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Semelhante a 13_Respiratory_distress_16-Sep-09[1].ppt
Semelhante a 13_Respiratory_distress_16-Sep-09[1].ppt (20)
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13_Respiratory_distress_16-Sep-09[1].ppt
- 1. The child with respiratory distress and an acute illness
- 2. What is this child’s problem?
- 3. Respiratory Distress Lung / Airway Disease • Acute Pneumonia • PTB • HIV • Stridor: – Croup (LTB) – Epiglottitis Systemic Disease • Malaria • Severe Anaemia • Severe dehydration • Heart Disease • Renal Disease
- 4. How severe is respiratory distress – Cough or Difficult Breathing 1 Cyanosed? Unable to drink? Reduced level of consciousness? Grunting (infants)? Lower chest wall indrawing? RR ≥ 50 aged 2 –11 months? RR ≥ 40 aged 1 – 4 yrs? Very Severe Pneumonia Severe Pneumonia Pneumonia None of the above? No Pneumonia Y Y Y Y
- 5. How severe is respiratory distress – Cough or Difficult Breathing 2 Cyanosed? Unable to drink? Reduced level of consciousness? Grunting (infants)? Very Severe Pneumonia Y High Risk of Death High Risk of Hypoxaemia = Need Oxygen May need fluid / feeding support Require Broad Spectrum Antibiotics
- 6. How severe is respiratory distress – Cough or Difficult Breathing 3 Lower chest wall indrawing? Severe Pneumonia Y Some Risk of Death = Need Admission Can feed orally Require Simple Antibiotics = Penicillin, and Observe for improvement / deterioration
- 7. How severe is respiratory distress – Cough or Difficult Breathing 4 RR ≥ 50 aged 2 –11 months? RR ≥ 40 aged 1 – 4 yrs? Pneumonia Y Not severely ill = Outpatient care Can feed orally Require Simple Antibiotics = Co-trimoxazole (Amoxicillin), and Review in 2-3 days for improvement / deterioration
- 8. Cause of Respiratory Distress 1? 12 months Difficult Breathing, AVPU = P RR = 43/min Indrawing +ve Blood Slide
- 9. Cause of Respiratory Distress 2? 12 months Difficult Breathing, AVPU = P RR = 43/min Indrawing +ve Blood Slide Very Severe Pneumonia Difficult breathing and AVPU = P
- 10. Cause of Respiratory Distress 3? 12 months Difficult Breathing, AVPU = P RR = 43/min Indrawing +ve Blood Slide Very Severe Pneumonia Difficult breathing and AVPU = P Severe Malaria with Respiratory Distress Difficult breathing, Indrawing AVPU = P, and +ve Blood Slide
- 11. Cause of Respiratory Distress 4? 12 months Difficult Breathing, AVPU = P Indrawing +ve Blood Slide Severe Pallor Very Severe Pneumonia Difficult breathing and AVPU = P Severe Malaria with Respiratory Distress Difficult breathing, Indrawing, AVPU = P, and +ve Blood Slide
- 12. Cause of Respiratory Distress 5? 12 months Difficult Breathing, AVPU = P Indrawing +ve Blood Slide Severe Pallor Very Severe Pneumonia Difficult breathing and AVPU = P Severe Malaria with Respiratory Distress Difficult breathing, Indrawing, AVPU = P, and +ve Blood Slide Severe Anaemia Respiratory distress plus severe pallor
- 13. Cause of Respiratory Distress 6? 12 months Difficult Breathing, Cannot drink Indrawing Wheeze ++ -ve Blood Slide Very Severe Pneumonia Difficult breathing, cannot drink and indrawing Very Severe Asthma Difficult breathing, Indrawing, Wheeze, and Cannot drink.
- 14. Wheeze – how severe is the asthma? Cyanosed? Unable to drink? Reduced level of consciousness? Grunting (infants)? Lower chest wall indrawing? RR ≥ 50 aged 2 –11 months? RR ≥ 40 aged 1 – 4 yrs? Very Severe Asthma Severe Asthma Mild Asthma Y Y Y
- 15. Causes of respiratory distress Pneumonia Malaria Anaemia Asthma Dehydration Acidosis Blood Film Pallor / Hb Acidosis Sunken Eyes, Skin Turgor, Acidosis Wheeze Crackles
- 16. Causes of respiratory distress Pneumonia Malaria Anaemia Asthma Dehydration Acidosis Blood Film Pallor / Hb Acidosis Sunken Eyes, Skin Turogor, Acidosis Wheeze Crackles Difficulty Breathing Indrawing Tachypneoa Consciousness?
- 17. Respiratory distress & Malaria Conscious level OK Deep / acidotic breathing Indrawing / Deep acidotic breathing PLUS severe pallor or Hb <5g/dl? Severe Malaria Life threatening anaemia plus malaria Y Y
- 18. Questions?
- 19. Summary • Key clinical signs define the severity of respiratory distress • There are several common causes that are hard to distinguish • Define severity and treat appropriately ALL likely problems.