The objective of the paper is to share our experiences using a Therapy Dog in our service and to demonstrate the benefits it can bring to patients and staff.Animals can play a valuable part in alleviating stress in many situations. Paediatric Intensive Care Medicine poses a unique set of challenges, not only in terms of clinical management but also in terms of the amount of emotional support that patients, their families and staff members require. The North West and North Wales Paediatric Transport Service (NWTS) is a specialised team that deals with the stabilisation and transfer of critically ill children. Communicating with families during transit and after arrival to PICU can be challenging, clinical information needs to be relayed during a very stressful period. To address this problem, we have produced a photo book for families to read to their children. It tells the story of a curious pug, Alfie, who is invited to join the NWTS team to find out what happens when a child is ill and needs to go to intensive care.Alfie is a therapy dog registered with Pets As Therapy UK, he has been assisting the critical care team in communicating with children and their families. He also has sessions whereby staff members who need help and support coping with stressful situations can spend time with him. Alfie also frequently visits the PICU and wards at the Royal Manchester Children’s Hospital and offers support to numerous children undergoing treatment.In order to assess how the information booklet was perceived and the impact that Alfie’s sessions have had on individuals we handed out feedback questionnaires to families and staff. The feedback was universally positive, leading to the conclusion that a registered therapy animal can be beneficial to both staff and patients in a PICU setting.
Centralisation of children’s services in the UK has decreased exposure of district general hospital (DGH) emergency department staff to paediatric airway management, especially in critically ill children. Regional Retrieval Teams such as the North West and North Wales Paediatric Transport Service (NWTS) provide advice and support but cannot be considered as the primary difficult airway management team leading to challenging scenarios, particularly for DGH teams managing patients with predicted or known difficult airways. Early recognition of the difficult airway is vital in decreasing morbidity and mortality, and anxiety for those involved. Prompt assembling of a competent multidisciplinary team in the emergency department, with appropriate equipment, drugs, monitoring as well as planning for failure or deterioration represents a major challenge.The difficult airway is the clinical situation in which a conventionally trained anaesthetist experiences difficulties with facemask ventilation, tracheal intubation, or both. Difficult intubation occurs approximately 0.42% in all elective paediatric tertiary intubations. Of these 0.08% occur in healthy children, increasing to 0.24% in the under ones. Difficult mask ventilation occurs in approximately 0.02%. Can’t intubate can’t ventilate situations occurs1 in 10–50,000 in adults. Paucity of published data on incidence of difficult airway during emergency intubation for respiratory failure is unknown, but likely to be significantly higher. NWTS data revealed 11.2% incidence of grade 2 or above laryngoscopy (357 intubations of critically sick 1–5 year olds); and in under 2 year olds 21% complication risk such as hypotension or hypoxia.We describe 8 cases referred to North West and North Wales Paediatric Transport Service (NWTS) from different emergency departments across the North West of the UK, that highlight importance of anticipating problems managing paediatric airways, and the proposed regional difficult airway and intubation guideline.The guideline highlights the importance of alternative plans required to ensure a successful outcome. Equipment and monitoring ideally should be standardised across all hospital departments where a critically sick child/neonate may present. Education and regular training in airway management reduces the risk of paediatric airway difficulties. Regional paediatric intensive care transport teams can facilitate access to specialist equipment and transfer to tertiary specialised units when required.
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