Dr Kee Wei Phang, Paediatric Emergency Medicine Grid Trainee, Dr Miriam Fine-Goulden, PICU Consultant My first experience of organ donation as a paediatric trainee was whilst working in PICU with a patient who sadly died, and I was asked to call the SNODs. SNODs? I had no clue – until a helpful senior PICU fellow explained that they were Specialist Nurses in Organ Donation. SNODs. They form part of the specialist team under the NHS Blood and Transplant service which manages donation, storage and transplantation of blood, organs, tissues, bone marrow and stem cells. In May 2020, the law concer ..read more

Dr Jonathan Round, PICU Consultant If you haven’t read it yet, you might want to start with Part 1 – click here The CVVH circuit Starting with the circuit (figure 1) used in almost every situation for CVVH, blood is taken out and returned using a large bore double lumen catheter. This could be a temporary cannula sited using a Seldinger technique or a permanent catheter. Its most important attribute is its ability to handle high blood flow rates. The more blood that passes through the filter, the faster its chemistry can be corrected. Flow rates of below 90 ml/min are not much use even for an ..read more

Dr Jonathan Round, PICU Consultant You may be reading this out of interest or more likely because you’re about to look after a patient on CVVH. This pair of articles (click here for part 2) will first go over what it is, then how to use it to manage a patient on CVVH. In Part 2, we will look at why you might want to use CVVH and how to get it going. If this seems a little backwards that’s because this article is written as “just-in-time” piece for those situations where one suddenly needs to have a small degree of understanding and ability. This is not intended to be exhaustive account of CVVH ..read more

Dr Jonathan Round – PICU Consultant When I left my first spell in neonatal training, I thought there were just two inotropes – dopamine and dobutamine. There was a myth of another agent called adrenaline and the even more elusive noradrenaline, but no one seemed to survive after these drugs. Later, in ICU training, I came across strange agents that I could not even spell, before working out the simple and the basic principles that have helped me and my patients ever since. Fundamentally, inotropes are properly dangerous drugs, and should only be used if you and the rest of the team know what t ..read more

Before calling your local retrieval team when you have a sick child, take a few moments to organise yourself: Getting this right will make everything more straightforward for you, the rest of your team, the transport service, and most importantly the child. Have you spoken to your consultant? Updated them on the situation? Asked for their advice? Are they coming in? It is essential to discuss a child with your consultant before calling a retrieval service, they are ultimately responsible for that child’s care and will be able to offer practical advice and support. Do you have all the relevant ..read more

Dr Niha Peshimam, Dr David Cox; Illustrations Dr Simone Paulson You are called to see an hour-old old term baby in the delivery suite with respiratory distress. You arrive to find a dusky, blue-tinged baby with significant respiratory distress. There is meconium staining of the skin and umbilical cord. You start face mask oxygen and call for help. Your consultant asks, do you think this could be PPHN? Persistent pulmonary hypertension of the newborn (PPHN) is a relatively common condition that we treat in NICU. It’s often used as a diagnosis, but if we’re going to be more accurate, it actual ..read more

Dr Hannah Wood, Dr Melody Bacon, Dr Louise Hartley What is ADEM?  ADEM is a rare, inflammatory, neurological disorder seen in children and young adults. It also has associations with chronic conditions like multiple sclerosis. These patients usually present a few weeks after an upper respiratory tract infection with confusion, headache and sudden onset neurological symptoms. ADEM can be tricky to diagnose – hopefully this article will help you to identify and treat it. Who gets ADEM?  ADEM usually seen in children between 5 and 8 years old. Boys are affected slightly more often than ..read more

Dr Constantinos Kanaris, PICU and retrieval consultant; @DrKanaris This blog is written with an aim to dispel the myth that 0.9% saline is superior to Hartmann’s solution (or indeed any other balanced solution). A common justification to this is that saline has no potassium yet balanced solutions have some potassium in them and therefore are “better for the patient”. This justification does not hold any water, either medically or physiologically. This is why: Q1. How much K+ do Hartmann’s and 0.9% Saline solutions contain respectively? (click arrow to right to reveal answer) a) 3mmol/L  ..read more

Manette Ness-Cochinwala, Buvana Dwarakanathan Traumatic brain injury (TBI) is one of the top causes of morbidity and mortality in paediatrics. In the UK, head injury is the most common cause of death and disability in people aged between 1-40 years old. There are 1.4 million A&E visits in England for head injury each year and between one third and one half of these are for patients under 15 years old. That’s huge! Unlike other types of injuries, like a broken arm, where the majority of the damage occurs at the time of injury, further brain damage can occur after the time of injury through ..read more

Essential reading for anyone who is about to start their first PICU rotation Basics of Ventilation   Inotropes Made Simple   Ventilation strategies for the critically ill asthmatic   Diabetic Ketoacidosis: Principles behind Protocols ..read more