1. Junior Doctor Induction Emergency Departments ARI / RACH
Working in the RACH
Junior Doctor Induction
Emergency Departments ARI / RACH
Gareth Patton 03/07/15 Updated 04/08/2016

2. They are just little adults…

3. 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

4. Staffing Weekday OOH Nursing Staff Duty Consultant 0800 – 1600
Late Consultant – 0000 (In Adults)
Registrar – 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

5. Typical Day 0800 Handover 0830 Virtual # Clinic 0900 Ward Round
1400 ED Review Clinic (Tue & Fri)
1530 Ward Round
1600 Handover
0000 Handover

6. 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

7. 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

8. Injury Follow-Up Wounds Fractures Practice Nurse
ED Nurses Clinic Daily
Fractures
Virtual Fracture Clinic* Daily (0830)
ED Doctors Clinic Tues & Fri ( )
Limping Child Clinic Tues & Fri (1000)
Orthopaedic # Clinic
*All X-Rays are reviewed be they +ve & -ve

9. Referrals All Referrals should be discussed with a senior
Medical Paediatrics
Paediatric Ortho
Paediatric Surgery
Other Specialties as per Adult

10. 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

11. PAU: ED Patients Admit to PAU for Observation / Treatment
Head Injuries
Mechanism of Injury
Toxicology
Psychiatry (pending assessment)
Age Ranges
Think about distance

12. PAU Admissions Need admission documents
Admission Pack
Proforma for Toxicology and HI
Kardex
With a written plan for observations, investigations and review times

13. ?

14. CHILD PROTECTION

15. 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

16. 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

17. 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

18. ?