An 8-year-old boy, Carlos, presents to ED with right ankle pain and swelling, with decreased range of motion. He is unsure of the mechanism of injury and thinks he may have rolled over his ankle. His mother tells you he has haemophilia…what do you do next? Haemophilia is a clotting factor deficiency Clotting factors are proteins in the blood that help control bleeding. When you bleed, your clotting factors form a blood clot. Haemophilia is a bleeding disorder due to low levels of a specific clotting factor. In Australia, haemophilia affects more males at 1 in 6000 to 10,000 than females at ..read more

Can’t get enough of Bubble Wrap? The Bubble Wrap Plus is a monthly paediatric journal club reading list from Anke Raaijmakers, working with Professor Jaan Toelen and his team at the University Hospitals in Leuven. This comprehensive list is developed from 34 journals, including major and subspecialty paediatric journals. We suggest this list can help you discover relevant or interesting articles for your local journal club or allow you to keep a finger on the pulse of paediatric research. This month’s list features answers to intriguing questions such as: ‘How useful is the antimicrobial lock ..read more

1 in 6 children lives in a conflict zone, exposed to ERWs (Explosive Remnants of War) or UXO (UneXploded Ordinance). Hargrave et al. (2019) trawled through over 70 papers and found that mortality from bomb and blast injuries in children is around 8%. Children have been dying in Iraq, Afghanistan, Syria, Gaza and most recently, Ukraine. Data from the Joint Theatre Trauma Registry in Afghanistan reveals the extent of the problem. In the six years between 2009 and 2016, 3746 children died and 7904 were injured as a result of explosive devices. 76% of these were boys. Most had more than one body r ..read more

14-year-old Charlie was diagnosed with T1DM last year. They present following a collapse during exercise and with an episode of hypoglycaemia. They have been losing weight but report this is due to training for a half-marathon, and you note that they have not been attending recent appointments. Eating disorders are almost twice as common in young people with Type 1 Diabetes (T1DM) than those without the condition. Sadly, approximately 30% of young people with T1DM have an eating disorder. Type 1 Diabetes with an eating disorder (T1DE), also called diabulimia, is when young people reduce or ..read more

A previously fit and well thirteen-year-old was admitted after a week of cough and fevers, followed by a twenty-four-hour history of worsening shortness of breath. She was initially treated as a possible asthma exacerbation with oxygen, nebulised salbutamol, ipratropium, intravenous magnesium, and aminophylline but she continued to deteriorate. She was intubated as an emergency when despite maximal therapy, she continued to desaturate and became increasingly obtunded. On intubation, copious amounts of red-tinged froth erupted from her ET tube. This was likely pulmonary oedema. An urgent bedsi ..read more

Our previous post introduced you to the normal and abnormal capnogram and the end-tidal carbon dioxide (ETCO2). In this post, we will dive deeper into the ETCO2 and explore how this relates to the clinically significant arterial partial pressure of carbon dioxide (PaCO2). Current guidance encourages using the ETCO2 as a stand-in for the PaCO2. However, the ETCO2 and PaCO2 do not always match, and the relationship between the two may not be as predictable as previously thought. How about a quick physiology primer? Before exploring the differences between PaCO2 and ETCO2, it is important to rec ..read more

With millions of journal articles published yearly, it is impossible to keep up.  Every month we ask some of our friends from PERUKI (Paediatric Emergency Research in the UK and Ireland) to point out something that has caught their eye. Article 1: Saline vs other fluids on PICU- how does it affect outcomes? Raman S, Gibbons KS, Mattke A, et al. Effect of Saline vs Gluconate/Acetate–Buffered Solution vs Lactate-Buffered Solution on Serum Chloride Among Children in the Pediatric Intensive Care Unit: The SPLYT-P Randomized Clinical Trial. JAMA Pediatr. Published online December 19, 202 ..read more

Lines and tubes are on every neonatal trainee’s wish list. This article is a guide to the size, location, and distance of insertion of neonatal lines and tubes. ENDOTRACHEAL TUBES (ETT) How big should they be? Laryngoscope blade: Miller size 1 for full term infant, Miller size 0 or 00 for preterm infants Where do I go? Between the vocal cords and into the trachea. Where do I stop? The ETT tip should be 1cm above the carina on X-ray (i.e. at T1-T2) Picture taken from: https://www.mdpi.com/2227-9067/8/5/324/htm LESS INVASIVE SURFACTANT ADMINISTRATION (LISA) CATHETERS How big should ..read more

You’re called to counsel the 36-weeker with abnormal dopplers and go to review the obstetric scans. Unfortunately, all you see are TLAs* and numbers. You try to make sense of it, but you can’t work out what’s going on—time to get a handle on umbilical dopplers in neonatology. *TLAs – three-letter acronyms Fetal Circulation Picture adapted from: https://www.cambridge.org/core/books/abs/placentalfetal-growth-restriction/fetal-arterial-and-venous-circulation-in-fetal-growth-restriction/C837078D9614A9A8E157C3338CE4F16D In order to understand what the dopplers mean, we need to understand the bas ..read more

5-year-old Damon scalded his chest after reaching up to grab a rather appealing hot chocolate. His Mum performed appropriate first aid and the injury was dressed and treated at their local minor injury unit. Unfortunately, Damon has been picking at the wound (a very bad habit). His Mum brings him to the emergency department two days later. He has a rash around the burn, fever, rigors and seems lethargic. Why worry about toxic shock with burns? Burns are common. Children are particularly vulnerable in the home. Children may be scalded (the most frequent cause), sustain a contact burn, or a fla ..read more