapter 20 Is the Baby's Heart Rate Supposed to Be Slower than Mine?

1. Should a bradycardic newborn baby be intubated?

2. What are the best methods to increase the heart rate when transferring a child and when should this be attempted?

Pharmacological Treatment

Non-pharmacological Treatment

3. Where is the best place for a baby with an antenatal diagnosis of complete heart block to be born?

Chapter 21 A Pale Lethargic Girl

1. What is the overwhelming clinical emergency in this child? What is your working differential diagnosis causing this emergency?

2. In this clinical emergency, how would you suggest resuscitating this child and what do you anticipate during resuscitation?

A: Airway

B: Breathing

C: Circulation

3. A 65-minute land transfer is required between the site of presentation at her local hospital and definitive management of this child. What precautions would you ensure are in place to manage the likely instability during transfer?

Chapter 22 Too Fast for Comfort.

1. When faced with a child with tachycardia, what should you consider?.

Notes:

Title from publisher's bibliographic system (viewed on 17 Dec 2021).

ISBN:

9781108944281

1108944280

9781108950510

1108950515

9781108946438

1108946437

OCLC:

1243908376