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ICU and You  ·  Bare Bones  ·  Number 1

The school-age child

Ten points. Five minutes. Nothing else.

About Bare Bones

Everything else on this site takes its time. This does not. Bare Bones is one topic, stripped to the points that carry the most weight, with no discussion, no argument and no stories.

It is for the shift you are about to start, the term you have just been allocated, or the morning you realise the topic is coming and you have read none of it. Five minutes, ten points, nothing decorative.

It is deliberately not enough. If a point lands, the rest of the fortnight is where it is explained — but a reader who only ever read these would still be better off than one who read nothing.

Roughly six to twelve years  ·  ten points

  1. 1 They are not little adults — except, increasingly, they are. The mantra expires somewhere around here and nobody tells you when.
  2. 2 “Fine” is not a symptom. They can tell you what is wrong and have learned not to. Offer time without the parent from about eleven, and at any age when the question is private.
  3. 3 By about eight the cords, not the cricoid, are the narrowest point. Cuffed tubes throughout, and watch the pressure.
  4. 4 Output is no longer rate-dependent. They compensate better than a toddler and therefore crash later and faster.
  5. 5 Everything per kilogram until puberty. Fluid 10 mL/kg, not the adult litre. Weigh them.
  6. 6 Asthma is the peak age for admission and for preventable death. A quiet chest in a tiring child is the emergency.
  7. 7 Trauma is the leading cause of death. Handlebar injuries hide in a soft abdomen; a seatbelt mark means bowel, mesentery and spine until excluded.
  8. 8 Ketoacidosis is often the first presentation of diabetes. Cerebral oedema is what kills. Follow the protocol exactly.
  9. 9 Myocarditis arrives dressed as gastroenteritis. The fluid bolus that makes them worse is the diagnostic moment.
  10. 10 Ingestions have stopped being accidental. Every deliberate one needs a mental health assessment, not just a level.

Challenge for you

What is your eleventh?

Ten is an arbitrary number and I have certainly left out something you would not have. Tell me the one you would add, in a sentence, and what it has cost somebody when it was missed.

I will publish the best of them, and where a point clearly should have been in the ten, I will put it there and say who sent it.

Send me your eleventh

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