171 lines
17 KiB
Text
171 lines
17 KiB
Text
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<diagram name="CXR QI Flowchart" id="9AojJ5SYZ3YuZ7WpwGyt">
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<mxGraphModel dx="1426" 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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<mxCell id="pRgEexwxrKvvUqylI0am-1" parent="1" style="text;html=1;align=center;verticalAlign=middle;resizable=0;points=[];autosize=1;strokeColor=none;fillColor=none;" value="<b style="font-size:15px;letter-spacing:1px;">QI TO DECREASE UNNECESSARY CHEST X-RAY<br>IN ACUTE ASTHMA EXACERBATION IN CHILDREN 2–18 YEARS</b>" vertex="1">
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<mxCell id="pRgEexwxrKvvUqylI0am-4" parent="1" style="text;html=1;align=left;verticalAlign=top;resizable=0;points=[];autosize=0;strokeColor=none;fillColor=none;" value="<div style="text-align:left;padding:10px 10px 4px 10px;"><b style="font-size:12px;">EXCLUSION CRITERIA</b><br><br>• Comorbidities: sickle cell disease, congenital heart disease,<br> immunodeficiency, BPD, severe malnutrition<br>• First-time wheezing unrelated to prior asthma diagnosis</div>" vertex="1">
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<mxCell id="pRgEexwxrKvvUqylI0am-6" parent="1" style="rounded=1;whiteSpace=wrap;html=1;fillColor=#f5e6e6;strokeColor=#d4a0a0;strokeWidth=1;arcSize=10;verticalAlign=top;align=left;shadow=0;dashed=1;dashPattern=4 4;" value="<div style="text-align:left;padding:8px 10px;"><b style="font-size:11px;color:#b85450;">⚑ Other conditions where CXR is required:</b><br><br><table style="font-size:11px;border-collapse:collapse;width:100%;"><tr><td style="padding:3px 8px;vertical-align:top;">•</td><td style="padding:3px 0;">Physical findings suggestive of <b>pneumonia or parenchymal disease</b><br><span style="color:#666;">(focal crackles, dullness, fever)</span></td></tr><tr><td style="padding:3px 8px;vertical-align:top;">•</td><td style="padding:3px 0;">Suspicion of <b>inhaled foreign body</b><br><span style="color:#666;">(sudden onset, unilateral decreased breath sounds)</span></td></tr><tr><td style="padding:3px 8px;vertical-align:top;">•</td><td style="padding:3px 0;">Suspicion of <b>structural complications</b><br><span style="color:#666;">(pneumothorax, pneumomediastinum)</span></td></tr><tr><td style="padding:3px 8px;vertical-align:top;">•</td><td style="padding:3px 0;"><b>Trauma, post-op</b></td></tr></table></div>" vertex="1">
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<mxGeometry relative="1" as="geometry">
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<mxCell id="pRgEexwxrKvvUqylI0am-11" parent="1" style="rounded=1;whiteSpace=wrap;html=1;fillColor=#d5e8d4;strokeColor=#82b366;strokeWidth=2;arcSize=20;shadow=1;" value="<b style="font-size:13px;">DO NOT ROUTINELY OBTAIN CHEST X-RAY</b><br><i>in typical / uncomplicated asthma exacerbation</i>" vertex="1">
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<mxCell id="pRgEexwxrKvvUqylI0am-17" parent="1" style="rounded=1;whiteSpace=wrap;html=1;fillColor=#f8cecc;strokeColor=#b85450;strokeWidth=2;arcSize=15;shadow=1;" value="<b style="font-size:12px;">Severe Respiratory Distress<br>Respiratory Score 7–12</b>" vertex="1">
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</mxCell>
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<mxGeometry relative="1" as="geometry">
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<mxCell id="pRgEexwxrKvvUqylI0am-19" edge="1" parent="1" style="endArrow=classic;endSize=8;html=1;strokeWidth=2;strokeColor=#4472C4;" value="">
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<mxGeometry relative="1" as="geometry">
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<mxCell id="pRgEexwxrKvvUqylI0am-20" parent="1" style="rounded=1;whiteSpace=wrap;html=1;fillColor=#f8cecc;strokeColor=#b85450;strokeWidth=2;arcSize=15;shadow=1;" value="<b style="font-size:12px;">Inadequate Response After ≥ 2 Hours<br>of Routine Asthma Exacerbation Management</b><br><i>WITH any of the following:</i>" vertex="1">
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<mxCell id="pRgEexwxrKvvUqylI0am-21" edge="1" parent="1" source="pRgEexwxrKvvUqylI0am-20" style="endArrow=classic;endSize=8;html=1;strokeWidth=2;strokeColor=#4472C4;exitX=0.5;exitY=1;exitDx=0;exitDy=0;" value="">
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<mxCell id="pRgEexwxrKvvUqylI0am-22" parent="1" style="shape=partialRectangle;whiteSpace=wrap;html=1;fillColor=#dae8fc;strokeColor=#6c8ebf;strokeWidth=1.5;top=1;left=1;bottom=1;right=1;align=center;verticalAlign=middle;fontSize=11;" value="<b>Past Medical<br>History</b>" vertex="1">
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<mxCell id="pRgEexwxrKvvUqylI0am-23" parent="1" style="shape=partialRectangle;whiteSpace=wrap;html=1;fillColor=#FFFFFF;strokeColor=#6c8ebf;strokeWidth=1.5;top=1;left=0;bottom=1;right=1;align=left;verticalAlign=middle;fontSize=11;" value="<div style="padding-left:12px;">1. History of recurrent pneumonia<br>2. History of pneumothorax</div>" vertex="1">
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<mxCell id="pRgEexwxrKvvUqylI0am-24" parent="1" style="shape=partialRectangle;whiteSpace=wrap;html=1;fillColor=#dae8fc;strokeColor=#6c8ebf;strokeWidth=1.5;top=0;left=1;bottom=1;right=1;align=center;verticalAlign=middle;fontSize=11;" value="<b>RR &gt; 40*</b>" vertex="1">
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<mxGeometry height="40" width="160" x="550" y="925" as="geometry" />
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<mxCell id="pRgEexwxrKvvUqylI0am-25" parent="1" style="shape=partialRectangle;whiteSpace=wrap;html=1;fillColor=#FFFFFF;strokeColor=#6c8ebf;strokeWidth=1.5;top=0;left=0;bottom=1;right=1;align=center;verticalAlign=middle;fontSize=11;" value="2–5 years of age" vertex="1">
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<mxGeometry height="40" width="340" x="710" y="925" as="geometry" />
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<mxCell id="pRgEexwxrKvvUqylI0am-26" parent="1" style="shape=partialRectangle;whiteSpace=wrap;html=1;fillColor=#dae8fc;strokeColor=#6c8ebf;strokeWidth=1.5;top=0;left=1;bottom=1;right=1;align=center;verticalAlign=middle;fontSize=11;" value="<b>RR &gt; 30*</b>" vertex="1">
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<mxCell id="pRgEexwxrKvvUqylI0am-27" parent="1" style="shape=partialRectangle;whiteSpace=wrap;html=1;fillColor=#FFFFFF;strokeColor=#6c8ebf;strokeWidth=1.5;top=0;left=0;bottom=1;right=1;align=center;verticalAlign=middle;fontSize=11;" value="6–8 years of age" vertex="1">
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<mxCell id="pRgEexwxrKvvUqylI0am-28" parent="1" style="shape=partialRectangle;whiteSpace=wrap;html=1;fillColor=#dae8fc;strokeColor=#6c8ebf;strokeWidth=1.5;top=0;left=1;bottom=1;right=1;align=center;verticalAlign=middle;fontSize=11;" value="<b>RR &gt; 20*</b>" vertex="1">
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<mxGeometry height="40" width="160" x="550" y="1005" as="geometry" />
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<mxCell id="pRgEexwxrKvvUqylI0am-29" parent="1" style="shape=partialRectangle;whiteSpace=wrap;html=1;fillColor=#FFFFFF;strokeColor=#6c8ebf;strokeWidth=1.5;top=0;left=0;bottom=1;right=1;align=center;verticalAlign=middle;fontSize=11;" value="9–18 years of age" vertex="1">
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<mxCell id="pRgEexwxrKvvUqylI0am-30" parent="1" style="shape=partialRectangle;whiteSpace=wrap;html=1;fillColor=#dae8fc;strokeColor=#6c8ebf;strokeWidth=1.5;top=0;left=1;bottom=1;right=1;align=center;verticalAlign=middle;fontSize=11;" value="<b>Pulse Oximetry</b>" vertex="1">
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<mxCell id="pRgEexwxrKvvUqylI0am-31" parent="1" style="shape=partialRectangle;whiteSpace=wrap;html=1;fillColor=#FFFFFF;strokeColor=#6c8ebf;strokeWidth=1.5;top=0;left=0;bottom=1;right=1;align=left;verticalAlign=middle;" value="<div style="text-align:left;padding-left:12px;font-size:11px;">Lowest SpO₂ &lt;91% on room air*<br><b>OR</b> required inhaled FiO₂ &gt;50% to keep saturations &gt;90%<br><i style="color:#888;">* after 2 hours of routine management</i></div>" vertex="1">
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