There is little consistency of practice in some areas such as pregnancy testing, DVT prophylaxis or partner visiting, whereas in others, such as involving young people in healthcare decisions where possible, practice is consistently good. Further research should focus on the young people's experience of critical care to refine healthcare policy. What is Known: • Adolescents have distinct health and psychosocial needs that are often poorly catered for in contemporary healthcare settings, including critical care. • As adolescents are infrequent patients for any intensive care unit, there is a poor research base and essentially no guidance, regarding optimal care. What is New: • We developed a mnemonic with adolescents and ICU staff to improve healthcare delivery to young people in critical care, the 6Ps: privacy, permission, DVT prophylaxis, personal life, puberty and practical issues. • Delivery of the adolescents' critical care varies greatly both between and within countries; the 6Ps offers a method of standardising and improving this across different countries.

other names eg. 'blackout', 'five-minutes-in-heaven and 'space monkey'. Participants are usually adolescentsa North American study found 68% had heard of the game, 45% knew somebody who played it, 6.6% had tried it and 40% perceived no risk, although this is difficult to quantify. Warning signs include marks on neck, headaches, bloodshot eyes, changes in personality. Social networking sites have enabled millions to watch videos of the choking game, which may normalise the behaviour. Most bunk beds are made using metal tubes or timbers, their design enabling easy attachment of ligatures. Conclusion Adolescents must be made aware of the dangers of this activity and parents and professionals need to recognise the warning signs. There is the potential for bunk beds to be designed to eliminate anchoring points for ligatures.

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