Check for General danger signsDr .Shazia MemonAssociate Professor
Learning objectives• Identify general danger signs.• How to check the child for general dangersigns• Know the D/D of child with convulsion,lethargy or coma.• To give pre referral treatment.• Base line investigations.
A general danger sign is present if:• The child is not able to drink or breast feed• The child vomits every thing• The child has had convulsions during currentillness• The child is lethargic or unconscious• The child is convulsing now.
Assess For General Danger SignAsk:•Is the childnot able todrink or feed?•Does the childvomit everything ?•Has the childhasconvulsions?Look:•See if thechild islethargic orunconscious.•See if thechild isconvulsingnow.CHECK FOR GENERAL DANGER SIGNS
WHEN YOU CHECK FOR GENERALDANGER SIGNSASK:• Is the child not able to drink or breast feed?• A child has the sign “not able to drink or breast feed” if he child is not ableto suck or swallow when offered a drink or breast milk.Causes:• CNS infections .• Acute gastroentritis with severe dehydration.• Sepsis• Throat abscess
DOES THE CHILD VOMITS EVERY THING?• A CHILD WHO IS NOT ABLE TO HOLD ANYTHING DOWN AT ALL HAS THE SIGN ”VOMITSEVERY THING”CAUSES• Lethargic/unconscious• Acute gastroenteritis with severe dehydration• Intestinal obstruction• sepsis
HAS THE CHILD HAD CONVULSIONS ?• CONVULSION: Paroxysmal, time limitedchange in motor activity and/or behaviourthat results from abnormal electrical activityin the brain• CAUSES:Causes In favourMeningitis •History of high grade fever•Recurrent history of otitismedia•Neck stiffness•Signs of meningial irritation•Petachial rashes (meningiococal meningitis)•Tense or bulging fontenelle•Abnormal posture•CSF suggestive of
Encephlitis •Reccent history of gastroentritis•Irritibility/behavioural changes•Raised ICP•CsfT.B meningitis •Hx of contact with t.b patient•Hx of weight loss•Low grade fever•Loss of appetite•Focal neurologicalsigns•Cranial nerve palsy•Labs: CXR ,Sputum AFB, montoux test,Febrile convulsions •Age 6 months to 5 years•High grade fever•No loss of consciousness•Positive family HxHead trauma
Poisoning •Hx of poison ingestion or drug over doseHypertensive Encephalopathy •Hx of head ache•Vomiting•Irritibility•Raised blood pressureDiabetic ketoacidosis •Hx of polydypsia, polyphagia, polyurea•Hx of weight loss•Acidotic breathing•Labs:High blood sugarUrinary ketones
Common cuases of convulsions• CNS Infection• Febrile convulsions• Epileptic convulsions• Metabolic. Hypoglycaemia• Head injury• Hepatic encephalopathy• DKA.• AGN ( hypertensive encephalopathy.• Most common causes are febrile convulsions and CNSinfections.
Community or outpatient department.• History : check for general danger signs.• Classify the illness.• Identify the treatment.• Give the pre-referral treatment• Write down the referral note.• Refer the child to inpatient department.
Management process of the sick child• The first step in assessing children referred to ahospital should be triage – the process of rapidscreening to decide to which of the followinggroup(s) a sick child belongs:• Those with emergency signs require immediateemergency treatment .• Those with priority signs should alert you to forimmediate assessment and treatment.• Children with no emergency or priority signs aretreated as non-urgent cases.
Emergency signs:• Obstructed breathing• Severe respiratory distress.• Central cyanosis.• Signs of shock• Coma• Convulsions• Signs of severe dehydration
priority signs:Sick child < 2 monthsTemprature : child very hotTrauma or other urgent surgicalPallorPoisoningPainRespiratory distressLethargic/ irrtibilitySevere malnutrition/visible wastingEdema on both feet.Burns.
Assessment of child withconvulsion or comaIntroduction to AVPU scale
Child presenting with coma or convulsion• History• Fever• Head injury• Drug overdose or toxin ingestion• Duration: how long do they last?• Previous history of febrile convulsion orepilepsy?
ExaminationGeneral:• Juandice and Severe Palmar Pallor.• Preipheral edema• Level of consciousness• Petechial rash/ purpuric spots.Head /neck• Stiff neck• Signs of head trauma or other injury• Pupil size and reaction to light.• Tense or bulged fontanelle• Abnormal posture.
Assessment of child with convulsion orcoma• AVPU scale.• Alert• Response to vocal commands.• Response to pain• Un-concouscious .
Lab investigation• CSF• CBC and MP• Blood glucose.• Assessment of blood pressure• Urine microscopy.• Other investigations according to presentation