Minutes of meeting
Present at meeting: Dr
Maria Atkinson (fellow)
Dr
David Bond (general paediatrician)
Dr Jim Bonham (clinical chemist)
Dr Richard Bowker (fellow)
Gordon
Denney (lay
representative/sponsor)
Sr
Sue Shipston (nurse
practitioner A+E)
Dr William Whitehouse (paed. neurologist)
Apologies from: Dr
Mandy Hampshire (primary care)
Miss Susie Hewitt (general A+E)
Dr Monica Lakhanpaul (guideline methodologist)
Dr
Ian Maconochie (paed. A+E)
Dr
Stephanie Smith (paed. A+E)
Prof
Terence Stephenson (chair)
Dr
Harish Vyas (PICU)
Dr
John Walter (metabolic
medicine)
AGENDA
1
Minutes of last meeting
The minutes of the last
meeting 23rd February were approved without changes.
2
Latest draft algorithm
The latest draft
algorithm was reviewed. Issues raised included the need for child protection to
be addressed in the algorithm; overdoses of opiates and benzodiazepines should
be included in the “no clinical clues” box; the terms “seizure”, “fitting” and
“ictal” should change to “convulsion”; and the “ongoing seizures” box should
only include convulsive status with non-convulsive status becoming part of the
“no clinical clues box”.
3
Review the scope of guideline again
The end point of each
management strategy was agreed upon.
“Shock” management will end after
boluses of fluid and intubation without giving guidance on inotropic agents.
“Sepsis” management will end with
tests sent and first line antibiotics given.
“Trauma” management will end with
the recognition of trauma.
“Raised intracranial pressure”
management will end with advice on who should have invasive intracranial
pressure monitoring in place and what the goals of therapy should be aiming
for.
“Intracranial infection” management
will end with first line antibiotics / acyclovir started and which tests to do
to diagnose the rarer infections.
“Metabolic Illness” management will
end with the emergency treatments of raised ammonia, severe acidosis and
ketosis, and hypoglycaemia with testing ongoing for definitive diagnosis of
other possible metabolic causes of reduced conscious level.
“Ongoing convulsion” management will
end with recognition of convulsive status.
“Post-convulsion” management will
finish with recognition and recovery within a time frame before considering
other causes.
“No clinical clues to cause”
management will finish with tests being extended to look for rarer causes and
supportive treatments started whilst awaiting those tests.
4
Evidence level system
The SIGN and the Oxford
CEBM levels of evidence systems were reviewed. For
the time being papers will be appraised using both systems and a decision will be taken which will be used for
clarity later.
5
Paper appraisal – internal validation
All papers are appraised
by Richard Bowker. Those papers appraised level A or B will be independently
checked by another member of the guideline development group.
6
Suggestions for
A decision to include
patients and paediatric endocrinologists was made.
The “Don’t know” box
should negate the need for highlighting groups of panellists to answer
individual statements.
7
Any other business
Implementation would be
aided by presentations at the Trent Paediatric Society meeting, publishing in
Emergency nurse journal/Paediatric nurse, and an education day on reduced conscious level.
8
Next meetings
Tuesday 21st
September,
Wednesday 17th
November,
Wednesday 9th
February,
Minutes written by Richard Bowker
20th July 2004
