LME 2021 Gen Paeds + Plastics/Ortho (VI)

The last one of the series. Enjoy~

February 2021

Having done my paediatric rotation in a DGH back in 2019/2020, the gen paeds caseload here is x1000 complex. You just need to glance at the handover notes to agree with me. Nevertheless, so eye-opening.

Firstly, I attended the medium-fidelity simulation involving doctors from all levels of training (FY1 to reg level). The scenario: a 10 year old child with a tracheostomy desaturating whilst on transport between hospital post-MLB (microlaryngobronchoscopy). She has a background of RLM (respiratory laryngomalacia) due to CP (cerebral palsy). She has a chest drain in-situ. How do (like 5 doctors and a nurse) manage the deterioration?

Me and my friend were happily observing (whohoo no stress!) only to be singled out (in the nicest way possible by the coordinators) to summarise and provide feedback AND say what we’ve learnt. Oh goodness, that was a surprise but it was so well done and the debrief was even better – so many learning points! 1) End of the bed inspection 2) Clarify unknown terms and history 3) Know how the chest drain actually works – what bubbles? What level? How to troubleshoot? 4) With tracheostomy, is there (or not) an intact upper airway? (As that will affect the ventilation options)

TLDR: The child had a tension pneumothorax, and her chest drain was clamped.

Moving swiftly on… onwards and upwards! To the SKY ICU aka a very state-of-the-art children’s ICU, with an equally techy seminar room (super decked out for the best live video conference experience + compatible with all the hospital systems).

XR teaching (aka complex cases discussion requiring the wisdom of radiologists): a disembodied voice eloquently describing all the imaging – NJ Tube (2 for the price of 1), osteomyelitis or acute pain crisis? Nephrodilatiation and bilobed kidney. It is beyond me how they interpret the spectrum of black/grey/whiteness of images.

The cherry on top to the end of my whirlwind elective – paediatric plastic surgery case and an orthoplastic case.

The context for the latter: debridement and washout of an infected ulcer on foot of a child with severe limb sensory and autonomic neuropathy. Quotable quote of the day: “Monocytes are like the NHS managers”, “Pus comprises of white cells and debris – basically the lymphocytes are sent on a suicide mission” – kudos to the friendly trainee who quickly whispered the answer in my ear whilst the consultant was preoccupied.

Pain sensation is so protective. Perhaps the only doctor who doesn’t mind the lack of pain sensation as much is the anaesthetist – inserting a peripheral line was not anxiety-provoking to the child at all.

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View from the hospital children's school (converted to staff well-being area) temporarily amidst covid times

All in all – I am so grateful to have had this opportunity to learn and be inspired by the lovely staff and students, and the well-constructed and designed hospital! (The atrium is beautiful especially on a sunny day, and the hospital school on site for the kids is a brilliant addition - although it is now temporarily staff's welfare area).

evelina, architecture, construction, plan, paediatrics, hospital, management
Design and construction of the Evelina back in 2004

P.S. Function + form: external walkway and garden, sunlit canopy, atrium with cafe and performance space (piano), hospital school, children's play areas, spacious well-designed wards and PICU - what's there not to love?

PPS. A certain MR PELVIS PRESLEY resides in the orthopaedic ward. Oh dear.

Snowy day view from Mountain Ward

Till next time, cheers!

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