MyCpdZw - Protocols Details

CROUP

Croup, also known as laryngotracheobronchitis, is a type of respiratory infection that is usually caused by a virus. The infection leads to swelling inside the trachea, which interferes with normal breathing and produces the classic symptoms of "barking" cough, stridor, and a hoarse voice.

Diagnosis

Usually easily recognizable triad of:

· Barking cough,

· Stridor &

· Hoarse voice.

Need to differentiate from epiglottitis, trancheitis & inhaled foreign body.

The most common cause of upper airways obstruction in 6 months – 3 years of age.

Look for accessory muscle use, trancheal tug/intercostals retraction & hypoxia.

Do not distress the child any further by trying to force a look at the back of their mouth.

Can progress rapidly & usually deteriorate in the middle of the night on the 2nd – 3rd days of the

illness.

Be VERY wary diagnosing croup in a child of less than 3/12 age- in this instance be highly

suspicious of congenital structural abnormalities.

Biphasic stridor should also alert you to fixed airway stenosis (e.g. vocal cord paralysisi or

subglottic stenosis) rather than croup (which has a “monophasic” inspiratory stridor). Bisphasic

stridor needs urgent investigation in hospital.

Management

Be calm

Nurse child on parents lap.

Assess severity interms of stridor, cyanosis, oxygen saturation and intercoastal recessions.

1. Mild:

· Probably no treatment required,

· Usually receive a single dose of Prednisolone 1 mg/kg.

2. Moderate:

· Paracetamol prn,

· High flow as indicated

· Budesonide 2 mg nebulizer (provide eye protection) may reduce the need for oral

steroid in children with recurrent croup (usually “Spasmodic” croup) requiring

frequent cources of steroids,

· Dexamethazone 0.15 mg/kg orally or Predmisolone 1-2 mg/kg,

· Consider nebuliserd Pulmicort or Adrenaline (see below),

· Observe & admit if doesn’t settle down or symptoms return within 4 hours.

3. Severe:

· Inform medical officer immediately & have them in attendance,

· Intubation may be necessary & may be very difficult,

· High flow ,

· Nebulised Adrenaline 1:1000 0.5 mLs/kg up to 5ml (Onset often within minutes

but be aware for rebound symptoms mins. Afterwards),

· Budesonide 2 mg nebulizer,

· IM/IV Dexamethazone 0.6mg/kg

· Prednisolone 2 mg/kg PO,

· Intubate at first signs of lethargy, agitation, increasing respiratory difficulty, or

deteriorating observations,

Admit. Consider referral to paediatric unit

Recent Protocols

COVID 19

COVID 19 is a disease caused by the most recently discovered coronavirus which is a large family of corona viruses causing illnesses. In humans it causes Respiratory infections for example Severe Acute Respiratory Disease (SARs) PRESENTATION Fever 77-98% Cough 46-82% Myalgia/Fatigue 11-52% Shortness of breath 3-31% Incubation period 14 days, most people develop symptoms between 5-6ays from exposure Stage1 (Early infection). Stage 2. Stage 3(Hyperinflation phase) Viral response---------------------------Pulmonary Phase----------------------Host Response *Anyone presenting with flu like symptoms should be assumed to be a COVID 19 case until proven otherwise*

WARFARIN OVERDOSE/ TOXICITY

Overdose of the oral anticoagulant warfarin (Coumadin), or drug interactions with warfarin, can lead to toxicity. Similarly, toxicity can result from exposure to superwarfarins, which are long-acting anticoagulants used in rodenticides. ... Warfarin is the most common oral anticoagulant in current use

SUICIDAL IDEATION

Suicidal ideation, also known as suicidal thoughts, is thinking about or having an unusual preoccupation with suicide.

SPINAL CORD INJURY

Emergency signs and symptoms of a spinal cord injury after an accident may include: Extreme back pain or pressure in your neck, head or back. Weakness, incoordination or paralysis in any part of your body. Numbness, tingling or loss of sensation in your hands, fingers, feet or toes. Loss of bladder or bowel control.