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121. Clinical care of severe acute respiratory infections – Tool kit

References and resources 115 10.1 Numerical pain assessment scales 117 10.2 Behavioural pain assessment scales 118 10.3 COMFORT-B Scale to assess sedation in children 122 10.4 Richmond Agitation-Sedation Scale (RASS) 125 10.5 Flowchart and worksheet for the Confusion Assessment Method of the ICU for adults (CAM-ICU) 126 10.6 Flowchart and worksheet for the Confusion Assessment Method of the ICU for children (pCAM-ICU) 128 10.7 Procedure for assessing attention: attention screening exam (ASE) for adults (...) and Quality (United States of America) AMS altered mental state ARDS acute respiratory distress syndrome ARI acute respiratory infection ART arterial pressure ASE attention screening exam AVPU alert, verbal, pain, unresponsive (scale for assessing level of consciousness) bCPAP bubble continuous positive airway pressure BEC basic emergency care BEE basal energy expenditure BPM beats per minute BPS Behavioural Pain Scale BSI blood stream infection CAM-ICU confusion assessment method for the intensive care

2020 WHO Coronavirus disease (COVID-19) Pandemic

122. The acute management of paediatric coronavirus disease 2019 (COVID-19)

, such as: Tachypnea (RR > 60 for infants <2 months; RR > 50 for infants 2 to 11 months; RR > 40 for children > 1 year of age) Hypoxemia (O2 saturation <92%) Cardiovascular effects (e.g., myocardial injury) Central nervous system (CNS) effects (e.g., a decreased level of consciousness, depression, seizures, or coma) Gastrointestinal (GI) effects (e.g., dehydration, difficulty feeding, elevated liver enzymes) Coagulation dysfunction, rhabdomyolysis, or other vital organ dysfunction Critical illness Rapid disease (...) room or outside of patient rooms, while minimizing the number of direct participants. Entry to a patient’s room should be limited to individuals required to perform a physical exam, and devices carried by HCPs, such as cell phones or laptops, should not be allowed in patient rooms. Dedicated stethoscopes are recommended, but when these are unavailable, personal stethoscopes must be cleaned between uses. To minimize interpersonal contacts, use technology to facilitate virtual communication among

2020 Canadian Paediatric Society

123. Effectiveness of interventions to manage acute malnutrition in children under five years of age in low- and middle-income countries Full Text available with Trip Pro

years of age and examine them for bilateral pitting oedema. 2. Assessment of nutrition status in primary health‐care facilities and hospitals through routine health‐facility screening. Health‐care workers should assess the MUAC or the WHZ status of infants and children under 5 years of age and also examine them for bilateral oedema. 3. Children who are identified as having SAM should first be assessed with a full clinical examination to confirm whether they have medical complications and whether

2020 Campbell Collaboration

124. Pharmacological interventions for the treatment of delirium in critically ill adults. (Abstract)

benefits and safety of available pharmacological interventions for this population.Primary objective1. To assess the effects of pharmacological interventions for treatment of delirium on duration of delirium in critically ill adults with confirmed or documented high risk of deliriumSecondary objectivesTo assess the following:1. effects of pharmacological interventions on delirium-free and coma-free days; days with coma; delirium relapse; duration of mechanical ventilation; intensive care unit (ICU (...) classes from existing trials), thus describing a treatment network of all possible comparisons between drug classes. We assessed the quality of the body of evidence according to GRADE, as very low, low, moderate, or high.We screened 7674 citations, from which 14 trials with 1844 participants met our inclusion criteria. Ten RCTs were placebo-controlled, and four reported comparisons of different drugs. Drugs examined in these trials were the following: antipsychotics (n = 10), alpha2 agonists (n = 3

2019 Cochrane

125. Risk reduction and management of delirium

or evolving neurocognitive disorder or coma. The disturbance develops over a short period of time and tends to fluctuate in severity during the course of the day with evidence of direct physiological consequence of another medical condition, substance intoxication or withdrawal, or exposure to a toxin, or is due to multiple aetiologies. It’s specified as ‘acute’, lasting a few hours or days and ‘persistent’, lasting weeks or months. 13 Delirium presents variably but its main characteristics are rapid (...) days. It is geared towards assessment of hyperactive delirium. Abbreviations: AMT – Abbreviated Mental Test; CAM – Confusion Assessment Method; DSD – delirium superimposed on dementia; DRS-98-R – Delirium Rating Scale; DOS - Delirium Observation Screening Scale; ICDSC – Intensive Care Delirium Screening Checklist; Nu-DESC – Nursing Delirium Screening Scale; MMSE – Mini Mental State Examination; RADAR – Recognising Acute Delirium As part of your Routine; mRASS – Modified Richmond Agitation-Sedation

2019 SIGN

126. Hyponatraemia

of hyponatraemia.) This topic principally focuses on hypotonic (hypo-osmolar) hyponatraemia, the most common type of hyponatraemia. History and exam presence of risk factors high fluid intake fluid losses history of diabetes mellitus history of cirrhosis, nephrosis, congestive heart failure nausea/vomiting mild cognitive symptoms altered mental status, seizures, coma low urine output weight changes orthostatic hypotension abnormal jugular venous pressure poor skin turgor dry mucous membranes absence

2019 BMJ Best Practice

127. Lassa fever

and death. History and exam presence of risk factors fever ≥37.5°C elevated respiratory rate low systolic blood pressure malaise nausea/vomiting headache sore throat/pharyngitis conjunctivitis chest pain/cough myalgia deafness (sensorineural) facial oedema bleeding abdominal pain diarrhoea confusion and altered Glasgow Coma Scale or seizures effusions occupational exposure living/working in, or arrival from, endemic area contact with infected body fluids butchering and/or eating rodent meat bioterrorism

2019 BMJ Best Practice

128. Guidelines for diagnosing and managing pediatric concussion

recovery and avoid errors or setbacks at school or work. Level of evidence: B. 5.4d(i): Assess for balance and vestibular impairments. When: On re-evaluation. Who: Health care professionals. • Example: Family physicians, pediatricians, nurse-practitioners. How: • Perform a neurological exam. o Tool 2.4: Neurologic and Musculoskeletal Exam. • Assess balance using the following tools, as appropriate. o Tool 0.2: ChildSCAT3 Sport Concussion Assessment Tool for Children aged 5-12 (balance examination). o (...) 5.4a(v) Refer the child/adolescent to a pediatric sleep specialist if sleep has not improved. C 5.4b(i) Take a history of any headaches. B 5.4b(ii) Establish the degree and duration of the disability that the headaches cause. B 5.4b(iii) Perform a neurological exam and a head/neck exam. C 5.4b(iv) Consider non-pharmacological, complementary and/or alternative medicine therapies for headache. C 5.4b(v) Consider treating migraine headaches with prescription medication. B Chapter: Tipsheet Guidelines

2019 CPG Infobase

129. Management of Poisoning

should be consulted (pg 55). GPP D Prolonged resuscitation should be attempted in drug-induced cardiac arrest (pg 55). Grade D, Level 3 C Titrated doses of naloxone, together with bag-valve-mask ventilation, should be administered for suspected opioid-induced coma, prior to intubation for respiratory insuf? ciency (pg 56). Grade C, Level 2+ D In bradycardia due to calcium channel or beta-blocker toxicity that is refractory to conventional vasopressor therapy, intravenous calcium, glucagon or insulin (...) serum electrolytes, glucose, BUN levels. Useful tests to exclude other causes of respiratory depression and predict severity of respiratory depression (pg 129). GPP21 D Diagnosis is usually based on a history of ingestion. Speci? c serum levels may con? rm diagnosis. Urine and blood screens are also available (pg 130). Grade D, Level 3 A Although ? umazenil may be effective to reverse coma from suspected drug poisoning in patients presenting to the emergency department, its routine use

2020 Ministry of Health, Singapore

130. Extended Stay Centers: Patient characteristics and appropriate procedures

, or complete heart block) POSSUM for Operative Morbidity and Mortality Risk estimate for general surgery patients based on history, findings, and intraoperative events Age Cardiac conditions Respiratory conditions Systolic blood pressure Heart rate Glasgow coma scale Hemoglobin White blood cell count Predicted morbidity Predicted mortality 15 ¦ Ambulatory Surgery Centers with Extended Stay Centers: Appropriate Procedures and Patient Characteristics Approved 5/16/2019 Risk Calculator Intended Use Inputs (...) freestanding ambulatory surgical centers. Journal of American College of Surgeons, 206(2), 301- 305. doi: 10.1016/j.jamcollsurg.2007.07.042 Parcells, B. W., Giacobbe, D., Macknet, D., Smith, A., Schottenfeld, M., Harwood, D. A., & Kayiaros, S. (2016). Total joint arthroplasty in a stand-alone ambulatory surgical center: short-term outcomes. Orthopedics, 39(4), 223-228. doi: 10.3928/01477447-20160419-06 Parikh R, Pollock D, Sharma J, Edwards J. Is there room for prevention? Examining the effect

2019 Oregon Health Evidence Review Commission

131. Can S100B Serum Biomarker Testing Reduce Head Computed Tomography Scanning in Children With Mild Traumatic Brain Injury? Full Text available with Trip Pro

follow-up. Authors did not indicate how they defined intracranial lesions on head CT. Studies were excluded for the following reasons: adult patients, non-English language, Glasgow Coma Scale (GCS) score of less than or equal to 12, insufficient data for analysis, literature reviews, and magnetic resonance imaging as the reference standard. Data Extraction and Synthesis Two authors independently screened studies for inclusion, assessed quality, and extracted data. Discrepancies were resolved (...) specificity implies that the test must be thoughtfully integrated into a traumatic brain injury clinical algorithm. The secondary analysis suggests that S100B results are also influenced by age, sampling time, and reference range. This review has several limitations. Despite the premise of using this assay in conjunction with a clinical algorithm such as PECARN, only 1 of the 8 studies actually examined the PECARN decision rule in association with S100B measurement. Further prospective study

2019 Annals of Emergency Medicine Systematic Review Snapshots

132. Treatment of Patients with Schizophrenia

substance use, a psychiatric treatment history, an assessment of physical health, an assessment of psychosocial and cultural factors, a mental status examination including cognitive assessment, and an assessment of risk of suicide and aggressive behaviors, as outlined in APA's Practice Guidelines for the Psychiatric Evaluation of Adults (3rd edition). 2. APA recommends (1C) that the initial psychiatric evaluation of a patient with a possible psychotic disorder include a quantitative measure to identify (...) examination including cognitive assessment, and an assessment of risk of suicide and aggressive behaviors, as outlined in APA's Practice Guidelines for the Psychiatric Evaluation of Adults (3rd edition). Implementation The importance of the psychiatric evaluation cannot be underestimated because it serves as the initial basis for a therapeutic relationship with the patient and provides information that is crucial to differential diagnosis, shared decision-making about treatment, and educating patients

2020 American Psychiatric Association

133. Guidelines for Perioperative Care in Cardiac Surgery Enhanced Recovery After Surgery Society Recommendations

. Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev . 2016;3:CD005563. Young J, Murthy L, Westby M, Akunne A, O’Mahony R; Guideline Development Group. Diagnosis, prevention, and management of delirium: summary of NICE guidance. BMJ . 2010;341:c3704. doi: Page VJ, Ely EW, Gates S, et al. Effect of intravenous haloperidol on the duration of delirium and coma in critically ill patients (Hope-ICU): a randomised, double-blind, placebo-controlled trial. Lancet Respir (...) in adult cardiac surgery. Innovations (Phila) . 2012;7(5):354-358. Sirch J, Ledwon M, Püski T, Boyle EM, Pfeiffer S, Fischlein T. Active clearance of chest drainage catheters reduces retained blood. J Thorac Cardiovasc Surg . 2016;151(3):832-838.e2. doi: St-Onge S, Ben Ali W, Bouhout I, et al. Examining the impact of active clearance of chest drainage catheters on postoperative atrial fibrillation. J Thorac Cardiovasc Surg . 2017;154(2):501-508. doi: Gercekoglu H, Aydin NB, Dagdeviren B, et al. Effect

2020 ERAS Society

134. Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients

in multiple clinical settings (pre-hospital, emergency department, ICU and operating room), and clinicians have seen improvement in pupil diameter, physical examination, or ICP meas- urements in response to this intervention. In addition, the harm associated with hyperventilation is generally related to the risk for cerebral ischemia with prolonged vasoconstriction. Given the potential life-threatening nature of elevated ICP, lack of apparent associated harm, and possible short-term benefit with transient (...) coma score; GOS: Glasgow out- come scale; GOSE: Glasgow outcome scale extended; HE: Hepatic encepha- lopathy; HES: Hydroxyethyl starch; HTS: Hypertonic sodium solution (usually referring to sodium chloride 3%, 7.5%, or 23.4%, but also inclusive of solutions ranging from 1.5 to 23.5% and various other sodium salts including lactate and bicarbonate); ICH: Intracerebral hemorrhage; ICP: Intracranial pressure; mRS: Modified Rankin scale; NaCl: Sodium chloride; NIHSS: National Institutes of Health

2020 Neurocritical Care Society

135. The Prevention, Assessment and Management of in-Hospital Newborn Falls and Drops

is trained and competent, complete neurological examination with modified paediatric Glasgow Coma Scale (Appendix -2) can be used for assessment and further management plan. Otherwise the following table can be used to guide immediate action plan (Table 2). ? If baby is in a setting with no paediatric support and needs ongoing assessment, the baby will need transfer to the nearest paediatric unit. ? Management of all babies following a fall and management should be discussed with the consultant after (...) . There should be a standardised debriefing tool to support staff in the event of a fall or drop. The Prevention, Assessment and Management of in-Hospital Newborn Falls and Drops A BAPM Framework for Practice 11 ©BAPM2020 Assessment and Management 15-35 This guidance aims to support units in assessing and managing babies safely following an in- hospital fall or drop specifically in relation to potential head injury. 1. Care pathway - Immediate action Physical examination and ongoing assessment of a child

2020 British Association of Perinatal Medicine

136. Occupational liver diseases

and pathology reports of VCM-exposed workers and patients with VCM-related liver angiosarcoma. Thesestudiesdidnotobserveevidence ofcirrho- sis, only periportal ?brosis. 16–19 In another example, despite prior experimental data associ- ating shift work with non-alcoholic fatty liver disease (NAFLD), 20,21 a cross-sectional study based on multiple cycles of the National Health and Nutrition Examination Survey (NHANES) cohort found no evidence of an association when comparing 1,019 shift-workers with 8,159 (...) was environ- mental though and not occupational. In conclusion, whilst high VCM exposure has a clear causative association with angiosar- coma of the liver, its link with HCC is not as well- established. 15 Following the control of occupational exposure to VCM in the mid-1970s, few additional cases of VCM- related angiosarcoma of the liver are anticipated in the future. By inference, this applies to other liver cancers too. Recommendation Surveillance with ultrasound for development of emer- gent liver

2019 European Association for the Study of the Liver

137. Appropriate Imaging for Common Situations in Primary and Emergency Care

specialist locally or through the RACE Line. Recommendation: Imaging is not recommended for uncomplicated headache unless red flags are present. Consider imaging in the following “red flag” situations: 2 sudden onset of severe headache (thunderclap) recurrent headache with unexplained focal neurological signs (reference: TOP Alberta) new onset in the setting of HIV or cancer abnormal neurological exam suspected intracranial infection new onset or worsening seizure new headache age>50 headache causing (...) awakening from sleep papilledema focal neurological deficit worsening headache frequency or severity in a patient with previous headache history or recent head trauma acute head trauma if indicated by CT head clinical decision rule Think twice before requesting head CT for: migraine syncope temporal arteritis multiple sclerosis sinusitis chronic post-concussion syndrome with normal neurological exam Key messages for counselling patients if imaging is not indicated: Most headaches are benign and self

2019 Clinical Practice Guidelines and Protocols in British Columbia

138. Triage of Scarce Critical Care Resources in COVID-19: An Implementation Guide for Regional Allocation: An Expert Panel Report of the Task Force for Mass Critical Care and the American College of Chest Physicians

, with greater variability and less accuracy at lower scores than at higher scores, and is not immediately applicable to all disease states: a patient with sepsis may have a SOFA score of 4 and a low mortality risk, for example, whereas a patient with an intracranial hemorrhage and a Glasgow Coma Scale score of 3 could share this SOFA score of 4 but have a very high risk of death. Potentially subjective elements, such as the dose of vasopressor administered or the assessment of Glasgow Coma Scale during (...) actions in the HCMC Crisis Care Annex which should be referred to for further details. Triage team documents decision-making in affected patient charts according to incident-specific template. Decision communicated to patient’s Attending MD and Inpatient Supervisor. Attending MD may make clinical appeal within 15 minutes if new clinical information suggest improvement (Triage Team – Reevaluates in light of new information and communications decision) IC directs Clinical Care Committee (CCC) to examine

2020 American College of Chest Physicians

139. Nuchal Translucency Evaluation at 11 to 14 Weeks Gestational Age

. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level (RRL) indication has been included for each imaging examination. The RRLs are based on effective dose, which is a radiation dose quantity that is used to estimate population total radiation risk associated with an imaging procedure. Patients in the pediatric age group are at inherently higher risk from exposure, because of both organ sensitivity and longer life expectancy (...) (relevant to the long latency that appears to accompany radiation exposure). For these reasons, the RRL dose estimate ranges for pediatric examinations are lower as compared with those specified for adults (see Table below). Additional information regarding radiation dose assessment for imaging examinations can be found in the ACR Appropriateness Criteria ® Radiation Dose Assessment Introduction document [76]. ACR Appropriateness Criteria ® 10 Nuchal Translucency Evaluation Relative Radiation Level

2020 American College of Radiology

140. Seizures-Child

trauma as indicated by Glasgow coma scores of 13-15. In this study, although CT results were negative in 53% of patients, 7% of patients had lesions that required surgical intervention. MRI is generally less appropriate in the acute trauma setting, depending on the overall clinical status of the child. However, it can be useful in detecting intracranial blood as well as post-traumatic gliosis. An important subgroup to consider for CT evaluation is the patient younger than age 2 presenting (...) ), are considerably higher than those from imaging of patients with generalized seizures whose neurologic examination is normal [20,21]. In a study by Jan et al [22], neuroimaging was positive in more than 50% of patients whose seizures had focal features. MRI was considerably more sensitive than CT. Young et al [23] noted a 50% positivity rate for CT when neurologic findings were focal. Ibrahim et al [24] found seizures to be the presenting symptom in 12% of 81 consecutive children with primary brain tumors

2020 American College of Radiology

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