I lay in the back of the van, as the landscape became increasingly stark, my throat stripped like bark, stopping for roadside coconuts cut open with machetes. I told myself it was only a cough and not to worry. The salt in the air was almost suspended by the thickness of the heat. It felt as though you were walking through endless veils.
Unwell by Leslie Lipton
In the eerie laptop glow, I googled the meaning of different coloured phlegm. Early the next day I shuffled from pharmacy to pharmacy because I heard you could get sleeping pills in Sri Lanka without a prescription. This turned out not to be true. I returned to the hotel with a blister pack of paracetamol and a small bottle of cough syrup.
That morning I crammed on to a fishing boat out to Delft Island, pressed in thigh to thigh, back to back with other tourists and religious pilgrims under the brutal sun, and then on the island travelled in an old Red Cross ambulance used now as a taxi, that took us down potholed roads lined with dry walls made from coral chunks to a colonial fort and a Hindu temple and a very old tree.
In the back of the ambulance we were thrown from our seats on the rough road and our shoes and clothes were covered in dust. I sucked on a lozenge and longed for the hotel room, and the bedsheets tight with their hospital corners. Back in Jaffna, as I coughed outside the library that had been burned down in the civil war, my driver suggested I go to a doctor. I resisted, because it was just a cough. But I was becoming afraid of the cough and kept hoping it would pass. I texted my group chat: Editia 37, saptamina Retrieved December 12, Archived from the original on North Tour Summer Tour.
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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.
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. 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.
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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. Don't try to open the mouth.
Unwell (tradução)
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.
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. As this is a review article summarising accepted management pathways, ethical committee approval was not needed.
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