Lessons from Don’t forget the bubbles 2019- day one

Spending time amongst much more experienced paediatricians and PEM doctors I have manage to pick up a few gems at this conference organised by the don’t forget the bubbles FOAMed crew. The live stream is available (and I am sure podcasts to follow) and various blog/books written by the speakers will say in more eloquently and accurately than me. But for what is worth here are my main take homes. Apologies for any errors or misquotes!

1/ @Freermary talks about “work-life balance.” This has been drilled into us so much throughout my life the hard work of showing up seems to take over. However, what I took away from what Mary was saying is that engaging with enthusiasm and putting some of your life into the work can lead to a better balance overall. This definitely how it feels travelling for some very enjoyable non-compulsory education whilst most my colleges stress about their compulsory sign offs.

2/ @Drkimholt reveal to us her difficult experience as a whistle-blower. Naively, I was shocked that non-disclosure agreements are common in the NHS. It is this sort of thing where the NHS looks more like a corporation than a service which is particularly worrying. The choice is quit, carry-on or speak up. I hope I would be as strong to do the speaking up.

3/  @Learnthrutalk mentions the limitation of the SBAR. Whilst a great tool for those hand-over care to usually a more powerful position; it is important for those in power/seniority to be receptive to input using active invitation to get everyone’s input(“anything we are missing”) .

4/ @nikkiabela gave a few tips on identifying the dehydrated child. Using the rule in/rule language that we should all use when it comes to clinical signs (or likelhood ratios!). Cap refill, skin turgor and respiratory good rule in’s but not good rule outs. Those with normal resp rate, high rate and eating are probably fine. Beware the vulnerable groups such as <6 months and those with learning disabilities.

5/@kriesed could make me look like a boss the next time I identify
pulsus paradoxus using the swings in a pulse oximetry trace with respiratory rate.

6/@dralangrayson not only reassured me that I probably won’t feel like a paediatrician even when I am a consultant. But also reminded us all to be kind to ourselves when one of the 5% of kids who are well with a fever come back unwell. But to not rely on the CRP with it’s limited specificity and sensitivity.

7/@danihalltweets, @drrachaelM showed that technology can be used in education without being a massive distraction with a “choose your own adventure” presentation which was slightly less morbid than the black mirror episodes. Also that high flow is quite useful in bronchiolitis but that steroids and hypertonic saline are less so (but may have a small place). Oh and amiodarone is great; except in prolonged QT (so look for it if a child collapses and take an ecg)

8/ I always enjoy listening to non-clinicians and @lizstokes was no exception, bringing a different (but of course equally scientific) perspective on things. Particularly gems and when communication the phrase “any questions” ends a discussion, bringing up “best interests” are unhelpful and that we must always provide options to enable real dialogue.

9/ Maybe most importantly, in different ways @emmanchester and @tessrdavis reminds us to, over and above everything to remember we are human.

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