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RAPID ASSESMENT OF AIRWAY AND BREATHING.pptx
- 1. Dr S K VENKATESH MD., DEPT. OF PAEDIATRICS, RMH,THANJAVUR
- 4. ๏ฝ PASSAGE THAT CONNECTS OROPHARYNX TO GLOTTIS ๏ฝ INHERANT TONE OF PALATOPHARYNGEAL MUSCLES AND TONGUE ๏ฝ COUGH REFLEX ๏ฝ DEGLUTITION REFLEX
- 5. ๏ฝ STABLE OR MAINTAINABLE ๏ฝ STRIDOR ๏ฝ UNSTABLE OR UNMAINTAINABLE
- 6. ๏ฝ HEAD TILT AND CHIN LIFT ๏ฝ SUCTION OROPHARYNGEAL SECRETIONS ๏ฝ INSERT NG AND DECOMPRESS STOMACH
- 7. ๏ฝ RESPIRATORY RATE COUNT IF NOT BREATHING OR BRADYPNEA
- 8. ๏ฝ NASAL FLARE ๏ฝ GRUNTING ๏ฝ STRIDOR ๏ฝ RETRACTION ๏ฝ PATTERN OF BREATHING
- 9. ๏ฝ INFRA AXILLARY REGION ๏ฝ ADDED SOUNDS WHEEZE CREPS CONDUCTED SOUND
- 10. ๏ฝ NORMAL ๏ฝ EFFORTLESS TACHYPNEA ๏ฝ RESPIRATORY DISTRESS ๏ฝ IMPENDING RESPIRATORY FAILURE ๏ฝ RELATIVE BRADYPNEA ๏ฝ APNEA
- 11. ๏ฝ NON REBREATHING MASK
- 13. ๏ฝ PROVIDES CPAP ๏ฝ AIDS IN OPENING UP THE AIRWAY ๏ฝ PREVENTS FROM ALVEOLAR COLLAPSE ๏ฝ REDUCES WOB ๏ฝ REDUCES PRELOAD AND AFTERLOAD
- 17. ๏ฝ DONโT RUSH TO INTUBATE ๏ฝ SMALLER BAGS ๏ฝ STANDING AND BENDING ๏ฝ NOT DECOMPRESSING STOMACH ๏ฝ NOT RECOGNISING AIR LEAK ๏ฝ O2 NOT CONNECTED ๏ฝ RESERVOIR BAG NOT ATTACHED
- 19. Shock is an acute process characterized by the bodyโs inability to deliver adequate oxygen to meet the metabolic demands of vital organs and tissues. ๏ Hypovolemic shock โ diarrhoea, vomiting ,haemorrhage, burns ๏ Cardiogenic shock โ CHD, cardiomyopathy, acute myocarditis ๏ Septic shock โ complex interaction of distributive , hypovolemic and cardiogenic shock
- 20. ๏ Distributive shock โ inadequate vasomotor tone โ capillary leak and maldistribution of fluid into the interstitium โ anaphylaxis, neurologic ๏ Obstructive shock โ mechanical barrier that impedes adequate cardiac output- pericardial tamponade, tension pneumothorax , pulmonary embolism
- 21. ๏ฝ Loss of volume exceeding 25 % of effective circulating volume leads to decreased cerebral perfusion and fall in level of consciousness. ๏ฝ Severe dehydration is attributed to loss of 10 % circulating volume which is not sufficient to cause decreased cerebral perfusion. ๏ฝ โLINEโ History LETHARGY INCESSANT CRY NOT AS USUAL EXCESSIVE SLEEPINESS
- 22. Oxygen through NRM Secure 2 IV lines Infuse RL 20 ml/kg using pull push technique until BP normalises for age Repeat modified rapid cardiopulmonary cerebral assessment after every fluid bolus until BP normalises.
- 23. ๏ฝ O2 VIA CPAP/JR ๏ฝ NS Bolus 20ml /kg over 20 min if child is normotensive for age. ๏ฝ If the child has respiratory distress and shock the bolus is given in smaller aliquots. ๏ฝ Push pull technique is used only if hypotension is documented. ๏ฝ Antibiotics ๏ถ ceftriaxone- 100mg/kg in children more than 3 months of age ๏ถ cefotaxime (200mg/kg)+ ampicillin( 200mg/kg) in children less than 3 months of age. ๏ถ Azithromycin 10mg/kg if fever for more than 5 days.
- 24. ๏ฝ Epinephrine โ hypotensive shock ๏ฝ Dopamine โ shock with normal systolic pressure with vasodilatation after establishing euvolemia ๏ฝ Dobutamine โ high systolic pressure with narrow pulse pressure shock ๏ฝ Norepinephrine โ dopamine refractory vasodilatory shock
- 25. ๏ฝ Consciousness is the state of full awareness of self and oneโs relationship to the environment. ๏ฝ AVPU scale is used.
- 27. ๏ฝ Unresponsiveness associated with fits? Posturing? Upward gaze? ๏ฝ Time /place ๏ฝ Regained basal level of consciousness or not? ๏ฝ Precipitating events- fever/URI/AWD/vomiting/FB/Abdominal pain/Distension/GI bleed/Jaundice/rash/Skin bleed/Snake bite/scorpion/submersion/toxin/fall/RTA/as sault/trauma
- 28. ๏ฝ ALOC after precipitating event- โLINEโ history ๏ฝ Development ๏ฝ Co morbidity ๏ฝ Drugs ๏ฝ Pre hospital care
- 29. THANK YOU