Acute Respiratory Illness(Ari)
Upcoming SlideShare
Loading in...5
×
 

Acute Respiratory Illness(Ari)

on

  • 2,271 views

 

Statistics

Views

Total Views
2,271
Views on SlideShare
2,271
Embed Views
0

Actions

Likes
0
Downloads
73
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Acute Respiratory Illness(Ari) Acute Respiratory Illness(Ari) Presentation Transcript

  • ACUTE RESPIRATORY ILLNESS
    DR.PARTH GURAGAIN
  • ACUTE RESPIRATORY ILLNESS(ARI)
    Most common
    Major cause of mortality and morbidity.
    Can affect anywhere from nose to alveoli.
    Can be classified into
    ALRI(Epiglottitis, laryngitis, laryngotrachietis, LTB, bronchitis, bronchiolitis, pneumonia)
    AURI(Common cold, pharyngitis,otitis media)
    In less developed countries measles and whooping cough are major cause of Respiratory tract infection.
  • PROBLEM STATEMENT
    ARI in young children is responsible for 3.9 million death world-wide.
    Bangladesh,India,Indonesia and Nepal together account for 40% of global mortality.
    90% of ARI death is due to pneumonia.
    Most is bacterial in origin.
    Incidence of pneumonia in developed countries 3-4%, in developing countries 20-30%
  • ARI in below 5yrs child is responsible for 30-50% of hospital visit..
    20-40% of hospital admission.
    It is leading cause of deafness as result of otitis media.
  • EPIDEMIOLOGICAL DETERMINANTS
    Agent factors
    Bacteria
    - Bordetella pertusis
    - Coryneabacterium diptheriae
    - Haemophilus influenzae
    - Klebsiella pneumonia
    - Staphylococcus pyogenes.
  • Virus
    - Adenoviruses-endemic types(1,2,5),epidemic type (3,4,7)
    - Enterovirus (ECHO and Coxsackie)
    - Influenza A,B,C
    - Measles
    - RSV
    Others
    - Chlamydia type B
    - Coxiella burnetti
    - Mycoplasma pneumoniae
  • HOST FACTORS
    Small children are most vulnerable
    Fatality more common in young infants, malnourished children, elderly.
    In developing countries fatality more due to malnutrition and LBW.
    URTI is more common in children than adults.
    Illness rate more common in younger children and decreases with increasing age.
  • At third decade of life there is surge in infection due to cross infection from their children.
    Women are more affected due to their exposure to small children.
  • RISK FACTORS
    Climatic condition
    Housing
    Level of industrialization
    Overcrowding
    Poor-nutrition
    LBW
    Indoor smoke pollution
    Maternal smoking
  • Mode of transmission
    Air borne route
    Person to Person
  • CONTROL OF ARI
    By improving primary medical care service
    Developing better method for:
    • Early detection
    • Treatment
    • If possible prevention
    Education of mother can be effective tool in reducing mortality and morbidity from ARI.
  • CLINICAL ASSESMENT
    - Access the child condition
    - Ask for:
    Age
    Duration of cough
    Is child able to drink (2mth-5yrs)
    Has child stopped feeding (<2mths)
    Had child suffered from any illness (e.g.: measles)
    Does child have fever
    Is child excessively drowsy
    Did child have convulsion
    Is there irregular breathing
    Short period of not breathing(apnea)
    Has child turned blue
    Any H/O T/t
  • PHYSICAL EXAMINATION
    Count the breathing in 1 min.
    Fast breathing present if:
    • RR 60b/min or more for <2mths.
    • RR 50b/min or more for 2mths to 12mths.
    • RR 40b/min or more for 12mths to 5yrs.
  • Phy. Exam: contd…..
    Look for chest indrawing
    Look and listen for Stridor (is the sound produced while breathing in aka croup)
    Look for Wheeze (sound produced when breathing out is difficult)
    Abnormally sleepy and difficult to wake.
    Feel for fever or low temperature.
    Check for severe malnutrition
    Look for cyanosis.
  • CLASSIFICATION OF ILLNESS
    A. Child aged 2mths -5yrs
    1. Very severe disease
    2. Severe Pneumonia
    3. Pneumonia
    4. No Pneumonia- cough, cold
  • VERY SEVERE DISEASE
    SIGNS
    Not able to drink
    Convulsion
    Abnormally sleepy or difficult to wake
    Stridor in calm child
    Severe malnutrition
    CLASSIFY AS-VERY SEVERE DISEASE
    TREATMENT
    Refer urgently to hospital
    Give 1st dose of antibiotics
    T/t of fever if present
    T/t of wheezing if present
    If cerebral malaria give anti malarial
  • SEVERE PNEUMONIA
    SIGNS
    Childs RR(if exhausted child’s RR may not be raised)
    Chest indrawing plus wheezing
    OTHER SIGNS
    -Nasal flaring
    -Grunting (sound made with voice if difficulty in breathing)
    -Cyanosis
    CLASSIFY AS –SEVERE PNEUMONIA
    TREATMENT
    Refer urgently to hospital
    First dose of antibiotics
    T/t of fever
    T/t of wheezing
  • PNEUMONIA
    SIGNS
    Fast breathing
    Absence of chest indrawing
    CLASSIFY AS-PNEUMONIA
    TREATMENT
    Home care
    Antibiotics
    T/t of fever
    T/t of wheezing
    Advice for re-assessment after 2days or if condition of child worsen
  • NO PNEUMONIA
    Cough/cold
    If cough more than 30 days needs assessment
    Look for ENT problem
    Home care
    T/t for fever
    T/t for wheezing
  • B.CLASSIFYING THE ILLNESS IN YOUNG INFANTS(<2MTHS)
    Signs may be difficult to find in young children
    Non-specific signs as poor feeding, fever,low body temperature,further mild chest indrawing may be present in young infants.
    CLASSIFIED AS
    • Very severe disease
    • Severe pneumonia
    • No pneumonia
  • VERY SEVERE DISEASE
    SIGNS
    Stopped feeding well
    Convulsion
    Abnormally sleepy or difficult to wake
    Stridor in calm child
    Wheezing
    Fever or low body temperature
    TREATMENT
    Refer urgently to hospital
    Keep warm
    Antibiotics
  • SEVERE PNEUMONIA
    Severe chest indrawing
    RR 60 OR more
    TREATMENT
    Refer urgently
    Keep warm
    Antibiotics
  • NO PNEUMONIA
    SIGNS
    No severe chest indrawing
    No fast breathing
    TREATMENT
    Keep warm
    Breast feed
    Return if sick , ↑RR, Difficulty in feeding
  • TREATMENT
    Treatment for 2mths to 5yrs (Pneumonia)
    Age/weight Paed tab Paed syp.
    Sulpha 100mg 5ml: Sulpha-200mg
    Trim 20mg Trim-40mg
    • <2mths 1tab BD Half spoon
    (3-5kgs) 2.5ml BD
    • 2-12mths 2tab BD One spoon
    (6-9kgs) 5ml BD
    • 1-5yrs 3tab BD One and half spoon
    (10-19kgs) 7.5ml BD
  • SEVERE PNEUMONIA(CHEST IND)
  • B1.IF CONDITION IMPROVES ,THEN FOR NEXT 3 DAYS
  • B.2.IF NO IMPROVEMENT THEN FOR NEXT 48 HRS
    Change antibiotics
    If Ampicillin –Change to Chloramphenicol IM
    If Chloramphenicol-Change to Cloxacillin 25mg/kg/dose 6hrly with gentamycin 2.5mg/kg/dose 8hrly
    If condition improves continue t/t orally
    C. Provide symptomatic t/t for fever and wheezing
    D. Monitor fluid and food intake
    E. Advice mother on home management
  • VERY SEVERE DISEASE
    Should be treated in centre with respiratory support
    Chloramphenicol IM is drug of choice
    If condition improves
    Oral Chloramphenicol for 10 days
    If condition worsen
    Inj Cloxacillin plus inj gentamycin
  • B.<2mths child
  • NO PNEUMONIA
    Symptomatic t/t
    Home care
    No antibiotics
  • PREVENTION
    Improve living condition
    Better nutrition
    Remove smoke pollution indoor
    Better MCH
    Immunization