Common Acute Presentations
Terms
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- Signs of serious illness
- loss of consciousness (not engaging, apathy, agitation, coma) hyperventilation/resp distress (wheeze, stridor, apnoea) cyanosed, dehydrated head nodding in time with resp weak/absent pulse, low cap refil increased core temperature with cool periphery unreactive pupils
- Primary survey
- A: airway with c-spine control B: breathing with support of ventilation Circulation with haemorrhage control Disability with prevention of secondary insult Exposure with temperature control Glucose!!!
- Red flags
- Purpuric rash bulging fontanelle biphasic stridor high pitched scream bile strained vomiting persisant tachycardia grunting respiration
- normal daily fluid balance in babies
- 6-8 bottles 4-5 wet nappies
- Decorticate posturing
- Arms flexed and feet dorsiflexed Lesion above the brainstem INTERVENE!!
- Decerebrate posturing
- arms extended, wrists flexed, feet extended Lesion below the brainstem, herniation is occurring!!
- Why is BP not a good sign of circulatory impairment?
- Very late sign Pressure is maintained up to 50% loss, followed by a sudden decompensation
- Causes of severe upper airway obstruction
- Croup Epiglottitis (Haemophilus type B) Bacterial tracheitis Foreign body (do a lateral decubitus XR)
- Causes of lower severe airway obstruction
- bronchiolitis asthma infection
- septic workup
- blood count and films blood cultures CXR urinalysis stool culture/faecal WCC LP
- Signs of effort of breathing
- recession resp rate insp/exp noises grunting accessory muscle use flare of the alae nasi
- Signs of effectiveness of breathing
- breath sounds chest expansion abdominal excursion
- Signs of inadequate respiration
- HR skin colour mental status
- resp rate by ages
- <1 30-40 1-2 25-35 2-5 25-30 5-12 20-25 >12 15-20
- Effects of circulatory inadequacy in other organs
- resp rate and character skin appearance and temp mental status urinary output
- Signs of heart failure
- raised JVP gallop rhythm creps in the lungs enlarged liver
- HR and BP by ages
- <1 HR 110-160 BP 70-90 2-5 95-140 80-100 5-12 80-120 90-110 >12 60-100 100-120