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. […]
Category: archimedes
Q: How long do you wait to clamp a cord?
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 […]
Ask, and it might be given unto you.
The five steps of evidence based practice are commonly summarised as ‘Ask, Acquire, Appraise, Apply and Assess’. The first one of these – just asking a question – can prove terribly time consuming and difficult, but with a bit of dissection can be made much easier. The first step when deconstructing the anatomy of inquiry […]
Making science of art
In the window of the Wellcome Collection in London artists work to interpret and explain science: it’s an impressive experience to the irregular visitor. When faced with the presenting problems of a child & family, we are faced with trying to do the reverse. We have the sometimes inaccurate recollections of history, the variable responses […]
Q: Honey for neutropenia?
It’s my own question, this time, and throws up lots of annoying little things. The problem is straightforward: I’m a paediatric oncologist in my spare time, and was asked about the use of LifeMel honey to prevent infections. Now, being both an EBMer and a Physician, I said I didn’t know, but didn’t think it […]
Q: CPAP for Bronchiolitis?
It’s simple really – Autumn is approaching and most paediatricians are gathering their Virally Protective Hankies to ward off the germs they know they’ll be assaulted by. There’s heavy training in many departments for the new docs — “if it’s bronchiolitis clinically, don’t X-ray them, don’t bleed them, don’t IV them and don’t give them […]
Here’s one for free (really)
A blog post of questions that are calling out to be answered. Ever looked at the Archimedes section and thought “I wonder what I could write about?” or “I wish they’d look at this?” Here’s the space you were looking for. […]
Q: Is an OGTT good enough for CF diabetes testing?
Jamie, a 13-year-old girl with cystic fibrosis (CF), has been referred to the Paediatric Diabetes clinic because of an abnormal oral glucose tolerance test (OGTT) in her recent CF Annual Review. It showed impaired glucose tolerance. Continuous glucose monitoring system (CGMS) over three days showed normal fasting and pre-prandial glucose but frequent post-prandial glucose excursions […]
Q: Clear CSF – Does it exclude meningitis?
A 20 month old presented with 1-day history of temperature, off food and ‘not herself’. Clinical examination showed a slightly irritable child with temperature 38.80C, slightly congested throat and doubtful neck stiffness. An LP shows WCC 2, RCC 0. A diagnosis of viral illness is made, and antibiotics are not commenced. […]
Q: Does nephrocalcinosis mean problems for neonates?
What do you do if, accidentally, you scan the abdomen of a neonate and find nephrocalcinosis? Book them in for a transplant in a couple of years? Annual serum electrolytes, blood pressure & isotopic GFR measurement? Pretend you hadn’t seen it? […]