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REFERRAL RECOMMENDATIONS PAEDIATRIC SURGERY

By Steven Wallace,2014-06-26 21:15
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REFERRAL RECOMMENDATIONS PAEDIATRIC SURGERY ...

REFREC022

    Diagnosis / Symptomatology Evaluation Management Options Referral Guidelines Problems include:

     These general symptoms may include 1. Where there is concern Specific treatments depend on the any and/or all of the general or specific regarding diagnosis, ? Airways disease specific problems identified, as noted problems noted. A thorough history investigation and/or treatment. ? Extra thoracic / neurological below. and physical examination is required to 2. Persistent problem, not conditions

    determine the specific diagnosis. controlled by current therapy. ? Infection 3. Please state if patient initiated ? Miscellaneous (See below) referral. ? Neoplasia 4. Please indicate perceived ? Parenchymal Category as per prioritisation ? Pleural disease criteria. ? Vascular If Category 1, referral to be made by

    telephone, Email or fax.

Last updated February 2006 Page 1 of 12

    REFREC022

    Diagnosis / Symptomatology Evaluation Management Options Referral Guidelines

    Airways Disease

     ? Should be considered in anyone ? Maintenance treatment: postural 1. Bronchiectasis All patients with suspected with chronic or recurrent purulent drainage/sputum clearing

    Bronchiectasis should be referred to sputum. Quantitate phlegm techniques are the cornerstone of

    respiratory physician for baseline production when well and when ill long term management (to be

    assessment. If severe : refer for referred to physiotherapist for ? Past history of severe respiratory

    admissions. education but not before CT scan). infection usually in childhood eg.

     Whooping cough. ? Long term antibiotics should be

    discussed with Respiratory ? Assess for asthma

    Physician. ? Spirometry with reversibility

    ? Fluvax and Pneumovax. ? Chest X-ray

    ? Treatment of non-infective airways ? HRCT Lungs, but not during an

    disease i.e. co-existing COPD and exacerbation

    asthma should be considered. See ? FBC, ESR below. ? Immunoglobulins plus IgG ? Management of acute infective subfractions exacerbations eg. Acute bronchitis, ? Sputum culture when patient pneumonia otherwise well and with ? Management in the community: exacerbations antibiotics preferably post sputum ? Assess for sinus disease culture/sensitivity. See Australian ? Assess for cor pulmonale Antibiotic Guidelines.

    ? Manage co-existent acute / chronic

    sinusitis.

    Severe: For Admission: Category 1 (Note: National Asthma Campaign 2. Asthma literature and Thoracic Society of ? High flow oxygen, IV/oral steroids, ? Acute moderate asthma not Australia & New Zealand guidelines) nebulised beta agonists. Transfer responding to GP management.

     to ED by ambulance. ? Acute severe asthma (via ? Breathlessness, tightness, ? Consider Adrenaline 200 ambulance) eg coexistent

    wheezing and cough. micrograms SC (=2ml 1:10,000 or pneumothorax or pneumonia, ? Recognition of severity 0.2ml 1:1,000) silent chest, cardiovascular

    compromise, altered ? Spirometry

    consciousness, relative ? Peak Expiratory Flow recording

    bradycardia or decreasing rate and ? Oxygen saturation Last updated February 2006 Page 2 of 12 depth of breathing.

    ? Asthma with intercurrent disease

    eg. Pneumonia.