Fifteen-minute consultation: An overview of major incidents

Major incidents are rare but require a large amount of preparation, co-ordination and communication across different emergency services and specialities. This ensures that casualties are efficiently managed within the constraints of limited clinical resources. This article aims to provide a brief understanding of what constitutes as a major incident, how it is declared and the chain of command in communication and action, focusing specifically on the paediatric process. It also aims to highlight important considerations that could potentially be missed (eg, the mental health impact, forensic evidence and so on).

Fifteen-minute consultation: Recognition of sickle cell crises in the paediatric emergency department

Children with sickle cell disease can develop life-threatening and painful crises that require prompt assessment and efficient management by healthcare professionals in the emergency or acute care setting. Due to migration patterns and improved survival rates in high-prevalence countries, there is an increased tendency to encounter these patients across the UK. These factors warrant regular revisions in sickle cell crisis management, along with education for medical personnel and patients to improve clinical care and patient management. The focus of this article is on the initial assessment and management of acute paediatric sickle cell complications in the emergency setting. Specific case studies, including acute pain crises, trauma, splenic sequestration, aplastic crises, acute chest syndrome, infection, avascular necrosis, osteomyelitis and stroke, are discussed. Due to the current COVID-19 pandemic, we have also reviewed specific concerns around this patient group.

How to interpret spinal imaging in paediatric trauma

Spinal injuries in children are fortunately rare; however, it is important that they are assessed and managed in a timely manner. A systematic approach to traumatic spinal injuries should be used, by following recent evidence and national protocols, in order to avoid misinterpretation and potentially, inappropriate discharge. The aim of this article is to highlight the concepts of spinal imaging in paediatric trauma with regards to indications, interpretation and limitations.

Feasibility of Transanal Minimally Invasive Surgery (TAMIS) for Rectal Tumours and Its Impact on Quality of Life - The Bristol Series

AIM

We assessed feasibility of the transanal minimally invasive surgery (TAMIS) procedure and quality of life postoperatively.

PATIENTS AND METHODS

A total of 28 patients with rectal lesions were treated using TAMIS at Southmead Hospital, North Bristol NHS Trust. Outcome measures included feasibility of excision, negative margin (R0) resection rate, length of hospital stay, morbidity and mortality, and postoperative quality of life associated with anal incontinence. Results; TAMIS was feasible in 90% of cases. R0 resection was 82%. The mean length of hospital stay was 1.5 days. Six (21%) patients experienced acute urinary retention postoperatively. One (4%) patient was re-admitted with rectal bleeding. One patient experienced a perforation. Mortality was 0%. Postoperative quality of life indicated low severity of symptoms of anal incontinence.

CONCLUSION

This study demonstrates that TAMIS is a feasible option in the treatment of rectal tumours and does not impair quality of life postoperatively.