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The document is a comprehensive guide titled 'Cases in Paediatric Critical Care Transfer and Retrieval Medicine,' edited by Shelley Riphagen and Sam Fosker, focusing on various critical care scenarios involving children. It includes contributions from numerous experts in the field and covers topics such as logistics, airway management, and specific medical cases. The publication aims to provide valuable insights and knowledge for healthcare professionals involved in paediatric retrieval and critical care.
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0% found this document useful (0 votes)
44 views16 pages

Cases in Paediatric Critical Care Transfer and Retrieval Medicine Full-Feature Download

The document is a comprehensive guide titled 'Cases in Paediatric Critical Care Transfer and Retrieval Medicine,' edited by Shelley Riphagen and Sam Fosker, focusing on various critical care scenarios involving children. It includes contributions from numerous experts in the field and covers topics such as logistics, airway management, and specific medical cases. The publication aims to provide valuable insights and knowledge for healthcare professionals involved in paediatric retrieval and critical care.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Cases in Paediatric Critical Care Transfer and Retrieval

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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
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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,
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First published 2022

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in this publication and does not guarantee that any content on such
websites is, or will remain, accurate or appropriate.
..................................................................
Every effort has been made in preparing this book to provide accurate and
up-to-date information that is in accord with accepted standards and practice
at the time of publication. Although case histories are drawn from actual
cases, every effort has been made to disguise the identities of the individuals
involved. Nevertheless, the authors, editors, and publishers can make no
warranties that the information contained herein is totally free from error,
not least because clinical standards are constantly changing through research
and regulation. The authors, editors, and publishers therefore disclaim all
liability for direct or consequential damages resulting from the use of
material contained in this book. Readers are strongly advised to pay careful
attention to information provided by the manufacturer of any drugs or
equipment that they plan to use.
Contents
List of Contributors viii
Preface xv
List of Abbreviations xvi

1 Models of Care 1 13 Difficult Asthma 70


Shelley Riphagen Christopher Hands and
Andrew Nyman
2 Logistics and Organisation 3
Shelley Riphagen and Karen Starkie 14 Transfer of Child with
Pulmonary Hypertension 74
3 Air Retrieval 7
Kenneth MacGruer and
Karen Starkie Alison Pienaar
4 Improving Team Performance 13 15 A Blue Baby 79
Shelley Riphagen and Joanna Davies and Shelley Riphagen
Karen Starkie
16 A Shocked Blue Baby Who
5 I Like Children, but I Don’t Fancy Won’t Improve 84
Intubating One … 19
Jenny Budd and Shelley Riphagen
Rumiko King and Joanne Perkins
17 Under a Spell 89
6 Upper Airway Obstruction 29
Catia Pinto and Miriam
Gareth Waters and Andrew Nyman Fine-Goulden
7 Just Bronchiolitis? 35 18 A Decline in Function 94
Sam Fosker and Shelley Riphagen Shelley Riphagen
8 Foreign Body Aspiration 41 19 Rash, Tachycardia
Alexander Hall and Andrew Nyman and Irritability 99
9 A Child with Facial Swelling 48 Shelley Riphagen
Michael Carter and 20 Is the Baby’s Heart Rate
Shelley Riphagen Supposed to Be Slower
10 Pneumonia and Empyema 53 than Mine? 105
Elizabeth Daisy Dunn and Olga Van Der Woude and
Marilyn McDougall Shelley Riphagen

11 The Child with a Cough and 21 A Pale Lethargic Girl 109


Concerning White Cell Count 59 Maria Gual Sanchez and
Jo Dyer and Maja Pavcnik Shelley Riphagen

12 Worsening Stridor, to Intubate … or 22 Too Fast for Comfort 116


Not to Intubate 65 Sarah Hardwick and
Joanna Davies and Shelley Riphagen Miriam Fine-Goulden

v
vi Contents

23 Chickenpox and Other Bugs 122 37 Encephalopathy 207


Michelle Alisio and Marilyn Fiona Bickell and Shelley Riphagen
McDougall
38 Adolescent Psychosis and Seizures:
24 When Amoxicillin Just Doesn’t Infection, Ingestion or
Cover It 127 Encephalitis? 210
Michael Carter and Marilyn Sasha Herring and Marilyn McDougall
McDougall
39 The Collapsed Neonate 216
25 Tumour Lysis 135 Ain Satar and Shelley Riphagen
Jo Dyer and Shelley Riphagen
40 A Floppy Breathless Child 221
26 Respiratory Insufficiency on Sam Fosker and Shelley Riphagen
Maximal Support: Is That It? 141
41 Fever in the Time of COVID-19
Federico Minen and Jon Lillie
(SARS-CoV2) 227
27 Cardiac Arrest 148 Marilyn McDougall
Abi Whitehouse and Jon Lillie
42 A Palliative Care
28 A Neurosurgical Emergency 154 Transfer Home 231
Livia Procopiuc and Alison Pienaar Miriam Fine-Goulden and Jo Laddie
29 A Fall from Height 159 43 A Story that Just Doesn’t
Caroline Smith, Sam Fosker and Add Up 237
Shelley Riphagen Emma Smith and Shelley Riphagen
30 Brain against the Clock 165 44 Multidrug Overdose: A Practical
Tanmay Toteja and Sam Fosker Guide to Stabilisation
and Transfer 243
31 When Vomit Turns to Blood 171
Nav Somasinghe and
Anna Canet Tarres and
Joanne Perkins
Shelley Riphagen
45 Death Is a Possible Outcome 248
32 Bilious Vomiting and Distended
Dawn Knight and Shelley Riphagen
Abdomen? Let’s Find
a Surgeon 178 46 A Cold, Unconscious 12-Year-
Xabier Freire-Gomez and Old Girl 253
Alison Pienaar Louisa Brock and
Marilyn McDougall
33 What Can’t Go Down, Must
Come Up 185 47 Another Collapsed Neonate 259
Emily Cadman and Hannah Hayden and
Alison Pienaar Maja Pavcnik
34 Not All Burns Can Be Seen 191 48 The Challenges
Alex Williams and Ariane Annicq of Chemotherapy 263
Heather Burnett and Maja Pavcnik
35 Drowning and Organ Donation 197
Emma Prower and Joanne Perkins 49 Diarrhoea and Vomiting 267
Georgina Humble and
36 The Cold Shocked Child 202
Shelley Riphagen
Sam Fosker and Shelley Riphagen
Contents vii

50 A Life-Threatening Sickle 55 Paediatric Airway Clearance for


Cell Crisis 272 Acute Management
Juan Ramon Valle Ortiz and on Retrieval 299
Shelley Riphagen Rosalie Summers
51 A Baby with Acute Liver Failure 277 56 Use of Ultrasound for
Marilyn McDougall Paediatric Retrieval 303
Ariane Annicq
52 Air Transport of a Critically
Ill Baby 281 57 Vasoactive Drugs on Retrieval 306
Joanna Davies and Benedict Griffiths
Shelley Riphagen
53 Crew Resource Management 288
Sam Fosker Index 311

54 Chest Drain Insertion 293 Colour plates can be found between


Marilyn McDougall pages 142 and 143.
Contributors
Editors
Sam Fosker is an anaesthetic trainee with an interest in pre-hospital and retrieval
medicine and is currently undertaking a clinical fellow role at the Evelina London
Children’s Hospital and South Thames Retrieval Service. He is a Fellow of the Academy
of Wilderness Medicine and has worked on projects in multiple different countries.
Shelley Riphagen is a South-African and Canadian-trained paediatric intensivist and
clinical lead for the South Thames Retrieval Service, integrated within the Evelina
London Children’s Hospital PICU. She has a keen interest in retrieval medicine and triage
and the electronic technology to support this. She continues to jointly deliver a successful
paediatric critical care advanced practitioner training programme for senior nurses and
allied health professionals that started in 2003.

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

PICU Paediatric intensive care unit


PIM-TS Paediatric Multisystem Inflammatory Syndrome – Temporally Associated
with SARS-CoV-2
POCUS Point of care ultrasound
PT Prothrombin time
PEA Pulseless electrical activity
PVL Panton-Valentine Leukocidin
RBC Red blood cells
RCPCH Royal College of Paediatrics and Child Health
RICP Raised intracranial pressure
ROSC Return of spontaneous circulation
RR Respiratory rate
SA Sinoatrial
SaO2 Arterial oxygen saturation
SCIWORA Spinal cord injury without radiological abnormality
SCUBU Special Care Baby Unit
SIRS Systemic inflammatory response syndrome
SMA Spinal muscular atrophy
SNOD Senior Nurses in Organ Donation
SOFA Sequential (or sepsis-related) organ failure assessment
SORT Southampton and Oxford Retrieval Service
SpO2 Pulse oximetry
STRS South Thames Retrieval Service
SV Stroke volume
SVR Systemic vascular resistance
SVT Supraventricular tachycardia
TAPVD Total anomalous pulmonary venous drainage
TGA Transposition of the great arteries
TLS Tumour lysis syndrome
TSS Toxic shock syndrome
VBG Venous blood gas
VILI Ventilator-induced lung injury
VSD Ventricular septal defect
VT Ventricular tachycardia
WCC White cell count

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