Table 5

 Findings associated with compensating primary survey positive patients and on route treatment

ProblemFindingsTreatment on route to hospital
Respiratory distress▸ Noisy upper airway (snoring, stridor, muffled, or hoarse speech)▸ Secure airway using simple manoeuvres if required: use advanced interventions (for example, intubation) only if simple manoeuvres fail
▸ Grunting▸ Give high concentration oxygen via non-rebreathing mask
▸ Increased respiratory rate▸ Consider nebulised budesonide in the presence of suspected croup (2 mg once only) or oral corticosteroids (dexamethasone syrup 0.15 mg/kg)
▸ Refuses to lie flat, or adopts tripod or sniffing position▸ In the presence of wheeze consider nebulisation with β2 agonist and anticholinergic (for example, salbutamol and ipratropium
▸ Use of accessory muscles (head bobbing in infants)
▸ Sternal, sub-sternal, supra-clavicular, or intercostal recession present
▸ Nasal flaring
▸ Increased or asymmetrical chest expansion
▸ Wheezing
▸ SpO2 less than 94% on room air
▸ Pallor or peripheral cyanosis
▸ Normal AVPU score
▸ Good muscle tone; may be playing with toys
▸ Interacts with carers or responders
▸ Focused gaze
▸ Strong cry
Compensated shock▸ Increased respiratory rate in the absence of increased work of breathing▸ Secure airway using simple manoeuvres if appropriate: use advanced interventions (for example, intubation) only if simple manoeuvres fail
▸ Peripheral pallor, mottling, or cyanosis▸ Give high concentration oxygen via non-rebreathing mask
▸ Cool skin peripherally, warm centrally▸ Consider intravenous/intraosseous fluid challenge of 20 ml/kg
▸ Increased heart rate
▸ Normal AVPU score
▸ Good muscle tone; may be playing with toys
▸ Interacts with carers or responders
▸ Focused gaze
▸ Strong cry