Trust the baseline you are givenThe parent has watched this child for years and you have watched them for four minutes. “Not himself” is an observation — chart it in their words, not yours.
O
Objects go in, and nobody says soAsk directly whether anything was swallowed or inhaled. The choking episode was an hour ago, it resolved, and it will not be volunteered. A normal film excludes nothing.
D
Development sets what is possibleWhat this child can physically do decides which injuries and which ingestions are plausible. A bruise in a child not yet cruising has almost certainly been inflicted.
D
Dose from a real weightEvery drug, every fluid volume and every tube size comes from it. Maintenance on the 4-2-1 rule, resuscitation at 10 mL/kg. An estimate carried through a resuscitation gets multiplied.
L
Lap, not cotExamine on the parent. Look before you touch, count for a full minute, and leave the throat and ears until last. A furious child is reassuring; a compliant one has told you something.
E
Emergencies with a clockA button battery in the oesophagus burns within two hours. A tiring asthmatic goes quiet. A drowning child has already had their injury. These do not wait for the morning.
R
Report what does not fitIf the injury and the story do not match, or the story keeps changing, say so. Every clinician in New South Wales is a mandatory reporter and suspicion, not proof, is the threshold.
Challenge for you
Which of the seven is most often skipped where you work?
Not the one you think matters least — the one that actually gets left out
when the department is full and it is half past two. Choose it, add a line on why, and I will publish
the tally and the best of the reasoning.
nothing selected yet
Choose one, then send. The button opens a reply straight to me with your choice already in it —
just add your reasoning.