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Clinical Cases from Resource Limited Settings: David Roesel
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Clinical Cases from Resource Limited Settings: David Roesel

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Participants will be able to: recognize importance and identify resources for learning about a country and local 'disease' profile; local/regional guidelines and algorithms appropriate for the ...

Participants will be able to: recognize importance and identify resources for learning about a country and local 'disease' profile; local/regional guidelines and algorithms appropriate for the specific clinical setting; how to address limitations in clinical resources for diagnosis and management of clinical cases; and understanding health care service structure and personnel/staffing structure.

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    Clinical Cases from Resource Limited Settings: David Roesel Clinical Cases from Resource Limited Settings: David Roesel Presentation Transcript

    • The Febrile Patient Clinical Essentials in Global Health: David Roesel MD, MPH, DTM&H
    • Top Ten Causes of Death in Low Income Countries WHO, Global Burden of Disease 2004 Update
    • Burden of Disease in Low Income Countries WHO, Global Burden of Disease 2004 Update 2004 Update
    • Adult Mortality by Region WHO, Global Burden of Disease 2004 Update
    • Child Mortality by Region: WHO, Global Burden of Disease 2004 Update
    • General Principles:
      • Fever is one of the most common reasons for seeking medical care in developing countries-- you must become comfortable evaluating and treating it .
      • Fevers in the tropics are often due to illnesses with which North American health-workers are not familiar.
      • The febrile patient may represent an infectious disease threat to others- including you.
      • Fever can represent a life-threatening emergency or a self-limiting viral illness: triage is essential .
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    • Do you . . . ?
      • Get a head CT.
      • Draw blood cultures.
      • Perform a lumbar puncture.
      • Get a chest X-ray.
      • Send a blood smear for malaria.
      • Start empiric treatment.
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    • Integrated Management of Childhood Illness: IMCI
      • A set of clinical guidelines developed by WHO and UNICEF for low-resource settings.
      • “ Reduce death, illness and disability, and promote improved growth and development among children under five years of age.”
      • Respiratory Illness
      • Diarrhea
      • Febrile Illness
      • Ear Infection
      • Malnutrition
      • Anemia
      • HIV infection
      Integrated Management of Childhood Illness: IMCI
    • Main Causes of Child Mortality: Other Infectious & Parasitic Diseases 9% Non-communicable diseases 4% Measles 4% HIV/AIDS 2% Malaria 7% Diarrheal diseases 16% Acute Respiratory Infections 17% Injuries 4% Neonatal deaths 36% Malnutrition 35% WHO, Global Burden of Disease 2004 Update
    • Prioritize Based on Danger Signs:
          • Persistent vomiting
          • Inability to drink/breastfeed
          • Convulsions
          • Decreased level of consciousness
    • Important Causes of Fever in Children
      • Respiratory illness
      • Malaria
      • Tuberculosis
      • Typhoid
      • Meningitis
      • Measles
    • IMCI Management of Fever: Give Tylenol as antipyretic. Refer if fever > 7 days Danger Signs/ Stiff Neck Broad Spectrum Antibiotics + Quinine + Glucose No Danger Signs Oral Malaria Treatment (ACT) Rash, Coryza Treat for Measles None of the above Supportive care
    • Malaria Kills
    • How should this child be managed?
    • ✓ ✓ ✓ ✓ ✓
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    • General Principles:
      • Explore the history, esp. exposure risks and duration of illness.
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      • Know the local epidemiology.
      • Do a thorough physical exam.
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      • Use wisely whatever diagnostic tests you have available.
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      • Be able to read X-rays.
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      • Learn to do ultrasounds.
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      • Tuberculosis is a common cause of persistent fevers.
      • Hospital-acquired infections are common.
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      • Know how to use a few key medications.
    • Essential Drugs:
      • Amoxicillin
      • Ampicillin
      • Co-Artem (Artemether + lumefantrine)
      • Benzylpenicillin
      • Chloramphenicol
      • Cloxacillin
      • Co-trimoxazole
      • Doxycycline
      • Erythromycin
      • Gentamycin
      • Metronidazole
      • Praziquantel
      • Quinine
      • Show respect, compassion, humility, and patience.
    • Why do millions die from treatable diseases every year? A. Because they’re poor. B. Who cares? C. Ignorance. D. It is written.
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