IMNCI integrated management of childhood disease ARI STRIDOR

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IMNCI integrated management of childhood disease ARI STRIDOR

  1. 1. IMNCI Integrated Management of Neonatal and childhood illness strategy
  2. 2. The 3 MAIN components  Improvement in the case management skills of health staff through use of locally adapted guidelines.  Improvements in the overall health systems  Improvements in family and community health center practices
  3. 3. GUIDELINES  Target children less than 5 year old  Evidence based syndromic approach  (1)health problems the child may have  (2)severity of the childs condition  (3)action that can be taken to the care of the child.
  4. 4. The PRINCIPLES 1  All children under 5 year of age must be examine3d for conditions which indicate immediate referral  Children must be routinely assessed for major symptoms nutritional ,immunization status , feeding problems and other problems  Only a limited number of clinical signs are used for assessment  CLASSIFICATION: REFERRAL---PINK TREATMENT IN HEALTHY FACILITY—YELLOW MANAGEMENT AT HOME --- GREEN
  5. 5. Color code: Referral for PINK Treatment in healthy facility for YELLOW Management at home is GREEN
  6. 6. THE PRINCIPLES 2  IMNCI addresses most common but not all pediatric problems.  IMNCI uses a limited number of essential drugs  Care takers are actively involved in the treatment of children.  IMNCI includes counseling of care takers about home care including feeding, fluids and when to return to health facility.
  7. 7. CASE MANAGEMENT  STEP1:Acess the young infant  STEP2:classify the illness  STEP3:identify treatment  STEP4:treat the young infant  STEP5:counsel the mother  STEP6:follow up care
  8. 8. ASSESSMENT  History taking and communication with the care taker  Checking for general danger sign  Checking main symptoms  Checking for malnutrition  Checking for anemia  Assessing child feeding  Checking immunization status  Assessing other problems
  9. 9. General danger signs  h/o of convulsion  Unconsciousness or lethargy  Inability to drink or breast feed  Child vomit everything  If the child have one or more of theses sign the child is said to be seriously ill.
  10. 10. CLASSIFICATION  Assessing the sick child age 2 month upto 5 year  Assessing the sick child from age 2 month to 5 year
  11. 11.  OP Management of sick child age 2 month to 5years
  12. 12. TREATMENT GUIDELINES 1  Tt of local infections: #Local Bacterial Infectioins:oral cotrimoxazole or amoxicillin *5days #Skin pustules:apply gentian violet paint twice daily at home #discharge from ear: try to dry the ear by wicking
  13. 13. TREATMENT GUIDELINES 2  Some or no dehydration:treat dehydration as per WHO guidelines.  Feeding problem: #teach the correct positioning and attatchment for breast feeding #teach the mother to manage the breast feeding and correct the nipple problem. #treat thrush:use gentian violet to clean childs mouth #feeding with cup and spoon. #counsel the mother abt feeding problems
  14. 14. Pre referral treatments 1  Convulsions: diazepam IV or rectally  Severe pneumonia, febrile illness, measles ,mastoiditis :chloramphenicol or ampicillin plus gentamycin or ceftriaxone i.m  Severe malaria:first dose of quinine  Persistent diarrhea,measles severe malnutrition:vitamin A
  15. 15. Pre referral treatments  Hypoglycemia prevention:breast feeding and sugar  Oral antimalarial as per guidelines.  High fever:paracetamol  Clouding of cornea:tetracycline eye ointment  Diarrhea:ORS 2
  16. 16. APAC  For effective communication and counseling APAC  ASK  PRAISE  ADVICE  CHECK
  17. 17. COUNSELLING  Advice to continue breast feeding  Teach how to give oral drugs or to treat local infections  Counsel to solve feeding problems  Advise when to return
  18. 18. WHEN TO RETURN! Mother should bring her child if she notices the below…..  Young infant (age 0-2m) #breastfeeding or drinking poorly #becomes sicker #develops fever or cold to touch #fast/difficult breathing  Sick child(2month to 5 year) #ANY CHILD *not able to drink or breast feed *becomes sicker *develops faster #CHILD WITH COUGH AND COLD *develops fast/difficult breathing #blood in stool #CHILD WITH DIARRHEA #yellow palms and soles. *has blood in stool *drinking poorly
  19. 19. Treatment guideline in OP & at home 1  Pneumonia:1st dose of Antibiotic in clinin and teach mother how to give oral drug cotrimoxazole 1st line, amoxicillin 2nd dose  Dysentry:cotrimoxazole 1st line nalidixic acid 2nd line  Cholera: single dose of doxycycline  Dehydration and persistent diarrhea: teat as per WHO gl
  20. 20. Treatment guideline in OP & at home 2  Persistent diarrhea: Zn 20 mg elemental daily for 14 days and a single dose of vitamin A  Malaria: as per recommendations  Anemia: Fe and Folic acid tabs for 14 days  Cough and cold: continue breast feeding, honey , tulsi  Local inf:Tt eye with tetracycline
  21. 21. ARI ACUTE RESPIRATORY TRACT INFECTIONS CONTROL PROGRAMME
  22. 22. Acute respiratory tract infections ARI  The common bacteria causing ARI:H.influenza,S.pneumonia and staphylococci.  Leading cause of mortality below 5 years  Clinical criteria for diagnosis:1.rapid respiration with or without difficulty in respiration. rapid respiration is respiration greater than 60/min in children below 2 mnth of age between 2mnth to 1 year and between 1yr to 5 yr.  Difficulty in respiration is lower chest indrawing.
  23. 23. ARI  In children below 2months of age , presence of any one of the following indicates severe diseases : fever(38 degree or more), convulsions, abnormally sleep or difficulty to wake , stridor in calm child, wheezing, not feeding , tachypnea, chest indrawing, altered sensorium, central cyanosis, grunting apneic spells or distended abdomen.
  24. 24. Signs and symptoms classification therapy Where to treat Cough or cold No fast breathing No chest indrawing Or indicators of severe illness NO pneumonia Home remedies Home RR/minute Age 60 or more ; less than 2 months 50 or more;2-12 months 40 or more;12 -60 months Pneumonia cotrimoxazole Home Chest indrawing Severe pneumonia IV/IM pencillin Hospital Cyanosis, severe chest indrawing, inability to feed Very severe pneumonia IV chloramphenicol Hospital
  25. 25. Less than 2 month- its treatment
  26. 26. 2 month to 5 years- its treatment
  27. 27. Cotrimoxazole - treatment for pneumonia –its dosage
  28. 28. STRIDOR
  29. 29. STRIDOR  It is a musical sound of single pitch that is produced by oscillation of critically narrowed extra thorassic pathways.  Initially its inspiratory but when obstruction become more severe it become both inspiratory and expiratory.  When stridor is high pitched the child is more distressed.  With the resolution of disease sridor becomes low in pitch
  30. 30. 2 TYPES OF STRIDOR SUPRAGLOTTIC OBSTRUCTION TRACHEAL OBSTRUCTION Inspiratory stridor Weak cry/dyspnea Dyspnea is generally mild Less pronounced cough Biphasic or expiratory Normal cry/voice May have severe dyspnea Deepbarking,brassy cough Physical findings: nasal flaring,suprasternal and intercostal indrawing Radiographs: Cxrays OF LATERAL NECK FILM. barium esophagogram
  31. 31. CAUSES for STRIDOR  INFECTIONS:CROUP , ACUTE EPIGLOTITTIS , BACTERIAL TRACHEITIS , RETROPHARYNGEAK ABCESS  CONGENITAL CAUSES:LARYNGOMALACIA , VOCAL CORD PARALYSIS , CONGENITAL SUBGLOTTIC STENOSIS , VASCULAR RING , SUBGLOTTIC HEMANGIOMA , CONGENITAL SACCULAR CYST, LARYNGEAL WEB , LARYNGEAK ATRESIA  IATROGENIC CAUSE: ACQUIRED SUBGLOTTIC STENOSIS, LARYNGEAL GRANULOMA  NEOPLASM:RECURRENT RESPIRATORY PAPILLOMA  FOREIGN BODY
  32. 32. INFECTIONS CROUP AC EPIGLOTITTIS BACTERIAL TRACHEITIS RETROPHARYN GEAL ABCESS 1-5 years Barking type Onset: several days Cxray:steeple sign Resolve in 1-2 days Supplemenal O2 Steroids h.Influenza And staphylococcus Acute onset Sore throat dysphagia fever. Tripod posture Cough is absent Lateral x ray: Thumb like thickening of epiglottis Young children Brassy cough stridor Life threatening High fever Reduced morbidity of neck Toxic appearing S.aureus Lateral xray: bulge in post pharyngeal wall Cefuroxime iv antibiotics H.influenza Tt:surgical drainage
  33. 33. RETROPHARYNGEAL ABCESS CROUP EPIGLOTITTIS
  34. 34. Congenital LARYNGO VC MALACIA PARALYSIS CONG. SUPRA GLOTTIC STENOSIS VASCULAR RING SUBGLOT TIC HEMANGI OMA CONG SACCUL AR CYST,L ARYNG EAL WEB,LA RYNGE AL ATRESI A Inspiratory stridor Aggravate d:crying supine Self limited 3rd MC Incomplete recanalizati on of laryngotrac heal tube during embryonic developme nt, 1st 6 month. Extrinsic compression of both trachea and esophagus Symptoma tic in 3-6 months Biphasdic stridor barking cough Endoscopy tracheosto my,intra lesion strd rare BL:arnold chiari syndrome,hy drocephalus, hypoxia UL:accidental injury during ligation of PDA Dysphagia plus stridor esphagogra m
  35. 35. LARYNGOMALACIA SUBGLOTTIC STENOSIS SUBGLOTTIC CYST VOCAL CORD PARALYSIS VASCULAR RING SUB GLOTTIC HEMANGIOMA
  36. 36. Iatrogenic Acquired subglottic stenosis Laryngeal granuloma MC acquired Long term endotracheal tube intubation Tracheostomy Widening of stenosis with cartilage grafts Excision of stenotic graft Result from prolonged intubation Endoscopy:granuloma in vocal cord
  37. 37. Neoplasm & foreign body RECURRENT RESPIRATORY PAPILLOMA FOREIGN BODY MC tumor of Larynx HPV type 6 and 11 Cause genital condyloma Infection via passaage through birth canal Tt with CO2 laser ablation/microdebrider excission of papilloma Alpha interferon,intra lesional cedofovir Potential cause Food and coins Young age at great risk Endoscopic visualization and removal Foreign body
  38. 38. TRACHEOSTOMY  INDICATION:ventilator dependance and airway obstruction  MC comlication:tube obstructions,accidental decannulation that occur months after injury  But Long term tracheostomy in children may affect speech and language development
  39. 39. Hoarseness  VOCAL NODULES: shouting and screaming children endoscopy BL opposing nodules at junction of ant &middle 1/3rd  REFLUX LARYNGITIS: Gastric secretions spilling on to larynx- laryngitis, subglottic stenosis, chr sinusitis otitis media with effussion.  HYPOTHYROID MYXODEMA: increased vocal fold edema look for thyroid function test.  LARYNGOTRACHEAL CLEFT :Cong defect in post cricoid cartilage in larynx. child experience recc RTI, feeding difficulty, hoarseness, severe cleft cause aspiration pneumonia
  40. 40. Reflux laryngitis hypothyroidism
  41. 41. Wish you a joyful life…. & thank you IMNCI - INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS .ARI-ACUTE RESPIRATORY TRACT INFECTION CONTROL PROGRAME .STRIDOR

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