TAILIEUCHUNG - ADVANCED PAEDIATRIC LIFE SUPPORT - part 5

Như là Không có điều trị cụ thể đối với viêm tiểu phế quản, hỗ trợ quản lý IS. Giao oxy ẩm IS vào headbox với tỷ lệ đó sẽ duy trì SaO2 trên 92%, và dịch truyền tĩnh mạch hoặc thông mũi dạ dày đang bắt đầu nếu cần thiết. | THE CHILD WITH AN ABNORMAL PULSE RATE OR RHYTHM solely on the haemodynamic status of the patient. A dose of adenosine may help identify the underlying aetiology of the arrhythmia but should be used with extreme caution in haemodynamically stable children with wide-complex tachycardia as acceleration of the tachycardia and significant hypotension are known risks. Consider using anti-arrhythmics Figure . Algorithm for the management of ventricular tachycardia 126 CHAPTER _ 12 The child with a decreased conscious level INTRODUCTION The conscious level may be altered by disease injury or intoxication. The level of awareness decreases as a child passes through stages from drowsiness mild reduction in alertness and increase in hours of sleep to unconsciousness unrousable unresponsiveness . Because of variability in the definition of words describing the degree of coma the Glasgow and the Children s Coma Scales have been developed as semi-quantitative measures and more importantly as an aid to communication between carers. The Glasgow Coma Scale was developed and validated for use in the head injured patient but has come to be used as an unvalidated tool for the description of conscious states from all pathologies. In children coma is caused by a diffuse metabolic insult including cerebral hypoxia and ischaemia in 95 of cases and by structural lesions in the remaining 5 . Metabolic disturbances can produce diffuse incomplete and asymmetrical neurological signs falsely suggestive of a localised lesion. Early signs of metabolic encephalopathy may be subtle with reduced attention and blunted affect. The conscious level in metabolic encephalopathies is often quite variable from minute to minute. The most common causes of coma are summarised in the box. Disorders causing coma in children Hypoxic ischaemic brain injury Following respiratory or circulatory failure Epileptic seizures Trauma lntracranial haemorrhage brain swelling Infections Meningitis Encephalitis Poisoning .

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