general danger signs and main symptoms of cough difficult breathing.ppt

7/29/2019 general danger signs and main symptoms of cough difficult breathing.ppt

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IMCI

Lecture (1)

IntegratedManagement of

ChildhoodIllness


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General Danger Signs

CHECK

for

GENERALDANGER SIGNS

inALL SICKChildren


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General Danger Signs

Checking for General danger:signs

Unable to drink or breastfeed-1Vomits every thing-2

Has the child had-3

convulsions?Unconscious, lethargic-4

Is the child convulsing now-5


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ASK THE MOTHER WHAT THE CHILDS PROBLEMS ARE?

Determine if this is an Initial or Follow Up visit for this problem

If Follow Up visit, use the follow up instruction onTREAT THE CHILD CHART

If Initial visit, assess the child as follows:

CHECK FOR GENERAL DANGER SIGNS

ASK and check LOOK

Is the child able to drink or breast-feed? Does the child vomit every thing? Has he had convulsions? (duringpresent illness)

See if the child is lethargic orunconscious See if the child is convulsingnow


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Unable to Drink or Breastfeed?

Ask the mother to describe exactly what

happens when she offers the childsomething to drink

Ask the mother to offer her child a drink of

clean water or breast milk and look to seeif the child is swallowing .

The child is unable (too weak) to suck orswallow when he is offered a drink orbreast milk


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Vomits Everything ?

Not able to hold down food, fluids or oraldrugs.

ALLwhat goes down comes back up

A child who vomits several times but canhold down some fluidsdoes nothave thisgeneral danger sign.

Not able to hold anything down AT ALL


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Has the child had convulsions?

Ask the mother if the child developedconvulsions during the current illness.

Use words the mother understands.


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Convulsions (cont)

Explain what do you mean exactlyby convulsions.

In a convulsing child the arms andlegs stiffen. The child may loose

consciousness or may not be able

to respond to spoken directions.


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Unconscious ?

An unconscious child is a child who cannot

be awakened.

The child doesNOTrespond when he is :

Touched

Shaken, or

Spoken to


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Lethargic ?

A lethargic child isNOTawake and

alert when he should be.

He is drowsy and does not show

interest in what is happening aroundhim.

Difficulty in maintaining the arousedstate


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Lethargic (cont)

Often a lethargic child

does not look to hismother or watch

examiner face whentalks.

A lethargic child may

stare blankly andappears not to noticewhat is going around.


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CoughORDifficult Breathing

Then

ASK

About:

COUGH OR

DIFFICULT

BREATHING


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Cough OR Difficult Breathing,NOTCough AND Difficult Breathing

Fewer than 25 percent of childrenwith cough also have difficult

breathing

Many causes of difficult breathing

are not related to cough

Using both can cause false positives


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Acute Respiratory Infections( ARI )

Common cause of mortality. Common cause of morbidity.

Commonest reason for irrational

drug prescription.

Global & National Health Problem


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Insure Adequate Case Management

Identify those who need URGENT REFERRAL

Identify cases of PNEUMONIA.

Rationalize the use of DRUGS

Breast feeding and optimal nutrition

Vaccination and Vitamin A supplementation

Role of IMCI in ARI


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Assessment

THEN ASK ABOUT MAIN SYMPTOMS

Does the child have Cough or Difficult breathing?

IF YES, ASK LOOK and LISTEN

For how long? Count the breaths in oneminute

Look for chest indrawing Look and listen for stridor

Look and listen for wheeze

Child

mustbe calm


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Pneumonia: Severity

Recognition is based on:

Lower chest wall indrawing Stridor

Fast breathing


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LOWER CHEST WALLINDRAWING

Index of:

Severe Pneumonia

or very severe disease

Reasonable sensitivity& specificity " 89%".


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Lower Chest Wall Indrawing

Studies found thatlower chest wall indrawingbest identified children who required referral,admission or further assessment.

Must bedefinite, presentall the time in a

calm child.


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STRIDOR

Is Another Indicator for SeverePneumoniaor V. Severe Disease.

It is a harsh Inspiratory Voice.

Look & Listen to Stridor:

Listen to the harsh voice (in a calm child)

Look at the chest wall (phase ofbreathing)


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WHY FAST BREATHING ?

Simplicity

Ease in training Reliability

Good Predictor of PNEUMONIA

In the sick child 2 months 5 years

**

Sensitivity & specificity around 80%

Sensitivity= proportion of those with the disease who are correctly identified by sign

Specificity= proportion of those without the disease who are correctly called free ofthe disease by using the sign.


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FAST BREATHING !Why not other signs of pneumonia?

Fever is poor predictor of pneumonia.

Auscultation is less sensitive indicator

and needs skills


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CUT-OFF POINTSfor FAST BREATHING

If the child is: FAST BREATHING IS:

2 months up to 12

months

12 months up to 5years

50 breaths per minuteor more

40 breaths per minute

or more

Best to count rate in a quiet and alert child

Fever can affect respiratory rates, but do notwait for fever to subside


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60

50

40

Cut-offs of Fast Breathing


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Wheezing: Causes

Under age of 2 years -Bronchiolitis

Older children plus those with recurrentattacks of wheeze -bronchial asthma orreactive airways disease

Transient wheezers

Persistent wheezers

Other respiratory infections

Inhaled foreign body

Tuberculosis node compressing bronchus


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Wheezing: Why Added ??

Morbidity from asthma is a problem in Sudan

Will reduce unnecessary referral to hospital

Rapid-acting bronchodilators are available at

first-level facilities

Health workers are trained to recognize audiblewheeze and use bronchodilators

Health worker can recognize when a child withrecurrent wheeze is not responsive in the first-level health facility


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CLASSIFFY COUGH ORDIFFICULT BREATHING


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Any General D.Sign or

STRIDOR

SEVERE PNEUMONIAOR VERY SEVERE DISEASE

CHEST INDRAWING or


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Severe PneumoniaOR

Very Severe Disease

Urgently Refer Children with CoughOR Difficult Breathing AND

Any general danger signOR

Lower chest wall indrawingOR

Stridor in a calm child

Recognition:


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FAST BREATHING

PNEUMONIA


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No Pneumonia,

Cough or Cold

Antibiotics

No signs ofPneumonia

or VerySevereDisease

Vid i


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