5.1. SHORT-TERM CAUSELESS DETERIORATION

Related Names

Life-threatening condition.

Purpose of assistance

1. Recognition of signs and symptoms associated with short-term causeless deterioration (KBPS).
2. Rapid detection and intervention in patients requiring EMF.
3. Choosing a hospital for hospitalization.

Patient description

Inclusion criteria

Suspicion of KBPS: the condition of a child under the age of 1 year, which describes the observer as sudden, short-lived (less than 1 minute) and disappears completely on arrival of the EMF team and includes one or more signs:

a) absent, weak or irregular breathing;
b) skin discoloration (central cyanosis or pallor);
c) a clear change in muscle tone (hyper- or hypotension);
d) altered level of consciousness.

Exclusion criteria

1. Any sign from the above, which is available upon arrival of the brigade:

a) pathological (for a given age) vital signs (including fever);
b) vomiting;
c) signs of injury;
d) noisy breathing.

2. The root causes of the condition are expressed, among which:

a) gastro-esophagal reflux (regurgitation);
b) impaired ability to swallow;
c) nasal congestion;
d) intermittent breathing in newborns;
d) breath holding;
e) a change in tone associated with suffocation, quieting, crying, feeding;
f) seizures (ocular deviation, nystagmus, tonic-clonic activity).

3. Available evidence or suspicion of child neglect/abuse.

4. Skin discoloration that includes only redness (eg, face) or isolated perioral cyanosis or cyanosis of the extremities.

Patient Management

Condition assessment

1. History

a) history of circumstances and symptoms before, during and after the event, including duration, interventions performed, skin color, tone, breathing, feeding, position, location, activity, level of consciousness;
b) other simultaneous symptoms (fever, cough, rhinorrhea, vomiting, diarrhea, rash, heaviness of breathing, fussiness, reduced activity, poor sleep, impaired appetite);
c) history of CBPS;
d) history (premature birth, complications before and after childbirth, reflux, congenital heart disease, developmental lag, airway abnormality, respiratory problems, previous hospitalization, surgeries, injuries);
d) family history of sudden deaths without obvious causes or cardiac arrhythmias in other children or young adults;
e) social history (who lives at home, stress initiators, exposure to toxins/narcotic drugs, contacts with patients);
f) suspicion of possible negligent attitude (difference in testimony; the named mechanism of trauma is not true, especially does not correlate with the current state of development).

2. Examination:

a) the whole range of vital signs (according to the guideline “General Rules for Assistance” includes: temperature, pulse, ND, AT, saturation);
b) general overview:

• • • • signs of respiratory disorders (grunting, swelling of the wings of the nose, retraction);
      • skin color (pale, cyanotic, normal);
      • state of consciousness (conscious, flabby, drowsy, unconscious, irritable);

c) head-to-toe examinations, including:

• • • •  
      • physical examination for signs of injury or bullying;
      • pupil reaction.

Treatment and intervention

1. Monitoring:

a) a heart rate monitor;
b) constant pulse oximetry;
c) checking glucose level;
d) periodic inspection during transportation to detect changes in condition.

2. Respiratory tract:

a) perform oxygen therapy for signs of respiratory disorders or hypoxemia – start with the use of nasal cannulas and, if necessary, go to the oxygen mask and non-reversible mask (see. instruction “Respiratory tract control”);
b) sanitize the nasal and/or oral cavity (using an aspiration catheter) in the presence of excessive secretion.

3. Provide IV access and injection of fluids:

a) not all patients with CBPS require IV access;
b) IV access is required only for children with clinical suspicion of shock or if it is necessary to administer IV drugs.

Patient safety

1. Regardless of the appearance, all patients with a history of symptoms of CBPS should be taken to the admission department for further examination.

2. Selection of the admission department:

a) select an emergency department that can provide EMF to infants in critical condition even with the following high-risk criteria available

• • • • a child younger than 2 months;
      • the baby was born prematurely (up to 32 weeks gestation or gestational age less than or exactly 45 weeks);
      • the presence of more than one case of CBPS, now or in history;

b) all patients should be taken to departments that have a constant willingness to provide EMF to the child

Useful information for training

1. CBPS is a group of symptoms, not a disease.
2. Children with KBPS in an emergency may need emergency care or medical intervention in the EMF department.
3. All children need to be hospitalized in the emergency room.
4. Contact the medical supervisor in case the parent/guardian refuses to provide the child with assistance and/or transport him to the emergency room under the available high-risk criteria (see above).
5. Key elements of documentation

1. Key points of history:

1. Key points of history:

a) skin discoloration;
b) apnea;
c) change in muscle tone;
d) resuscitation attempts by the caregiver;
d) premature birth;
e) previous cases of KBPS;
f) history.

2. Key points regarding patient examination to assess changes after each manipulation:

a) the whole range of vital signs (temperature, pulse, ND, AT, saturation);
b) breathing;
c) state of consciousness;
d) skin color;
d) the presence of signs of injury or bullying.

Criteria for the effectiveness of care

1. Documentation of all vital signs.
2. Delivery to the correct reception office given the risks.