An optimal healthcare system for children balances the need to provide immediate emergency care with the need to make specialized care available to all patients throughout a geographical region. No matter what the country or type of healthcare system, it is logistically impossible to have pediatric specialists at all emergency locations throughout a large region, especially in rural locations. Therefore, when children fall gravely ill or suffer trauma, they are often brought to regional hospitals for initial stabilization and then transferred to centrally located children’s hospitals for ongoing care. As a result, in regional hospitals, referred to as District General Hospitals in the United Kingdom, children are often initially cared for by providers, such as emergency physicians, intensivists, and anesthesiologists, who normally take care of adults. If general pediatricians are present, they may not be specialists in critical or emergency care. Managing the Critically Ill Child: A Guide for Anaesthetists and Emergency Physicians is an excellent reference for clinicians in regional settings who are asked to care for critically ill children sporadically. This book was designed specifically for practitioners at District General Hospitals in the United Kingdom who are asked to stabilize pediatric patients before they can be transferred to tertiary children’s hospitals. Although the intended audience is quite small and some information is pertinent only to practice in the United Kingdom, this book is a great resource for any physician who finds him/herself in a practice as described above. The book also is an excellent reference for students learning the basics about emergency and critical care of pediatric patients. It offers insight into, and practical suggestions for, dealing with the challenges of resource allocation, communication, and patient transfers within a healthcare system.
This book is organized into five sections. Section 1: The District General Hospital Setting focuses on methods to ensure a District General Hospital is ready to care for children. Although specific to the United Kingdom, this information is generalizable to any regional hospital. Chapters in Section 2 discuss management of children with specific medical conditions, including sepsis, cardiac disease, asthma, diabetic ketoacidosis, and increased intracranial pressure. Most chapters are divided into background information, presentation, assessment, management, testing, and a general summary. Tables, lists, and flow diagrams, such as those found in the chapter on managing increased intracranial pressure, are useful for providers with general knowledge but who need refreshers about details specific to treating children. A highlight of this section is the chapter entitled The Difficult Paediatric Airway, which discusses appropriate equipment to have available and the importance of creating a strategy for oxygenation and ventilation. It offers detailed suggestions for managing the difficult pediatric airway when equipment and personnel resources may be limited. Paediatric Difficult Airway Guidelines, published by the Difficult Airway Society, are included for easy reference.
The text discusses logistics related to caring for children until transport to a children’s hospital arrives in Section 3: What You Could Be Expected to Do in a District General Hospital. Challenges, including caring for children on an adult unit and reporting suspected cases of child abuse, are addressed. Section 4: The Children’s Hospital Setting reviews ventilation, fluid management, and pharmacology for children. A chapter on neonates rounds out this section. Finally, Section 5 is a practical quick reference guide, including information on drug infusions and common pediatric syndromes.
As indicated by the title, this text is a guide or handbook for practitioners who rarely care for children but are required to do so occasionally in the regional hospital emergency room or critical care unit. The information is practical and well organized, with charts and tables that are easy to follow and offer an efficient way to transfer information to the reader, who may be stretched for time. This book is a great introduction for emergency medicine, pediatric, and anesthesia residents during their pediatric or critical care rotations. Although I am a pediatric anesthesiologist who regularly cares for children, I learned practical information from this concise, easy to read guide.
In conclusion, I highly recommend this text as an excellent resource for any healthcare provider involved in the emergent or critical care of pediatric patients. This is potentially one of those books that becomes coffee stained because practitioners find themselves reading it in the middle of the night to double check they are not missing anything when stabilizing a critically ill child.