Download PDF: Clinical Communiqué September 2016 Edition
In this edition
Editorial
In our third edition for the year, we explore three very sad cases involving young children who all had relatively uncommon conditions. The healthcare-related death of a child is always a profoundly upsetting experience for everyone concerned – from the treating clinicians, to those called upon to investigate the circumstances of the death, and most of all, to the parents and relatives who suffer such a loss. There are usually many difficult questions that need to be asked and answered. What is all too jarring is the death of a previously well child, who had no known natural diseases or medical conditions, and who had no real reason to become unwell. In those scenarios, the relatively rapid course that can progress from a child appearing completely well to being gravely ill is particularly distressing. Compounded by the inability of young children to understand or communicate their symptoms, parents and clinicians are left wondering what could have, or should have, been done sooner.
The paediatric stories in this edition have been undeniably tough to write, and will be confronting to read. They are stories that we may remember for a long time to come. Yet in many ways, this is not an edition about paediatric illnesses. It is about seeing the signs, even if you do not see the diagnosis. The cases presented here serve to highlight the universal themes that come up time and again, in the care of adults as well as children. In each of the cases, the parents sought medical attention on multiple occasions, however, the treating staff were arguably blinkered to their concerns by preformed assumptions, and did not react to a few vital cues that could lead them to recognise a sick patient and investigate further. If we remember these stories we can change our practice for the better.
The expert commentary for this issue has been written by Dr Annie Moulden, a paediatrician with extensive experience in quality and safety networks. Her commentary explores the importance of a framework that every clinician should have for safely managing the undifferentiated patient. When a person is suffering from a rare condition (one that we may never have come across before), and the diagnosis eludes us, there are ways in which we should approach the situation, irrespective of the missing pieces of the puzzle. Being cognisant of the physiological changes that are occurring, even without a clear picture of the prevailing disease process, allows for specific measures to be put in place to manage acute complications and possibly avoid a catastrophic event. The trigger points do not need to be complex. Sick or not sick, admit to hospital or not. Focus on the warning signs – pain out of keeping with appearance, repeat presentations, family concerns, abnormal vital signs – and effect a plan that is simply and safe. Adjustments and fine tuning can follow later.
In this issue, we are very fortunate to welcome back Dr Fennessy as a case author, and also to welcome a new member to our team of authors, Dr D’Costa, an intensivist and the State Medical Director of DonateLife. Both authors share their sage insights with us on the lessons learned from these tragic deaths.
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