I was on call last night for a co-op based in a small DGH with no A&E
consultant/middle grade and no paediatricians.
I received a call from a patient who's 15 week old baby had was "pale and
unresponsive". I told the mother to dial 999.
When the baby arrived in A&E some minutes later I was told by the A&E SHO
that my patient had arrived and would I be willing to see them.
I pointed out that 999 calls and shocked babies were not really a GP OOH
co-op type thing and that it seemed more sensible for the baby to be dealt
with in A&E itself.
But the A&E staff nurse asked me if I would assess the baby as the SHOs had
"no paeds experience" and the consultant physicians were unwilling to get
involved in paeds cases.
The child was dehydrated, tachycardic, pale and poorly responsive (but
crying weakly intermittently) with an sao2 of 97% and a BM of 12. I set up
an iv and gave a bolus of fluid and some benzyl pen and admitted the child
to the paeds unit (a 3 hour ambulance ride in winter).
Does anyone else think that it is a little bizarre to be relying on ad hoc
support from GPs to deal with life threatening paeds cases in A&E?
Are there any guidelines or 'rule of engagement' that I should be looking to
obtain or implement to reduce the risk of a critical incident?
--
Robbie Coull
email: [log in to unmask] website: http://www.coull.net
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