check for general danger signs
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TRANSCRIPT
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Check for General danger signs
Dr .Shazia Memon Associate Professor
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Learning objectives
• Identify general danger signs.• How to check the child for general danger
signs • Know the D/D of child with convulsion,
lethargy or coma. • To give pre referral treatment.• Base line investigations.
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A general danger sign is present if:
• The child is not able to drink or breast feed• The child vomits every thing • The child has had convulsions during current
illness• The child is lethargic or unconscious• The child is convulsing now.
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Assess For General Danger Sign
Ask:•Is the child not able to drink or feed?•Does the child vomit every thing ?•Has the child has convulsions?
Look:•See if the child is lethargic or unconscious.•See if the child is convulsing now.
CHECK FOR GENERAL DANGER SIGNS
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WHEN YOU CHECK FOR GENERAL DANGER SIGNS
ASK:• Is the child not able to drink or breast feed?• A child has the sign “not able to drink or breast feed” if he child is not able
to suck or swallow when offered a drink or breast milk.Causes:• CNS infections . • Acute gastroentritis with severe dehydration.• Sepsis• Throat abscess
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DOES THE CHILD VOMITS EVERY THING?
• A CHILD WHO IS NOT ABLE TO HOLD ANY THING DOWN AT ALL HAS THE SIGN ”VOMITS EVERY THING”
CAUSES• Lethargic/unconscious • Acute gastroenteritis with severe dehydration• Intestinal obstruction• sepsis
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HAS THE CHILD HAD CONVULSIONS ?
• CONVULSION: Paroxysmal, time limited change in motor activity and/or behaviour that results from abnormal electrical activity in the brain
• CAUSES: Causes In favour
Meningitis •History of high grade fever•Recurrent history of otitismedia•Neck stiffness•Signs of meningial irritation•Petachial rashes (meningiococal meningitis)•Tense or bulging fontenelle•Abnormal posture•CSF suggestive of
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Encephlitis •Reccent history of gastroentritis•Irritibility/behavioural changes•Raised ICP•Csf
T.B meningitis •Hx of contact with t.b patient •Hx of weight loss•Low grade fever•Loss of appetite•Focal neurologicalsigns•Cranial nerve palsy •Labs: CXR ,Sputum AFB, montoux test,
Febrile convulsions •Age 6 months to 5 years•High grade fever•No loss of consciousness•Positive family Hx
Head trauma
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Poisoning •Hx of poison ingestion or drug over dose
Hypertensive Encephalopathy •Hx of head ache •Vomiting •Irritibility•Raised blood pressure
Diabetic ketoacidosis •Hx of polydypsia, polyphagia, polyurea•Hx of weight loss•Acidotic breathing•Labs: High blood sugar Urinary ketones
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Approach to child with convulsion or coma
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Why convulsion is selected as general danger sign.
• If occur with underlying disease indicate morbidity and mortality.
• If uncontrolled will lead to brain damage.
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Fever and convulsion/coma
• History.• Examination • Investigation • Provisional diagnosis• Final diagnosis.
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Child with convulsion
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Child with coma
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Investigation• Lumber puncture
conditioncondition colorcolor TLCTLC proteinprotein sugarsugar
NormalNormal ClearClear 0-50-5
lymphocylymphocytete
20-20-45mg/dl45mg/dl
50-50-70mg/dl70mg/dl
(75%of (75%of blood blood sugarsugar
Septic Septic PurulePurulentnt
100-100-6000060000
PMNPMN
100-100-20002000
mg/dlmg/dl
<40 <40 mg/dlmg/dl
TBMTBM OpalesOpalescentcent
10-500 10-500
LymphocLymphocyteyte
100mg-100mg-5gm/dl5gm/dl
<40 <40 mg/dlmg/dl
Viral Viral encephalitencephalitisis
ClearClear <1000 <1000 lymphocylymphocytete
20-10020-100
mg/dlmg/dlNormalNormal
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Common cuases of convulsions
• CNS Infection• Febrile convulsions• Epileptic convulsions • Metabolic. Hypoglycaemia • Head injury• Hepatic encephalopathy • DKA. • AGN ( hypertensive encephalopathy.• Most common causes are febrile convulsions and CNS
infections.
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Community or outpatient department.
• History : check for general danger signs. • Classify the illness. • Identify the treatment.• Give the pre-referral treatment • Write down the referral note.• Refer the child to inpatient department.
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Management process of the sick child
• The first step in assessing children referred to a hospital should be triage – the process of rapid screening to decide to which of the following group(s) a sick child belongs:
• Those with emergency signs require immediate emergency treatment .
• Those with priority signs should alert you to for immediate assessment and treatment.
• Children with no emergency or priority signs are treated as non-urgent cases.
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Emergency signs:
• Obstructed breathing • Severe respiratory distress.• Central cyanosis.• Signs of shock• Coma • Convulsions• Signs of severe dehydration
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priority signs:
Sick child < 2 months Temprature : child very hot Trauma or other urgent surgicalPallorPoisoningPainRespiratory distressLethargic/ irrtibility Severe malnutrition/visible wastingEdema on both feet.Burns.
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Assessment of child with convulsion or coma
Introduction to AVPU scale
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Child presenting with coma or convulsion
• History • Fever • Head injury• Drug overdose or toxin ingestion• Duration: how long do they last?• Previous history of febrile convulsion or
epilepsy?
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Examination
General: • Juandice and Severe Palmar Pallor.• Preipheral edema• Level of consciousness• Petechial rash/ purpuric spots.Head /neck • Stiff neck• Signs of head trauma or other injury• Pupil size and reaction to light.• Tense or bulged fontanelle• Abnormal posture.
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Assessment of child with convulsion or coma
• AVPU scale.• Alert• Response to vocal commands.• Response to pain • Un-concouscious .
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Lab investigation
• CSF • CBC and MP• Blood glucose.• Assessment of blood pressure• Urine microscopy. • Other investigations according to presentation
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THANK-YOU!
THANK-YOU!