24 Apr, 09 | by Bob Phillips
You have a 7 year old in the ED that needs sutures to a wound inflected when he and his twin were playing Pirates of the Caribbean with kitchen knives … he’s not the sort of chap that will lie still while you stitch him up … so what would you use to keep him down? more…
7 Dec, 08 | by Bob Phillips
A 6 year old girl with Acute Lymphoblastic Leukaemia presents with another episode of febrile neutropenia with positive blood culture from her Hickman line. On a ward round, her parents discuss that they would like her to have a Portacath device inserted so that she can go swimming and is more comfortable around her friends. They are worried that she will be more susceptible to infection as the device is just below the skin and would like to avoid further hospital admissions. They ask if the portacath will increase her risk of infection during her remainder of her treatment? more…
7 Dec, 08 | by Bob Phillips
When I was doing neonates, it was considered good practice to get little babies spliced away from their Mother, given oxygen to breathe and wrapped up warm, all pretty damn quickly. I keep hearing rumours from my neonatally biased friends that perhaps there are other, better ways of doing things.
So - how long do you advise waiting until clamping the umbilical cord after delivery? Two, three minutes (where the baby can chill & develop polycythaemia?) or as little time as it takes you to get hold of a clamp (so the child can be deprived of the last few teaspoons of good fetal blood?).
2 May, 08 | by BMJ Group
A 13 year old boy with a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) comes to the clinic with his mother for a review. He was started on atomoxetine 6 weeks prior to this visit for hyperactive/impulsive symptoms and poor concentration. The boy was admitted in the hospital one week ago for changed behaviour, disorientation, irrelevant speech and self-harming behaviour. He was reported as very aggressive and hostile towards other children and adults. In past use of stimulant medication was not considered because of the risk of abuse and drug diversion. Mother correlates this hospitalization due to side effect of atomoxetine. She asks your opinion about increased aggression and hostility related to atomoxetine .
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