Added qi asthma final from external feedback Mar 17th.drawio
This commit is contained in:
Daniel Onyejesi
parent
d4761b61b7
commit
62a8eaed35
1 changed files with 117 additions and 0 deletions
117
qi asthma final from external feedback Mar 17th.drawio
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117
qi asthma final from external feedback Mar 17th.drawio
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<mxfile host="app.diagrams.net" agent="Mozilla/5.0 (X11; Linux x86_64; rv:147.0) Gecko/20100101 Firefox/147.0" version="29.6.1">
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<diagram name="CXR Guideline" id="ukCZ23so56w79gaJ0hgR">
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<mxGraphModel dx="1371" dy="765" grid="1" gridSize="10" guides="1" tooltips="1" connect="1" arrows="1" fold="1" page="1" pageScale="1" pageWidth="850" pageHeight="1100" math="0" shadow="0">
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<root>
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<mxCell id="0" />
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<mxCell id="1" parent="0" />
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<mxCell id="HgR85e6-FbMYOLLO1WxG-1" parent="1" style="text;html=1;align=center;verticalAlign=middle;resizable=0;points=[];autosize=1;strokeColor=none;fillColor=none;fontFamily=Arial;" value="<font style="font-size:20px;"><b>GUIDELINE FOR OBTAINING CHEST X-RAY (CXR)</b></font><br><font style="font-size:20px;"><b>IN ACUTE ASTHMA EXACERBATION (AAE)</b></font><br><font style="font-size:20px;"><b>IN CHILDREN AGED 6–18 YEARS</b></font>" vertex="1">
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<mxGeometry height="90" width="900" x="410" y="120" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-2" parent="1" style="rounded=1;whiteSpace=wrap;html=1;fillColor=#dae8fc;strokeColor=#6c8ebf;arcSize=15;fontFamily=Arial;align=center;verticalAlign=middle;" value="<font style="font-size:16px;"><b>Patient Presenting with<br>Acute Asthma Exacerbation (AAE)</b><br><br><br></font>" vertex="1">
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<mxGeometry height="90" width="600" x="560" y="230" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-3" edge="1" parent="1" source="HgR85e6-FbMYOLLO1WxG-2" style="edgeStyle=orthogonalEdgeStyle;rounded=0;orthogonalLoop=1;jettySize=auto;exitX=0.5;exitY=1;exitDx=0;exitDy=0;entryX=0.5;entryY=0;entryDx=0;entryDy=0;strokeWidth=3;fontFamily=Arial;" target="HgR85e6-FbMYOLLO1WxG-4" value="">
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<mxGeometry relative="1" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-4" parent="1" style="rhombus;whiteSpace=wrap;html=1;fillColor=#fff2cc;strokeColor=#d6b656;fontFamily=Arial;align=center;verticalAlign=middle;" value="<font style="font-size:16px;"><b>Assess<br>Respiratory Score<br>(RS)</b></font>" vertex="1">
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<mxGeometry height="180" width="260" x="730" y="440" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-5" edge="1" parent="1" source="HgR85e6-FbMYOLLO1WxG-4" style="edgeStyle=orthogonalEdgeStyle;rounded=0;orthogonalLoop=1;jettySize=auto;exitX=0;exitY=0.5;exitDx=0;exitDy=0;entryX=0.5;entryY=0;entryDx=0;entryDy=0;strokeWidth=3;fontFamily=Arial;labelBackgroundColor=#FFFFFF;fontStyle=1;fontSize=17;" target="HgR85e6-FbMYOLLO1WxG-7" value="">
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<mxGeometry relative="1" x="-0.0213" as="geometry">
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<mxPoint as="offset" />
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</mxGeometry>
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-6" edge="1" parent="1" source="HgR85e6-FbMYOLLO1WxG-4" style="edgeStyle=orthogonalEdgeStyle;rounded=0;orthogonalLoop=1;jettySize=auto;exitX=1;exitY=0.5;exitDx=0;exitDy=0;entryX=0.5;entryY=0;entryDx=0;entryDy=0;strokeWidth=3;fontFamily=Arial;labelBackgroundColor=#FFFFFF;" target="HgR85e6-FbMYOLLO1WxG-8" value="">
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<mxGeometry relative="1" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-7" parent="1" style="rounded=1;whiteSpace=wrap;html=1;fillColor=#d5e8d4;strokeColor=#82b366;arcSize=15;fontFamily=Arial;align=center;verticalAlign=middle;" value="<font style="font-size:16px;"><b>Respiratory Score 1–7</b><br><br>Do NOT routinely obtain<br>Chest X-Ray in typical /<br>uncomplicated asthma<br>exacerbation</font>" vertex="1">
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<mxGeometry height="180" width="340" x="220" y="660" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-8" parent="1" style="rounded=1;whiteSpace=wrap;html=1;fillColor=#f8cecc;strokeColor=#b85450;arcSize=15;fontFamily=Arial;align=center;verticalAlign=middle;" value="<font style="font-size:16px;"><b>Respiratory Score 8–12</b><br><br>Severe Respiratory Distress</font>" vertex="1">
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<mxGeometry height="140" width="340" x="1140" y="660" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-9" edge="1" parent="1" source="HgR85e6-FbMYOLLO1WxG-8" style="edgeStyle=orthogonalEdgeStyle;rounded=0;orthogonalLoop=1;jettySize=auto;exitX=0.5;exitY=1;exitDx=0;exitDy=0;entryX=0.5;entryY=0;entryDx=0;entryDy=0;strokeWidth=3;strokeColor=#b85450;fontFamily=Arial;" target="HgR85e6-FbMYOLLO1WxG-10" value="">
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<mxGeometry relative="1" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-10" parent="1" style="rounded=1;whiteSpace=wrap;html=1;fillColor=#f8cecc;strokeColor=#b85450;arcSize=15;fontFamily=Arial;align=center;verticalAlign=middle;strokeWidth=3;" value="<font style="font-size:18px;" color="#b85450"><b>→ OBTAIN CHEST X-RAY</b></font>" vertex="1">
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<mxGeometry height="80" width="360" x="1130" y="860" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-11" edge="1" parent="1" source="HgR85e6-FbMYOLLO1WxG-7" style="edgeStyle=orthogonalEdgeStyle;rounded=0;orthogonalLoop=1;jettySize=auto;exitX=0.5;exitY=1;exitDx=0;exitDy=0;entryX=0.5;entryY=0;entryDx=0;entryDy=0;strokeWidth=3;fontFamily=Arial;" target="HgR85e6-FbMYOLLO1WxG-12" value="">
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<mxGeometry relative="1" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-12" parent="1" style="rounded=1;whiteSpace=wrap;html=1;fillColor=#fff2cc;strokeColor=#d6b656;arcSize=12;fontFamily=Arial;align=center;verticalAlign=middle;" value="<font style="font-size:16px;"><b>CONSIDER OBTAINING CXR IF:</b><br><br>Inadequate Response After ≥ 2 Hours<br>of Routine Asthma Exacerbation Management<br><i>WITH any of the following:</i></font>" vertex="1">
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<mxGeometry height="160" width="400" x="190" y="900" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-13" edge="1" parent="1" source="HgR85e6-FbMYOLLO1WxG-12" style="edgeStyle=orthogonalEdgeStyle;rounded=0;orthogonalLoop=1;jettySize=auto;exitX=0.5;exitY=1;exitDx=0;exitDy=0;entryX=0.5;entryY=0;entryDx=0;entryDy=0;strokeWidth=3;fontFamily=Arial;" target="HgR85e6-FbMYOLLO1WxG-14" value="">
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<mxGeometry relative="1" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-14" parent="1" style="rounded=1;whiteSpace=wrap;html=1;fillColor=#f5f5f5;strokeColor=#666666;arcSize=5;fontFamily=Arial;fontColor=#333333;" value="" vertex="1">
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<mxGeometry height="520" width="620" x="180" y="1110" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-15" parent="1" style="rounded=0;whiteSpace=wrap;html=1;fillColor=#dae8fc;strokeColor=#6c8ebf;fontFamily=Arial;align=center;verticalAlign=middle;" value="<font style="font-size:14px;"><b>Past Medical<br>History</b></font>" vertex="1">
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<mxGeometry height="70" width="170" x="200" y="1125" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-16" parent="1" style="rounded=0;whiteSpace=wrap;html=1;fillColor=#FFFFFF;strokeColor=#6c8ebf;fontFamily=Arial;align=left;verticalAlign=middle;spacingLeft=10;" value="<font style="font-size:14px;">1. History of recurrent pneumonia<br>2. History of pneumothorax</font>" vertex="1">
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<mxGeometry height="70" width="410" x="370" y="1125" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-17" parent="1" style="rounded=0;whiteSpace=wrap;html=1;fillColor=#dae8fc;strokeColor=#6c8ebf;fontFamily=Arial;align=center;verticalAlign=middle;" value="<font style="font-size:14px;"><b>RR &gt; 40*</b></font>" vertex="1">
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<mxGeometry height="55" width="170" x="200" y="1195" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-18" parent="1" style="rounded=0;whiteSpace=wrap;html=1;fillColor=#FFFFFF;strokeColor=#6c8ebf;fontFamily=Arial;align=center;verticalAlign=middle;" value="<font style="font-size:14px;">2–5 years of age</font>" vertex="1">
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<mxGeometry height="55" width="410" x="370" y="1195" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-19" parent="1" style="rounded=0;whiteSpace=wrap;html=1;fillColor=#dae8fc;strokeColor=#6c8ebf;fontFamily=Arial;align=center;verticalAlign=middle;" value="<font style="font-size:14px;"><b>RR &gt; 30*</b></font>" vertex="1">
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<mxGeometry height="55" width="170" x="200" y="1250" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-20" parent="1" style="rounded=0;whiteSpace=wrap;html=1;fillColor=#FFFFFF;strokeColor=#6c8ebf;fontFamily=Arial;align=center;verticalAlign=middle;" value="<font style="font-size:14px;">6–8 years of age</font>" vertex="1">
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<mxGeometry height="55" width="410" x="370" y="1250" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-21" parent="1" style="rounded=0;whiteSpace=wrap;html=1;fillColor=#dae8fc;strokeColor=#6c8ebf;fontFamily=Arial;align=center;verticalAlign=middle;" value="<font style="font-size:14px;"><b>RR &gt; 20*</b></font>" vertex="1">
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<mxGeometry height="55" width="170" x="200" y="1305" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-22" parent="1" style="rounded=0;whiteSpace=wrap;html=1;fillColor=#FFFFFF;strokeColor=#6c8ebf;fontFamily=Arial;align=center;verticalAlign=middle;" value="<font style="font-size:14px;">9–18 years of age</font>" vertex="1">
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<mxGeometry height="55" width="410" x="370" y="1305" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-23" parent="1" style="rounded=0;whiteSpace=wrap;html=1;fillColor=#dae8fc;strokeColor=#6c8ebf;fontFamily=Arial;align=center;verticalAlign=middle;" value="<font style="font-size:14px;"><b>Pulse<br>Oximetry</b></font>" vertex="1">
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<mxGeometry height="110" width="170" x="200" y="1360" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-24" parent="1" style="rounded=0;whiteSpace=wrap;html=1;fillColor=#FFFFFF;strokeColor=#6c8ebf;fontFamily=Arial;align=center;verticalAlign=middle;" value="<font style="font-size:14px;">Lowest SpO₂ &lt;91% on room air*<br><b>OR</b> required inhaled FiO₂ &gt;50%<br>to keep saturations &gt;90%<br><i><font color="#999999">* after 2 hours of routine management</font></i></font>" vertex="1">
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<mxGeometry height="110" width="410" x="370" y="1360" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-25" parent="1" style="rounded=0;whiteSpace=wrap;html=1;fillColor=#dae8fc;strokeColor=#6c8ebf;fontFamily=Arial;align=center;verticalAlign=middle;" value="<font style="font-size:14px;"><b>Lung Exam</b></font>" vertex="1">
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<mxGeometry height="70" width="170" x="200" y="1470" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-26" parent="1" style="rounded=0;whiteSpace=wrap;html=1;fillColor=#FFFFFF;strokeColor=#6c8ebf;fontFamily=Arial;align=center;verticalAlign=middle;" value="<font style="font-size:14px;">Localizing findings or asymmetry<br>on lung examination</font>" vertex="1">
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<mxGeometry height="70" width="410" x="370" y="1470" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-27" edge="1" parent="1" source="HgR85e6-FbMYOLLO1WxG-14" style="edgeStyle=orthogonalEdgeStyle;rounded=0;orthogonalLoop=1;jettySize=auto;exitX=0.5;exitY=1;exitDx=0;exitDy=0;entryX=0.5;entryY=0;entryDx=0;entryDy=0;strokeWidth=3;fontFamily=Arial;" target="HgR85e6-FbMYOLLO1WxG-28" value="">
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<mxGeometry relative="1" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-28" parent="1" style="rounded=1;whiteSpace=wrap;html=1;fillColor=#f8cecc;strokeColor=#b85450;arcSize=15;fontFamily=Arial;align=center;verticalAlign=middle;strokeWidth=3;" value="<font style="font-size:18px;" color="#b85450"><b>→ OBTAIN CHEST X-RAY</b></font>" vertex="1">
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<mxGeometry height="80" width="400" x="290" y="1680" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-29" parent="1" style="rounded=1;whiteSpace=wrap;html=1;fillColor=#f8cecc;strokeColor=#b85450;arcSize=8;fontFamily=Arial;opacity=40;" value="" vertex="1">
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<mxGeometry height="460" width="620" x="860" y="1020" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-30" parent="1" style="text;html=1;align=center;verticalAlign=middle;resizable=0;points=[];autosize=1;strokeColor=none;fillColor=none;fontFamily=Arial;fontColor=#b85450;" value="<font style="font-size:18px;"><b>EXCLUSION CRITERIA</b></font>" vertex="1">
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<mxGeometry height="40" width="220" x="1040" y="1030" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-31" parent="1" style="text;html=1;align=left;verticalAlign=top;resizable=0;points=[];autosize=1;strokeColor=none;fillColor=none;fontFamily=Arial;spacingLeft=10;" value="<font style="font-size:14px;"><b>Comorbidities:</b> sickle cell disease, congenital heart disease,<br>immunodeficiency, BPD, severe malnutrition<br><br><b>• First-time wheezing</b> unrelated to prior asthma diagnosis</font>" vertex="1">
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<mxGeometry height="100" width="580" x="880" y="1075" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-32" parent="1" style="rounded=1;whiteSpace=wrap;html=1;fillColor=#FFFFFF;strokeColor=#b85450;arcSize=8;fontFamily=Arial;dashed=1;dashPattern=5 5;opacity=80;" value="" vertex="1">
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<mxGeometry height="270" width="580" x="880" y="1190" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-33" parent="1" style="text;html=1;align=left;verticalAlign=middle;resizable=0;points=[];autosize=1;strokeColor=none;fillColor=none;fontFamily=Arial;" value="<font style="font-size: 15px;" color="#b85450">&nbsp;<b>Other conditions where CXR is required:</b></font>" vertex="1">
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<mxGeometry height="30" width="320" x="900" y="1203" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-34" parent="1" style="text;html=1;align=left;verticalAlign=top;resizable=0;points=[];autosize=1;strokeColor=none;fillColor=none;fontFamily=Arial;spacingLeft=10;" value="<font style="font-size:14px;">• Physical findings suggestive of <b>pneumonia or<br> parenchymal disease</b><br> <font color="#888888">(focal crackles, dullness, fever)</font><br><br>• Suspicion of <b>inhaled foreign body</b><br> <font color="#888888">(sudden onset, unilateral decreased breath sounds)</font><br><br>• Suspicion of <b>structural complications</b><br> <font color="#888888">(pneumothorax, pneumomediastinum)</font><br><br>• <b>Trauma, post-op</b></font>" vertex="1">
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<mxGeometry height="210" width="380" x="900" y="1240" as="geometry" />
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</mxCell>
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<mxCell id="HgR85e6-FbMYOLLO1WxG-35" parent="1" style="text;html=1;align=left;verticalAlign=middle;resizable=0;points=[];autosize=1;strokeColor=none;fillColor=none;fontFamily=Arial;fontColor=#666666;" value="<font style="font-size:13px;"><i>* Respiratory rate thresholds apply after ≥ 2 hours of routine asthma exacerbation management</i></font>" vertex="1">
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<mxGeometry height="35" width="650" x="180" y="1800" as="geometry" />
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</mxCell>
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</root>
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</mxGraphModel>
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</diagram>
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</mxfile>
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