RUSH Protocol: rapid ultrasound for shock and hypotension:
Takes less than 2mins hypovolaemic shock Distributive Obstructive Cardiogenic
3 step approach Pump (heart) tamponade LVEF and RV size Tank (intravascular) IVC, thoracic, abdo compartments Pipes (Large arteries and veins - aorta femoral and popliteal veins
The PUMP: Three findings: effusion/tamponade (RV can be collapsed) LV Contractility: M-mode gives chamber diameter - fraction shortening 30-40% correlates to normal EF RV DILATED? L-R ratio normally 1:0.6. RV big - possibly PE pushes septum to left
TANK: IVC Assessment: <2.1cm and collapses >50% at 2cm normal >2.1 and <50% overload/PE
LEAKINESS: -FAST Scan B-Lines - >3 is overload/effusion in chest per view top to bottom of field in more than one view
TANK COMPROMISE: pneumothorax Pleura normally moves but not in pneumothorax No sea shore line Curley B lines - suggest overload
PIPES: Aorta Root less than 4cm normally DVT: two views compression method - vein needs to be completely collapsible to rule out DVT
Button batteries: 2/day in UK present to ED 4 deaths in 18/12 in UK Changing case loads
USA have button battery advice line
Death is not uncommon - so be aware - sometimes batteries are not seen (vomited out/passed PR)
Burn is ongoing, batteries found in more and more items (cards etc)
Patient safety alert
Burns can continue for upto 2/53 post injestion
So if you see a child with haematemesis consider button battery
Image while child
Often has a herald bleed
Don't assume it is a coin, get lateral views if unsure - button batteries have a halo in AP. Lip on Lateral.
Trauma in Kids
Interim update of APLS Feb 2015 I 10ml/kg initial bonus and then blood (give 10ml/kg if blood slow) Don't forget MTP
C-spine - use manual in line stabilisation and NOT collars unless child is unconscious
20degree tilts not full log roll
Radiology: FAST in children not useful (but can help guide down a pathway) Neck imaging: plain film then MRI if concerns but discussions around CT are ongoing
Infections in Kids
Rotavirus vaccine has reduced incidence by 50% as have attendances
Meningitis B: 1:10 will die from a current strain 3:10 have lasting disability Beware teenagers are not included in vaccination
A&C vaccinated in the UK 27th March vaccine for Men B approved - for babies NOT teenagers
Future
PERUKI.org
Eclipse RCT - kepra a vs Phenytoin
CAP IT - dose of amoxicillin for CAP (reduce dose)
I am heartily thankful to you that you have shared important and essential information with us. I got some different kind of knowledge from your webpage, and it is very much important for everyone. Thanks medical alert system for home emergency
RUSH Protocol: rapid ultrasound for shock and hypotension:
ReplyDeleteTakes less than 2mins
hypovolaemic shock
Distributive
Obstructive
Cardiogenic
3 step approach
Pump (heart) tamponade LVEF and RV size
Tank (intravascular) IVC, thoracic, abdo compartments
Pipes (Large arteries and veins - aorta femoral and popliteal veins
The PUMP:
Three findings:
effusion/tamponade (RV can be collapsed)
LV Contractility: M-mode gives chamber diameter - fraction shortening 30-40% correlates to normal EF
RV DILATED? L-R ratio normally 1:0.6. RV big - possibly PE pushes septum to left
TANK:
IVC Assessment: <2.1cm and collapses >50% at 2cm normal >2.1 and <50% overload/PE
LEAKINESS:
-FAST Scan
B-Lines - >3 is overload/effusion in chest per view top to bottom of field in more than one view
TANK COMPROMISE:
pneumothorax
Pleura normally moves but not in pneumothorax
No sea shore line
Curley B lines - suggest overload
PIPES:
Aorta
Root less than 4cm normally
DVT: two views compression method - vein needs to be completely collapsible to rule out DVT
Paediatric Emergency Medicine Update
ReplyDeleteButton batteries:
2/day in UK present to ED
4 deaths in 18/12 in UK
Changing case loads
USA have button battery advice line
Death is not uncommon - so be aware - sometimes batteries are not seen (vomited out/passed PR)
Burn is ongoing, batteries found in more and more items (cards etc)
Patient safety alert
Burns can continue for upto 2/53 post injestion
So if you see a child with haematemesis consider button battery
Image while child
Often has a herald bleed
Don't assume it is a coin, get lateral views if unsure - button batteries have a halo in AP. Lip on Lateral.
Trauma in Kids
Interim update of APLS Feb 2015
I
10ml/kg initial bonus and then blood (give 10ml/kg if blood slow)
Don't forget MTP
C-spine - use manual in line stabilisation and NOT collars unless child is unconscious
20degree tilts not full log roll
Radiology: FAST in children not useful (but can help guide down a pathway)
Neck imaging: plain film then MRI if concerns but discussions around CT are ongoing
Infections in Kids
Rotavirus vaccine has reduced incidence by 50% as have attendances
Meningitis B: 1:10 will die from a current strain 3:10 have lasting disability
Beware teenagers are not included in vaccination
A&C vaccinated in the UK 27th March vaccine for Men B approved - for babies NOT teenagers
Future
PERUKI.org
Eclipse RCT - kepra a vs Phenytoin
CAP IT - dose of amoxicillin for CAP (reduce dose)
FISH - fluids in shock 10 v 20ml
EVITA - IV therapy in asthma review
I am heartily thankful to you that you have shared important and essential information with us. I got some different kind of knowledge from your webpage, and it is very much important for everyone. Thanks medical alert system for home emergency
ReplyDelete