Start here if adolescent self-harm or hopelessness appears anywhere in your practice. The episode gives a usable structure for asking directly about non-suicidal self-injury, suicidal thoughts, intent, plan, past behaviour, protective factors, and access to lethal means, then building a realistic safety plan.

The clue is in the floor rise, the gait and the tone. This episode is the strongest paediatric listen today because it turns Gowers' sign, marked CK, early hand preference and trisomy 21 screening into concrete actions rather than delayed referrals.

Most paediatric epistaxis stops when families pinch the soft lower nose firmly and long enough. Recurrent reattendance often reflects poor technique, so correct compression first, add oxymetazoline when needed, and escalate or refer early if bleeding persists, packing is required, or obstruction suggests a posterior source or mass.

Integrated behavioural health works when access is immediate, not theoretical. A positive depression, suicidality or postpartum screen should trigger a same-day warm handoff, shared plan and social-context review, because transport, school absence and readiness often decide whether referral becomes care.