Seeing Paediatric Patients in OPD

Prof. Pushpa Raj Sharma

Why it is special?

Common problem: fever (90%) Limited time Large number of patients. Not to miss the serious ones. Not to over prescribe drugs. Parents satisfaction Ethical

Serious conditions

Not able to suck, swallow Unconscious, drowsy, lethargic Convulsion in this episode Neonate Chest indrawing Oedema Tachypnoea

History taking in OPD

Write main presenting complaint Start examining while asking

questions around the presenting complaint

Commonest complaints Fever Loss of appetite Diarrhoea cough

Examples of questions for fever For how long? Usually 1-3 days Does he/she coughs? Any diarrhoea: blood in stools Any rash Any body at home/hostel having similar

problem Ear discharge Any convulsion Any swelling or wound Any joint problem

Looking a child with fever

Congested eyes Runny nose Congested throat/ulcers/enlarged

tonsils Rash Tachypnoea observation Spleen and liver

Fever diagnostic appraochToxic look without any localising signs Paracetamol/ if more than 2 days ask for

culture/TLC and DLC Follow up day with reportLocalising signs (red eyes/ runny nose/

congested throat.) Paracetamol Follow-up after 2 daysLocalising signs (liver/spleen_ Enteric/hepatitis/malaria/viral

Final prescription

Presenting complaint and duration Principle findings: toxic/localizing

signs Paracetamol Antibiotics

Formulations costs