Neobook — clinical reference

How to refer?
Presenting Problems
Emergencies: to be discussed with the on-call registrar for immediate referral
Urgent issues: to be discussed with the on-call registrar for OPD appointment within a week
Elective issues: do not need to be discussed with registrars and can get an out-patient appointment
Conditions where management should be attempted at a primary healthcare level
Common conditions in alphabetical order

Paediatric surgical problems are common and numerous. Parents and caregivers will bring children of all ages in with a variety of problems: some of these issues will be emergencies that need to be dealt with immediately, whilst many will be issues than can be dealt with on a more elective basis.

Below is a list of common problems, and the Red Cross Surgical Department’s suggested referral strategy. Sticking to this referral strategy should ensure that emergencies get to us timeously, whilst at the same time preventing patients and their care-givers from making costly and unnecessary trips to the hospital.

How to refer?

Surgical Registrar-On-Call:
- There is always a registrar on call, and the Red Cross switchboard will put you through to their mobile phone. If they are unable to take your call (they may be scrubbed in theatre, out of cell-phone range or busy with an emergency), please leave a detailed voice message, or call back again in half an hour. If despite these efforts you are still not able to contact the registrar, the switchboard will also be able to put you through to the consultant on call.
Surgical Out-Patients Department:
- Appointments can be made between 09:00 and 15:30 from Monday to Friday. Central booking station numbers are: 021 658 5850 and 021 658 5851 They will direct your call to the correct department.
- If you are seeing a patient outside of these hours and would like to refer then:
  - Take the patient’s contact details down, make the appointment during office hours the next day, and then call the patient back OR
  - Give the patient a referral letter, and write down the name and phone number of the clinic you are referring to so that the patient’s care-giver can call and make the appointment themselves
- Red Cross has many surgical clinics, including ENT, orthopaedic, burns, plastic surgery, neurosurgery, hand and eye clinics. Please try to refer to what seems to be the most appropriate clinic, and if you are unsure then please contact the registrar on-call for advice.

Contact Numbers:

Red Cross Switchboard: 021 658 65111
General Paediatric Surgery, Fracture clinic, Orthopaedics, Burns Out-Patients Department: 021 658 5400/5386
Ward D2 (Surgical Ward): 021 658 5154
Trauma Unit: 021 658 5198

Presenting Problems

Please note:

The below list deals only with general surgical problems, and not with trauma-related issues, or other specialized surgical issues
The below list deals with patients that are most likely to present from home, and not with issues that will be diagnosed prior to discharge after birth

1) Emergencies: to be discussed with the on-call registrar for immediate referral

Neonates/small babies

Bile-stained vomiting (suspected mid gut volvulus)
Umbilical sepsis
Projectile vomiting of feeds (suspected Hypertrophic Pyloric Stenosis)
Any neonatal sepsis with suspected intra-abdominal cause
Abscesses and cellulitis, including mastitis

All age groups

Acute abdomen
Acute Scrotum
Bowel obstruction
Irreducible hernias
Abscesses and some cellulitis
Paraphimosis not reducible at CHC
Rectal bleeding or haematemesis WITH sepsis or haemodynamic compromise

2) Urgent issues: to be discussed with the on-call registrar for OPD appointment within a week

Neonates and small babies

Reducible inguinal hernias

All age groups

Pathological cervical adenopathy – after infective conditions have been treated
Abdominal masses or suspicious soft-tissue masses
Rectal bleeding or upper-GI bleeding (haematemesis) in the absence of sepsis and haemodynamic compromise

3) Elective issues: do not need to be discussed with registrars and can get an out-patient appointment

Any age group

Constipation: after management has been attempted at a primary-care level
Reducible inguinal hernias in older babies and children
Undescended testes
‘Lumps and bumps’ – dermoid cysts, thyroglossal cysts, branchial cysts, suspected BCG adenosis (non-infected), hypermastia, gynecomastia, breast masses, cervical adenopathy
Suspected pathological phimosis

Refer only when child is more than a year old

Hydroceles

Refer only when child is more than four years old

Uncomplicated umbilical hernias

4) Conditions where management should be attempted at a primary healthcare level

Umbilical granulomas
Uncomplicated paraphimosis
Constipation
Uncomplicated cellulitis
Uncomplicated Lymphadenitis

If you are unsure, please call the surgical registrar, regardless of the time of day. It is better to wake the registrar with a phone call in the middle of the night than to unnecessarily get the patient to travel a far distance at an inappropriate time.

5) Common conditions in alphabetical order

Abdominal Mass
- Discuss with registrar
Abscess
- Emergency: discuss with registrar
Acute abdomen
- Emergency: discuss with registrar
Acute Scrotum
- Emergency: discuss with registrar
Bowel obstruction
- Emergency: discuss with registrar
Cellulitis
- Emergency: discuss with registrar
Constipation
- Attempt management, OPD appointment if no success
Haematemesis
- Discuss with registrar
Hernia
- Inguinal (reducible)
  - Small baby: discuss with registrar
  - Larger baby/child: OPD appointment
- Irreducible
  - Emergency: discuss with registrar
- Umbilical (reducible)
  - Elective OPD appointment after 4 years of age
Hydrocele
- Elective OPD appointment after 1 year of age
Lymphadenopathy
- Elective OPD appointment if not pathological
Lumps and bumps
- Elective OPD appointment
Omphalitis
- Emergency: discuss with registrar
Penis
- Balanitis - Discuss with registrar
- Paraphimosis - Attempt reduction, discuss with registrar if unsuccessful
- Phimosis - Elective OPD appointment
Rectal bleeding
- Discuss with registrar
Umbilical sepsis
- Emergency: Discuss with registrar
Undescended testes
- Elective OPD appointment
Vomiting
- Bile-stained - Emergency: discuss with registrar
- Projectile - Emergency: discuss with registrar