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 |