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