Ari Workshop.2

8/13/2019 Ari Workshop.2

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ARI WORKSHOP



ACUTE RESPIRATORY

INFECTIONS

Leading cause of illness and death under 5 yearsof age about 2 million deaths annually

Out patient about 30-60%

80% with upper respiratory infections and

mostly require symptomatic treatment

20% with lower respiratory infections majority with pneumonia





OBJECTIVES

Reduce mortality of children under 5 years withpneumonia

Differentiate upper ARI from lower ARI

Rationalize the use of antibiotics, coughsuppressants, and anti histamines

To reduce complications of URTI likerheumatic fever and AGN after streptococcalsore throat and deafness after otitis media



ASSESSMENT

ASK:

How old is the child ?

Is the child coughing ? For how long ?

Is the child able to drink ? (2months to 5 years)

Has child stopped feeding well ? ( < 2 months age).

Has the child had fever ? For how long ?

Had the child had convulsions ?



ASSESSMENT

LOOK, LISTEN:- child must be calm

Count the breath in one minute.

Look for the chest in-drawing esp sub-costal.

Listen for stridor/wheeze.

See if the child is abnormally sleepy/difficult toarouse.

Feel for fever/too cold.

Check for clinically severe malnutrition.



Classification in a sick child age 2

month up to 5 years

NO PNEUMONIA

PNEUMONIA

SEVERE PNEUMONIA VERY SEVERE DISEASE



Respiratory rate cut off

Age less than 2 month 60/min or more

Age 2 month to one year 50/min

Age one to 5 years 40/min



NO PNEUMONIA

Hx :- Cough or difficult breathing

Signs :- No fast breathing; no chest in-drawing

TREATMENT:- ADVISE MOTHER TO GIVE HOME CARE

Treat ear problem/sore throat if present

Treat fever if present Treat wheeze if present



HOME CARE

Feed the child: Wt loss can contribute PCM

Feed the child during illness.

Increase feeding after illness.

Clear nose if it interferes with feeding.

Offer extra fluids to prevent dehydration.

Soothe the throat and relieve cough with saferemedy.

When to come back.





WHEN TO COME BACK

If breathing becomes difficult.

If breathing becomes fast.

Child is not able to drink.

Child becomes sicker.



HOW TO TREAT FEVER

If fever is less than 39°C; give more fluids.

If fever is more than 39°C; give extra fluids

and paracetamol in a dose ofFrom 2monts to 3yrs 5ml x 6 hourly

(5ml=120mg)

3 years to 5 years 10 ml x 6 hourly

Dose of paracetamol is 10 mg/kg/dose





HOW TO TREAT WHEEZE

Children with 1st episode of wheeze In respiratory distress give one dose of rapidly acting

bronchodilator and refer

No respiratory distress give oral salbutamol x 5days Children with recurrent wheeze

Give 1st dose of salbutamol and reassess in 30 min

If resp:distress persist with one danger sign-refer Fast breathing: treat pneumonia, give oral salbutamol

No fast breathing:- Oral salbutamol





How to use Salbutamol

Nebeulized Salbutamol: (5mg/5ml) 0.5 ml salbutamol and 2 ml sterile water

Oral salbutamol three times daily for 5 days Pediatric dose 0.3 mg/kg/day x 3 doses

5ml salbutamol = 2 mg (for oral use)



PNEUMONIA


Signs :- Fast breathing but no chest in-drawing

Treatment :- ADVISE MOTHER TO GIVE HOME CARE

Give an antibiotic

Treat fever if present

Treat wheeze if present

Reassess after 2 days.



ANTIBIOTIC

Co-trimoxazol syp:- (5ml=4omg trimethoprimand 200 mg sulfamethaxazol) < 2 months 2.5 ml x BD x 5 days

2 months to 12 months 5 ml x BD x 5 days 1 year to 5 years 7.5 ml x BD x 5 days

Syp Amoxycillin 125mg/5ml

< 2 months 2.5 ml X 3doses 2 months to 1 year 5 ml X 3 doses

1 year to 5 years 10 ml X 3 doses





REASSESS AFTER 2 DAYS

If child is improving; complete 5 days

antibiotic

If condition is same; change antibiotic If condition is worse; refer to hospital



SEVERE PNEUMONIA


Signs :- Fast breathing & chest in-drawing

Treatment :- Give 1st dose of antibiotic



Refer urgently to hospital



VERY SEVERE DISEASE


Signs :- Fast breathing, chest in-drawing and oneof the danger signs

Not able to drink

Convulsions

Abnormally sleepy/difficult to arouse

Stridor in a calm child

Clinically severe malnutrition



VERY SEVERE DISEASE

TREATMENT:-

Give 1st dose of antibiotic






YOUNG INFANT

AGE < 2 MONTHS

NO PNEUMONIA

SEVERE PNEUMONIA

VERY SEVERE DISEASE



NO PNEUMONIA

Hx :- cough or difficult breathing

Signs :- No fast breathing; no chest in-drawing

Treatment :- ADVISE MOTHER TO GIVE HOME CARE

Keep baby comfortably warm

Breast feed frequently

Clear nose if it interfere with feeding

Watch for signs of illness



NO PNEUMONIA

Advise mother to return if

Breathing becomes difficult

Breathing becomes fast

Feeding becomes a problem

Young infant becomes sicker

High fever



SEVERE PNEUMONIA

Hx :- cough or difficult breathing

Signs :- Fast breathing or chest in-drawing

Treatment :- Give 1st dose of antibiotic (preferably injection)

Keep young infant comfortably warm


If referral is not feasible treat with injectableantibiotic and follow daily



VERY SEVERE DISEASE

Hx :- Cough or difficult breathing Signs :- Fast breathing; severe chest indrawing & one of

the following danger signs Stopped feeding well Convulsions Abnormally drowsy/difficult to arouse Grunting Wheezing

Cyanosis Stridor in calm child Fever /feels to cold



VERY SEVERE DISEASE

Treatment :-

Give 1st dose of antibiotic (preferably injection)

Keep young infant comfortably warm




UPPER

RESPIRATORYINFECTIONS



CLASSIFICATION

Upper RTI Ear problem

Mastoiditis

Acute ear infection Chronic ear infection

Throat infection Streptococcal sore throat

Viral sore throat

Pharyngeal abcess





Mastoiditis: Tender swelling behind the ear may indicate a deep

infection in the mastoid bone

Treatment: antibiotic + surgery Acute Ear Infection:

Pus draining from the ear for < 2 weeks, ear pain ora red, immobile ear drum

Treatment: antibiotic, dry ear with wick; ear dropsare NOT recommended



Chronic Ear Infection:

Pus draining from ear > 2 weeks

Treatment: Keep ear dry by wicking,

supportive







Sore throat

Throat abscess

A child who is unable to drink

Treatment: Antibiotics + I&D

Streptococcal sore throat

Tender enlarged jugulodigastric lymph nodes & white exudate on the throat

Treatment: Antibiotics





Viral sore throat

Able to drink, but painful

Does not have tender enlarged lymph nodes

Does not have white exudate on throat Treatment:

Soothing remedies

Documents

Ari Workshop.2