BAHAN BACAAN SIMULASI KES KECEMASAN JENIS KES KECEMASAN 1. PAEDIATRIC DR NOR AIN IZZATI 2. ABDOMINAL PAIN DR ZARINA 3. RESPIRATORY DR NORLINA 4. CARDIO DR AIN SABRINA 5. OBSTETRIC DR NOR SHAZATUL SALWANA 6. FACIAL PUFFINESS DR VENOTHA
Disediakan Oleh: Dr. Nor Ain Izzati
MANAGEMENT OF HYPOGLYCEMIA IN PEDIATRICS Treatment: • The aim of treatment is to return BGL to within the normal range (>3.9 mmol/L) through normal nutritional intake. See flow chart • Severe symptomatic hypoglycaemia should be corrected with an IV 10% dextrose bolus 2 mL/kg or IM glucagon (Neonate: glucagon 0.03-0.1 mg/kg, <25 kg give ½ vial (0.5 Units), <25 kg give ½ vial (0.5 Units), >25 kg give full vial (1.0 Units)) • BGL should return to the normal range within 10-15 mins and remain so for 1 hour. Ideally, the child should start to feed and BGL should be rechecked within 30 mins • Persistent hypoglycaemia - consider consultation with Endocrinology and/or Metabolic specialist
PAEDIATRIC BLS
Disediakan Oleh: Dr. Zarina ACUTE ABDOMEN IN REPRODUCTIVE AGE WOMAN ECTOPIC PREGNANCY INTRODUCTION • Always consider Ectopic Pregnancy in women of childbearing age presenting with abdominal pain and vaginal bleeding • Pregnancy must be evaluated as part of the initial examination • The key diagnostic features are abdominal pain,vaginal bleeding and amenorrhoea • If undiagnosed and untreated,leading to maternal death,rupture of the implantation site and intraperitoneal haemorrhage CLINICAL PRESENTATION SYMPTOMS SIGNS Abdominal Pain Amenorrhoea Vaginal Bleeding Dizziness or syncope GIT symptoms Adnexal tenderness Abdominal tenderness Fever Uterine enlargement The most important sign is abdominal pain The most important sign is adnexal tenderness (cervical excitation) SYMPTOMS OF RUPTURED ECTOPIC PREGNANCY • Hypovolaemic shock- Tachycardia and hypotension • Syncope • Acute abdominal pain • Febrile • Urge to defecate and urinate • Vomiting • Peritoneal signs (Haemoperitoneum) • Shoulder pain (Diaphragmatic Irritation) CLINICAL EXAMINATION Haemodynamic Status General Examination/Vital Signs Abdominal Examination Peritoneal signs-Rebound tenderness Per Speculum To see the os,cervix and presence of products of conception Vaginal Examination and Bimanual Assess os,elicit cervical excitation abd adnexal mass INITIAL INVESTIGATIONS • Urinary Pregnancy Test • Transvaginal ultrasonography DIFFERENTIAL DIAGNOSIS Miscarriage Acute Appendicitis Torsion Ovary Tubo Ovarian Abscess Urinary Tract Infection Renal Calculi
Hypovolemic/ Haemorrhagic Shock in Ectopic Pregnancy - Life threatening – require immediate and intensive treatment. - Causing inadequate perfusion of organs and cells with oxygenated blood Clinical features Main signs and symptoms: - weak and fast pulse (PR>90/min) - Low BP (systolic < 100 mmHg) - late sign Other signs and symptoms: - Pale, clammy, and cold periphery - Rapid breathing, restlessness - Altered/ loss of consciousness Management of Ectopic Pregnancy with Shock Using an ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach, assess whether the patient is hypovolaemic and needs fluid resuscitation. 1. Airway & Breathing – Supply with oxygen - Maintain airway patency in unconscious patients by use of head tilt-chin lift/jawthrust, oropharyngeal airway (OPA) or nasopharyngeal airway (NPA). Use advanced airways if needed (e.g. LMA or ETT) - Assess the adequacy of oxygenation and ventilation by: • Clinical criteria (colour, chest rise, auscultation) • Oxygen saturation 2. Circulation - Venous access (2 wide bore branula) -replacement of circulating blood volume (IV fluids/blood transfusion) - Indicators that a patient may need fluid resuscitation include: i) Heart rate >90bpm. ii) Systolic BP<100mmHg. iii) capillary refill >2s or peripheries cold to touch. iv) respiratory rate >20 breaths per min. v) reduced level of consciousness or new confusion. - Give a fluid bolus of 500 ml of crystalloid over less than15 minutes - Reassess the patient using the ABCDE approach. Fluid bolus can be repeated if needed up to 2L after expert’s consultation. 3. Disability – Assess consciousness level using GCS or AVPU (Alert,Verbal,Pain,Unresponsive) 4. Exposure - Keep her warm, insert CBD, I/O charting. 5. Monitor vital sign & GCS every 15mins. 6. Immediate surgical intervention (urgent referral to O&G team) 7. In case of cardiac arrest start CPR (cardiac arrest algorithm) 8. After initial stabilisation refer the patient to tertiary centre with referral letter (include brief history and examination, vital signs, investigations done, diagnosis, treatment given) and fill in interfacility transfer monitoring form. 9. Vital signs and GCS must be documented in interfacility form prior to transfer, every 15mins during transport and once prior to pass over to hospital team.
DIAGNOSTIC ALGORITHM AND INITIAL MANAGEMENT ECTOPIC PREGNANCY Premenopausal woman with amenorrhoea,abdominal pain or vaginal bleeding Positive pregnancy test Initial assessment of vital signs Abdominal and Vaginal Examination Unstable Vital Signs Pallor,tachycardia,hypotension with abdominal distension,guarding and rigidity Cervical motion tenderness Activation of red alert Vital Signs Stable No signs of shock No signs of intraabdominal bleed or cervical motion tenderness ABCDE assessment & Fluid resuscitation Stabilisation & Transportation Transvaginal Sonography Ectopic Pregnancy Pregnancy of unknown location Intrauterine pregnancy Further management for viable fetus Referral to hospital (O & G) Referral to hospital (O&G)
Disediakan Oleh: Dr. Norlina
Disediakan Oleh: Dr. Ain Sabrina
Disediakan Oleh: Dr. Nor Shazatul Salwana
Disediakan Oleh: Dr. Venotha ANAPHYLAXIS INTRODUCTION Anaphylaxis is a medical emergency requiring immediate treatment with adrenaline, as well as ongoing management. Important steps for long-term risk minimisation include avoidance of triggers, prescription of an adrenaline autoinjector, maintenance of a personalised emergency action plan for anaphylaxis, education for patients and families and regular review to optimise management. CAUSES Medication- especially older adults- antibiotics/ anaesthetic drugs/ NSAIDs/ opiates Food allergy- most common in children Insect venom COMMON FEATURES RISK FACTORS
MANAGEMENT Additional supportive therapy with nebulised beta-2 agonists (for bronchospasm), H1 antihistamines (for cutaneous symptoms), and/or glucocorticoids (may reduce the risk of biphasic reactions) is often utilised in clinical practice, but plays a less important role and is considered second line.These medications should never be used as an alternative to, or before, adrenaline for anaphylaxis REFERRENCES 1.Australian Family Physician Vol. 42, No. 1/2, January/February 2013