Anand Nitin Kanani
I am a Doctor who is specialising in Paediatric Emergency Medicine at Birmingham Children's Hospital. I have a keen interest in improving the outcomes for children through supporting education.
Location West Midlands
Activity
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Anand Nitin Kanani replied to Lee Kay
Hi Lee,
I think that using oxygen in any sick child would be a safe and appropriate plan. In APLS (advanced paediatric life support course), we teach that every sick child should have oxygen applied regardless of the saturation. -
Thanks for bringing in the parental perspective.
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Anand Nitin Kanani replied to Jacqui Baca
Hi Jacqui,
Yes - I think that 5 mls / kg then a reassessment to analyse whether a further 5 mls kg is required is the safest approach. -
Anand Nitin Kanani replied to Avril R
That's great Avril - why do children with DKA get cerebral oedema?
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Hi Donna, we usually suggest 5 mls every 5 minutes as small and often reduces the risk of vomiting.
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Thanks for bringing in a parental perspective!! As professionals, we need to understand your voice.
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Thanks for bringing in a parental perspective!! As professionals, we need to understand your voice.
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Thanks for bringing in a parental perspective!! As professionals, we need to understand your voice.
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Thanks for bringing in a parental perspective!! As professionals, we need to understand your voice.
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Thanks for bringing in a parental perspective!! As professionals, we need to understand your voice.
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Excellent Alan, we should never lie / hide things from parents!
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Excellent Chris!
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Hi Robert,
Many thanks for bringing in your clinical experience. -
Hi,
Thanks for your honesty. This is a safe area to learn. Hopefully, this module will help you to remember DKA next time (in real clinical practice). -
Many thanks for your comments.
I agree that we should reduce the fluid volume in a bolus in DKA. The usual fluid bolus in medical conditions is 20 mls / kg . I would even suggest that a fluid bolus is not required in this condition as the child is not in shock. If we were to use a fluid bolus in DKA then I would suggest only using 5 mls / kg.
What is the... -
Anand Nitin Kanani replied to Dom Gething
Hi Dom,
Many thanks for your excellent comments.
Why is fluid rehydration a high risk strategy in DKA? Why does cerebral oedema occur in DKA?
I think that you have hit some excellent point. -
Anand Nitin Kanani replied to paula clarkson
Hi Paula,
Yes I agree - the cannulation procedure in children can be very traumatic therefore you must be sure about your indication and why cannulation will alter your management plan. -
Anand Nitin Kanani replied to Rhea M
Many thanks for your comments.
I agree that we should reduce the fluid volume in a bolus in DKA. The usual fluid bolus in medical conditions is 20 mls / kg . I would even suggest that a fluid bolus is not required in this condition as the child is not in shock. If we were to use a fluid bolus in DKA then I would suggest only using 5 mls / kg.
What is the... -
Anand Nitin Kanani replied to Jacqui Baca
Hi Jacqui,
Many thanks for your comments.
I agree that we should reduce the fluid volume in a bolus in DKA. The usual fluid bolus in medical conditions is 20 mls / kg . I would even suggest that a fluid bolus is not required in this condition as the child is not in shock. If we were to use a fluid bolus in DKA then I would suggest only using 5 mls / kg.... -
Anand Nitin Kanani replied to Avril R
Hi Avril,
I think that you have hit on an excellent point. Why do you think there is too much fluid - if the child has DKA? Why would you be worried about giving too much fluid in DKA? -
Excellent, thanks Richard! :-)
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Hi Kathryn,
Can you please explain 5 mls every 5 minutes in a bit more detail for everyone. I think that its a great strategy ! -
Thanks for bringing in your own clinical experiences!
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love 'little and often'
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Anand Nitin Kanani made a comment
Hi Everyone,
There is lots of comments of the appropriateness or not appropriateness of Dad calling the ED.
I would just like to say that at this stage the assessment is not fully completed yet.
Please be careful of jumping to conclusions of the appropriateness of an ambulance call until the assessment is complete. If you jump to conclusions then you may... -
And that is why...... this training is published to try and support our excellent paramedics.
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Excellent, Andrea! It's very dangerous to jump to conclusions based on very little evidence. After your assessment = you may think that Dad was right to call an ambulance.
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Excellent..... BM is often forgotten but an essential investigation in vomiting and loose stools,
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Excellent Chris
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Excellent Chris!
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Hi Anthony,
Whats a DK test? -
Hi Valentine,
Thanks for your comments and honesty.
Is there anything I can help with? -
Hi,
I think that a BM above 11 in a child with symptoms of diabetes (excessive thirst / urine output) would be suggestive. I would recommend that these children are transferred to a Hospital for further assessment with a blood gas etc.
If you are unable to measure blood ketones then urinary ketones are also appropriate.
Do you know the triad for formally... -
Excellent Kieran!
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Anand Nitin Kanani replied to Peter Turner
Hi Peter,
Thanks for your comments.
Why do you suggest sniffing the breath? -
Excellent Jennifer .... 'dehydration' is not a diagnosis! What is the cause? Diabetes / sepsis / gastroenteritis???
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Anand Nitin Kanani replied to Chris Rigby
Excellent!
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Anand Nitin Kanani replied to Peter Ball
HI Peter,
Thanks for your comments.
Yes, I think Diolyte would be a good option - there was recent research that demonstrates that re hydration via weak apple / orange juice is equally effective so you don't need any 'fancy' or 'expensive' medication. -
Anand Nitin Kanani replied to Gerald Spawton
Hi Gerald,
Although you are not a medic - I think you have ' hit the nail on the head'. -
Anand Nitin Kanani replied to Gail Haughey
Excellent Gail.
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Anand Nitin Kanani replied to Jonathan Harris
Hi Jonathan,
Excellent - you have picked up a good point. There is a difference between being dehydrated and shock.
This child is dehydrated but not in shock.
What do you think about fluid boluses in children with possible DKA? -
HI Richard,
Many thanks for your comments.
What makes you think that this child does not need the hospital at this stage? -
Hi Theresa,
The diabetes can be triggered by a simple viral infection - so children who present with the first signs / symptoms of diabetes can also have a simple at the same time.
Thanks
Anand -
Hi Chris,
Thanks ..... could you explain DKA for everyone please? -
Excellent - it is all about balance of probabilities - does it all fit the picture? Making a diagnosis is like fitting the pieces of jigsaw together - they should all fit to make a picture.
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Hi Chris,
Can you really say that the child is fine until you have completed your assessment?
The child has deteriorated and although the Dad did not call the GP initially the breathing has worsened and this has made him call the ambulance.
As you say - it is easy to miss subtle yet important signs if you jump to conclusions.
Always be careful to complete... -
Hi Joathan,
What makes you think its 'stupid'? What do you think was going through the Dad's mind? -
Hi Victoria,
Thanks for your comments.
Could you explain / outline DKA for people please.
Thanks!
Anand -
Excellent..... the unusual point of struggling to breathe will point towards 'big sick'
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Hi Helena,
Thanks for your comment.
How do you assess if an IV is needed? Do you have any experience of a oral 'fluid trial' or NG (nasogastric) dehydration?
Thanks
Anand -
Anand Nitin Kanani replied to Marjorie Blomeley
Hi Blessing,
Yes, the temperature may still rise after giving paracetamol - whilst the medicine is still 'kicking in' but once the medicine starts working then it should reduce the temperature.
I know that many families will use sponging or fans to try and reduce the temperature. There is no medical evidence that these strategies work so I would still give... -
Hi
Are there any terms that I can help with? -
Hi Lyndsey,
Do you think that cool flannels / fans help to reduce temperature? -
Hi
Why do you think that this child needs antibiotics? How do you differentiate between bacterial and viral ear infections? -
What safety netting advice would you give?
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Hi Guys,
If the cause of the 'ear infection' is viral then you can catch the virus from other people. This virus may cause ' cold ' like symptoms or an ear infection.
You can't catch a ear infection from people if the cause of the ear infection is bacteria. -
Hi John,
I think you are right to consider the coping mechanisms of the family. As pediatricians we have a responsibility to the whole family and ensuring the family can cope with looking after the child is a major consideration. -
Hi Guys,
I agree that premature birth can lead to more infections and usually worse infections. However, after the age of 5 these effects are usually minimal. -
yes NICE is generic information for children.
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Hi Billy,
Have you heard about the 'glass test'? Please see the link below.
https://www.meningitisnow.org/meningitis-explained/signs-and-symptoms/glass-test/ -
Blood tests are quite distressing in children and should only be undertaken with a specific question in mind. In a child with a possible viral infection : how will blood tests alter your management? will abnormal blood tests prove tonsillitis etc?
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Hi Chris,
In my experience children are agreeable to being stripped and examined as long as you have the support and help of the parents. It is important to conduct a full skin examination in any child with fever. -
Anand Nitin Kanani replied to Philip de Bruyn
Hi Emma,
First let's be clear what is meant by 'rigours'. Rigors is 'shivering' usually associated with high fever.
In my experience 'rigours' make children feel uncomfortable and therefore these children should be treated with (antipyretics) paracetamol etc to ease their symptoms.
I hope that is helpful.
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Anand Nitin Kanani replied to Philip de Bruyn
HI Guys, yes - I just want to re enforce the point that paracetamol (anti pyretics) will not prevent febrile convulsions.
Leaflet on febrile convulsion
http://patient.info/health/febrile-seizure-febrile-convulsion -
Anand Nitin Kanani replied to Tim Evans
Excellent point TIm. If you are not sure then ask for help. This method maintains patient safety.
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excellent point, documenting the safety advice given is very impotrant.
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Hi Tolu, do we always need tests to make sure that everything is OK?
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Are there any apps that you have used and found particularity useful?
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Hi Claire,
Good point about parental responsibility? How do you define this? -
Hi Senga,
Can you explain why you think that this child may need blood tests?
Many thanks
Anand -
Hi, are there any specific terms that I can help with?
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Hi Adrian, many people may not of heard about the 'below the elbows' guidance, could you explain it so people can learn?
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Hi Guys, in clinical practice we would encourage care givers to remain close by, This is because the child will need support but also the care givers will want to stay with their children. I can understand that upset care givers and interfere with your assessment but clear communication by the professionals with the child / care giver should minimise the...
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HI Beverley,
This is a good point. Can you explain your thinking so we can all learn?
Many thanks
Anand -
Excellent Zunaida, that is the reason that we have included this case. Fever is a common issue that can represent 'big sick' or 'small sick' so it is important to know how to assess this children with a structured approach and identify the 'big sick' patients.
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Hi
Belynda, you mentioned Gillick competence. Some people may not have come across this concept before. Could you explain this concept so everyone can learn......
Many thanks
Anand -
Hi Guys, are there any specific abbreviations that you guys are struggling with ? How can I help?
Many thanks
Anand -
Hi
A normal body temperature is between 36.5 - 37.5. So a fever is children is usually defined as > 38 degrees.
Thanks Anand -
Hi Guys, well done guys. Low or high blood sugar can be a sign of sepsis. Thanks Anand
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Anand Nitin Kanani replied to VALENTINE ONYEBARA
Excellent Valentine!
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Anand Nitin Kanani replied to Marjorie Blomeley
Hi Majorie,
Paracetamol will reduce the fever whatever the cause. i.e. paracetamol will reduce the fever in a 'cold' or meningitis.
But I think that you make an excellent point - a 'big' sick patient will still be sick after the fever has resolved so a patient feeling / looking better after treatment with paracetamol is a good sign.
So in summary a... -
Anand Nitin Kanani replied to James Lidington
Excellent point James.
The real question here is...... what is the cause of the temperature? A basic cold can cause a temperature but meningitis will also cause a temperature?
The traffic light system helps to decide if the cause is 'little' or 'big'. -
Excellent point Ben :
The latest recommendation from NICE is that paracetamol isnt given routinely for fever control. Fever is beneficial, and paracetamol/ibuprofen is recommended if child is in pain/distressed.
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Hi Ben
Excellent point!
On going parental concern is a red flag! They are the expert in their child!
We need to always take parental concerns seriously.
If they report the child has had a fever because they felt hot then evidence suggests that they are correct! -
Hi Thomas,
Where did you get the information that reliance of calpol is linked to asthma?
I am not aware of any evidence that links paracetamol and asthma. I am also not aware of paracetamol damaging the heart.
This is not the advice that we provide patients and their families.
Many thanks
Anand -
Hi
Excellent point. We always need to ensure that we specifically communicate the diagnosis. i.e. 'We think that this is a viral infection.'
Be careful about advicing the dose of calpol - there can be different strengths and therefore the volume given is different. -
Anand Nitin Kanani made a comment
Hi Guys,
Lots of people want to give safety net advice.
Does anyone know of any leaflet / written information that can be given to parents? This would supplement the discussions and give something for parents to refer to in the future.
Many thanks -
Hi Chris
Excellent point! We need to give advice but also direct people to appropriate levels of care! -
Many people are saying that they would keep the child at home with the grandmother.
Can people think about 'safety net advice' or advice for the grandmother to help her keep an eye out for deterioration?
Does anyone know of any good parent information leaflets about fever?
Many thanks
Anand -
Hi Guys,
Chris - I think that you make an excellent point.
Guideline are there to guide us i.e to help us!
They are only a piece in the jigsaw and we need to think about the whole patient.
Graham, I think that you are the expert on your child. If you are worried then please call for help! The traffic light system was designed to help clinical judgement so... -
Hi Tia,
Excellent post!
You know your child best! You are the expert on your child!
Be careful of google! As you know there is lots of inaccurate information on the internet as as discussed earlier the machine may not be accurate.
If you are worried then call for help!
Many thanks
Anand -
Hi Rob,
Excellent point. If you are not sure about the values then best to consult with an expert rather than rely on the internet!
Many thanks
Anand -
Hi Beverley,
Excellent point!
Never trust the number without looking at the patient!!!!!
Have you had experience of inaccurate numbers?
Can you think of any example when the numbers could be inaccurate?
Many thanks
Anand -
Hi Guys,
Lots of excellent points. So far this child looks 'little sick' and has normal observations.
Many people have noted that you don't always need to treat a fever immediately.
Fever is the body's reaction to an infection. It is actually a good process as the body is trying to fight the infection. Current guidance only suggests paracetamol if the... -
Hi Nick,
I think that you have made an excellent point. Fever is the body's reaction to an infection. It is actually a good process as the body is trying to fight the infection. Current guidance only suggests paracetamol if the child is distressed as it help the child to feel better.
How would you decide if the child is distressed an needs... -
Hi Guys,
Excellent questions. Children who were born prematurely will often suffer from more infections and the effects of these infections can often be more severe. However, usually after the age of 5 years then the effects of the premature birth will fade.
Many thanks
Anand -
Hi Amy,
Could you explain JRCALC so we can all learn? We could all use a 'cheat sheet'
Many thanks
Anand -
Hi Ben,
Excellent point.
We are here to help families. If a grandmother is worried then our job to to reassure her and help support her. Maybe some education will help her next time and keep her calm.
Please see the post below for further ideas.
http://rolobotrambles.com/inappropriate/
Many thanks
Anand -
Hi Ben,
Excellent post. An immunization history is very important!
Do you know what immunizations children should have at different ages?
What things in the history would point to a child being immuno compromised?
Many thanks
Anand
