Approaches to a child with fast breathing

Approaches to a child with fast breathing APPROACH TO A CHILD WITH FAST BREATHING Fast breathing is the most common presentation in children visiting a hospital emergency. These children have the respiratory rate more than the normal upper limit for that age group; (see table 1), with or without increased work of breathing in the form of chest indrawing, nasal flaring and head nodding. It may also be associated with stridor or wheeze suggestive of upper and lower airway obstruction respectively. There is a need of urgent assessment of airway patency and breathing when a child with fast breathing is first evaluated. Stabilization of vital parameters may require intubation, oronasal suctioning, use of oxygen by hood/nasal prongs, intravenous fluid boluses, correction of hypoglycaemia, nebulization with bronchodilator, intercostal tube drainage, correction of hyperthermia/ hypothermia etc. Such initial treatment coupled with a thorough history, physical examination and relevant investigations, is followed by establishing a provisional diagnosis and instituting approp riate empirical treatment in the emergency ward itself. Table 1: The upper limits of respiratory rate defined by the WHO Etiology of fast breathing: Fast breathing may not always result from a lung disease. It may be physiological e.g., exercise induced, or pathological due to pulmonary or non-pulmonary causes (table 2) Table 2: Causes of fast breathing in children Clinical Features: A child with fast breathing be may have increased work of breathing (suggested by use of accessory muscles), cyanosis and lethargy or altered sensorium. Alteration in sensorium (in the form of irritability, agitation, lethargy or coma) indicates brain hypoxia and is one of the earliest indicators of impending respiratory failure. While fast breathing is commonly associated with respiratory diseases, it may also occur with fever, crying or metabolic acidosis. However, normal or decreased respiratory rate may be more ominous if it is associated with severe retractions (paradoxical breathing), cyanosis, grunting or altered sensorium. Central cyanosis is a late sign but may not be detected in presence of severe pallor (low Hb) and dark skin colour. Stridor is a harsh inspiratory sound that indicates upper airway obstruction. Grunt is a loud noise produced by a forceful expiration against a closed glottis. Grunt and wheeze (a musical sound) are suggestive of lower airway obstruction. A complete history should reveal the onset, duration, progression of dyspnea, the aggravating and relieving factors as well as the associated symptoms like fever, cough, sore throat, chest pain, choking episodes, accidental ingestion of poisons etc. (table 3) Table 3: Symptom based diagnostic clues Clinical pearls: Investigations: Laboratory investigations help to confirm the diagnosis but the immediate management of a patient should not be delayed pending the reports of the investigations. Use of non-invasive devices such as pulse oximeter and ET CO2 detector (fitted in the ventilator) lessen the need for repeated invasive tests for monitoring of the child. Table 4 shows the relevant investigations to ascertain the cause of respiratory distress in a child. Table 4: Laboratory investiagations Treatment: The management of a child with fast breathing includes supportive treatment in the form of stabilization of vital parameters i.e. temperature, airway, breathing and circulation followed by definitive treatment by instituting appropriate respiratory support, antibiotics, chest tube drainage, decongestive measures etc. Acute onset of fast breathing, esp following choking, and stridor indicate foreign body, and warrants prompt bronchoscopic search and removal of foreign body. Algorithmic approach to management of fast breathing: Conclusion: It is essential to promptly triage children with impending respiratory failure and quickly institute supportive management, simultaneously searching for the etiology and planning a definitive treatment. The above mentioned approach will improve the outcome of children, especially the under-five ones, in whom respiratory infections contribute to the highest number of mortalities. Suggested reading: Kilham H, Gillis J, Benjamin B. Severe upper airway obstruction. Pediatr Clin North Am 1987; 34: 1–14. Mathew JL, Singhi SC. Approach to a child with breathing difficulty. Indian J Pediatr 2011 Sep;78(9):1118-26. Fallot A. Respiratory distress. Pediatr Ann. 2005;34:885–91. Singh V, Tiwari S. Respiratory problems. In: Gupta P,editor. Textbook of Pediatrics, editition 1. India: CBS publishers;2013, pp 335-368.

Is Joko Widodo a Good Leader?

Joko Widodo or better known by his nickname Jokowi is a politician in Indonesia and the current Governor of Jakarta period 2012 until 2017. Jokowi graduated with an engineering degree from the Faculty of Forestry at Gadjah Mada University in 1985. He was as the Mayor of Sukarta on period 2005 until 2012, before him currently being a Governor of Jakata. He was nominated in the Indonesian Democratic Party-Struggle to run in the Governor election of Jakarta 2012 with his running mate Basuki Tjahaja Purnama. He was elected as Governor of Jakarta on 20 September 2012 after a second round of voting in which he defeated incumbent previous Governor of Jakarta Fauzi Bowo. While running for the office of mayor of Surakarta, many doubted the ability of a man who worked as a property and furniture businessman, but after a year in office, he successfully led many progressive breakthroughs which became widely praised nationally. He adopted the development framework of European cities (which he frequently traveled to as a businessman) into his own city of Surakarta. Bases on Wikipedia, Joko Widodo was chosen by the Tempo magazine as one of the ‘Top 10 Indonesian Mayors of 2008'. In 2011, he was awarded the Bintang Jasa Utama by the government. The next year, he received 3rd place of the 2012 World Mayor Prize for â€Å"Transforming a crime-ridden city into a regional center for art and culture and an attractive city to tourists†. Jokowi has vision and mission to lead Jakarta and solve all the problem that is not the simple problem, but very complicated and complex. Jakarta is a big city and also has a big population. Governor of Jakarta is just as a political leader, but also to mange this city. Jakarta has some problem such as traffic and also floods if there is heavy rain and still many problem that have to solve by a leader. Jokowi’s vision is to make new face Jakarta, neat modern city and also humane, with leadership and good government and also serve the residents. To realize that vision, he also make some mission, that are five and one of that is make Jakarta as a city that is free from chronic problems such as traffic jams, floods, slums, waste and others. And then some work plan of Jokowi to make green areas to decrease the floods and also the reservoir to relocate rainwater. And also he will increase the public transportation that environmentally friendly, to decrease private transport users and would switch to use public transport and then more efficient and safe. For the conclusion, I think he is a good leader for Jakarta even several problems in Jakarta still not solve yet by him, but he still try to solve. As we know, Jakarta is the capital of Indonesia, the problems is not only one but so many problems. He should manage Jakarta to be a neat modern city and also he visited flood victims when the big flood in Jakarta for several times. That is to show his responsibility as the Governor of Jakarta.

How to Choose Transfer Application Essay Samples to Ucla

How to Choose Transfer Application Essay Samples to Ucla Ok, I Think I Understand Transfer Application Essay Samples to Ucla, Now Tell Me About Transfer Application Essay Samples to Ucla! To be productive, you want to take into account several facets. Colleges are seeking a feeling of maturity and introspectionpinpoint the transformation and demonstrate your private growth. At exactly the same time, you're impress the college admissions folks greatly if it's possible to present your capacity to learn from your failures and mistakes. As a consequence, spending money to take care of your essays could possibly be challenging. In the majority of instances, the prompt is quite intricate and open to interpretation. One reason that the admissions office would like to figure out which of the applicants has been through something unlike the majority of other people is that they're hoping to raise the number of points of view in the student body. When you start to compose your college application essay, think about all the things which make you the person which you're. The way you start your application essay is important to how well it is going to be received. Generally speaking, the very first, setup, section of the essay ought to be shorter, as it is not going to be focused on what you were doing. For a beginning, the typical application essay topics need you to use language that's absolutely free from language flaws and grammatical mistakes. Get your creative juices flowing by brainstorming all the potential ideas you can imagine to handle your essay question. For instance, if your preferred topic is the discipline of literature, you could speak about your experiences with distinctive genres or with foreign writers. Concentrate on the message, and give it in an easy and straightforward language. Share an essay on any subject of your pick. Individual schools sometimes need supplemental essays. Colleges are more inclined to admit students who can articulate certain explanations for why the school is an excellent fit about them beyond its reputation or ranking on any list. Community is a rather important point to colleges. An admissions officer is significantly more likely to try to remember an applicant who has a rather specific essay written in a special and quirky way. Choose a law and explain why it's so important to you. If you would like to create a college essay which works, you will need to provide importance on the content you will supply the admissions officer of your intended university with. The essay for Florida state university isn't required, but it's highly encouraged. Key Pieces of Transfer Application Essay Samples to Ucla Tell us a topic which you have changed your head on in the last three decades. There isn't a prompt to direct you, and that means you must ask yourself the questions that will get at the center of the story you wish to tell. From time to time, the best method to learn and understand new information is via seeing and understanding work which is already completed. Last, the detail of real speech makes the scene pop. What to Expect From Transfer Application Es say Samples to Ucla? Really, the application essays are a lot closer to a brief story. Possessing good essay examples provides the reader an in-depth and on-the-court idea about what a well structured and coherent essay appears like. You'll observe a similar structure in a lot of the essays. An essay can be wholly heartfeltand terrible. Following your nomination, you're required to forward an essay. If you are in need of a well-crafted essay, then you can count on us to deliver. Our admission essay examples can prove that we're here in order to provide simply the ideal assistance to assure you which you submit an application essay that you could be confident in. The second portion of this essay would like you to examine the present instead. Stephen's essay is quite effective. When writing this essay, select a subject of interest. The very first portion of this essay is all about problem-solving. The Upside to Transfer Application Essay Samples to Ucla Make certain you give clear explanations of the things on your list too. The general format of your essay, for example, font size and margins, will solely are based on the instructions offered to you. Even more than knowing that you had the ability to correct the issue, colleges wish to observe how you approached the circumstance. Note you do not need to have solved the issue, and a few of the greatest essays will explore problems that have to be solved later on.

Unequal Opportunity For Women s Workplace - 1334 Words

Unequal Opportunity For Women in Workplace According to Merriam Dictionary Unequal means, giving more advantages, power etc to some people and less to other people for unfair reasons. (Unequal, 2015) According to Covert, Bryce (2013), nearly 30% of the women population are facing discrimination and have reported against it. This data came out via the help of new poll data from the Center for American Progress and Elle Magazine. No matter where the women is, what her position is, she is most likely to face discrimination. According to the poll 30% of the women reported their discrimination, but what about the rest 70% are they discrimination free or not is still unknown. Many women tend to resign or prefer not to talk with anyone regarding the discrimination in the workplace. Discriminating and harassing women is one of the crooked practice in the society, that is still alive till today. Even the most educated men do follow this practice and believe they need to be paid more, because they are men. People may feel that they are bridging the gender gap, but the truth is not yet there is still a very long way to go and it is still not sure whether the gap can be bridged or not. Most of the women have a feeling of not treated in a right way. Is this just their psychological feeling or they are really in trouble can be a very interesting topic for research and survey. When it comes to public policy such as equal pay, paid sick leave, Paid time off or Paid maternity leave thenShow MoreRelatedGender Inequalities Of Workforce And Gender Inequality1594 Words   |  7 Pagesevident that women face far more significant barriers in the workforce than men do. A clear representation of this barrier is established by the gender pay gap, which is the difference in monetary amount received between a woman s and a man s average weekly earnings. 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