Recognition and pre-transportation treatment of the decompensating primary survey positive patient
| Problem | Findings | Pre-transportation treatment |
|---|---|---|
| Respiratory failure | ▸ Noisy upper airway becoming quiet without improvement in condition | ▸ Secure airway using simple manoeuvres if possible: use advanced interventions (for example, intubation) only if simple manoeuvres fail |
| ▸ Very rapid and shallow or slow weak respirations | ▸ Give high concentration oxygen via non-rebreathing mask | |
| ▸ Decreasing evidence of increased work of breathing because of exhaustion | ▸ Consider assisting ventilation with bag valve mask if respiratory rate is very fast or slow | |
| ▸ Significantly decreased air entry on auscultation | ▸ Consider nebulised adrenaline in the presence of suspected croup (5 ml of 1:1000 once only) | |
| ▸ Limited chest expansion | ▸ In the presence of wheeze consider nebulisation with β2 agonist and anticholinergic (for example, salbutamol and ipratropium) | |
| ▸ Loss of wheeze without improvement in condition | ▸ Decompress tension pneumothorax | |
| ▸ SpO2 less than 90% on high concentration oxygen | ▸ Consider intravenous/intraosseous 10% dextrose 5 ml/kg | |
| ▸ Cyanosis | ||
| ▸ Reduced AVPU score | ||
| ▸ Flaccid or increased muscle tone | ||
| ▸ No interaction with carers or responders | ||
| ▸ Glazed, unfocused gaze | ||
| ▸ Abnormal, weak, or absent cry | ||
| ▸ Hypoglycaemia | ||
| Circulatory failure | ▸ Increased respiratory rate in the absence of increased work of breathing | ▸ Secure airway using simple manoeuvres if possible: use advanced interventions (for example, intubation) only if simple manoeuvres fail |
| ▸ Central pallor, mottling, or cyanosis | ▸ Give high concentration oxygen via non-rebreathing mask | |
| ▸ Cool skin centrally | ▸ Consider intravenous/intraosseous fluid challenge of 20 ml/kg | |
| ▸ Bradycardia or falling heart rate in the absence of improvement in condition | ▸ Consider intravenous/intraosseous 10% dextrose 5 ml/kg | |
| ▸ Central capillary refill time >5 seconds or absent | ▸ Consider benzylpenicillin 300 mg/kg IV | |
| ▸ Reduced AVPU score | ||
| ▸ Flaccid muscle tone | ||
| ▸ No interaction with carers or responders | ||
| ▸ Glazed, unfocused gaze | ||
| ▸ Weak or absent cry | ||
| ▸ Non-blanching rash and history of flu-like illness | ||
| Central nervous system failure | ▸ Reduced AVPU score | Consider the presence of undiagnosed respiratory or circulatory failure and treat accordingly. Otherwise: |
| ▸ Flaccid muscle tone | ▸ Secure airway using simple manoeuvres if possible: use advanced interventions (for example, intubation) only if simple manoeuvres fail | |
| ▸ No interaction with carers or responders | ▸ Give high concentration oxygen via non-rebreathing mask | |
| ▸ Glazed, unfocused gaze | ▸ Consider assisting ventilation with bag valve mask if respiratory rate is very fast or slow | |
| ▸ Weak or absent cry | ▸ Consider rectal diazepam (0 to 1 yr 2.5 mg, 1 to 3 years 5 mg, 4 to 12 years 10 mg) or IV diazepam 250 to 400 μg/kg | |
| ▸ Continuous fits, or failure to regain consciousness between fits | ▸ Consider intravenous/intraosseous 10% glucose (5 ml/kg) | |
| ▸ Hypoglycaemia |