chilhood emergency, choking, near drawning, and aspiration_prof.dr. purnomo suryantoro, dtm&h,...

8/16/2019 Chilhood Emergency, Choking, Near Drawning, And Aspiration_Prof.dr. Purnomo Suryantoro, DTM&H, Ph.D., S.an

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CHILDHOOD EMERGENCIESChocking - Near Drowning - Aspiration

Adapted from : EMERGENCY MEDICINE .PRINCIPLE AND PRACTICE .Gordian W.O.

Fude M!Lennan"Pett#. London

$# Purnomo %ur#antoroGad&a' Mada Medi!a %!'oo.


2/29

Genera

• Important: 'i(tor# ta)in* ande+amination.

• Rapid# !ini!a deterioration

pre'o(pita !are are mo(t important• An# dou,t !a !'idren emer*en!ie(

'o(pita for ad-i!e or admittan!e

• %pe!ia !are for C'id'ood emer*en!ie( !'idren are not (ma adut /0

• Carin* and (#mpat'eti! approa!' aree((entia


3/29

Topi!(

• 1. nconscio!s or ac!te"# i"" chi"$• %. &e'er• (. Hea$ in)!r#• *. Con'!"sions

• +. Stri$or• ,. Ac!te a$oina" pai• /. Ac!te Gastroenteritis• 0. Chi"$ a!se

• . 2!rp!ra• 13. Near-$rowning• 11. 4!rns• 1%. 2oisonings


4/29


5/29

Appearance

567ick"es8 97ICLS:Tonus

Interactiveness

Consolability

Look/Gaze

Speech/Cry

A p p e a r a

n c e


6/29

Work of Breathings

W o r k o

f B r e

a t h i n g s

Abnormal airwaysounds

Abnormal positionin

!etractions

"asal #larin


7/29

$allor

%ottlin

Cyanosis

Circulation to Skin

Circulation to Skin


8/29

Respirator# $istress

N

N

N

Car$iop!"onar#;ai"!re

/

Shock

≠N

≠N

2riar# CNS$#s;!nction<

etao"icanora"it#

≠N

≠NN

N

≠

N


9/29

eature

1. Unconsciousor acutely ill

child

• Re(pirator# (tatu( & 1entiation 2 re(pirator# a,normaitie( & Ade3uate air4a# & %emi prone po(ition in !a(e of -omitin* & O+#*en

• Cir!uator# (tatu( & E(ta,i(' i.- a!!e(( !r#(taoid( or e+pander

• Loo) for & ra(' purpuri! menin*o!o!!a (epti!emia( 0 & Fe-er or '#pot'ermia & E-iden!e of 'ead in&ur#

& 5i*' or o4 *u!o(e e-e( & $ood pre((ure o4 or 'i*' & 5#dration & Intra!rania pre((ure retina 'emorr'a*e( 4it'out trauma !'id

a,u(e 0 & Neuroo*i!a (i*n( & A!!identa in*e(tion a!o'o6 dia,ete( 0


10/29

Mana*ement

7 In(ert air4a# or ETT7 Prepare -entiation7 C'e!) ,ood (u*ar and $ood Ga( ana#(i(7 Immediate treatment

In-e(ti*ation

7 depend on 'i(tor# ta)in* and e+aminationin!ude

,ood !ount6 ,ood *u!o(e6 ,ood !uture6ee!tro#te and urea6 urine6 )etone( and dru*a((a#

7 Lum,ar pun!ture if intra!rania pre((ure not 'i*'


11/29

8. Fe-er

• 9 of ; mo79#r od prone to fe,rie!on-u(ion( (#mptomati!treatment

• Ta)e o< ,an)et and e+tra !ot'e(

• Para!etamo => m*2?* $W. nota(pirin0 e-er# @7; 'our.

• Coo ,# tepid ,at' dont u(e !od4ater0


12/29

Cau(e of fe-er

• 1ira ine((

• $a!teria %epti!emia(

• Menin*iti(• BTI

• Pneumonia

• Otiti( media• Ton(iiti(


13/29

. 5ead in&ur#

• Rapid deterioration air4a#o,(tru!tion6 poor -entiation priorit#

• A%%E%%

& =.%e-erit# of in&ur# & 8. Le-e of !on(!iou(ne(( A1PB 0

& . Re(pirator# (tate

& @.Ear6no(e6 t'roat for ,ood ea)a*e andCN%

& 9. $ood pre((ure

& ;. Rea((e(( and rea((e((


14/29

5o(pita admittan!e

• Lo(( of !on(!iou(ne((

• Neuroo*i!a (i*n(

• Repeated -omitin*• %e-ere 'eada!'e

• %)u fra!ture

• An# 4orr#in* feature 'i(tor# and orp'#(i!a0


15/29

@. CON1BL%%ION%

• Fe,rie !on-u(ion(6 Menin*iti(6Meta,oi!6 Ee!tro#te im,aan!e6De'#dration6 ,rain anomaie( 6

epiep(#.

• Ma(3uerade a( !on-u(ion : (#n!ope6,reat' 'odin* 'i(tor# ta)in*.


16/29

Prioritie( for !on-u(ion

• Pre-ent '#po+ia !ear air4a#6 ieon ri*'t (ide6 *i-e =>> O+#*en(.

• %top !on-u(ion Diaepam >.8m*2?* repeat if ne!e((ar#. I1 orre!ta


17/29

9. %TRIDOR

• Partia o,(tru!tion of air4a#( !roup -ira 0epi*otiti(6 forei*n ,od#.

• A!ute epi*ottiti( !ompete o,(tru!tion fata.Gi-e o+#*en6 dont attempt to -i(uaie epi*otti(

trauma to tota o,(tru!tion If ne!e((ar# !aoperation t'eatre to in(ert ETT Cefota+ime =9>m*2)* @de-ided do(e(

• Croup 'umidied in!ude o+#*en o,(er-ed6ma# need ETT.

• In'aed forei*n ,od# 'i(tor# ta)in* (udden!'o)in* or !ou*' 06 a(#mmetri!a !'e(t mo-in*6de!rea(ed air entr# or o!aie ron!'i06 do !'e(t H7ra#6 ,ron!'(!op# for remo-a materia


18/29

;. A!ute A,domina pain

• Bnder #ear( t'e ori*in of pain are notat a,domen ma# a!ute ton(iiti(6 o4erpneumonia6 te(ti!uar tor(ion6 'ernia.

• O,(er-ed (#mptom( : -omitin*6diarr'ea6 fe-er6 ra('6 ,eedin*.

• Di!ut ,eo4 8 #ear( : Appendi!iti(

4it' or 4it'out perforation a,dominatenderne(( peritoniti( J0.


19/29

K. Intu((u(!eption(

• 5i*' in!iden!e for 8 mo 8 #r od !ompete *ut o,(tru!tion.

• %e-ere pain (!reamin*6 dra4in* up

e* and paor. $ood (tain mu!u(re!ta. $anana7('ape ma(( ri*'tupper 3uadrant intraa,domina.

$arium enema for H7ra# ma# redu!et'e e(ion ,ut !a t'e operationt'eatre in t'e !a(e of perforation.


20/29

. Cau(ed of a,domina pain(

• Appendi!iti(6

• Brinar# tra!) infe!tion6 C#(titi(

• Trauma e.! (peni! rupture6 duodenarupture

• Diarr'ea : Amu,e6 %'i*ea

• 5ei!o,a!ter P#ori Ga(triti(• Fre3uent( -omitin*


21/29

. A!ute Ga(troenteriti(

• Can ,e a trap t'at ma)e (#mptom(a,domina pain and or -omitin* andde'#dration

• In!ude(: appendi!iti(6 intu((u(!eption(6dia,eti! )etoa!ido(i( BTI6 (epti!emiaand menin*iti( 'i(tor# ta)in* andp'#(i!a e+amination.

• Dia*no(i( 6 !riteria and treatment referred to Ga(troenteroo*#department /


22/29

=>. C'id A,u(e

• Coon pro"es in =esterners> on"# soe inEasters .

• C"inica" shows in)!ries> !rns an$ or poisonings.• S!spect ?

& $iscrepancies etween ph#sica" @n$ings with those o;

ananesis. & De"a#e$ o; seeking e$ica" ai$ & Ananesis 'aries & M!"tip"e in)!r# in $ierent stage & Spira" ;ract!res 5twisting> shearing ;orce:> etacarpa"

chip ;ract!re

& 7wo "ack e#es> heatoa o; the ear & Retina" heorrhages & &inger print r!ising 5 shows 'io"ent gripping : & Anora" in)!re$ in p"a# & 4!rns on !ttock> perine! > cigarette !rns


23/29

Mana*ement

• 5o(pitaied for prote!tion and treatment• %)eeta (ur-e# ,# H7ra# di


24/29

==. PBRPBRA

• 5emorr'a*e in ()in

• Po((i,e !au(e : & Menin*o!o!!a (epti!emia

& ITP

& 5eno!'7(!'oenein purpura

& Leu)emia

& Me!'ani!a• $ood !uture Cefota+ime =>>

m* 2)* 2da#


25/29

=8. NEAR7DROWNING

• Cardiopumonar# re(u(!itation ('oud ,e*i-en on (ite !orreated 4it' (ur-i-a.

• Aid( :

& Cear air4a# & E+terna !ardia! ma((a*e

& 1entiate

& O,tain I.1 a!!e((

& Ta)e Arteria $ood Ga( & C'e!) ee!tro#te ,aan!e and 'emo*o,in

& A((e(( and rea((e((.


26/29

=. $BRN%

• A((e(( t'e de*ree of ,urn(

• Di 7 #ear( #ear(5ead and ne!) = =8

Trun) 8

$ot' arm( 8> 8>

$ot' e* > >


27/29

Cini!( of ,urn

• %mo)e in'aation (4ein* and o,(tru!tionof air4a#6 dama*e of o4er re(pirator# tra!t

• Car,on mono+ide poi(onin* ead( to

impairment of o+#*en !arr#in* !apa!it#.• Need( : & A((e((ment in!ude a!!urate 4ei*'t6 area of

,urn and re(pirator# (tatu(

& Ana*e(ia and (edation

& Fuid repa!ement => of ,od# (urfa!e I.1.

& 1oume of uid : $W)*0 + 8 + ,od# (urfa!e,urnt area

=@ POI%ONING


28/29

=@. POI%ONING• Common in Indone(ia• %u(pe!t 4i (u


29/29

%B5B $IP5A%I?

chilhood emergency, choking, near drawning, and aspiration_prof.dr. purnomo suryantoro, dtm&h,...

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