Some wheezy children appear to tolerate moderate wheeze very well, for example, but they may have reduced oxygen saturations. The use of pulse oximetry in primary care is increasing and provides an extremely valuable part of the assessment of an ill child. There are various taught courses to assist non-paediatric trained staff to identify sick babies and children. Paediatric Immediate Life Support is a one-day course to enable participants to: Paediatric Advanced Life Support runs over two days.
Spotting the Sick Child is a new interactive tool commissioned by the Department of Health to support health professionals in the assessment of the acutely sick child. It concentrates on the seven most common acute presentations breathing difficulties, fever, rash, fits, dehydration, abdominal pain and head injury. It is essential that the airway is adequately assessed and high flow oxygen is given before continuing to breathing and circulation. It is also important to check the blood glucose level.
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Please also refer to the British Thoracic Society Guidelines, from which the information in Table 3 is taken. The following is taken from the SIGN quick reference guide on bronchiolitis. Refer urgently any infant with acute bronchiolitis or suspected acute bronchiolitis if there are any of the following:. Take into account whether the infant is in the early stages of the illness as the illness is likely to worsen over the first few days.
I have drifted into the kingdom of the unwell – will I ever escape?
The threshold for hospital referral should be lower in those who are less than three months old, those born at fewer than 35 weeks gestation and those with comorbidities especially congenital cardiac or lung disease. Children with pneumonia are more unwell and tend to have a higher temperature than those with minor respiratory illness.
They may not have cough in the early stages and may present with fever and vomiting or abdominal pain. They are often off feeds. It may not be possible to localise the site of the pneumonia as sounds are transmitted all over a small chest. As with other illnesses, families who may not be able to provide adequate observation at home or may not be able to access help quickly should also be referred. The following is a brief reference only.
All staff should have basic life support training according to surgery requirements. A child who is talking or crying is unlikely to have significant airway obstruction but this can change quickly if the foreign object is dislodged. Try to keep the child and parents as calm as possible.
Crying increases the work of breathing. Alert the receiving hospital of an incoming call and the need for an anaesthetic assessment and possibly a surgeon to perform an emergency cricothyroidotomy. See Table 4 for estimates of weight by age if able to tolerate by mouth.
Stridor at rest is an indication for hospital admission. Estimates of weight and height by age from BNF for children 8. A treatment algorithm poster from the Resuscitation Council. Make sure the child is in a safe position, lying in the recovery position away from any potentially dangerous objects.
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Don't try to open the mouth. Make a note of the time. If the seizure continues beyond four to five minutes call for help or dial Babies and young children can become dehydrated very quickly. Worrying features in the history would be no wet nappy for 12 hours although urine may be missed if it is mixed in with watery diarrhoea.
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The parents may know a recent weight which can be useful in assessing potential fluid loss. Lethargy and drowsiness are worrying features. The skin may also stay elevated for longer than one second when pinched over an area such as the abdomen. Children who are not able to tolerate oral fluids or who have moderate or severe dehydration need referral for hospital admission.
The dehydration associated with DKA can be life threatening. The degree of dehydration is moderate or severe, and there is a raised respiratory rate and glucose and ketones detected in the urine. DKA is an emergency and these children must be referred urgently to hospital. If there are signs of shock, high flow facial oxygen should be given. It is easy to miss hypernatraemic dehydration in infants as the skin turgor is maintained by the high sodium and the baby may not appear dehydrated. They will however have physiological signs of dehydration such as a raised pulse rate and a raised respiratory rate.
They may also have meningitis. With newer models of urgent care delivery, GPs may be faced with sicker children than they would normally see in their surgery. However, by anticipating these events and making use of the wide range of resources available, they will minimise the anxiety associated with managing unwell children. The author is a general paediatrician based at Hammersmith Hospital where there is a Children's Ambulatory Unit providing an extended day service. This is open access for local families and the Unit also receives referrals from local general practitioners.
A general practitioner is co-located in the unit seeing children with minor illnesses. Archived from the original on North Tour Summer Tour. Discography The Break and Repair Method. Retrieved from " https: Articles with hAudio microformats Singlechart usages for Australia Singlechart usages for New Zealand Singlechart usages for UK Singlechart usages for Billboardhot Singlechart called without song Singlechart usages for Billboardadultpopsongs Singlechart usages for Billboardadultcontemporary Singlechart usages for Billboardpopsongs.
Views Read Edit View history. Languages Simple English Edit links. This page was last edited on 7 December , at By using this site, you agree to the Terms of Use and Privacy Policy. It is impossible to know what someone is really thinking, and I think this book brings the importance of KNOWING that something is wrong, something that everyone should be able to sense, to realize I'm going off a tangent right now, really, because the human brain is really difficult to sum up, to describe in a few short phrases. In this novel, we see how terrible and cruel the human brain can be But I'm not leaving off at that sad note..
And we have to fight for it. Jul 02, Gigi rated it really liked it. I didn't expect this book to be good. I related to Stefanie in so many ways.
Eating Well When Unwell
I felt like the author was writing myself in this book. It was hard for me to get through and I was very emotional when view spoiler [ Stefanie explained how Sarah died. I expected one of them to die but I didn't expect she's make two of them die.
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I couldn't even read the last few pages because I was crying so hard. I think I related too much to this book. It was very realistic, so I highly recommend it. Nov 28, Rebecca McNutt rated it it was ok Shelves: I didn't really like this novel, it kept ruminating over the exact same things over and over again and I couldn't really relate to the main character, although I did pity her.
I think this is one of those books where, unless you've been through it yourself or had a loved one suffer from an eating disorder, you can't understand it as well. Apr 19, erica rated it really liked it Shelves: This book felt very authentic.
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Definitely one of my new favorite ED books. Dec 27, Hannah rated it did not like it. Horribly written and painfully inaccurate. Jun 12, Sarah Quinn rated it really liked it. This book, to me, got very real, raw, and emotional in the process of recovering from an eating disorder. I loved the fact that it showed that recovery is not easy, and that just because you relapse here or there does not mean you should give up entirely.
As one who has struggled like Stefanie, I relate to this book quite a bit and to me it was a wonderful read. Nov 17, jazmyn haiayiele rated it really liked it. A really good book about reading disorders. If you or someone you know is currently experiencing dealing with an eating disorder, I recommend reading this. Or, if you just like the topic of it, even. Dec 18, Liralen rated it it was ok Shelves: As the story opens, sixteen-year-old Stefanie is feeling isolated, inadequate -- and a bit fat.
Nobody has explained to her, apparently, that fat is not a feeling.
A diet, she decides, is in order. As it happens, her health class is learning about eating disorders, but -- ha, ha! It takes about two days for her to go from 'diet' to 'disorder'. A month later, everyone is worried; a month after that , off to hospital she goes. I can live with the rapi As the story opens, sixteen-year-old Stefanie is feeling isolated, inadequate -- and a bit fat. I can live with the rapid development, I suppose and anyway, it's not exactly rare in this kind of book , but I don't think the story's terribly well done.
It's not awful or anything, and I actually think there are a number of quite perceptive moments So there's stuff that feels quite honest. Needed better proofreading -- just little things, but they niggled Stephanie instead of Stefanie on page 4, Starbuck's Frappacino's on page 3.