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Subnormal
Normal
Subfebrile
Fever
High fever
Hyperpyrexia
ABG
<36.6C
37.4C
35.7 38.0C
38.0C
>39.5C
>42.0C
AGE
HR (bpm)
BP (mmHg)
Preterm
Term
0-3 mo
3-6 mo
6-12 mo
1-3 yrs
3-6 yrs
6-12 yrs
12-17 yrs
120-170
120-160
100-150
90-120
80-120
70-110
65-110
60-95
55-85
55-75/35-45
65-85/45-55
65-85/45-55
70-90/50-65
80-100/55-65
90-105/55-70
95-110/60-75
100-120/60-75
110-135/65-85
pH:
pCO2:
pO2:
RR (cpm)
40-70
30-60
35-55
30-45
25-40
20-30
20-25
14-22
12-18
RBC
NB
4.8-7.1
Infant
3.8-5.5
WBC
PMNs
Lymph
Hgb
9-30,000
61%
31%
14-24
6-17,500
61%
32%
11-20
Hct
44-64%
35-49
22-26mEq/L
+/- 2mEq/L
97%
Child
3.8-5.
Adole
M: 4.6-6.2
F: 4.2-5.4
5-10,000 6-10,000
60%
60%
30%
30%
11-16
M: 14-18
F: 12-16
31-46
M: 40-54
F: 37-47
150-450 150-450
0-2
0-2
BT
CT
PTT
Caucasian
<18.5
18.5 24.9
25 29.9
1-6
5-8
12-14
Kilograms
3kg (Fil)
3.35kg (Cau)
Age (mo) + 9 / 2
Pounds
7
Age (mo) + 10 (F)
Age (mo) + 11 (C)
Age (y) x 5 + 17
Age (y) x 7 + 5
Age (y) x 2 + 8
Age (y) x 7 5 / 2
COUNT (%)
BMI
Asian
<18.5
18.5 22.9
23.0
23 24.9
25 29.9
30
HCO3:
B.E.:
O2 sat:
Underweight
Normal
Overweight
at risk
Obese I
Obese II
7.35-7.45
35-45
80-100
ANTHROPOMETRIC MEASUREMENTS
Age of Infant
4-5 months
1 year
2 years
3 years
5 years
7 years
10 years
1-6
5-8
12-14
Ideal Weight
2 x Birth Weight
3 x Birth Weight
4 x Birth Weight
5 x Birth Weight
6 x Birth Weight
7 x Birth Weight
10 x Birth Weight
30 39.9
>40
APGAR
LENGTH / HEIGHT
(50 cm)
Age
At Birth
1y
2-12 mo
Age
0-3 mo
3-6 mo
6-9 mo
9-12 mo
Centimeters
50
75
Age x 6 + 77
Age
Inches
20
30
Age x 2.5 + 30
At Birth
1y
6y
5-12 mo
1-2 yrs
3-5 yrs
6-20 yrs
Inches
Transverse = AP
Transverse > AP
Transverse >>> AP
FONTANELS
st
Inches
35 cm (13.8 in)
+ 2 in
(1/2 inches / mo)
+ 2 in
(1/4 inches / mo)
+ 1 inch
+ 1.5 in
(1/2 inches / year)
+ 1.5 in
(1/2 inches / year)
2 x 2 cm (anterior)
= 18 months, or as early
as 9-12 months
= 6 8 weeks or
2 4 months
TI =
+ 5.08cm
(1.27cm / mo)
+ 5.08cm
(0.635cm / mo)
2.54 cm
+ 3.81cm
(1.27cm / mo)
+ 3.81cm
(1.27cm / mo)
AGE
Birth
or 6 wks
DPT
6 wks
DOSE
0.05mL
(NB)
0.1mL
(older)
0.5mL
OPV
HEPA B
6 wks
6 wks
2 drops
0.5mL
3
3
PO
IM
MEASLES
9 mos
0.5mL
SC
BCG-2
School entry
0.1mL
ID
TetToxoid
Childbearing
women
0.5mL
IM
(-)
Response
Grimaces
(-)
Movement
Some flexion /
extension
Absent
Slow / Irregular
Function
Eye
Opening
Birth
1 year
6 years
Verbal
Infants/Young
4- Spontaneous
3- To speech
2- To pain
1- None
5- Appropriate
4- Inconsolable
3- Irritable
2- Moans
1- None
6- Spontaneous
5- Localize pain
4- Withdraw
3- Flexion
2- Extension
1- None
: 1.0
: 1.25
: 1.35
#
1
ROUTE
ID
SITE
RDeltoid
IM
Upper
Outer
thigh
Mouth
Anterolateral
thigh
Outer
upper
arm
LDeltoid
Deltoid
2
Completely
pink
> 100
Coughs,
Sneezes,
Cries
Active
movement
Good,
strong cry
GCS
Motor
Normal
Mild / Moderate Asphyxia
Severe asphyxia
THORACIC INDEX
Centimeters
1
Pink body/ Blue
extremities
Slow (<100)
8 10:
4 7:
0 3:
Posterior
HEAD CIRCUMFERENCE
(33-38 cms)
Age
At Birth
< 4 mo
Transverse-AP
Diameter ratio
1.0
1.25
1.35
0
Blue /
Pale
Absent
Older
Spontaneous
To speech
To pain
None
Oriented
Confused
Inappropriate
Incomprehensible
None
Spontaneous
Localize pain
Withdraw
Flexion
Extension
None
BCG
DPT
4 wks
4 wks
4 wks
1 mo then
6-12 mos
OPV
HEPA B
MEASLES
PASSIVE
Diphtheria
Tetanus
Tetanus Ig
Measles Ig
Rabies (HRIg)
Hep A Ig
Hep B ig
Rubella Ig
H.E.A.D.S.S.S.
Sexual activities
Sexual orientation?
GF/BF? Typical date?
Sexually active? When started? # of persons?
Contraceptives? Pregnancies? STDs?
Suicide/Depression
Ever sad/tearful/unmotivated/hopeless?
Thought of hurting self/others?
Suicide plans?
Safety
Use seatbelts/helmets?
Enter into high risk situations?
Member of frat/sorority/orgs?
Firearm at home?
F.R.I.C.H.M.O.N.D.
Fluids
Respiration
Infection
Cardiac
Hematologic
Metabolic
Output & Input [cc/kg/h] N: 1-2
Neuro
Diet
H.E.A.D.S.S.S.
Home Environment
With whom does the adolescent live?
Any recent changes in the living situation?
How are things among siblings?
Are parents employed?
Are there things in the family he/she wants to
change?
Employment and Education
Currently at school? Favorite subjects?
Patient performing academically?
Have been truant / expelled from school?
Problems with classmates/teachers?
Currently employed?
Future education/employment goals?
Activities
What he/she does in spare time?
Patient does for fun?
Whom does patient spend spare time?
Hobbies, interests, close friends?
Drugs
Used tobacco/alcohol/steroids?
Illicit drugs? Frequency? Amount?
Affected daily activities?
Still using? Friends using/selling?
NUTRITION
AGE
0-5 mo
8-11 mo
1-2 y
3-6 y
7-9 y
10-12 y
13-15 y
16-19 y
WT.
3-6
7-9
10-12
14-18
22-24
28-32
36-44
48-55
TCR
TCR
CAL
115
110
110
90-100
80-90
70-80
55-65
45-50
CHON
3.5
3.0
2.5
2.0
1.5
1.5
1.5
1.2
= Wt at p50 x calories
= CHON X ABW
: calories X amount of
intake (oz)
Gastric Capacity
: age in months + 2
: 2-3 hours
1:1
Alacta
Enfalac
Lactogen
Lactum
Nan
Nestogen
Nutraminogen
Pelargon
Prosobee
1:2
Bonna
Nursoy
Promil
S-26
Similac
SMA
Habit 1:
Habit 2:
Habit 3:
Habit 4:
Habit 5:
Be Proactive
Begin with the end in mind
Put First Things First
Think Win-Win
Seek first to understand and
then to be understood
Habit 6: Synergize
Habit 7: Sharpen the saw
EXPECTED LA SALLIAN
GRADUATE ATTRIBUTES
(ELGA)
1. Competent & safe physicians
2. Ethical & socially responsible
Doctors / practitioners
3. Reflective lifelong learners
4. Effective communicators
5. Efficient & innovative managers
DIARRHEA
Chronic
: >14 days, non-infectious causes
Persistent : >14 days, infectious cause
5-100mL
100-200mL
As much as wanted
500mL
1000mL
2000mL
4 Major Mechanisms
1. Poorly absorbed osmotically active substances in
lumen
2. Intestinal ion secretion (increased) or decreased
absorption
3. Outpouring into the lumen of blood, mucus
4. Derangement of intestinal motility
Rotaviral AGE (vomiting first then diarrhea)
30mL/kg
1H
30 mins
75mL/kg
5H
2H
Patient in SHOCK
ETIOLOGY of AGE
Bacteria
Aeromonas
Bacillus cereus
Campylobacter jejuni
Clostridium perfringens
Clostridium difficile
Escherichia coli
Plesiomonas shigelbides
Salmonella
Shigella
Staphylococcus aureus
Vibrio cholerae 01 & 0139
Vibrio parahaemolyticus
Yersinia enterocolitica
Viruses
Astroviruses
Caloviruses
Norovirus
Enteric Adenovirus
Rotavirus
Cytomegalovirus
Herpes simplex virus
Parasites
Balantidium coli
Blastocyctis hominis
Cryptosporidium
Giardia lamblia
Amoeba
Ascariasis
Cholera
Shigella
Salmonella
TREATMENT PLAN A
Metronidazole
Al/mebendazole
Tetracyline
TMP/SMX
(Cotri)
Chloramphenicol
TREATMENT PLAN C
Infants
(<12mo)
Children
(12mo-5yrs)
First give
30mL/kg in:
Age
Then give
70mL/kg in:
1 hour*
5 hours
30 min*
2 hours
2 years or more:
140-200 mL
:- give frequent small sips from a cup
:- if the child vomits, wait for 10 min then
resume
:- continue giving extra fluids until diarrhea
stops
TREATMENT PLAN B
Recommended amount of ORS over 4 hour period
Age up to:
Wt:
(mL)
4 mo 4 mo
<6kg
200-400
12 mo 12 mo
6-9.9kg
400-700
CHILDS WT (kg) x 25
AFTER 4 HOURS
reassess the child & classify dehydration status
select the appropriate plan to continue treatment
begin feeding the child while at the clinic
2 yrs 2 yrs
10-11.9kg
700-900
5 yrs
2-19kg
900-1400
Glucose:
100mmol/L
Na:
60 mol/L
K:
20 mmol/L
Cl:
50mmol/L
Mg:
5mmol/L
Citrate:
10 mmol/L
Glucose 45mEq
Na: 20mEq
K: 35mEq
Citrate: 30mEq
Dextrose: 20g
Gluconate:
5mmol/L
Hydrite
-: 2 tab in 200ml water or 10sachets in 1L water
Glucose:
111mmol/L
Na:
90 mmol/L
K:
20 mmol/L
Cl:
80mmol/L
HCO3:
5mmol/L
Pedialyte 45 0r 90
-: prevention of DHN & to maintain normal
fluidelectrolyte balance in mild to moderate
dehydration.
Glucose 90mEq
Na: 20mEq
K: 80mEq
Citrate: 30mEq
Dextrose: 25g
Pedialyte mild 30
-: to supplement fluid & electrolyte loss due to
active play, prolonged exposure, hot and humid
environment
Glucose:
11mml/L
Na:
90 mmol/L
K:
20 mmol/L
Glucose: 30mEq
Na: 20mEq
K:
30mEq
Mg: 4mEq
lactate: 20mEq
Ca:
4mEq
Energy:
20kcal/ 100ml
Glucolyte 60
-: for acute DHN secondary to GE or other forms
of diarrhea except CHOLERA. In burns, postsurgery replacement or maintenance, mild-salt
loosing syndrome, heat cramps and heat
exhaustion in adults.
ORS
Bacterial
- Streptococcus pneumoniae
- Group B streptococci
(neonates)
- Group A streptococci
- Mycoplasma pnemoniae
(adolescents)
- Chlamydia trachomatis
(infants)
- Mixed anearobes
(aspiration pneumonia)
- Gram negative enteric
(nosocomial pneumonia)
Viral
- Respiratory syncitial virus
- Parainfluenza type 1-3
- Influenza types A, B
- Adenovirus
- Metapneumovirus
Fungal
- Histoplasma capsulatum
- Cryptococcus neoformans
- Aspergillus sp.
- Mucormycosis
- Coccidioides immitis
- Blastomyces dermatitides
- Pneumocystis carinii
ETIOLOGY OF PNEUMONIA
(Croup)
SMR GIRLS
LUDANS METHOD (HYDRATION THERAPY)
MILD
DEHYDRATION
50 cc/kg
30 cc/kg
D5 0.3% in
6-8 hours
MODERATE
DEHYRATION
100 cc/kg
60 cc/kg
st
1 hr: Plain LR
Next 5-7 hrs:
D5 0.3% in
5-7 hours
SEVERE
DEHYDRATION
150 cc/kg
90 cc/kg
st
1 hr: Plain LR
Next 5-7 hrs:
D5 0.3% in
5-7 hours
Stage
1
2
3
4
5
Pubic Hair
Preadolescent
Sparse, lightly pigmented, straight,
medial border of labia
Breasts
Preadolescent
Breast & papilla elevated, as small
mound, areola diameter increased
Breast & areola enlarged, no contour
separation
Areola & papilla formed secondary
mound
Mature, nipple projects, areola part of
general breast contour
SMR BOYS
Stage
1
2
3
4
5
Pubic Hair
None
Scanty, long slightly
pigmented
Darker, starts to curl, small
amount
Resembles adult type but
less in quantity, course,
curly
Adult distribution, spread
to medial surface of thigh
Penis
Preadolescent
Slightly enlargement
Testes
Preadolescent
Enlarged scrotum, pink
texture altered
Longer
Larger
Adult size
Adult size
ATYPICAL PNEUMONIA
-:
-:
-:
-:
-:
> 3-12 mo
- RSV
- Other respiratory viruses
- Streptococcus pneumoniae
- Haemophilus influenzae (Type B)
- C. trachomatis
- M. pneumoniae
- Group A Streptococcus
extrpulmonary manifestations
low grade fever
patchy diffuse infiltrates
poor response to Penicillin
negative sputum gram stain
Etiologic Agents Grouped by Age
DENGUE
> MOT:
mosquito bite
> Vector:
Aedes aegypti
DENGUE PATHOPHYSIOLOGY
4-6 days
> Serotypes:
- Type 2 most common
- Types 1& 3
- Type 4 least common but most severe
> Main pathophysiologic changes:
a. increase in vascular permeability
extravasation of plasma
- hemoconcentration
rd
- 3 spacing of fluids
b. abnormal hemostasis
- vasculopathy
- thrombocytopenia
- coagulopathy
MANAGEMENT OF DENGUE
A. Vital Signs and Laboratory Monitoring
Monitor BP, Pulse Rate
We have to watch out for Shock (Hypotension)
MANAGEMENT OF HEMORRHAGE
Torniquet Test:
probable etiology is
Pseudomonas
ACUTE GLOMERULONEPHRITIS
Complications of AGN
- CHF 2 to fluid overload
- HPN encephalopathy
- ARF due to GFR
RHEUMATIC FEVER
JONES CRITERIA:
STAGES of AGN
- Oliguric phase [7-10days]
complications sets in
- Diuretic phase [7-10days]
recovery starts
- Convalescent phase [7-10days] patients are
usually sent home
Prognosis
- Gross hematuria
- Proteinuria
- C3
- microscopic hematuria
2-3 weeks
3-6 weeks
8-12 weeks
6-12 mo or
1-2 years
4-6 weeks
- HPN
A. Major Manifestations
- Carditis
- Polyarthritis
- Chorea
- Erythema Marginatum
- Subcutaneous Nodules
A. Antibiotic Therapy
- 10 days of Oral Penicillin or Erythromycin
- IM Injection of Benzethine Penicillin
(50-60%)
(70%)
(15-20%)
(3%)
(1%)
B. Minor Manifestations
- Arthralgia
- Fever
- Laboratory Findings of:
Acute Phase Reactants (ESR / CRP)
Prolonged PR interval
C. PLUS Supporting Evidence of Antecedent
Group-A Strep Infection
- (+) Throat Culture or Rapid Strep-Ag Test
- Rising Strep-AB Test
*** NOTE:
Sumapen
= Oral Penicillin!
B. Anti-Inflammatory Therapy
1. Aspirin (if Arthritis, NOT Carditis)
Acute: 100mg/kg/day in 4 doses x 3-5days
Then, 75mg/kg/day in 4 doses x 4 weeks
2. Prednisone
2mg/kg/day in 4 doses x 2-3weeks
Then, 5mg/24hrs every 2-3 days
PREVENTON
A. Primary Prevention
B. Secondary Prevention
C. Duration of Chemoprophylaxis
KAWASAKI DISEASE
TREATMENT
CDC-CRITERIA FOR DIAGNOSIS:
ADOPTED FROM KAWASAKI
(ALL SHOULD BE PRESENT)
NOTE:
>30min or back-to-back
w/o return to baseline
B. Aspirin
HIGH Dose ASA (80-100mg/kg/day divided q 6h)
should be given Initially in Conjunction with IV-IG
THEN
Reduced to Low Dose Aspirin (3-5mg/kg/day)
AND
Continued until Cardiac Evaluation COMPLETED
(approximately 1-2 months AFTER Onset of Disease)
HARADA Criteria
- used to determine whether IVIg should be given
- assessed within 9 days from onset of illness
1. WBC > 12,000
2. PC <350,000
3. CRP > 3+
4. Hct <35%
5. Albumin <3.5 g/dL
6. Age 12 months
7. Gender: male
SEIZURES
> Etiology:
- V ascular
- I nfections
- T raumatic
- A utoimmune
- M etabolic
- I diopathic
- N eoplastic
- S tructural
:
:
:
:
:
:
:
:
- S yndrome
TYPES OF SEIZURES
CLASSIFICATION BY CAUSE
A. Acute Symptomatic
(shortly after an acute insult)
Infection
Hypoglycemia, low sodium, low calcium
Head trauma
Toxic ingestion
B. Generalized Seizures
Absence
(Petit mal)
Myoclonic
Clonic
Tonic
Tonic-Clonic
Atonic
B. Remote Symptomatic
Pre-existing brain abnormality or insult
Brain injury (head trauma, low oxygen)
Meningitis
Stroke
Tumor
Developmental brain abnormality
C. Idiopathic
No history of preceding insult
Likely genetic component
Controlled
Partly Controlled
none
> 2x per wk
none
any
none
any
< 2x per wk
> 2x per wk
normal
< 80%
none
> 1x per yr
Uncontrolled
3 or more symptoms
of Partly Controlled
Asthma in any week
1x / week
Clinical Features:
TUBERCULOSIS
A. Pulmonary TB
fully susceptible M. tuberculosis,
no history of previous anti-TB drugs
low local persistence of primary resistance to
Isoniazid (H)
Retractions:
o Due to (-) intrapleural pressure produced by
interaction b/w contraction of diaphragm & other
respiratory muscles and mechanical properties of
the lungs & chest wall
Nasal flaring:
o Due to contraction of alae nasi muscles leading to
marked reduction in nasal resistance
Pathophysiology:
1. Impaired/delayed surfactant synthesis & secretion
2. V/Q (ventilation/perfusion) imbalance due to
deficiency of surfactant and decreased lung
compliance
3. Hypoxemia and systemic hypoperfusion
4. Respiratory and metabolic acidosis
5. Pulmonary vasoconstriction
6. Impaired endothelial &epithelial integrity
7. Proteinous exudates
8. RDS
Grunting:
o Expiration through partially closed vocal cords
Initial expiration: glottis closed
lungs w/ gas
inc. transpulmo P w/o airflow
Last part of expiration: gas expelled against
partially closed cords
Cyanosis:
o Central
UMBILICAL CATHERIZATION
NEWBORN RESUSCITATION
AIRWAY: open & clear
Positioning
Suctioning
Endotracheal intubation (if necessary)
BREATHING is spontaneous or assisted
Tactile stimulation (drying, rubbing)
Positive-pressure ventilation
CIRCULATION of oxygenated blood is adequate
Chest compressions
Medication and volume expansion
RESUSCITAION MEDICATIONS
Atropine
Bicarbonate
Calcium
Calcium chloride
Calcium gluconate
Dextrose
Epinephrine
Cathether length
Standardize Graph
Perpedicular line from the tip of the shoulder to
the umbilicus
Measure length from Xiphoid to umbilicus and add
0.5 to 1cm.
Birth weight regression formula
Low line
: UA catheter in cm = BW + 7
High line
: UA catheter
= [3xBW] + 9
UV catheter length
= [0.5xhigh line] + 1
Indications
Vascular access (UV)
Blood Pressure (UA) and blood gas monitoring in
critically ill infants
Complications
Infection
Bleeding
Hemorrhage
Perforation of vessel
Thrombosis w/ distal embolization
Ischemia or infarction of lower extremities, bowel
or kidney
Arrhythmia
Air embolus
Procedure
Determine the length of the catheter
Restrain infant and prep the area using sterile
technique
Flush catheter with sterile saline solution
Place umbilical tape around the cord. Cut cord
about 1.5-2cm from the skin.
Identify the blood vessels.
(1thin=vein, 2thick=artery)
Grasp the catheter 1cm from the tip. Insert into the
vein, aiming toward the feet.
Secure the catheter
Observe for possible complications
Cautions
Never for:
Omphalitis
Peritonitis
Contraindicated in
NEC
Intestinal hypoperfusion
Line Placement
Arterial line
Low line
Tip lie above the bifurcation between L3 & L5
High line
Tip is above the diaphram between T6 & T9
BILIRUBIN
PRETERM:
0-1 hr
1-2 d
3-5 d
mg/dl
1-6
6-8
10-12
mmol/L
17-100
100-140
170-200
mg/dl
2-6
6-7
4-12
<1
mmol/L
34-100
100-120
70-200
<17
TERM
0-1 hr
1-2 d
3-5 d
1 mo
JAUNDICE
II
III
IV
V
SERUM
BILIRUBIN
6-8
9-12
12-16
15
15
MKD COMPUTATION
LUMBAR PUNCTURE
SPINE
spinal cord stops near L2
lower lumbar spine (usually between L3-L4 or
L45) is preferable
Indication
to diagnose some malignancies (brain cancer and
leukemia)
to assess patients with certain psychiatric
symptoms and conditions.
for injecting chemotherapy directly into the CSF
(intrathecal therapy)
Complication
Local pain
Infection
Bleeding
Spinal fluid leak
Hematoma (spinal subdural hematoma
Spinal headache
Acquired epidermal spinal cord tumor
CSF
clear, watery liquid that protects the central
nervous system from injury
cushions the brain from the surrounding bone.
It contains:
glucose (sugar)
protein
white blood cells
Rate
: 500ml/day or 0.35ml/min
Range
: 0.3-04 ml/min
Volume : 50ml (infants)
150ml (adults)
12kg x 10mg
1 drop
1 teaspoonful
1 tablespoonful
1 wineglassful
1 glassful
1 grain
1 pint
1 quart
1 ounce
1 Kg
1 lb
= 1/20 mL
= 5 mL
= 15 mL
= 60 mL
= 2 ounces
= 250 mL
= 8 ounces
= 60 mg
= 500 mL
= 1000 mL
= 30 mL
= 2.2 lbs
= 0.45359 Kg
Empirical dose
6 months
tsp TID QID
6 mos 2 yrs
tsp
2-6
1 tsp
6-9
1 tsp
9-12
2 tsp
Procedure
Apply local anesthetic cream (ideally)
Position the patient
Prepare the skin using sterile techniques
Anesthetize the area with lidocane
Puncture the skin in the midline just caudal to the
spinus process, angle cephalad toward the
umbilicus using a g23 needle
Collect the CSF for analysis
CSF Analysis
1. Gram stain, culture and sensitivity
2. Cell count, differential count
3. Chemistries sugar, protein
4. Special studies
After care
Cover the puncture site with a sterile bandage,
apply pressure packing.
Patients must remain lying down for 4-6 hours
NPO for 4 hrs
CLINICAL FEATURES
CLASSIFICATION BASED ON SEVERITY
MILD
INTERMITTENT
Exacerbation
Brief
Day-time Sxs
Nightime Sxs
PEFR
PEFR VAR
FEV1
<1x/wk
<2x/mo
>80%
<20%
>80%
MILD
Affects daily
activity &
sleep
>1x/wk
>2x/mo
>80%
20 - 30%
>80%
PERSISTENT
MODERATE
Affects daily
activity &
sleep
daily
>1x/wk
60 - <80%
>30%
60 - <80%
SEVERE
Limits daily
activity &
sleep
continuous
frequent
<60%
>30%
<60%
Breathless
Talks in
Alertness
RR
Accessory
muscles &
retractions
MODERATE
sentences
may be
agitated
- talking
- INF: softer,
shorter, cry,
difficulty
feeding
- prefers
sitting
phrases
usually
agitated
- walking
- can lie down
none
(+)
SEVERE
- at rest
- INF: stops
feeding
- hunched
forward
words
usually
agitated
often >30
mins
(+)
RESPIRATORY
ARREST
Imminent
drowsy /
confused
bradypnea
(+) thoracoabd
movement