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Lecture notes Acute Care (SHN2004)
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Caring for the Critically Ill Child or Young Person Policy Issues
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SHN2004 (Acute Care) – Caring for the Critically Ill ChildCaring for the Critically Ill Child or Young Person – Policy Issues
Objectives
To give a brief overview of the historical context of caring for critically ill CYP’s and to
provide some working definitions
Paediatric Intensive Care (PIC)
Who is it for: Children and young people with potentially recoverable diseases and
conditions who need constant observation and increased treatment
o Vary rarely will CYP be admitted at the end of life stage. PIC is normally only
for those with the potential to recover
o Problems with this definition
Important to take into account Rights of the Child and the Human
Rights of CYP
Problem that generally speaking in terms of healthcare childhood
viewed as ending at age 16 in terms of healthcare – this is at odds
with WHO, UNCAR and the UK law where it is regarded as 18
Transition to adult (preparation) can begin as young as 12
2006-2008: 47,125 PIC admissions in 28 NHS hospitals in the UK 1
o 47% of these were children under 1 year
o 56% boys and 44% girls
More boys as they tend to be more susceptible to illness (men
physiologically the weaker sex)
Linked directly to the size of their airways which are smaller
than girls. This means they are more likely to be adversely
affected by things such as bronchiolitis
Men are the ‘weaker’ sex – men will typically die c.5 years younger
than women
o 57% admissions unplanned
Retrieval: 78% by a specialist PIC team
Historical Background
PICU’s developed in an ad hoc manner in children’s hospitals and/or within specialist
services for children – e.g. cardiac surgery
o Lack of consistency across not just Health Boards but also hospitals
British Paediatric Society (1993)
o 29% of children cared for in children’s wards
o 20% in adult ITU’s (<2% of nurses had a children’s nursing qualification)
o 51% in PICU’s
1
One of the first studies that looked at what was going on in PIC in the UK
1
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