Adolescent medicine in the emergency department

30.1 Adolescent medicine in the emergency department



Katherine Barton, Donald Payne




Essentials



1 Establishing rapport is essential for a successful adolescent health consultation.

2 Interviewing adolescents in a quiet, more private setting, removed from the main ED, is a great advantage.

3 It is important to see adolescents on their own.

4 Using the HEADSS framework as an aide-mémoire will help exploration of relevant psychosocial issues.

5 Explanation of confidentiality is essential.

6 Discussion should be professional and in language the young person is able to understand.


Introduction


Many health professionals find working with adolescents challenging. Communication can be difficult, the priorities of adolescents are different to those of adults and issues of consent, confidentiality and privacy take on particular significance.1 Adolescents also take time, which is not always readily available in the emergency department (ED). The perceived discomfort that some professionals experience working with adolescents usually reflects a lack of training in this area.2 However, as with any area of medicine, specific training can lead to an increase in clinicians’ competence and confidence in dealing with adolescents.3 Keys to working effectively with this group include developing confidence in talking to adolescents and understanding the concept of adolescent development.


Although different age ranges have been proposed, it is more appropriate to think of adolescence as a process – during which an individual moves from being a dependent child to an independent adult.4 The developmental changes that occur during adolescence include the obvious physical changes of growth and puberty as well as the less well-recognised cognitive and social changes. A key task of adolescence is for individuals to establish their own identity and self-image. This involves developing independence from parents, forming relationships outside the family, challenging authority and experimenting with different behaviours, some of which can pose a health risk. Health professionals working with adolescents need to acknowledge this process and be aware of the impact of emerging adolescent behaviours on health outcomes, as well as the effect of illness on normal adolescent development.4,5



Adolescent health problems in the ED


Whether the setting is an adult, mixed or paediatric ED, all emergency doctors are likely to see adolescents in their daily practice. The leading causes of death among adolescents and young adults are motor vehicle accidents and suicide.6 The most common causes of morbidity include injuries (both intentional and non-intentional), mental health problems, drug and alcohol misuse and sexual health problems (Table 30.1.1). In addition, the number of adolescents and young adults growing up with chronic diseases of childhood is increasing as a result of improved treatment of these conditions. Many presentations to ED for primary physical problems are linked with psychosocial issues or with health risk behaviours, such as drug and alcohol use, unsafe sex and physical risk-taking. Clinicians working in ED must therefore be aware of these underlying risk factors and feel confident in being able to discuss them and liaise with local adolescent resources as needed.
















Table 30.1.1 Health issues for adolescents presenting to medical care
Accidents and injuries: motor vehicle accidents, bicycle and pedestrian accidents, work related injuries, falls, assaults, poisonings
Mental health issues: anxiety, depression, self harm, suicide attempts, psychosis, personality disorders, eating disorders
Drug related: alcohol, illicit drug use
Infectious diseases: e.g. influenza, meningococcal infection, pneumonia
Chronic disease: asthma, cystic fibrosis, diabetes mellitus, inflammatory bowel disease, chronic pain/fatigue syndromes, allergies
Sexual health: pregnancy, sexually transmitted infections

Source: Australian Institute of Health and Welfare (AIHW) 2007. Young Australians – Their Health and Well Being 2007. Cat. No. PHE 87. Canberra. www.aihw.gov.au.



The approach to the adolescent in the ED



Establishing rapport


Establishing rapport is essential for a successful adolescent health consultation. Empathy, trust and respect are important keys in any doctor–patient relationship, but especially so for adolescents. Establishing rapport in ED can be challenging, but not impossible. Adolescents may present to an adult department, where they could find themselves surrounded by much older patients, or to a paediatric department, full of infants, toddlers and understandably anxious parents. The setting may therefore have a significant impact on the consultation. The ability to see adolescents in a quiet, more private setting, removed from the main business of the ED, is a great advantage.



Seeing adolescents alone


It is important to see adolescents on their own, separate from parents, for at least part of the consultation. This helps to establish rapport and trust and optimises the chances that the young person will talk openly about relevant issues. Adolescents often contribute little to the history when parents are present. However, on their own, they are much more likely to open up. Parents may find it difficult to separate from the adolescent for the health consultation. This process is helped by explaining that it is routine practice to see adolescents on their own and emphasising the importance of the young person beginning to take responsibility for their own health. Spending time with parents on their own afterwards (after discussing with the young person what you will tell them) may alleviate their anxieties.


Unless the urgency of the situation dictates otherwise, it is helpful to begin the consultation by asking adolescents one or two general questions (e.g. what school do you go to? where do you live? who else is at home?) rather than immediately focusing on the medical presentation. This helps to put them at ease and shows that you see them as a person first who happens to have a medical problem.

Related posts:

Syncope Abdominal and pelvic trauma Paediatric advanced life support (PALS, APLS) Pertussis Infective endocarditis Specific poisons

Stay updated, free articles. Join our Telegram channel
Tags:
Sep 7, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Adolescent medicine in the emergency department

Full access? Get Clinical Tree
Get Clinical Tree app for offline access