Things We Liked This Month – September 2020
Predictions in July on when the wheezers would start coming through the doors probably didn’t have good odds on “15 seconds after schools reopened”. However, after several shifts in which I’ve had to wash my scrubs multiple times to get the smell of salbutamol out of them, this seems to have been the winner. Winter is here, apparently, which is a little concerning, because winter isn’t actually here yet.
However, with acuity racking up, now is more important than ever to take a break, and breathe. So, whilst grabbing a nice set of biscuits that is absolutely not from the patients supply, why not have a peruse over this month’s Things We Like – a round up of our favourite things from around the Web!
Journal Articles we like
Fluid Management in DKA: Consensus, recommendations and clinical judgement
Fluid management in DKA has been a very hot topic of late. Since the publication of the PECARN RCT into fluid rates in DKA, both the ISPAD and BSPED guidelines regarding fluid management have changed, from a restrictive course to a more liberal one, in keeping with the findings of the trial. Letters from both sides of the coin have come in to the BMJ. On one side, the #PedsICU consultants worried that the guidance is unnecessarily confusing, and promotes excessive fluid boluses to critically unwell children with cerebral oedema, and on the other, consultants from the BSPED guidance group, defending the shift following the trial. In this excellent editorial, Robert Tasker looks at both sides of the coin, and gives a balanced view on guidelines, and whether large scale RCTs can truly give clear views on patients at either end of the spectrum.
How to interpret lactate – ADC E&P
In a follow up to an excellent article from 2014, this barn-storming tour of lactate is a must read for all. Anyone involved in the care of unwell children will have noticed a significant increase in the interest in lactate in unwell children, and yet misconceptions around it’s elevation, and subsequent fall remain abound in the clinical world. As with all clinical tests, measurements of lactate have their uses, but only when correctly interpreted in the clinical context of the patients, and this article excellently and succinctly separates the wheat from the chaff.
(Ed. note: as an aside, for all things related to lactate, my first port of call is this fantastic article from 2014. Although based in the adult world, it’s an excellent overview article)
#FOAMed we like
Post-ROSC care – Costas Kanaris via DFTB
As acute paediatricians, the APLS algorithm for cardiac arrest is drilled into us. The goal is clear, we want to return spontaneous circulation to the child. However, what is less clearly covered, and less often experienced by those who aren’t PICU consultants is “What happens now?” once you actually get ROSC. I confess, until this article was published, I’m not sure I would have had a clear answer for you. This article focuses on clear sections of post-rescuscitative care, the aims, and outcomes we are looking for. For those of us without PICU on site, we will be charged with looking after these patients until the cavalry arrive, and as ever, prior planning and preparation prevent poor performance.
Correlation confounded by timing – PulmCrit
Soon, it will be bronch-season. Bronch-season means one thing, and one thing only: lots of friendly disagreements about whether or not the salbutamol given to a 9 month old with barn-door bronchiolitis should be discontinued because “it seems to be helping them”. Josh Farkas has written excellently on a number of different subjects. Here, he breaks down correlation confounded by timing, or why we like to believe that bad therapies are actually helping, when in likelihood, they probably aren’t.
Podcasts we like
The PicPod – PIMS-TS/MIS-C
One of the more unexpected outcomes of the first wave of the COVID-19 pandemic was the small, but sudden influx of young people with a Kawasaki-like syndrome being admitted to PICUs across Europe. Although the syndrome itself is still very rare, it is important to be aware of this new emerging phenomenon, and be alert to the presenting characteristics, so that help can be sought early, and the appropriate tests be undertaken. In this lovely podcast from our friends in the #PedsICU community, they break down their paper in JAMA outlining the characteristics of 58 children with PIMS-TS, along with discussing pathophysiology, outcomes and treatments.