Awareness Of Normal And Abnormal Physiological Parameters In Children: A Survey Of Staff Working In Southwest England

摘要

A survey was carried out amongst clinical staff working on paediatric burns units in Salisbury, Bristol and Oxford. The main aim of the survey was to find out about how confident staff are in looking after children with burns injuries and how much formal training staff received. A secondary aim was to assess, via a series of scenarios, whether staff were able to pick up abnormal values for heart rate, systolic blood pressure or respiratory rate. The survey found that more than half of staff working on these units do not feel confident in managing children with burns injuries and that although staff are generally able to pick up abnormal physiological values, an abnormal heart rate is less likely to be recognised than an abnormal systolic blood pressure or respiratory rate. The authors of this paper would recommend that formal training is incorporated into the induction programme of new clinical staff and that all staff are provided with a table of normal ranges for physiological parameters. Introduction Burns are the third most common cause of injury-related death in children aged less than 9 years1. The type of burn injury varies according to age group. Scalds are more common in toddlers whilst flame burns are more common in 6-10 year olds and both flame and electric burns cause the majority of burns in older children and adolescents2. The Children’s Burns Trust have reported that scalds from hot drinks are the cause of 50% of children admitted to hospital for burns injuries3.Life-threatening consequences can arise as a result of a lack of vigilance and a lack of awareness of abnormal physiological parameters in children. The mortality in paediatric burns ranges from 0.2% to 10.2% as reported by Papp et al in 20082. Paediatric patients lack the reserves and resources of their adult counterparts and can deteriorate extremely quickly. Monitoring of the basic physiologic parameters such as heart rate, respiratory rate, blood pressure, temperature and urine output, along with appropriate and timely interventions can make a real difference in outcome to unwell children.Burns and scalds in children require careful and precise fluid resuscitation, striking a balance between worsening oedema and hyponatraemia and maintaining intravascular volume for perfusion of vital organs. The Lund and Browder chart, developed in 19444, is widely considered to be the most accurate for calculating total body surface area affected by a burn or scald injury. The Parkland formula is universally regarded as an appropriate guide to fluid resuscitation, although fluid regimens must be adjusted for each individual child according to response. A survey conducted in Germany in 2008 found that 78% of clinicians use the Parkland formula ‘always’ or ‘often’5.Children with severe burns in the UK are managed in specialist burns centres, ideally with an attached paediatric intensive care unit. Aggressive management in a specialised burns unit results in an excellent prognosis in children with large burns2. Medical staff on these units, who are generally plastic surgeons or anaesthetists, should be trained to provide the best possible care for children after initial stabilisation at referring units. The need for this is reflected in the national service framework for the care of children which states that ‘whatever the setting they work in, professionals are trained and competent to provide consistent advice and to assess and treat a child who is ill’6.Children with burns are at risk of developing toxic shock syndrome (TSS), diagnosis of which is difficult in the early stages – and requires prompt detection and recognition in changes of the physiological parameters. Toxic shock syndrome (TSS) due to staphylococcal infection is a treatable condition with a mortality rate of up to 50% and where vigilance and early detection of abnormal physiology has been shown to affect outcome7.The Odstock Centre for Burns and Plastic Surgery in Salisbury, Wiltshire is a regional