Junior Doctor Induction Emergency Departments ARI / RACH Working in the ED @ RACH Junior Doctor Induction Emergency Departments ARI / RACH Gareth Patton 03/07/15 Updated 04/08/2016
They are just little adults…
The Department Resus Treatment Area 2 Bays Attached to Adult Resus Trauma / Arrest / ‘Sick’ Treatment Area 9 Treatment Rooms; 3 Bays 8 & 9 Larger ABC Equipment in 8 & 9
Staffing Weekday OOH Nursing Staff Duty Consultant 0800 – 1600 Late Consultant 1600 – 0000 (In Adults) Registrar 0800 – 1800 Late Registrar 1600 – 0030 OOH FY/ST with Senior in Adults Nursing Staff All very experienced and have vast array of knowledge and skills
Typical Day 0800 Handover 0830 Virtual # Clinic 0900 Ward Round 1400 ED Review Clinic (Tue & Fri) 1530 Ward Round 1600 Handover 0000 Handover
What do we see? Injuries: Medical and Surgical Presentations Head Injuries Limb Injuries Medical and Surgical Presentations Difficulty in breathing / Wheeze Pyrexia Abdominal Pain Toxicology Trauma Cardiac Arrest
Injuries A whole talk in itself... Shop floor exposure Steep learning curve Nurses / Seniors will guide Variety of Patient Information Leaflets Have a read yourself! Folder on how to treat common # All hand injuries that need specialist input go to Plastics Please Please Please Ask! Beware: Pain Management Prescribing The Limping Child Vermillion Borders Wound Closure Returning patients to be reviewed by senior
Injury Follow-Up Wounds Fractures Practice Nurse ED Nurses Clinic Daily Fractures Virtual Fracture Clinic* Daily (0830) ED Doctors Clinic Tues & Fri (1400-1600) Limping Child Clinic Tues & Fri (1000) Orthopaedic # Clinic *All X-Rays are reviewed be they +ve & -ve
Referrals All Referrals should be discussed with a senior Medical Paediatrics Paediatric Ortho Paediatric Surgery Other Specialties as per Adult
Resus YOU WILL NOT BE ALONE 2222 Call for Paediatric Arrest Anaes / Paeds / Nursing / ED 2222 for Paediatric Code Red/Trauma Call 2222 for Paediatric Major Haemorrhage Protocol WETFLAG / Resus Cards You will have simulation training during induction
PAU: ED Patients Admit to PAU for Observation / Treatment Head Injuries Mechanism of Injury Toxicology Psychiatry (pending assessment) Age Ranges Think about distance
PAU Admissions Need admission documents Admission Pack Proforma for Toxicology and HI Kardex With a written plan for observations, investigations and review times
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CHILD PROTECTION
Think About Child Protection Presents in a variety of ways Not only physical abuse Emotional Neglect Sexual Red Flags: Delayed Presentation Inconsistent History Injury not in keeping with developmental age Interactions IF YOU DON’T THINK ABOUT IT YOU WILL MISS IT
Important CP Points Documentation Draw Pictures Social History Who said what State facts If you speak to anyone Record - Name / Role / Time / Discussion / Contact Details Draw Pictures Social History Who’s at home Other children who could be at risk
DO NOT CONFRONT ANYONE UNLESS CHILD IS AT IMMEDIATE RISK What do you do? Discuss with Senior Staff Ask Nursing Staff regarding their interactions Discuss with Services (SW, HV, Midwife, GP) ‘Yellow Box’ Discuss with Child Protection Team / Paeds Reg (OOH) Check CP Register DO NOT CONFRONT ANYONE UNLESS CHILD IS AT IMMEDIATE RISK
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