Aims: As Paediatric Emergency Departments (PED) become busier the number of children requiring painful procedures continues to increase. We aimed to evaluate a locally developed paediatric procedural sedations (PPS) service using ketamine for safety, efficiency and efficacy in the context of the national 4 hour operational target which is due to be revised this year in the UK Methods: We enrolled consecutive patients over 12 months suitable for PPS ketamine and collected data for demographics, time to patient identification, time to ketamine administration, procedural duration and time to recovery. We also documented procedure outcome, adverse events, consent, ketamine dosage and baseline physiological observationsResults: From May 2017 to May 2018 ketamine PPS was performed on 36 patients with a mean age of 7 years (range 1.8 to 14.6 years). The most common procedure performed was manipulation of forearm fractures (n=21, 58%), followed by facial laceration repair (n=10, 28%). Total intravenous Ketamine dosages were; 1mg/kg (n=23, 64%) 1.5mg/kg (n=10, 28%) and 2mg/kg (n=3, 8%). Average time to referral to surgical speciality was 33 minutes which improved from 40 minutes (pre Sept) to 27 minutes (post Sept). Average time to ketamine administration was 168 minutes, improved from 185 minutes (pre Sept) to 155 minutes (post Sept). The average time taken to complete procedures, all under 20 minutes, also decreased from 19 minutes (pre Sept) to 10 minutes (post Sept) averaging 15 minutes overall. The recovery time was similar throughout the study period. The overall average length of stay (LOS) was 284 minutes, improved from 297 minutes (pre Sept) to 274 minutes (post Sept) figure 3. 20 (55%) of the 36 patients breached the 4 hour target. 10 (28%) patients were admitted, 9 for further neurovascular observations and only 1 where the outcome of a procedure was unsatisfactory. There were no seminal untoward incidents in our study. Vomiting occurred in 4, there was 1 drug error and one patient required brief airway manoeuvres for decreased oxygen saturations Conclusion:We have confirmed PPS ketamine service to be safe and further demonstrated good outcomes in procedures carried out. Despite improved efficiency in the study period the average LOS still falls outside the 4 hour target and a revision would be welcomed to reduce anxiety related to breaches in this group and encourage more uptake of PPS ketamine nationally
There are increasing numbers of refugee and asylum-seeking children entering the UK annually who face significant barriers to accessing healthcare services. Clinicians working in the emergency department should have an awareness of the journeys children may have taken and the barriers they face in accessing care and have a holistic approach to care provision. We conducted a narrative literature review and used experiential knowledge of paediatricians working in the Paediatric Emergency Department to formulate a step-by-step screening tool. We have formulated a step-by-step screening tool, CCHILDS (Communication, Communicable diseases, Health—physical and mental, Immunisation, Look after (safeguarding), Deficiencies, Sexual health) which can be used by healthcare professionals in the emergency department.Conclusion: Due to increasing numbers of refugee and asylum-seeking children, it is important that every point of contact with healthcare professionals is an impactful one on their health, well-being and development. Future work would include validation of our tool. What is Known: •The number of refugees globally are rapidly increasing, leading to an increase in the number of presentations to the PED. These patients are often medically complex and may have unique and sometimes unexpected presentations that could be attributed to by their past. There are a multitude of resources available outlining guidance on the assessment and management of refugee children. What is New: •This review aims to succinctly summarise the guidance surrounding the assessment of refugee children presenting to the PED and ensure that healthcare professionals are aware of the pertinent information regarding this cohort. It introduces the CCHILDS assessment tool which has been formulated through a narrative review of the literature and acts as a mnemonic to aid professionals in their assessment of refugee children in the PED.
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