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Tachypnoea in a well baby: What to do next
In an excellent leading article Ian Balfour Lyn and Michael Rigby outline the management of the ‘well’ term infant who presents with tachypnoea, ie not acutely unwell. There are many useful points made including the fact that the normal respiratory rate has a wide normal range (figure two in the paper), decreases during infancy, is higher when the infant is awake and higher during fever. There are a series of useful headers—what is tachypnoea, is the baby tachypnoeic, is the baby unwell, is the examination normal, immediate and further investigations and less common diagnoses. There is an excellent algorithm (figure one in the paper). Red flag symptoms include—persistent cough, apnoeic episodes, noisy breathing, poor feeding, vomiting, choking when drinking. Red flag signs include respiratory distress, cyanosis, cardiac murmur, abnormal femoral pulses, hepatomegaly, hypotonia. The most important initial investigations are to measure the oxygen saturation – should be 97–98% and a chest X-ray. If the saturation is low then a hyperoxia test should be considered. Potential causes of tachypnoea when the diagnosis is not immediately obvious are discussed in detail. See page 722.
Defining normal heart rate
The …
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