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ACUTE RESPIRATORY ILLNESS <br />     DR.PARTH GURAGAIN<br />
ACUTE RESPIRATORY ILLNESS(ARI)<br />Most common<br />Major cause of mortality and morbidity.<br />Can affect anywhere from...
PROBLEM STATEMENT<br />ARI in young children is responsible for 3.9 million death world-wide.<br />Bangladesh,India,Indone...
ARI in below 5yrs child is responsible for 30-50% of hospital visit..<br />20-40% of hospital admission.<br />It is leadin...
EPIDEMIOLOGICAL DETERMINANTS<br />Agent factors<br />Bacteria<br />   -   Bordetella pertusis<br />   -   Coryneabacterium...
Virus<br />- Adenoviruses-endemic types(1,2,5),epidemic type (3,4,7)<br />   - Enterovirus (ECHO and Coxsackie)<br />   - ...
HOST FACTORS<br />Small children are most vulnerable<br />Fatality more common in young infants, malnourished children, el...
At third decade of life there is surge in infection due to cross infection from their children.<br />Women are more affect...
RISK FACTORS<br />Climatic condition<br />Housing<br />Level of industrialization<br />Overcrowding<br />Poor-nutrition<br...
Mode of transmission<br />Air borne route<br />Person to Person<br />
CONTROL OF ARI<br />By improving primary medical care service<br />Developing better method for:<br /><ul><li>  Early dete...
  Treatment
  If possible prevention</li></ul>Education of mother can be effective tool in reducing mortality and morbidity from ARI.<...
CLINICAL ASSESMENT<br />  - Access the child condition<br />  - Ask for:<br />Age<br />Duration of cough<br />Is child abl...
PHYSICAL EXAMINATION<br />Count the breathing in 1 min.<br />Fast breathing present if:<br /><ul><li>RR 60b/min or more fo...
RR 50b/min or more for 2mths to 12mths.
RR 40b/min or more for 12mths to 5yrs.</li></li></ul><li>Phy. Exam: contd…..<br />Look for chest indrawing<br />Look and l...
CLASSIFICATION OF ILLNESS<br />A. Child aged 2mths -5yrs<br /> 1. Very severe disease<br /> 2. Severe Pneumonia<br /> 3. P...
VERY SEVERE DISEASE<br />SIGNS<br />Not able to drink<br />Convulsion<br />Abnormally sleepy or difficult to wake<br />Str...
SEVERE PNEUMONIA<br /> SIGNS<br />Childs RR(if exhausted child’s RR may not be raised)<br />Chest indrawing plus wheezing<...
PNEUMONIA<br /> SIGNS<br />Fast breathing<br />Absence of chest indrawing<br />CLASSIFY AS-PNEUMONIA<br /> TREATMENT<br />...
NO PNEUMONIA<br />Cough/cold<br />If cough more than 30 days needs assessment<br />Look for ENT problem<br />Home care <br...
B.CLASSIFYING THE ILLNESS IN YOUNG INFANTS(<2MTHS)<br />Signs may be difficult to find in young children<br />Non-specific...
Severe pneumonia
No pneumonia</li></li></ul><li>VERY SEVERE DISEASE<br /> SIGNS<br />Stopped feeding well<br />Convulsion<br />Abnormally s...
SEVERE PNEUMONIA<br />Severe chest indrawing<br />RR 60 OR more<br /> TREATMENT<br />Refer urgently <br />Keep warm<br />A...
NO PNEUMONIA<br />  SIGNS<br />No severe chest indrawing<br />No fast breathing<br /> TREATMENT<br />Keep warm<br />Breast...
TREATMENT<br />Treatment for 2mths to 5yrs (Pneumonia)<br />Age/weight       Paed tab                           Paed syp.<...
SEVERE PNEUMONIA(CHEST IND)<br />
B1.IF CONDITION IMPROVES ,THEN FOR NEXT 3 DAYS<br />
B.2.IF NO IMPROVEMENT THEN FOR NEXT 48 HRS<br />Change antibiotics<br />If Ampicillin –Change to Chloramphenicol IM<br />I...
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Acute Respiratory Illness(Ari)

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Acute Respiratory Illness(Ari)

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

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