\documentclass[10pt,a4paper]{article}

% Packages
\usepackage{fancyhdr}           % For header and footer
\usepackage{multicol}           % Allows multicols in tables
\usepackage{tabularx}           % Intelligent column widths
\usepackage{tabulary}           % Used in header and footer
\usepackage{hhline}             % Border under tables
\usepackage{graphicx}           % For images
\usepackage{xcolor}             % For hex colours
%\usepackage[utf8x]{inputenc}    % For unicode character support
\usepackage[T1]{fontenc}        % Without this we get weird character replacements
\usepackage{colortbl}           % For coloured tables
\usepackage{setspace}           % For line height
\usepackage{lastpage}           % Needed for total page number
\usepackage{seqsplit}           % Splits long words.
%\usepackage{opensans}          % Can't make this work so far. Shame. Would be lovely.
\usepackage[normalem]{ulem}     % For underlining links
% Most of the following are not required for the majority
% of cheat sheets but are needed for some symbol support.
\usepackage{amsmath}            % Symbols
\usepackage{MnSymbol}           % Symbols
\usepackage{wasysym}            % Symbols
%\usepackage[english,german,french,spanish,italian]{babel}              % Languages

% Document Info
\author{Nursententious (nursententious)}
\pdfinfo{
  /Title (paediatric-respiratory-assessment.pdf)
  /Creator (Cheatography)
  /Author (Nursententious (nursententious))
  /Subject (Paediatric Respiratory Assessment Cheat Sheet)
}

% Lengths and widths
\addtolength{\textwidth}{6cm}
\addtolength{\textheight}{-1cm}
\addtolength{\hoffset}{-3cm}
\addtolength{\voffset}{-2cm}
\setlength{\tabcolsep}{0.2cm} % Space between columns
\setlength{\headsep}{-12pt} % Reduce space between header and content
\setlength{\headheight}{85pt} % If less, LaTeX automatically increases it
\renewcommand{\footrulewidth}{0pt} % Remove footer line
\renewcommand{\headrulewidth}{0pt} % Remove header line
\renewcommand{\seqinsert}{\ifmmode\allowbreak\else\-\fi} % Hyphens in seqsplit
% This two commands together give roughly
% the right line height in the tables
\renewcommand{\arraystretch}{1.3}
\onehalfspacing

% Commands
\newcommand{\SetRowColor}[1]{\noalign{\gdef\RowColorName{#1}}\rowcolor{\RowColorName}} % Shortcut for row colour
\newcommand{\mymulticolumn}[3]{\multicolumn{#1}{>{\columncolor{\RowColorName}}#2}{#3}} % For coloured multi-cols
\newcolumntype{x}[1]{>{\raggedright}p{#1}} % New column types for ragged-right paragraph columns
\newcommand{\tn}{\tabularnewline} % Required as custom column type in use

% Font and Colours
\definecolor{HeadBackground}{HTML}{333333}
\definecolor{FootBackground}{HTML}{666666}
\definecolor{TextColor}{HTML}{333333}
\definecolor{DarkBackground}{HTML}{2292C9}
\definecolor{LightBackground}{HTML}{F1F8FB}
\renewcommand{\familydefault}{\sfdefault}
\color{TextColor}

% Header and Footer
\pagestyle{fancy}
\fancyhead{} % Set header to blank
\fancyfoot{} % Set footer to blank
\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
    \SetRowColor{DarkBackground}
    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
    }
\end{tabulary}
\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Paediatric Respiratory Assessment Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Nursententious (nursententious)} via \textcolor{DarkBackground}{\uline{cheatography.com/41286/cs/12534/}}}
\end{tabulary}
\end{multicols}}

\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
  \SetRowColor{FootBackground}
  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Nursententious (nursententious) \\
  \uline{cheatography.com/nursententious} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 17th August, 2017.\\
   Updated 17th August, 2017.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Sponsor}}  \\
  \SetRowColor{white}
  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
\end{tabulary}
\end{multicols}}




\begin{document}
\raggedright
\raggedcolumns

% Set font size to small. Switch to any value
% from this page to resize cheat sheet text:
% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.

\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{p{0.4577 cm} x{1.92234 cm} x{2.19696 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{PEWS - ABCDEFG}}  \tn
% Row 0
\SetRowColor{LightBackground}
A & {\bf{A}}irway & Is the airway \seqsplit{patent/maintainable/compromised}? Is there difficulty \seqsplit{breathing/speaking?} Are there associated breath sounds? \tn 
% Row Count 7 (+ 7)
% Row 1
\SetRowColor{white}
B & {\bf{B}}reathing & Look, Listen, Feel: Look - count RR; assess respiratory effort (i.e. use of accessory muscles, nasal flaring, abnormal rhythm, etc.); body position; colour. Listen - noisy breathing = upper airway secretions; stridor/wheeze = partial airway obstruction; \seqsplit{grunting/gasping/apnoea}. Feel - for deformities (i.e. surgical emphysema, crepitus). \tn 
% Row Count 25 (+ 18)
% Row 2
\SetRowColor{LightBackground}
C & {\bf{C}}irculation & Record HR, measure CRT, BP. \tn 
% Row Count 27 (+ 2)
% Row 3
\SetRowColor{white}
D & {\bf{D}}isability & Asses neurological status - \seqsplit{alert/voice/pain/unresponsive;} pupil size; glucose; Glasgow Coma Scale (older children). \tn 
% Row Count 34 (+ 7)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{p{0.4577 cm} x{1.92234 cm} x{2.19696 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{PEWS - ABCDEFG (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
E & {\bf{E}}xposure & Temperature (consider core/peripheries); rash; pain; skin integrity (blood loss, lesions, wounds, drains); consider fluid balance \tn 
% Row Count 7 (+ 7)
% Row 5
\SetRowColor{white}
DEFG & {\bf{D}}on't {\bf{E}}ver {\bf{F}}orget {\bf{G}}lucose &  \tn 
% Row Count 10 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{5.377cm}}{According to PEWS chart. RR = respiratory rate. HR = heart rate. BP= blood pressure. CRT = cap refill time.}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.14011 cm} x{2.83689 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Signs of Deterioration}}  \tn
% Row 0
\SetRowColor{LightBackground}
Abnormal RR/effort & Outside usual parameters for age group. \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\seqsplit{Recession/accessory} muscle use & Subcostal/intercostal recession; tracheal tug. \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
Abnormal breath sounds & Stridor/wheeze \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
Pulse Oximetry & Value below 96\%. \tn 
% Row Count 8 (+ 1)
% Row 4
\SetRowColor{LightBackground}
Oxygen Therapy & Need for inspired oxygen. \tn 
% Row Count 10 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Call for help if {\bf{head bobbing}}/{\bf{grunting}}/{\bf{gasping}}/{\bf{apnoea}}/{\bf{central cyanosis}} noted} \tn 
% Row Count 12 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{RR = respiratory rate.}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.69349 cm} x{0.96117 cm} x{1.92234 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{Respiratory Failure}}  \tn
% Row 0
\SetRowColor{LightBackground}
Initial stages & \seqsplit{Physiological} cause: & Attempt to compensate O2 deficit \& airway obstruction; beginning hypoxia \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
 & Signs & Restlessness; tachypnoea; tachycardia; diaphoresis \tn 
% Row Count 9 (+ 4)
% Row 2
\SetRowColor{LightBackground}
Imminent respiratory failure & \seqsplit{Physiological} cause: & Attempt to use accessory muscles to assist intake O2; persistent hypoxia; use up more O2 than obtained \tn 
% Row Count 16 (+ 7)
% Row 3
\SetRowColor{white}
 & Signs & Tachypnoea, dyspnoea \& tachycardia; nasal flaring ; retractions; grunting/head bobbing; wheezing; hypoxia (\textless{}92\%); difficulty speaking; \seqsplit{anxiety/irritability;} mood changes; headache; confusion \tn 
% Row Count 28 (+ 12)
% Row 4
\SetRowColor{LightBackground}
Ominous imminent respiratory arrest & \seqsplit{Physiological} cause: & Overwhelming O2 deficit; cerebral oxygenation affected (CNS changes ominous imminent respiratory arrest) \tn 
% Row Count 35 (+ 7)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.69349 cm} x{0.96117 cm} x{1.92234 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{Respiratory Failure (cont)}}  \tn
% Row 5
\SetRowColor{LightBackground}
 & Signs & Severe hypoxia (pO2 \textless{}60\%); \seqsplit{dyspnoea/bradypnoea/silent} chest/apnoea; bradycardia ; cyanosis; stupor/coma \tn 
% Row Count 7 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{5.377cm}}{pO2 = oxygen saturations.}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.64241 cm} x{3.33459 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Other Diagnostic Tests}}  \tn
% Row 0
\SetRowColor{LightBackground}
SaO2 saturations & Arterial blood gas \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Bloods & FBC - WCC slightly raised \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
Blood gases & pH 7.35-7.45; pO2 75-100mmHg (10-13.3kPa); pCO2 36-46mmHg (4.8-6.1kPa); Bicarbonate HCO\textasciicircum{}3\textasciicircum{} 22-30mmol/L\textasciicircum{}-1\textasciicircum{}; Base excess -2.3 - +2.3mmol/L \tn 
% Row Count 9 (+ 6)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Chest x-ray} \tn 
% Row Count 10 (+ 1)
% Row 4
\SetRowColor{LightBackground}
Spirometry & PEF; FEV1 \tn 
% Row Count 11 (+ 1)
% Row 5
\SetRowColor{white}
Common \seqsplit{abnormalities} & Respiratory acidosis: pCO2 and HCO\textasciicircum{}3\textasciicircum{} increased, pH and pO2 decreased. \tn 
% Row Count 14 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{SaO2 = oxygen saturations. FBC = full blood count. WCC = white cell count. pO2 = partial pressure oxygen. pCO2 = partial pressure carbon dioxide. PEF = peak expiratory flow. FEV1 = forced expiratory volume in 1 second.}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}