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Conditions which may cause a
Decreased Level Of Consciousness?
- Inadequate Perfusion:- Hypovoleamia
- - Cardiac Arrhythmias
- - Distributive shock
- - Neurogenic Shock
- - Raised ICP
- Altered Metabolic States- Hypoglycaemia & Hyperglycaemia
- - Hypoxia
- Intoxication or poisoning- Drug overdose
- - Alcohol Intoxication
- - Carbon Monoxide poisoning
- Medical Conditions- Stroke
- - Subarachnoid Haemorrhage
- - Epilepsy
- - Meningitis
- - Hypo & Hyperthermia
- Head Injury
What are the four elements of eyes in GCS scoring?
- 4 - Opens spontaneously
- 3 - Opens to voice
- 2 - Opens to pain
- 1 - None
What are the five elements of voice in GCS scoring?
- 5 - Orientated
- 4 - Confused
- 3 - Inappropriate words
- 2 - Incomprehensible sounds
- 1 - No Verbal Response
What are the six elements of motor GCS scoring?
- 6 - Obeys Commands
- 5 - Localises Pain
- 4 - Withdraws from pain
- 3 - Decorticate posturing
- 2 - Decerebrate posturing
- 1 - No response to pain
Headache Red Flags
- - Headache of severe, sudden (thunderclap) onset
- - Headache localised to the vertex
- - Escalating headache of unusual nature
- - Changed visual acuity
- - Changed mental state and inappropriate behaviour
- - Newly presenting ataxia
- - Assess GCS
- - Only give O2 if Hypoxaemic
- - Consider symptomatic pain relief
- - Avoid morphine- Time critical transfer to nearest A&E
Which diagnoses should be specifically considered in the febrile child?
- - Meningococcal Septicaemia
- - UTI
- - Pneumonia
- - Herpes Simplex encephalitis
- - Septic Arthritis
- - Kawasaki's disease
Management of febrile child
- - Antipyretics should not be given purely to treat fever.
- - Antipyretics are not proven to decrease the risk of seizure
- - Antipyretics may relieve other unpleasant symptoms of febrile illness
- - Antibiotics should not be given unless diagnosis is known.
Which children MUST be transported to hospital?
- - Any child under 5 fulfilling the red criteria
- - Any febrile baby <1 month old.
- - Any febrile child less than <3 months, unless obvious cause (as a minimum a urgent urine sample would be required)
- - Those aged under 3 years without an obvious cause, if a urine sample cannot ne obtained through GP.
- - Those with any signs of serious illness.
- - Any child with significant fever but not localising symptoms or signs, who has received antibiotics within 48 hours.
What is the croup scoring system?
Mild = 1-2 Moderate = 3-4 Severe = 5-6
- 0 - None
- 1 - Only on crying
- 2 - At rest
- 3 - Severe (Biphasic)
- Recession0 - None
- 1 - Only on crying, exertion
- 2 - At rest
- 3 - Severe (Biphasic)
What are the features of heat exhaustion?
- -Systemic reaction to prolonged heat exposure (hours to days)
- -Temperature >37 and <40
- - Headache, dizziness, nausea, vommiting and tachycadia
- - Hypotension, sweating, muscle pain, weakness and cramps.
Definition of heat stoke?
A 'Systemic inflammatory response' to a core body temperature >40.6°C in addtion to a change in mental status and organ dysfunction (European resuscitation guidelines)
Features of heat stroke
- - Core temperature >40°C
- - Hot, dry skin (Sweating is present in about 50% of cases of exertional heat stroke)
- - Early signs and symptoms e.g. extreme fatigue, headache, fainting, facial flushing, vommiting and diahorrhea.
- - Cardiovascular dysfunction including arrythmias and hypotension
- - Respiratory disfunction including seizures and coma.
- - Liver and renal failure
- - Coagulopathy
- - Rhabdomyolysis.
Sickle Cell Anemia Management Principles
- - Adults Aim for target O2 saturations of 94-98%
- - Children Administer high flow Oxygen
- - Perform 12 Lead ECG
- - Entonox initally, but not for long periods of time.
- - Opiates should be administered orally or subcutaneously rather than IV, dose should be guided by the patients hand held record.
When should you consider anaphylaxis?
- Sudden onset or rapid progression
- Airway and/or Breathing problems (e.g. dyspnoea, hoarseness, stridor, wheeze, throat or chest tightness)
- and/or Circulation (e.g. hypotension, syncope, prnounded tachycardia)
- and/or Skin (e.g. erythema, uticaria, mucosal changes) problems
Management of Anaphylaxis
- - Administer high levels of supplimentary Oxygen
- - Administer Adrenaline IM
- - Consider fluid therapy
- - Consider chlophenamine
- - Consider administering hydrocortisone
- - Consider nebulised Salbutamol for bronchospasm.
- - Monitor - reassess ABC
Signs of severe asthma
- - PEF 33-50% of best or predicted
- - Respiratory rate >25 BPM
- - Heart Rate > 110 BPM
- - Inability to complete sentances in one breath
Signs of life threatening asthma
- - Altered LOC
- - Exhaustion
- - Arrythmia
- - Hypotension
- - Cyanosis
- - Silent Chest
- - Poor respiratory effort
- - PEF <33% Predicted
- - SPO2 <92%
Treatment of Life Threatening asthma
- - Administer Adrenaline
- - Positive pressure ventiallation with bag-valve-mask and 'T' piece
- Mild to Moderate Asthma- Move to calm enviroment
- - Encourage use of own inhaler, preferibly using spacer. Ensure correct technique is used; two puffs followed by two puffs every 2 minutes to a maximum of ten puffs.
- - Administer high levels of supplimentary oxygen
- - Administer nebulised salbutamol using oxygen driven nebuliser
- Severe Asthma
- - If no improvement, administer ipratropium bromide by nebuliser
- - Administer steroids
- - Continous Salbutamol nebulisation may be administered unless clinically significatn side effects occour.
- Life Threatning Asthma- Administer IM adrenaline
- - PPV with T piece neb