E for Exposure, Don’t Ever Forget Glucose

4 November, 2010 by: colinparker

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Exposure: getting a look at the whole patient, while preventing hypothermia.  It’s just part of being thorough, and thorough is Good.

Many have erred in the heat of the moment… it’s easy to get distracted by a sick-looking kid or a serious injury, but: Don’t Ever Forget Glucose!

On this episode we run through the meaning of “E”, and then move on swiftly to discuss hypoglycaemia and its treatment.


Outline of this PEMcast: EFG

[CP] Intro & disclaimer

Exposure

E is for exposure: complete examination of the whole child, whilst preventing hypothermia.

In trauma situation, refers to secondary survey, head-to-toe examination.

What can we discover with full exposure in the unwell / injured child:

[CP] Rash (urticaria = anaphylaxis/allergy, petechiae / purpura = ?meningococcaemia), fever/hypothermia

[KB] Occult injury – in obvious trauma patient, or in non-specifically unwell NAI victim – patterns of injury in NAI – in brief

[SF] Toxidromes (skin sweaty vs warm & dry, fasciculations, etc)

[CP] Causes of crying infant (hair tourniquet, clavicle fracture, corneal abrasion, etc)

DEFG: blood glucose

[KB] Normal physiology of maintaining blood glucose (glycogen stores, etc)

[SF] At what age can young children maintain their blood glucose during starvation?

[CP] Clinical manifestations of hypoglycaemia in children

-can be unexpected finding, can be overlooked, hence the need for reminders (DEFG, documentation on ED nursing record)

[KB] Causes of hypoglycaemia in children

[SF] Treatment – oral or IV glucose (?bolus),

[KB] find & treat cause

[SR] special endocrinologist tricks (glucagon, hydrocortisone, diazoxide, octreotide)

[all] Summary & goodbye

Please feel free to send us your comment, opinion, or money…

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