HEART Pathway for low risk chest Pain

HEART Pathway for low risk chest Pain

Glasgow Coma Scale

Here is the traditional GCS

RSI/ Airway Management Drugs

Rapid Sequence Incubation

Airway Management Drugs are listed below

WHAT IS SHOCK- A Simplified approach, iSHOCK

iSHOCK

Condition of severe impairment of tissue perfusion leading to cellular injury and dysfunction. Rapid recognition and treatment are essential to prevent irreversible organ damage and death

Common CAUSES

Oligemic shock

Hemorrhage

Volume depletion (e.g., vomiting, diarrhea, diuretic overusage, ketoacidosis)

Internal sequestration (ascites, pancreatitis, intestinal obstruction)

Cardiogenic shock

Myopathic (acute MI, dilated cardiomyopathy)

Mechanical (acute mitral regurgitation, ventricular septal defect, severe aortic stenosis)

Arrhythmic

Extracardiac obstructive shock

Pericardial tamponade

Massive pulmonary embolism

Tension pneumothorax

Distributive shock (profound decrease in systemic vascular tone)

CLINICAL FEATURES:

Hypotension (mean arterial bp <60 mmHg), tachycardia, tachypnea, pallor, restlessness, and altered sensorium.

Signs of intense peripheral vasoconstriction, with weak pulses and cold clammy extremities. In distributive (e.g., septic) shock, vasodilatation predominates and extremities are warm.

Oliguria (<20 mL/h) and metabolic acidosis common.

Acute lung injury and acute respiratory distress syndrome with noncardiogenic pulmonary edema, hypoxemia, and diffuse pulmonary infiltrates.

EXAMINATION:

FEVER IN A CHILD

Fever in a Child

is the most common chief complaint presenting to an emergency department and accounts for 30% of outpatient visits each year. Early studies suggested that infants younger than 3 months were at high risk of a serious bacterial illness (SBI), which included sepsis, pyelonephritis, pneumonia, and meningitis. Current practice guidelines vary in their cut-offs for evaluation and treatment strategies. Neonates are clearly at the highest risk, while infants in their second and third months of life gradually transition to the lower risk profile of older infants and children. The incidence of bacteremia falls from around 10% among febrile neonates to approximately 0.2% in immunized infants and children older than 4 months; meningitis risk decreases from about 1% in the first month of life to < 0.1% later in infancy; the risk for pyelonephritis remains relatively constant among young girls with fever, and gradually decreases among boys over the first year of life. The individual practitioner must weigh these risks against the invasiveness of their ED evaluation and make shared decisions with the family on the best approach.

CLINICAL FEATURES:

In the neonate or infant < 2 to 3 months of age, the threshold for concerning fever is 38°C (100.4°F); in infants and children 3 to 36 months old, the threshold is 39°C (102.2°F). In general, higher temperatures are associated with a higher incidence of serious bacterial illness.

Young infants are especially problematic in assessing severity of illness. Immature development and immature immunity make reliable examination findings difficult. Persistent crying, inability to console, poor feeding, or temperature instability may be the only findings suggestive of an SBI.

Epiblepharon & Euryblepharon

Epiblepharon

 Extra fold of skin in the lower lid with inturning of eyelashes

 Nasal 1/3rd is most commonly affected

 Treatment: Plastic repair if necessary to prevent recurrent infection.

Euryblepharon

Rare, congenital, bilateral, not so serious condition

•  Palpebral apertures are larger than normal 

              and may be with epicanthus

• Excessive watering may be a problem due to more exposure

 Treatment:

 No treatment for most of the cases; lateral tarsorrhaphy for symptomatic cases.

Bilateral eyelids drooping Disease

Blepharophimosis Syndrome (Bilateral eyelid drooping disease)

 Autosomal dominant Condition
(Can be transmitted from both mother or father, usually express in every generation)

Features:

Syndrome consists of bilateral:

– Narrowing of vertical and horizontal palperbral apertures

– Telecanthus

– Inverse epicanthus folds

– Lateral ectropion and moderate to severe ptosis

 May be asymmetrical and without epicanthic folds

 Treatment: 

Plastic reconstruction of lids, along with bilateral brow suspension for ptosis.