Lessons from Don’t forget the bubbles- Day two

There was so much, with a lot of papers today so I could properly nerd out. All links to papers and often to reviews are available on twitter(#dftb19). But here is my main take-aways.

First up were two Aussies (Stuart Dalziel and Meredith Borland) emphasising the importance of collaboration in research networks. How to find out the right questions (delphi studies-which I had never appreciated the point of before) and answering these questions in kids (who fortuantley rarely get proper sick) requires big RCT’s crossing many hospitals and countries such as proving that in DKA fast vs slow fluid doesn’t make much difference. Was also good to hear the need for more African and Asian involvement (especially with @PECCAfrica adding to twitter conversation).

@Damian_roland continuing the evidence based theme and I like the 40:40:20 theory that 40 percent of patients don’t get evidence based theory and 20% get therapies we know aren’t helpful. Interesting to hear that the aussie’s research network is older and better integrated into guideline creation which helps knowledge implementation.

@DrMikeFarquhar is the sleep guru highlighting again how important and undervalued this is. So much info but I managed to scribble down that you three times more likely to get flu so read this advice and get some sleep. For parents he also recommended this aussie website in helping kids with difficulties sleeping (don’t have any myself but I gather this is an issue…)

Adam jaffe gave a surprisingly wide ranging talk on the narrow topic of cough. A few gems; early pneumonia’s don’t always cough, the term wheeze does not cross languages, if persistent and wet think about persistent bacterial bronchitis (always nice and humbling to learn about new disease), all cough’s during sleeping are bad and simple treatments that work are vicks rub to the chest, methanol, lemon and honey.

@camillakingdon firstly reassured me that even paediatricians are scarred by preems but that the recent progress has been amazing due to some great integrated care (such as mg and steroids for high risk mums). But the simple things I can do as a generalist are to check they are plugged into follow up, check growth including head and height and to check on the parents- they can understandably be struggling and if they are charities such as bliss and best beginnings can help.

In the afternoon more rapid research. From APGAR (the simpler and more widespread a scoring system the better), to transfusion indications (to the drier end for both platelets and red cells. Bruise patterns tend to be single and not on neck, ear or genitalia, dex is similar to pred for wheezers and if really bad can have a punt on nebulised magnesium but probably won’t do much. Annoying I may have to be less cynical about our local huddles as these are evidenced based. Also good to hear from speakers whose background didn’t involve med school. A clued up nurse or paramedic is vastly superior to a dogmatic doc.

To finish up with some inspiration from @rcempresident that I might not be so lonely in my future career in EM as more and more are signing up, from @helenbevan that change can be implemented about from top down channels via influences and last but not least from @hann_gayle and amani reminding us that all our patients are still just children with long bright futures ahead of them.

Leave a Reply