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Microsoft word - bhrut primary care tool child over 2 with asthma.doc

Out of Hospital Clinical Assessment Tool for Children
Aged Over 2 years with Acute Asthma and Wheeze

Child presenting with cough, wheeze and difficulty breathing:
Any of the following may indicate diagnoses other
These children are at increased risk of
than asthma or viral induced wheeze:
deterioration in acute asthma and wheeze:
• Attack in late afternoon, at night or early morning • Recent admission or previous severe attack • Social needs that make care at home difficult Consider referral to the appropriate specialty Children with all of the following can
Children with any of the following signs or symptoms need further
be managed safely at home:
assessment:
Unable to rouse
Cyanosed
Poor respiratory effort
Exhaustion
Agitation or confusion
Silent chest on auscultation
Mild to moderate exacerbation
Moderate to severe exacerbation
Life threatening exacerbation
• Give 2-10 puffs of inhaled salbutamol spacer device OR nebulised
Safe to be managed at home
• Stay with the child until LAS arrive Contact numbers:
Date: October 2012 Review date: October 2014 Authors: Dr S Wong, Dr L Etheridge and Dr Z Rooney, department of paediatrics, BHRUT This guideline has been written based on the BTS and SIGN guideline for the management of asthma Out of Hospital Clinical Assessment Tool for Children
Aged Over 2 years with Acute Asthma and Wheeze
Box 1: Normal Paediatric Values:

Resp Rate
Heart Rate
Box 2: Guidelines for use of bronchodilators
Inhaled
β2 agonists are the first line treatment for acute asthma and wheeze, except in life threatening
Salbutamol: up to 10 puffs of a metered dose inhaler (MDI) via a spacer device can be safely
given, up to 4 hourly. MDIs should never be given directly into the mouth in children. Children under 3 years will need a face mask connected to the mouthpiece of the spacer. After each puff of the MDI allow the child to take 5 breaths and then repeat. Oxygen driven nebulised bronchodilators should be used in children with red features (life threatening cases), those who cannot tolerate a spacer device, or who are worsening despite inhaled treatment • Salbutamol: dose 2-5 years give 2.5mg, over 5 years give 5mg
Ipratropium: dose under 12 years give 250micrograms, 12-16 years give 500micrograms
Box 3: Guidelines for oral corticosteroids
• Give soluble prednisolone by mouth once daily for 3 days
• Dose is 20mg for children aged 2-5 years and 30-40mg for children aged 5-16 years • If the child has already been taking an oral corticosteroid for more than a few days then increase the dose to 2mg/kg (max 60mg) for the time needed to bring about recovery • Weaning is unnecessary unless the length of steroid treatment exceeds 14 days • Children can continue with their usual maintenance inhaled steroids while taking oral steroids • There is limited evidence for the benefit of steroids in pre-school children with simple viral induced wheeze and there are potential side effects
Box 4: Guidelines for using peak expiratory flow rate (PEF) in the assessment of acute asthma
Measurement of PEFR can help guide assessment of the severity of exacerbations in children over
the age of 5 years who are able to perform a PEFR. Take the best of 3 measurements.
• PEFR >50% predicted = green (mild to moderate)
• PEFR 33-5-% predicted = amber (moderate to severe)
• PEFR <33% predicted = red (life threatening)
Predicted peak flow (for use with EU/EN13826 scale PEFR meters only)
Height (m)

Height (ft)
Predicted EU
Height (m)
Height (ft)
Predicted EU
PEFR (L/min)
PEFR (L/min)
0.85 2’9” 87 1.3 4’3” 212 0.9 2’11” 0.95 3’1” 104 1.4 4’7” 254 1.0 3’3” 115 1.45 4’9” 276 1.05 3’5” 127 1.5 4’11” 299 1.1 3’7” 141 1.55 5’1” 323 1.15 3’9” 157 1.6 5’3” 346 1.2 3’11” Date: October 2012 Review date: October 2014 Authors: Dr S Wong, Dr L Etheridge and Dr Z Rooney, department of paediatrics, BHRUT This guideline has been written based on the BTS and SIGN guideline for the management of asthma

Source: http://www.supportyourhospital.org/Downloads/services/bhrut-primary-care-tool-child-with-asthma-1212.pdf

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Journal of Antimicrobial Chemotherapy (2006) 57, 142–145doi:10.1093/jac/dki389Advance Access publication 10 November 2005First outbreak of multidrug-resistant Klebsiella pneumoniae carryingblaVIM-1 and blaSHV-5 in a French university hospitalNajiby Kassis-Chikhani1,2, Dominique Decre´3*, Vale´rie Gautier3, Be´atrice Burghoffer3,Faouzi Saliba4, Daniele Mathieu1, Didier Samuel4, Denis Cas

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Generative Migration of Agents F.M.T. Brazier; B.J. Overeinder; M. van Steen; N.J.E. WijngaardsDepartment of Computer Science, Faculty of Sciences, Vrije Universiteit Amsterdam;de Boelelaan 1081a, 1081 HV Amsterdam, The Netherlands Abstract Agents, and in particular mobile agents, offer a means for application developers to build distributed applications. Incurrent agent systems, mobility

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