If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
Paediatric surgery registrars at Children's Health Queensland and Gold Coast University Hospital can offer telephone advice to rural HHS. In some areas it would be more appropriate to seek initial advice from local paediatric medical service or general surgery services:
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Children's Health Queensland (previously known as LCCH): 07 3068 1111
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Gold Coast University Hospital (GCUH): 1300 744 284
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Burns
NB All major burns require emergency management and referral
- Acute burns injury (ANZBA guidelines)
- Any new burn in a child: with comorbidities; who is under 6 months age; is febrile or unwell
- Any burn injury irrespective of size or depth not healed in 1 week
- Ingested caustic and acid substances and batteries
- Ingested foreign bodies causing distress
Antenatal & neonatal surgical conditions
- Patients with congenital malformations causing bowel obstruction or respiratory compromise are emergency referrals not outpatients. Resuscitation and safe transfer to tertiary paediatric unit is a priority. Notify neonatal unit or appropriate neonatal/paediatric medical specialist of neonatal/fetal diagnosis as per local protocol.
- Acute neonatal bowel obstruction
Enlarged lymph nodes
- Acute infective node with no improvement within 48 hours
- Nodes rapidly increasing in size, overlying skin erythema or very tender
- Acute infection not responding to treatment/antibiotics
Umbilical and peri umbilical pathology
- Any painful, red, or irreducible hernia – discuss with on-call paediatric surgical registrar
- Suspected vitello-intestinal remnant or patent urachus
Abdominal pain – chronic
- Acute abdominal pain (suspected serious pathology) especially peritonitis
- Intussusception
- Hypertrophic pyloric stenosis
- Suspected bowel obstruction with bile stained vomiting
- Suspected malignancy – discuss with on-call paediatric surgical registrar if serious pathology is suspected
Acute abscess
- Bile stained vomiting is a surgical emergency – phone the on-call paediatric surgical registrar,
- Suspected pyloric stenosis – phone the on-call paediatric surgical registrar
Stomas and abdominal devices
- Accidental removal of gastrostomy button or ACE tubing – phone on-call paediatric surgical registrar
- Any stomal or abdominal device issues refer to treating hospital
Hernia, hydrocele and testicular conditions
- Irreducible, incarcerated or strangulated inguinal hernia
- Suspected testicular torsion
- Inguinal hernia: If under <52 weeks post conceptual age, call nearest paediatric surgical unit for urgent review
- Acute scrotal pain with or without swelling
- Ambiguous genitalia and neonatal bilateral undescended testes are urgent referrals to service
Renal and bladder congenital lesions
- Acute retention
- Poor urinary stream in neonate / suspected valves
Severe pain or peritonitis
- Acute infection requiring admission or drainage
Urinary tract infections (UTI)
- Acute infant urinary tract infection presenting septicaemia or acutely unwell
- Hypertension > 97 percentile for age and/or height
- Presumed UTI in infant <3 months
Penile conditions
- Paraphimosis (when unable to replace foreskin)
- Disorder of sexual development (DSD) – refer to paediatric surgeon or paediatric medicine immediately
Skin and soft tissue masses
- Acute infection - If unresponsive to treatment or acutely unwell from infection
- Suspected solid paediatric tumours should be urgently referred through local paediatric medical service and/or paediatric oncology services
Vascular anomlaies/haemangioma
- Obstruction of vision, airway compromise, uncontrolled bleeding, ulceration, suspected kapsiform haemangioendothelioma (KHE) or cardiac output compromise - contact paediatric surgical registrar on call