Hey Reader,

Welcome to another edition of Bursting The Bubbles, DTFB's newsletter with some top tips, evidence highlights, and the best dad jokes.

This week we look at contraceptive choices, pulled elbows, and a poignant reminder of how important it is to have quick management of anaphylaxis.

Let's do it...

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WEEKLY BUBBLE WRAP: CONTRACEPTIVE CHOICES

What’s It About?

The PREFER study looked at whether watching a bespoke online education affected decision-making around contraceptive choices.

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The study, conducted in Australia, used a pre/post-intervention model. 322 participants, between 16 and 25, were recruited via Facebook. Participants took part in three surveys – one before the video was shown, one immediately after and then one six months later. They rated their knowledge of contraceptives using a Likert scale at each stage.

There was a 10-fold increase in participants feeling more knowledgeable about all contraceptive options after watching the video. Interestingly, contraception preferences also changed, with more participants choosing LARC (Long Acting Reversible Contraceptives) over COCP (Combined Oral Contraceptive Pill) or barrier methods. At six months, there was a modest increase (of 4.3%) in the use of LARCs.

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Why Does It Matter?

According to Public Health England, 45% of UK pregnancies are unplanned. The UK school curriculum contains no structured teaching about contraception, and many young people are not aware of the options available​

Only 6% of participants in this study reported a reasonable level of knowledge about contraceptive methods before watching the video. After the short educational video, young people felt more informed about their options, and there was a higher use of LARCs. These are the preferable contraceptive choice, so this point appears to have been well communicated in the video.

This study also demonstrated the usefulness of social media as a research platform. Though Facebook was the only platform used in this study, it does suggest that there is scope for this methodology to become more widespread.

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Clinically Relevant Bottom Line:

A short educational video promoted via social media can increase the understanding and use of LARCs. This resource could easily be used by clinicians when counselling young people about contraception.

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Reviewed by: Nikesh Bhatt and Lauren Peaker. Read the full Bubble Wrap here​

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TOPIC OF THE WEEK: PULLED ELBOWS

Even though we see pulled elbows every day, most of us don't know exactly what a pulled elbow is....now there's no excuse.

The medial and lateral collateral ligaments hold the humerus and ulna together (one on either side).

The annular ligament holds the radius and ulna together.

In a pulled elbow, the annular ligament slips off the head of the radius and can get trapped in between the radius and humerus. This causes restriction of movement and pain on pronation and supination.

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How Do Pulled Elbows Occur?

It’s usually from a pull of the arm, e.g. when the child falls down while holding the parent’s hand and the parent tries to stop them from falling by pulling the arm.

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How Do Children With Pulled Elbows Present?

Children most commonly present with not using their arm. On assessment, the arm often hangs limply by their side. When asked, they may point to the distal radius as the point of pain, which can lead us to suspect a buckle fracture.

They have pain on pronation and supination.

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How Can I Reduce It?

There are two main techniques to reduce a pulled elbow.

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The hyper-pronation method

The first is hyper-pronation. Rest your thumb over the radial head. This isn’t to apply pressure, it’s just so you can feel the click when it reduces. Then hyper-pronate the arm.

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The supination method

The second technique is supination-flexion. Again rest your thumb over the radial head, supinate the arm, and then flex the elbow (while the arm is still supinated).

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But here's a video that shows you exactly how to do it:
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What happens if it doesn’t go clunk?

Sevencan et al. (2015) looked at 66 patients presenting with pulled elbows. 57 were successfully reduced on the first attempt. A first attempt successful reduction was more likely in patients presenting within 2 hours of the injury. After two years follow up 24% had recurrence (but they will eventually grow out of it).

After a successful reduction, the child should be using the arm normally within 10-15 minutes. If it fails on the first attempt, try again using the other technique. If the child is still not using the arm, get an x-ray.

Sometimes you may feel like the reduction was successful, but they are not using the arm normally. This may be because the annular ligament was torn when the elbow was pulled, and this may take time to heal. In these cases, put the child in a broad arm sling and review them again in a few days.

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If you want to learn more about pulled elbows (and elbows in general) then click here to sign up for our Free Elbow Excellence Email Course:

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(If you want to share this Email Course with someone who's not getting this email then they can sign up here.)

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HIGHLIGHT: AMAX4 - ANAPHYLAXIS

Max McKenzie was an otherwise healthy teenager but died from a hypoxic brain injury sustained during food anaphylaxis-related bronchospasm/asthma. He was talented, happy and loved, and his death was a tragedy causing unimaginable pain for his family and the broader community.

He died in Victoria, Australia, in 2021 after a period of prolonged brain injury sustained in a fully equipped metropolitan hospital.

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When Max entered the healthcare system, he was alert and could ask for help.

Tragically, inadequate emergency health care resulted in Max sustaining an unsurvivable brain injury.

Max's father, Ben is an Emergency Physician

Ben McKenzie has made it his mission to ensure this cannot happen again. To do that, he has created the AMAX4 algorithm – a best practice for algorithm for Critical Care Clinicians to use in Anaphylaxis and Asthma resuscitation.

Please check it out here:

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Read more about AMAX4 here.

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EVENT OF THE WEEK

The 16th of June was Rare Chromosome Disorder Day.

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Whilst genomic sequencing may seem beyond you, Sarah Josephi-Taylor has written an excellent article on what it's all about and when we should do it.

You can check that out here.

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TIP OF THE WEEK

Remember, kids are brutally honest.

If your outfit is questionable, be prepared for some hilarious fashion critiques.

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JOKE OF THE WEEK

I used to hate facial hair, but then it grew on me.

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That's it for this week, Reader.

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Remember, your work makes a difference in the lives of paediatric patients every day.

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Stay tuned for next week's edition of Bursting The Bubble.

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From Tessa (on behalf of Team DFTB)

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