ICU and You

This week

The adolescent

Puberty to eighteen. An adult body, and not an adult — and almost every error in this age group comes from applying one of those and quietly forgetting the other. The physiology has finished arguing; what has not is who may consent, who may be told, and what they will admit to with a parent in the room.

• Bare Bones2

  The adolescent

  Ten points, five minutes, nothing decorative. An adult body with a child's legal status, capacity that turns on maturity rather than a birthday, deliberate self-harm as 7.2% of Australian ICU admissions in this age band, the serogroup B gap, and the dosing rule that is a myth.

  Open
• Mind map35

  The adolescent

  Four stations rather than six, and deliberately shorter than the last one. What has changed, what brings them in, what hides, and the part that outlasts the admission.

  Open
• Aphorism39

  Never say non-compliant

  “With teenagers, never say they are non-compliant.” A word that is a verdict wearing the clothes of an observation — it describes the behaviour accurately and explains it wrongly, and the explanation is what follows the patient through the record for years. Yes, no, maybe.

  Open
• Podcast59

  The protocol is the problem

  Nicole Glaser on PedsCrit. Hyperosmolar DKA does badly on the standard DKA pathway — because somebody put it on the pathway. Why the fluid has to go in before the insulin, why these children get less cerebral oedema rather than more, and the single thread running through the malpractice cases.

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• Journal club100

  The sixteenth birthday

  37,320 adolescent intensive care admissions across eight years of UK audit data. At fifteen, three in four are in a children's unit; at sixteen, three in four are in an adult one. What actually decides where they go, the two mortality figures that will be misquoted, and the question a regional Australian hospital cannot ask because it has no choice.

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• A View from England1

  Bound out

  A new column. The London Foundling Hospital took children in by lottery drawn in public, renamed them after its donors, publicly denied teaching them to write, and then at fourteen bound them out to a master and stopped. Of fifty-three apprenticed in 1805, fewer than half were doing well and more than a quarter had run away. The same transition problem as this fortnight's journal club, 270 years earlier.

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• Superpuzzle52

  The adolescent

  Twenty clues from the fortnight — consent and capacity, the front-of-neck membrane whose size matters more than any birthday, the serogroup the school dose misses, a sea captain, and the Australian vaccine that may eliminate a cancer. Fill it in on screen, or print it.

  Open the puzzle
• Notable Doctors1

  The warts that would not clear

  A new column. The cervical cancer vaccine did not begin in a laboratory. It began in a Melbourne clinic in the early 1980s, with a physician noticing that a group of his patients could not get rid of their warts, and a cytologist who asked him what that might mean in women. Ian Frazer worked as a clinician for twenty years. Jian Zhou, who suggested the step that made the particle assemble, died in 1999 aged forty-two, seven years before the vaccine was approved.

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• Mnemonic57

  ADULT

  An adult body, and not an adult — which is the trap the word is named for. Five things: adult doses with no pubertal switch, admissions that are decisions rather than failures of character, seeing them without the parent in the room, a law that differs by country and by state, and the transition to adult services where a chronic disease comes off the rails.

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