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SOP floods doctors light

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  • 1. *itti:,i? ry {
  • 2. Hearth Emergencress*andard #p*rativ* suideline far tr*aring comrnon $Is*md F4*d$cm*dr.rn*ng by Sffic*n"s remain vrllages cases any without marooned number people shelter.school/make of take at shift-camps side dam. some onroad or InDuring a large flood people to make and drug providers make isto health accessible displaad marooned and services to those or Maiorcommunication. challenges health before ts guideirne operative situation following ,*ron hearth and emergencies communicable in constrained The rerated diseases t0 treat avairabrerogistics toiniended help officers such emergencies situation medical totreat health insuch *f #r*w*ir"eg&,-F4*ac"t;Eg*{t"x*nt ,,. , t. ,-:-^!! 0xygenatr0n spasm.Ihis to ineffective leads water toobstruction leads by aspiration orbylaryngeal ofainnay either offluidDrowning indeep shallow both and brain occurs condition than minutes death formore 5 vital lf brain suffers suchtothe organs. tissue from hypothermia cardiac and(e) arrest cyanosis,(c) sputum(d) frothy pink featuressalient patients semi-consciousness/unconsciousness,(b) ofdrowning are:(a)Tn*ixflrlr*ln{:llAfterthedrowningpatientisrescuedtodryplace,cardiopulmonaryresuscitation(CPR)istobestarted of in llethodsCPR Pictures: -,i& ",1""&3 i;qutt I i should checkeddebris be for should flatonhis and mouth victim The be back his ,t r,-" , { i:gLr*ll ; lf ihe is ainray,lift back tilthead viaim unconscious,openneckand {" i,1-gll:t: 1#.r* with quick breaths breathing four full ". .{ara& f viaim notbreathing, artificial is begin ; -r-iil iig*rti} . Check carotid for Pulse. irg*rtf. I sternum cirtulationdepressing by lf pulse absent, artificial is begin i ";uit I ofaninfant resuscitation 1,r Mouth+o-mouth " .,, 4 not water victim,s Do attemptdrain from to 3) Cover blanketprevent with to 4) lf patient betransferred can Lasix,to pulmonary treat hypothermia oedema;sodium sub rungs.0nry then with centre treat to health lYto bi-carbonate presure be if any **- diaphragmatic courd advocated foreignboot to remove :..o : II tl 5) lf norecovery, patient higher refer to centre hie*: ."ry. * * ffi. Fianager*e*rtclfsnalce (CobraKrait)bite have broadtypes snakes:(a)Elapids dwhich"-* ofpoisonous lnIndiawe two $t*.m Ho w t o k n o w t ha tth e p a ti e n ti sb i tte nbypoisonoussnake?r . *t - ffi : i) Localpain numbness pain spreading indicadffirotoxictitc! and orburning with oedema bite pain,oedema,oozing and p*tthitl from site ,r,n bite haemorrhagehaemotoxic indicate Local qanosis,respiratory apPeart snake,urtimatery bite neurotoxic systemic of &pharynx incase by a) ptosis,dipropia,parsy deveropsof rimb snake. mucosal haematemesis, o{bite haemotoxic b) Haematuria, b|eeding, incase by shock
  • 3. :iitairtlent: l. Rest the with to limb snake onsplint loose bite with bandage. bandage applied. l,lo tight tobe l. Clean site povidone-iodine bite with solution l.0bverse casereast 24hours reassure every at for and thepatient. 4 see signspoisoning. haemotoxicity, few ofvenous in the of Iotest collect ml a blood a dry, test and for20minutes. isno clean tube keep lf there clotting it isindication then ofhaemotoxicity. 5 AdministerAVS sign ifthere ofpoisoning.Before infusion,skin 0.02 ofAVS is startingAVs testwith ml has bedone.compare srre to wirh control (normal injected saline subcutaneously)minutes. isnoswelling after l5 lf there orerythema site AVS attest start infusion Normal with saline (l: 0)ata rate | 5-20 | of drops/min may increased which be tocomplete by|-2hours. for adult child: infusion Dosesboth and a) Swellingmild and systemic feature-5-10 AVS. vials of b) llarked haemolysisfeatures_10_20 vials ofAVS. Incase isreaction site,keep there attest adrenaline andbydrocortisone startsecond ready and a lVchannel. 6. Inj.T.Ioxoid andantibiotic. 7 Refer t0higher iftheredeterioration, patient centre, is for haemodialysis orventilatory support. . :.-=i:,:==::: * a: * f * r;n"r * rt i r.tj ri ex" .: r a *1 uDuring patient have flood may injuries tocollapse by due ofhouseforce ofwater.These blunt are mostly injuries resulting infracture injury. orheadRemove patienta safe injured to place. a) Remove and rapid ofwhole clothing have survey body. b) Ensure and neck lateral air way turn to side. c) Check breathing. d) Check bleeding; control if present bleeding bycompression orapplication bandage oftourniquet. e) Splint injured the limb. f) Administer Inj.I.Toxoid and anargesic.Avoid sedation proper before diagnosis. g) Infuse toovercome loss. lV fluid blood lf shock ispresent, be it shouldcorrected promptly.Refer tohigher incaseserious patient centre of injury. ,=i ::;==+.:-.s:t *f cli **"rlt**m; . s-:Diarrhoeaiscommonflood in affectedpopulation due non mainly to availability drinking absence ofsafe water, ofhygyene sanitation, and crowdingpeople of as shelters. sare Providing drinking and sanitation be top warer propJr shoutdgiven priorirv help pHE and or and::.j]|::l:::9.1Tll:li:i}:::l of.However,treatmentother departments beavailed should ofdianhoea inflood situation beiomes challenging;;ffi;;;;#H;;r#; t"t tases death.Treatment 0,, and prevent ordiarrhoea ,rrrr,nginf becomes ;ry:i.ir{jl#{,.:*l:1ilil:ffiff:,ffiil::: & (a) Replacementlost offluid through and stool vomitus. (b) Continued feeding be feeding: shouldstarted as as soon {c) Rationaluse ofdrugs.Drugs only indicaha are requiredin ! " .ffi#:*;,ffi I -TW ,* a.t **?Incasediarrhoea: of ,T* r :- J ilf f+ 6 lF I *l- l. Examine and dehydration. the patientassess *r ,{S ## Thechildiscategorizedas"nodehydrati0n,,,,,someOrnyArrtion,,*r,,r,r$,nrf,,# * l lf nodehydration then 50-100ofORS each ispresent,give ml after loocffil for ;hfidtfis thanyrru. 2 fofold,, after stool| cup each ( equals ml). 200 Breast ornormal tocontiffi Zinc feed feed supplementation to begiven. demonstrate [Practically preparation and ofORS ensure family that members undentand.]
  • 4. J. Incase moderate of dehydration thechild treat underobservation atl|edical orPHC.) (either Camp Durins 4 rours ORI ml)(body first give 75 weight kg0r in wetght In Age <4 months 4-l I months l -2years years 2-4 Above5yearsIn - lnml 200 400 400 600 - 600-800 1200 800- |200- 2200 . Use osmolar low 0R5. . occurs,wait minutes then lfvomiting for5-10 more at minutes and resume therapy slowly3-4 0RS interval. . Continue feeding. breast dianhoeaIncase severe of treatmentbedone to pre{erablyat health lactate normal centre. fluid(Ringeis lV or of lV saline) to beadministered.Volume has to infused:fluid be . than age- Less I year a) 30ml/kgI hour in b) 70ml/kg 5 hours. innext . Ageyear more I or a) 30ml/kgl/2 hour in b) 70ml/kg %hours. in2 tonote:lmoortant a) Patients severe/moderate shouldre-examined hours. whether passed. with dianhoea be 2 after Look urine b) lf dehydrationnotcorrected, 0RS/II/ regime. repeat fluid c) Change oftreatment plan todehydration. according d) Look signs for ofoverhydration accordingly. andtreat e) lf fluidcannotadministered lVroute,give be through 0RSthrough tube. nasogastric f) Patient continue feed should normal (available food flood) during g) Anti-microbialstobe only casecholera, used in of dyssentery, and amoebiasis giardiasis. f,i Suspect ina child 5 yearsage adulthe having watery cholera above of or if is severe diarrhoeaassociated and disproportionatel with vomiting a dehydration.Any waterysevere caseof diarrhoea a declared ofepidemiccholera betaken cholera. sample becollected from zone of should as Stool may andsent lab cary medium. to in Blair : Anti-microbials bestarted with should along other oftreatment. modalities c0mmon 0fsevere lr,|ost cause outreakfood diarrhoea in affected ischolera. population proper washing prevent hand can diarrhoea. everyone about washing preparing ortaking llake aware hand before food food. people add Aware to halogen orbleaching tablets to water use. solution drinking beforel. for anti-microbials Specific ofcholera treatment Drugscommonlyrecommended are- forcholera |2.5mg/kg weight/dose, for3 days (i) Ietracyciine- body 6 hourly not in of because (should begiven children 7 years age, below ofchance ofteethstarnrng). (Il|P) (ii) Trimethoprim - TMP@ (SMX) Sulfamethoxazole body 3 days. l2 hourly,for 5mg/kg weight/dose, i}c. r l2.5mg/kg weight/dose,6for days. (iii) furazolidine- body hourly 3 .S..; i& .$ ,ir$:t : *g {!d $r: (iv) Chloramphenicol- weight/dose,6for3 days. 2Omg/kgbody hourly l2.5mg/kg weight/dose for dayl, . (r) Erythromycin- body 6 hourly 3 for ofdysentery treatment i,. antimicrobialsll. Specific (i) lnmost the offirst areas drug isNalidixic Dose choice acid. I likeNorfloxacin, (ii) tluroquinolones are Ciprofloxacin very !erli ,l Howeverhave widely without obvious side they been used any *h:1 such effeetffiffimmendsJfiaTt]fi[Orugafirs{ skofthe treated) disease t# 20-30mg/kg/day dosef{or cip,ofro*r,in- in2divided 5dfr. ft t t - usuallydrug the treatment for5 days isgiven (iv) 0ral followed6mg/kg daily 4 days. Azithoromycin- once onIstday |2mg/kg daily by once for
  • 5. fortreatment anti-microbialslll. Specrfic giardiasis. and ofamoebiasis Amoebiasis: |0mg/kg/dose a day 5 days. Metronidazole: 3 times for Tinidazole be can as dose doses orally) divided also given asingle (50mg/kg intwolV Giardiasis: iletronidazole:5mg/kg/dose 5 days. 3 times for a dayF. Hanage$!entof *ther enmmunicable diseaser: diseases, water diseases, Communicable especially borne arecommon displacedto In cases live are in inpopulation due food. some where stocks kept same as shelter cases may occur people, ofleptospirosis tever):(|) Enteric (Iyphoid tever symptoms.Diagnosis atfield "typhi kitTreatment bedone High ofmore I week variable intestinal fever than with gastro can done be by dot" can with andantipyretic. Cifrofloxacin Shouldreferred be centre tobe fever.Advice tohigher forcontinued given hygienic offaeces safe about disposal water. and drinking(2) Viral Hepatitis: hypochondrium byjaundia. followed isabsolute and Treatment of Domperidone rest plenty glucose.Iab be can History mild withpain right of fever in given control to sensorium, to bereferredhigher nausea. ofaltered lncase patient to to be about and drinking offaeces safe centre.Advice given disposal water.(l) Scabies: communicable due mite characterised Highly disease to and byitching secondary and be can by benzoate ofBenzyl infection.Treatmentdone application from tofoot head except and tab.Cetrezine prescribed.Ensurefamily pruritus face scalp.For canbe thatall members/persons contact treated inclose are with benzoate. Benzyl Respiratory (ARl):(4) Acute infeaion l. fever Cough Cold Nasopharyngiti$: with and (Acute . No ofrandom need antibiotics - viral). (maiority . Commercialformula not cough mostly usually needed.Cough may needed:- sel[limiting.Cough be syrup - With with exhausting associated cough vomiting: severe - e.g.dextromethorphan cough (codein-free) simple syrup may used be - Incough bronchospasm:salbutamol. with . Nose saline + moist byN. block:Clear droP wick Nomedicated drop needed. nasal usually forfever Paracetamol feeding: fluid. Normal Extra Look signspneumonia. for of T tr / ol
  • 6. ll. CI|ILDREII2I101{THS AGED T05YRS.WITH 0R ICULT C0UGH Dltf BREATI|II{G:CLllllCAL T0 CLA$ltlCATl0t{ IACIIITATE TRIATI.iE1{T DttlSl0l{S: Clinical Category Essential Features Treatment Strategy very severe pneumonia Central cyanosis, Lethargy, unconsciousness, Inpatient care. Convulsion Refenal tohealth centre llot todrinkfeed, able / Head nodding respiratory (severe distress) Severe pneumonia Lower indrawingnasal chest or flaring InPatient care. No ofabove sign Refenal tohealth centre Pneumonia Fastbreathing: Homecare. Ag, Resp.rate/min. 0ralCo-trimoxazole, or orAmoxycillin 2 m o - 1 2 m> 5 0 o. Ampicillin. 1 2 m o - 5 y r> .4 0 s for7 days. Nosign severe very of of severe pneumonia. Nopneumonia 0nlycough cold orwithout and with fever. Paracetamol forfever, Noantibiotic. NB:Children 2 months fast below with breathing,chest indrawing etc.Should bereferredhealth to centre. 4.5.ACUTE RESPIMTORY R UPPt II{IECTIOIIS Clinical Condition Features Treatment Strategy Common cold Fever, nose-block cough, Discussed Acute Media 0titis Pus theear <2 wk, from for Sudden persistent Cotrimoxazole,Ampicillin for5 ofAmoxycillin ear orredness pain, & decreased of mobility days. ear onotoscopy. drum Streptococcal pharyngitis Tender,enlarged cervical nodes lymph plus Ampicillin/Amoxycillin for |0 days. white pharyngeal axudate.Absence of ofsigns Nasopharyngitis.DOSAGE OICOTRIIIO)(AZOLE BY ORWEIGHT &AIIO)(YCILLII{ AGE TATEGORIES: AGE ORWEIGHT c0RTl1,l0- c0RTtl,t0- c0RItl10- )(AIOIT xAzotE Adult Tablet strength Single Paediatric Tablet (40mg + Iyrup Tl{P (80mg + 400m9 TMP Sl1) INP,t.f,Q.$. 1z0mg lll (200mgper Stl 5ml) |2 months to5years up (10-leks)T||P :Irimethoprim,S|| :Sulphamethoxazole $; - 2 Times for - 3 Times forC0TRI||0XAZ0LE daily 5-7days.A||0XYClLLll| daily 5-10 ,f ,il
  • 7. during withprescribed fordrildren rdul6.Common to bekept drugs flood doses ildsL. SCHEDULE OI ROUTE DOSE NAl4E OI sL 0r l{AHt i0lE0uLl mm 0f DottN0. DRUGS AD14INIS- |lO. DRUGI ADIIITIT TRATION IMTIO}ichilren AdultI Paracetamol0ral to4 times l0-l5mg/kg/dose,up Paracetamol0ral 500ni &i05 TD5 at interval. daily 6 houn ltaoBDPCX5oays L Co-trimoxazole0 r a l7 0ral Co-trimoxazole Asnoted) 3 Amoxycillin 0ral 500mg X5 dayr IDS Amoxycillin 0ral in page- 5 Ciprofloxacin0ral 20-30ms/kg/day doses in2 divided 4 0ral Ciprofloxacillin 500mgBDPtX5days45 Norfloxacin 0ral l0-l5mg/kg/day divided in2 doses 5 Norfloxacillin 0ral 400mgBDPCX5days6 Domperidone 0ral 0.2-0.4mg/kg/dose, 6 Domperidone0ral lOmgltabBDACX3days be may siven 6-hourly I tabBDPC days X3 1 Cetrizine 0ral7 Cetrizine 0ral 2-6 BD years:2.5mg, > 6years: 0D 8 ||etroidazole 0ral 200mgIDSX5days Smg Ampicillin 0ral 25mg/kg/dose,6 hourly 9 Azithromycin 0ral 500mg 3 to 5 days 0DI0 0ral ||etronidazole l0mg/kg/dose aday 3 times t0 0R5 0ral AsNoted llanagement undert0 Furazolidine 0ral lOmg/kg/dose aday 3 times ll N5/Ringers IV ofdiarrhoeatl Azithromycin0ral l2mg/kg daily once Lactate forl" 5 daysthen I tabTDPC t2 Anacid 0ral 6ms/ks for4 days daily t3 InjTet vac Il,l I amp stat t2 0Rs- 0ral As notedunder Hypo-osmolar ofdiarrhoea |,|anagement t4 AVS tv under bite noted snake As t3 (lV Saline Intravenous l|ormal t5 lodine Povidone applied Locally t4 (lV lactateIntravenous Ringers Solution washinglllustrationhand of ff I tF
  • 8. Some important guidelines disinfection: onwaterl. Disinfeaion ofhousehold water. drinking a) P r e p a r a t C h lo fr i n e s o l u t i o n : A d d 3 ( t h r eb l)e a b he n p o o lwidferron a t e r . S t i r t h e s o l u t i o n a n d ion o e t c l i s g p n o e iw l t f discard sediment.This solution forhousehold it can kept covered,colored the chlorine isready useand be in container for month one b) Add dropschlorine to I liter water drinking oradd halogen The can used 3 of solution of for purpose I tablet. water be for drinking half after hour.7. Disinfeaion well well. oftube & Routine disinfection 4 Disinfection not during months isusually done winter (November to[ebruary) b) During monson disinfection oncemonth toJune pre month tobedone a (llarch / July) Q D i s i n f e c t i o n t o b e d o n e t w i c e a m o n t h d u r i n g m oo s o n s e ms o n ( J u no b J u) y t n Septea ber/0ct e/ er l Suspected outbreak diarrhea situation a) Disinfection once week. tobedone every Number ofdiarrhea tobe cases monitored increasing (whether ordecreasing) b) lf there increase is in numbercases disinfection done every till numbernew is of then to be twice week of case controlled. c) Inspite disinfectiondone a week, of being twice if there report new then disinfection tobe is of cases, daily mayneed done.3 llethod ofdisinfection well well. oftube & a) Roughlymatch (normal ofbleaching (33 one box size) powder gram)needed is todisinfect ofstandard I well diameter of2 meter I tube or well. b) llake ofbleaching with paste powder water, it and allow sediment Supernatant tobeput stir then the t0settle. solution ina bucket.the Dip bucket well and up&down inthe water stir several times. ,,,. " ,. c) Incase tube handle seat toberemoved / Panchayet. of well, and valve byPHE Supernatant sohltionlas poured the into pipe. d) There besmell chlorinewater the will of in if e) Water well tube to beconsumed of or well evening it is notused thedwellers when by done during daytime villagers to consum@vater and asked # rit ,f ** I