ACUTE LIFE THREATENING EVENTS
FEATURES/ DEFINITION
- Apnoea
- Colour change
- Abnormal tone
- Choking
DIFFERENTIAL DIAGNOSIS-
* from Dewolfe CC: review Pediatr clin north Am-2005
HISTORY
- Description of event/Duration
- Awake or asleep
- Position (prone, supine, side)
- Location (crib, bed)
- Bedclothes, blankets, pillows
- Activity at the time: feeding/coughing/gagging/choking/vomiting
- Breathing efforts
- Colour: Pallor/Central or Peripheral cyanosis.
- Abnormal Movement or tone
- Observations – a cough, vomiting, blood, or noise (silent, cough, gag, wheeze, stridor, crying)
- Resuscitation Interventions
- Present illness/Medical history
- Fever/Poor feeding/Weight loss/Rash/Irritability/lethargy
- Contact history
- Medications/Immunization
- Prenatal history/Birth history/Developmental history
- Accidents/Family history/Congenital problems
BASELINE INVESTIGATIONS
- Complete blood count (Infection, anaemia, blood cultures)
- Liver function / Renal function ( calcium/ magnesium)
- Lumbar puncture- Nasal swab for RSV / Pertussis culture
- Inborn errors of metabolism (glycogen storage type I, fatty acid oxidation defects)
- Arterial blood gases
- Toxicology screen
- Urinalysis (Infection/ Ammonia/ Toxicology)
- Chest X-Ray (Infection, cardiomegaly)
- ECG/ Holter monitoring
- Hypoxia -( Saturation monitoring)
- Neoplasm/congenital abnormalities
- Stool cultures
- Radioisotope milk scan- for reflux
- Brain imaging (CT/ MRI)
- Radiologic skeletal survey
TREATMENT
- Apnoea /saturation monitor for 12-24 hours OR longer as a diagnosis.
- Basic life support training to parents.
- Specific therapy, eg anti-reflux, antibiotics, child protection measures
FOLLOW UP
In few weeks.