Recognising children with surgical problems in the pre-hospital setting

Identifying surgical condition in children can be challengingIt is of paramount importance that surgical teams are involved early in cases where the situation can progress and rapidly deteriorate (e.g. intussusception or appendicitis) (UK Ambulance Service Clinical Practice Guidelines, 2006). The variation in presentation caused by age-related, idiosyncratic or non-specific presentations in children, however, increases the diagnostic challenge.Therefore, whenever a suspicion about a surgical problem arises, the child should be transferred to specialist services. Some of the reasons why recognising and diagnosing surgical conditions in children can be challenging are highlighted below:The history is usually obtained from another individual (parent or carer)Vomiting is a common presentation in surgical problems; however in children it is a very common feature even in the absence of a surgical pathology (e.g. gastro-oesophageal reflux, anxiety, gastroenteritis)Younger infants are more likely to present with congenital anomalies (e.g. malrotation, gut atresia, pyloric stenosis)There is a general lack of understanding amongst the public (and healthcare professionals) (Walker et al. 2006) about what constitutes ‘bilious’ vomiting. (Bile has a distinctive dark green colour; however, yellow vomiting is often reported as ‘bilious’. The child that truly vomits bile has a bowel obstruction until proven otherwise)The physical assessment and diagnostic procedures can be difficult from technical, physical and emotional aspects.

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