ABSTRACT
In routine practice, intensive care physicians rarely have to manage children under 18years of age, particularly those under 15. This study's objectives were to assess the quality of training in pediatrics of adult intensive care teams, to document the workload generated by care of pediatric patients, and to identify the difficulties encountered in managing minors as patients. A survey was administered in Lower Normandy from 4 April 2012 to 1 September 2012. Physicians, residents, nurses, and nurses' aides practicing in one of the nine intensive care units of Lower Normandy were asked to complete an electronic or paper format questionnaire. This questionnaire assessed their level of pediatric training, the workload management of pediatric patients entailed, and the challenges posed by these patients. One hundred and nine questionnaires were returned (by 26 attending physicians, 18 residents, 38 nurses, and 27 nurses' aides). Eighty-three of the respondents (76%) had no experience in a pediatric unit of any kind. Forty-two percent thought that the pediatric age range lies between 3months and 15years of age. However, more than 50% of respondents would like the upper limit to be 16years or even older. Ninety-three respondents (85%) estimated having some exposure to pediatric patients in their routine practice, but this activity remained quite low. Seventy-three (67%) reported difficulties with the management of these young patients. This survey provides current information regarding the level of training of adult intensive care unit professionals and their concerns about managing patients under 18years of age, both in terms of workload and specific challenges.
Subject(s)
Intensive Care Units/organization & administration , Patient Care Team/organization & administration , Pediatrics/education , Transition to Adult Care/organization & administration , Workload , Adolescent , Adult , Child, Preschool , Clinical Competence , Female , France , Humans , Infant , Inservice Training , Male , Quality Assurance, Health Care/organization & administration , Resuscitation/education , Surveys and Questionnaires , Young AdultSubject(s)
Bronchiolitis/therapy , Emergency Medical Services , Respiration, Artificial/methods , Humans , InfantSubject(s)
Emergency Medicine/education , Emergency Service, Hospital/standards , Guideline Adherence , Hypovolemia/therapy , Pediatrics/education , Child, Preschool , Education, Medical , Emergency Medicine/standards , Fluid Therapy/standards , Humans , Infant , Infant, Newborn , Outcome and Process Assessment, Health Care , Pediatrics/standards , Practice Guidelines as Topic , Prospective StudiesABSTRACT
Bernard-Soulier syndrome (BSS) is a congenital autosomal recessive bleeding disorder characterised by giant platelets, the lack of thrombocytopenia or a moderate one, prolongation of skin bleeding time, and absent platelet aggregation in response to ristocetin. We report a case of BSS revealed by major neonatal thrombocytopenia. A newborn was admitted for thrombocytopenic purpura initially believed to be due to a maternal auto-immune thrombocytopenia. Because of the persistence of the thrombopenia till the age of 7 months despite therapy by corticosteroids and immunoglobulins, and because of the detection of anti-1b antiplatelets antibodies after transfusion, BSS diagnosis was evoked. In such a situation of major thrombocytopenia, the main therapeutic measure is prevention. Therapy by DDAVP may be used after the age of 3 years in situations of high haemorrhagic risk. This case report underlines the importance of a precise diagnosis in front of a maternal thrombocytopenia and the possibility of antenatal diagnosis of BSS.