Cases in Paediatric Critical Care Transfer and Retrieval Medicine Full-Feature Download
Cases in Paediatric Critical Care Transfer and Retrieval Medicine Full-Feature Download
Medicine
Visit the link below to download the full version of this book:
https://medidownload.com/product/cases-in-paediatric-critical-care-transfer-and-
retrieval-medicine/
Edited by
Shelley Riphagen
Evelina London Children’s Hospital
Sam Fosker
Evelina London Children’s Hospital
University Printing House, Cambridge CB2 8BS, United Kingdom
One Liberty Plaza, 20th Floor, New York, NY 10006, USA
477 Williamstown Road, Port Melbourne, VIC 3207, Australia
314–321, 3rd Floor, Plot 3, Splendor Forum, Jasola District Centre,
New Delhi – 110025, India
103 Penang Road, #05–06/07, Visioncrest Commercial, Singapore 238467
www.cambridge.org
Information on this title: www.cambridge.org/9781108931113
DOI: 10.1017/9781108946438
© Cambridge University Press 2022
This publication is in copyright. Subject to statutory exception
and to the provisions of relevant collective licensing agreements,
no reproduction of any part may take place without the written
permission of Cambridge University Press.
First published 2022
v
vi Contents
Contributors
Michelle Alisio is a South-African trained paediatrician working at the Royal London
Hospital as a Senior Clinical Fellow in Paediatric Emergency Medicine (PEM). She is
currently assisting in creating an online PEM teaching programme with Don’t Forget the
Bubbles. Outside of work, she enjoys being in nature, travelling and music. She draws
inspiration from Nelson Mandela’s quote ‘There can be no keener revelation of a society’s
soul than the way in which it treats its children.’
Ariane Annicq is a paediatrician from Belgium who has specialised in paediatric intensive
care and retrieval medicine since 2014, having worked in a number of international models
of care. She became a consultant at the Evelina London Children’s Hospital in 2019. She is
continuing to develop the Paediatric Critical Care Advanced Practitioners Masters’ pro-
gram with Riphagen. Ariane has a special interest in point-of-care ultrasound (POCUS) and
is a POCUS trainer.
Fiona Bickell is currently the Lead Nurse for PICU and the South Thames Retrieval Service
at the Evelina London Children’s Hospital. She has been a paediatric intensive care nurse
for over 25 years and has a passion for retrieval and transport medicine. Her appointment
as Lead Nurse will enable her to enhance the experience of families in PICU and ensure the
development of PICU nurses of the future.
Louisa Brock is an Adult and Paediatric Emergency Medicine Consultant working in South
West London. She completed a year-long post Certificate of Completion Training second-
ment with South Thames Retrieval Service to gain more experience in retrieval medicine
and stabilisation of the critically unwell child. Prior to settling in London, she worked in
Emergency Departments in Wales, Manchester and South Africa and is grateful for the
varied and valuable experience these places have offered her. Away from work she enjoys
horse riding, triathlons and supporting Welsh rugby.
Jenny Budd is a paediatric intensive care nurse with 20 years of experience within this
speciality. Budd is a qualified Advanced Nurse Practitioner (ANP) and is the nursing lead
viii
List of Contributors ix
for ECMO at the Evelina London Children’s Hospital. She is proud to be part of an
outstanding team at Evelina and South Thames Retrieval Service. She hopes that this book
provides useful information for those undertaking paediatric retrieval.
Heather Burnett is an ANP working on PICU at the Evelina London Children’s Hospital,
and for the South Thames Retrieval Service. She previously worked on the PICU at St
Mary’s Hospital.
Emily Cadman is a final year paediatric emergency medicine trainee from London. She
studied in Bristol and started training in the south west. Early experiences in training gave
her a taste for retrieval and transport medicine and her younger self wishes this book existed
back then. As well as acute and emergency medicine, she interested in medical education,
ethics and law and is Vice-Chair of a London research ethics committee.
Anna Canet Tarres is a paediatrician from Spain who has been training in paediatric
intensive care since 2017. Since September 2019, she has been a PICU fellow at the Evelina
London Children’s Hospital and part of the South Thames Retrieval Service.
Michael Carter is an NIHR Academic Clinical Lecturer in Paediatrics at King’s College
London, and Sub-speciality Registrar in Paediatric Intensive Care and Retrieval Medicine at
Evelina London Children’s Hospital. He works in the Schools of Life Course Sciences, and
in Dr Shankar-Hari’s group (Immunology and Microbial Sciences) to investigate the
pathophysiology of severe inflammation following cardiac surgery and in sepsis. He aims
to take a ‘life course’ view of our patients in intensive care, acknowledging that the
consequences of each admission to an intensive care unit will have profound importance
for a patient’s long-term health.
Joanna Davies trained at the Nightingale School of Nursing. She has worked in PICU for
27 years and has been a Retrieval Nurse Practitioner (RNP) for South Thames Retrieval
Service for the last 14 years. She is co-author for Children in Intensive Care: a Survival
Guide, now on its third edition.
Elizabeth Daisy Dunn is a senior paediatric trainee, with a particular interest in high
dependency care in unwell children, simulation training and medical education. Having
been part of the team at the Evelina London Children’s Hospital Paediatric Intensive Care
Unit, she is now currently undertaking a Medical Education Fellowship in Paediatrics at St
George’s Hospital, and is also an honorary senior lecturer at St. George’s University of
London Medical School. She is heavily involved in both undergraduate and postgraduate
medical education and is herself undertaking a Postgraduate Certificate in Healthcare and
Biomedical Education. Having trained both within London and the surrounding area,
Dunn hopes this book will help to educate and inform all those involved in the care of
unwell children, thus helping to provide better care to the patients they treat.
Jo Dyer has been a paediatric intensive care nurse since 2000, training in Southampton
before joining the Evelina London Children’s Hospital PICU team in 2006. She qualified as
a RNP in 2014 and now works both as an RNP for South Thames Retrieval Service and a
Band 7 nurse on the PICU.
Miriam Fine-Goulden is a paediatric intensive care consultant at the Evelina London
Children’s Hospital, Guy’s & St. Thomas’ NHS Foundation Trust and South Thames
Retrieval Service for Children. She is an honorary clinical senior lecturer at King’s
x List of Contributors
College London. She trained in the UK at Cambridge University and at University College
London. She has written for The Science of Paediatrics: MRCPCH Mastercourse (Elsevier)
and co-edited Challenging Concepts in Paediatric Critical Care (OUP). Her specialist
interests include: ECMO, education, child mortality, healthcare policy and strategy and
medical communications. She tweets @finegoulden.
Xabier Freire-Gomez is a qualified paediatrician trained in Spain, pursuing a career in
paediatric intensive care. He has worked at the Evelina London Children’s Hospital PICU as
a senior fellow (ECMO and Airway Fellow) with a special interest in congenital heart
disease and mechanical ventilation, including non-invasive ventilation. He’s currently
working as a critical care retrieval consultant in Barcelona and is very excited about his
future job at RCHM PICU (Melbourne).
Benedict Griffiths is an intensive care and retrieval medicine consultant at the Evelina
London Children’s Hospital with South Thames Retrieval Service. He started his medical
career as a physiotherapist. He has an interest in fluid shifts in critical illness and paediatric
difficult airways.
Alexander Hall is a senior anaesthetic registrar with an interest in paediatric anaesthesia
and difficult airway management. He is currently undertaking his advanced paediatric
anaesthetic fellowship at the Evelina London Children’s Hospital. Hall has an interest in
peri-operative care and is completing a postgraduate diploma in anaesthesia and
perioperative medicine.
Christopher Hands trained in paediatrics and paediatric intensive care in London. He is a
clinical fellow in paediatric intensive care at Evelina London Children’s Hospital, and an
honorary lecturer in child health at the Liverpool School of Tropical Medicine.
Sara Hanna is a paediatric intensive care consultant at the Evelina London Children’s
Hospital. She is a Cambridge graduate and completed paediatric intensive care training at
Guy’s and St Thomas’ and Royal Melbourne Children’s Hospital. She is also Medical
Director of the Evelina London.
Sarah Hardwick works as an ANP in PICU at the Evelina London Children’s Hospital and
for South Thames Retrieval Service. She joined Evelina in 2000 and qualified as an ANP in
2009. Prior to this she worked in children’s and adult nursing in various settings after
qualifying in 1991.
Hannah Hayden is a UK-trained paediatric intensivist with an interest in organ donation,
retrieval medicine, global health and education. She has worked in many countries overseas
including teaching on ETAT+ Courses as well as Masters of Health Professions Education
in Somaliland with King’s Somaliland Partnership.
Sasha Herring began her nursing career in Australia and worked in PICU at the Royal
Children’s Hospital Brisbane. Since 1998 she has been at the Evelina London Children’s
Hospital, beginning her training as an RNP in 2003. Her area of special interest is the
continuing professional development of non-medical prescribers who are prescribing
for children.
Georgina Humble qualified as a paediatric nurse at Kingston University. Post qualifying
she started working in PICU at St George’s Hospital and after 7 years relocated to PICU at
List of Contributors xi
the Evelina London Children’s Hospital to undertake ANP training. She currently works as
a paediatric critical care ANP for South Thames Retrieval Service and in the PICU.
Paul James is South-African and British-trained doctor who has specialised in paediatric
anaesthesia and intensive care. His main areas of interest are paediatric airway manage-
ment, paediatric cardiac anaesthesia and ECMO. He also enjoys taking these skills outside
the UK and works for a number of charities including Healing Little Hearts, Chain of Hope
and Medical Education for Kenya. Outside work he is never off his bike or running up a hill
and enjoys long distance ultra-triathlons.
Rumiko King is an anaesthetic registrar at St. George’s Hospital in London with interest in
paediatric anaesthesia.
Dawn Knight. After nearly 11 years practicing as a corporate lawyer Knight qualified as a
children’s nurse in 2002 from Southbank University London. On qualification she joined
Evelina London Children’s Hospital and after a 1-year rotation, joined PICU where she
remains. She qualified as an RNP in 2013 and shortly after as a non-medical prescriber.
Since then she has consolidated this RNP role and developed as an ANP on PICU.
Jon Lillie is a paediatric intensivist and ECMO lead at the Evelina London Children’s
Hospital. Having worked across six PICUs and three ECMO centres, he has realised that
there are different valid approaches to the same problem and dogma prevents improvement
within paediatric critical care. The right answer is not always offered by those that shout the
loudest and there may not even be a ‘right’ answer. Through research and teamwork, he
hopes to enjoy the next 20 years, improving care and knowledge within the speciality. He
tweets @DrJonLillie.
Kenneth MacGruer is a final year paediatric intensive care medicine (PICM) trainee. After
studying in Edinburgh, he trained in paediatrics in Manchester and Melbourne before
starting PICM in Evelina London Children’s Hospital.
Marilyn McDougall completed her paediatric training in Cape Town, South Africa and
now works as a full-time paediatric intensive care consultant at the Evelina London
Children’s Hospital and South Thames Retrieval Service. She is the Clinical Director of
the South Thames Paediatric Network and an honorary senior lecturer at Kings College
London. She enjoys teaching and has developed a particular interest in simulation educa-
tion. She co-authored Children in Intensive Care: A Survival Guide, now in its third edition
and published by Elsevier in 2018.
Federico Minen is an Italian-trained paediatrician who moved to the UK to specialise in
paediatric intensive care. Currently a senior fellow in the Evelina London Children’s
Hospital paediatric intensive care, he has a special interest in cardiac diseases, airway
management and procedural sedation.
Andrew Nyman is a paediatric intensive care consultant at the Evelina London Children’s
Hospital, Guy’s & St. Thomas’ NHS Foundation Trust and South Thames Retrieval Service
for Children. He is an honorary clinical senior lecturer at King’s College London. He
obtained his medical training in South Africa and completed paediatric specialisation in
the UK, with further subspecialty training in Australia. His specialist interests include:
bronchoscopy and airway pathology, ECMO, clinical research and health informatics.
xii List of Contributors
Juan Ramon Valle Ortiz completed paediatric training in Spain and is currently working in
paediatric intensive care and anaesthesia.
Maja Pavcnik is a paediatric intensive care consultant at the Evelina London Children’s
Hospital, Guy’s & St. Thomas’ NHS Foundation Trust, and South Thames Retrieval Service
for children. She is from Slovenia and has worked in a number of international models of
care. Her specialist interests include: education, retrieval medicine and child mortality.
Joanne Perkins is a consultant in paediatric intensive care and in paediatric anaesthesia at
the Evelina London Children’s Hospital. She completed medical training in Ireland and
came to London to complete post-Certificate of Completion Training fellowship in paedi-
atric intensive care. Her areas of interest include audit, education and medicine safety.
Alison Pienaar has worked as a consultant in paediatric intensive care at the Evelina
London Children’s Hospital Guy’s and St Thomas’ Foundation Trust and South Thames
Retrieval Service from 2013. She is an Honorary Clinical Senior Lecturer at King’s College
London. She completed her training in South Africa and her areas of clinical interest
include transport medicine, extracorporeal life support and patient safety.
Catia Pinto is currently training to become an ANP at the Evelina London Children’s
Hospital. She started her intensive care training in an adult cardiac intensive care unit where
she developed an interest in congenital heart disease. She later specialised in a PICU at
Great Ormond Street Hospital before moving to Evelina in 2019 to start her ANP training.
Livia Procopiuc is a German trainee in anaesthesia and adult intensive care currently
pursuing an out of programme Fellowship in Paediatric Intensive Care at the Evelina
London Children’s Hospital and the South Thames Retrieval Service.
Emma Prower is a senior registrar in Intensive Care Medicine based at Kings College
Hospital. She has a particular interest in intensive care outreach and the deteriorating
patient.
Maria Gual Sanchez studied medicine in Barcelona and then moved to Madrid (Hospital
Universitario La Paz) for her paediatric training. The last part of her training was focused
on the critically ill child. Since September 2019 she has been a PICU fellow in Evelina
Children’s Hospital and part of the South Thames Retrieval Service.
Ain Satar is a trainee paediatrician working in the Evelina PICU. As part of her training she
is developing a particular interest in allergy, simulation and high dependency care. Satar is a
passionate educationalist currently completing a Postgraduate Certificate in Medical
Education, and is active in both undergraduate and postgraduate education in London.
Caroline Smith is a maxillofacial clinical fellow at the Royal London Hospital having
worked previously in other maxillofacial teams and dental practice. She is a Dental
Officer in the British Army and has a Masters in Humanitarianism and Conflict Response.
Emma Smith is a senior paediatric registrar who has trained at a number of central London
hospitals including Evelina Children’s Hospital, where she spent a year working on PICU
and as part of the South Thames Retrieval Team. She has a special interest in paediatric high
dependency care as well as simulation.
List of Contributors xiii
Nav Somasinghe is an adult nephrology and intensive care medicine trainee with an
interest in retrieval medicine and pre-hospital care.
Karen Starkie is a paediatric, intensive care nursing sister based at the Evelina London
Children’s Hospital. She has been retrieving for over 17 years and is currently the South
Thames Retrieval Service Co-ordinator.
Rosalie Summers is a Highly Specialist Paediatric Respiratory Physiotherapist who has
worked within Evelina London Children’s Hospital and its PICU since 2005.
Physiotherapists are an integral part of the PICU team within Evelina and Rosalie feels
confident this improves patient care. She has a keen interest in using her knowledge of
ventilation and physiotherapy techniques to treat critically unwell children often at the
point of admission. She has led work developing an online learning package to assist in
training her physiotherapy colleagues and the wider multidisciplinary team, ensuring
effective quality care for all.
Tanmay Toteja is a paediatric intensive care trainee presently at the Royal Brompton
Hospital, London. He trained as a paediatrician in New Delhi, India and then in London
at the Imperial College NHS trust and the Evelina London Children’s Hospital. Initially
trained in neonatal intensive care, he is currently pursuing PICM training. He has a keen
interest in medical education, simulation learning (part of the London School of Paediatrics
simulation programme), cardiac intensive care and retrieval of sick children.
Olga Van Der Woude is an anaesthetist from the Netherlands who moved to the UK after
completing her specialist training in Utrecht, the Netherlands. She specialised in paediatric
anaesthesia at Royal Manchester Children’s Hospital and currently is a Senior Clinical
Fellow in Paediatric Cardiac Anaesthesia and Intensive Care at the Evelina London
Children’s Hospital.
Gareth Waters is a UK PICM Grid trainee, currently working on PICU at the Evelina
London Children’s Hospital. His background is in anaesthesia, and he trained in the Oxford
Deanery, after having studied medicine at the University of Oxford.
Abi Whitehouse is a general paediatric registrar with special interests in both respiratory
and HDU medicine. She enjoys cycling, walking and sewing alongside completing her
paediatric training. Whitehouse also has a keen research background, with a PhD in
paediatric respiratory medicine and ongoing research projects looking at interventions to
prevent the health effects associated with air pollution exposure.
Alex Williams is an ANP. He works at Evelina London Children’s hospital on Paediatric
Intensive Care and South Thames Retrieval Service. He has worked in PICU since 2010.
Preface
The Service
The South Thames Retrieval Service (STRS) is a paediatric emergency inter-hospital
transfer service for critically ill children. Integrated within the Paediatric Intensive Care
Unit (PICU) at the Evelina London Children’s Hospital (ELCH), it operates two retrieval
teams 24/7 all year round.
STRS is the hub of a Paediatric Critical Care Network for South London and the South
East of England, serving 20 district general hospitals in the region and three network PICU’s
in South London at the Evelina, St George’s Hospital and Kings College Hospital.
STRS supports the care of children presenting critically ill to their local hospitals from
the first referral call until resolution of the case. This support is facilitated through a
dedicated phone line. The calls are taken by doctors (PICU fellows) or paediatric critical
care retrieval advanced nurse practitioners, who are able to take details of the referral and
provide immediate advice to referrers. Calls are then triaged by the responsible retrieval
consultant, with additional resuscitation and stabilisation advice to the local team. The
STRS team is dispatched to undertake the transfer, as soon as it is ascertained that the child
will need ongoing critical care and it is necessary to transfer the child.
Over the past 20 years, STRS has transferred between 500 and 1000 children per annum,
rapidly rising from lower levels in the year 2000 to current numbers. This has provided a
huge number of interesting and challenging cases of very sick children, many of which are
expanded in this book.
The Book
Learning from personal and from other’s experience is a fundamental learning tool
in medicine.
The aim of this book is to use challenging cases in the management of critically ill
children, from presentation to transfer and admission to PICU to identify key learning
from others’ experience. It provides an opportunity to participate in the resuscitation,
stabilisation and transfer virtually, without the stress associated with having the critically
ill child and distressed family in front of you. It provides an opportunity to consider how
you would have done things, perhaps differently, and review what was done. It has the
benefit of seeing the case through from start to finish, so that personal management
strategies applied can be reviewed without impact to the child. It also gives opportunity
to learn from the good practice or insight of others and to take this learning forward, to
ensure that the next child with similar presentation has the best outcome.
xv
Abbreviations
(D+) HUS Diarrhoea positive haemolytic uraemic syndrome
AKI Acute kidney injury
ALL Acute lymphoblastic leukaemia
ALT Alanine aminotransferase
AML Acute myeloid leukaemia
APLS Advanced Paediatric Life Support
APTT Activated partial thromboplastin time
APTTR Activated partial thromboplastin time ratio
ARDS Acute respiratory distress syndrome
ASD Atrial septal defect
AV Atrioventricular
AVNRT Atrioventricular node re-entry tachycardia
AVPU Alert, verbal, pain, unresponsive
AVRT AV re-entry tachycardia
BE Base excess
BNP Brain natriuretic peptide
BP Blood pressure
BPD Bronchopulmonary dysplasia
Bpm Beat per minutes
BSPED British Society of Paediatric Endocrinology and Diabetes
BTS British Thoracic Society
BVM Bag valve mask ventilation
CATS Children’s Acute Transport Service
CDH Congenital diaphragmatic hernia
CHD Congenital heart disease
CNS Central nervous system
CO Cardiac output
CPAP Continuous positive airway pressure
CPAP/BiPAP Continuous/bilevel positive airway pressure
CPR Cardiopulmonary resuscitation
CRP C-reactive protein
CrUSS Cranial ultrasound
CSF Cerebrospinal fluid
CT Computed tomography
CVVH Continuous veno-venous haeomofiltration
CXR Chest X-ray/radiograph
DBD Donation after brain death
DCD Donation following circulatory death
DGH District general hospital
DKA Diabetic ketoacidosis
DNAR Do not attempt cardiopulmonary resuscitation
DOPES Displacement, obstruction, pneumothorax, equipment, stomach
xvi
List of Abbreviations xvii
ECG Electrocardiogram
ECMO Extracorporeal membrane oxygenation
ENT Ear, nose, throat
ESR Erythrocyte sedimentation rate
ETCO2 End-Tidal Carbon Dioxide
ETT Endotracheal tube
FiO2 Fraction of inspired oxygen
GAS Group A Streptococcus
GCS Glasgow Coma Scale
HDU High dependency unit
HFNC High flow nasal cannula
HFOV High frequency ventilation
HIE Hypoxic ischaemic encephalopathy
HR Heart rate
HUS Haemolytic uraemic syndrome
ICP Intracranial pressure
INR International Normalized Ratio
IV Intravenous
IVIG Intravenous immunoglobulin
LMA Laryngeal mask airway
MAP Mean airway pressure
MAS Meconium aspiration
MCCD Medical Certificate of Certification of Death (usually referred to as ‘death
certificate’)
MHI Manual hyperinflation
MRI Magnetic resonance imaging
MRSA Multi-resistant Staphylococcus aureus
NBP Non-invasive blood pressure
NDMA N-methyl-D-aspartate receptor
NICE National Clinical Institute of Excellence
NICU Neonatal intensive care unit
NIV Non-invasive ventilation
NPIS National Poisons Information Service
NSAID Non-steroidal anti-inflammatory drug
ODT Organ donation team
OPA/NPA Oropharyngeal/nasopharyngeal airways
OSI Oxygen saturation index
OI Oxygenation index
PALISI Paediatric Acute Lung Injury and Sepsis Investigators
PaO2 Partial pressure of oxygen
pCO2 Partial pressure of carbon dioxide
PCR Polymerase chain reaction
PCT Procalcitonin
PDA Patent ductus arteriosus
PEEP Positive end-expiratory pressure
PEG Percutaneous endoscopic gastrostomy
PFO Patent foramen ovale
xviii List of Abbreviations