Things We Like This Month – November
November is here. Last year, I distinctly remember my arrival on CAU being heralded by a familiar honking sound. Was I in the wrong place? Had I accidentally walked into Sea World? No, just every child in the greater Norfolk area had croup. My well-constructed plan of sealing the doors and fumigating the department with budesonide fell on deaf ears though, and we just rattled through, with a bucket of dexamethasone at the front desk.
This year, however, we don’t seem to have that. I almost miss it. Almost. And, with Lockdown II: Electric Boogaloo in full effect, there is seemingly little to fill our evenings. But fear not! If you find yourself at a loose end, why not settle down and drift through our Things We Like This Month – our monthly(ish) round up of our favourite things from around the Web!
Journal articles we like
Petechiae in Children: The PiC Study
To paraphrase Damian Roland at DFTB19: every benign diagnoses in paediatrics has a sinister twin. Uncomplicated URTI and sepsis. Innocent murmur and pathological cardiac disease. Bronchiolitis and myocarditis.
Benign fever with non-blanching rashes and meningococcal disease are one of those twins. We know we overtreat them. Mostly, we accept that, because meningococcal disease still carries a very significant burden of disease and disability. However, the guidelines that we refer to are based on data collected before widespread meningococcal vaccination was introduced. So, excitingly, in the first large-scale study in a post-vaccination era, we can get a peek at just how good those guidelines are at separating the wheat from the chaff. Bottom line: NICE vastly overtreats, tailored local guidelines do better, and teaching should be more targeted towards purpura, rather than blindly treating every fever with a non-blanching spot. Watch this space for a full write up soon.
Prescription of acid inhibitors in infants: an addiction hard to break
Prescription of acid inhibitors is a topic that we have covered here before, and remains a divisive one in the paediatric community. Their effects are pharmacologically sound, but have never been proven effective in the treatment of troublesome symptoms of GORD. I had rather hoped that the worldwide shortage of ranitidine might force us back to the excellently written and practical recommendations in the ESPGHAN guidelines, however, they are still prescribed in droves. If you are finding it difficult to break up with omeprazole, this editorial piece sets out, in a well written manner, why you should probably put it back on the shelf for now.
#FOAMed we like
SVT vs VT on ECG – A LITFL ECG Basics guide
This month has seen a larger than normal number of ECGs floating past my eyes on CAU. This is fine, because I actually happen to like ECGs…most of the time. Sometimes however, ECGs can look a little troublesome. Apropos to nothing, I found myself delving a little deeper into common pathological ECGs and their mimics. As ever, the granddaddy of them all, and the father of FOAMed, LITFL has the review I wanted, this time looking at broad complex tachycardias, and differentiation between VT and SVT with aberrancy.
The fallacy of time-to-intervention studies – Josh Farkas via PulmCrit
Though we are probably unaware of it, a not-insignificant amount of medical guidelines are based on time-to-intervention studies. The most visible of those on a day to day basis is the Surviving Sepsis campaign, and the recommendation of administration of antibiotics within an hour of diagnosis. This recommendation is largely based on a study by Kumar et al, which showed that for every hour after shock sets in in sepsis, mortality increases by 8%. Pretty convincing stuff, no?
In another excellent article by Josh Farkas, he explains the fallacy behind time-to-intervention trials, and why the interpretation of their data is much more difficult than meets the eye on initial inspection.
YouTube we like
Paediatric Emergencies 2020 Conference
A new segment for sure, as we often save this spot for podcasts. However, a favourite podcast of ours delivered content via Youtube, so I guess we’ll go with it. The entirety of the Paediatric Emergencies 2020 conference is available above. A wealth of great speakers from the Pediatric ED and PICU world, the talks here on stabilisation and transfer of our sickest patients will arm you with the knowledge to keep the most vulnerable patients we have safe.