Ward Round Notes

AVPU Alert Verbal Pain Unconcious Glasgow coma score Eye 4 – spontaneous eye opening 3 – opens to verbal command 2 – opens to pain 1 – no eye opening Verbal 5 – obeys commands 4- confused speech 3 – inappropriate words 2 – Incomprehensible sounds 1 – no response Motor 6 – Obeys commands 5 – localizes to pain 4 – flexion or withdrawal to pain 3 – abnormal flexion 2 – extension 1 – no response

Ottawa rules are used to decide whether an injury needs an xray to rule out fractures or not.   Ankle rules: x rays are needed if: unable to weight bear after injury and at examination (take more than 4 steps) tenderness of the posterior surface of the distal 6cm of the posterior lateral or medial malleolus. Tenderness over base of 5th metatarsal bone tenderness of the navicular or calcaneum.  

1. subcostal recession 2. Intercostal recession 3. Sternal recession 4. use of accessory muscles 5. Tracheal tug 6. nasal flaring 7. head bobbing Other signs of respiratory effort: Stridor, grunting, Silent chest Tachypnoea Cyanosis Tripod Seesaw respiration

Some respiratory diseases seen in children (click to enlarge)