This document provides information on the management of severe malaria. It discusses:
1. The signs and symptoms of severe malaria including prostration, altered consciousness, respiratory distress, convulsions, severe anemia, hypoglycemia, and jaundice.
2. The diagnosis of severe malaria which involves parasitological confirmation through blood smear when possible and presumptive treatment while awaiting results.
3. The pre-referral management of severe malaria patients which involves administration of IM artesunate, rectal artesunate, or IM quinine and ensuring they are accompanied for referral.
4. The inpatient management of severe malaria which involves IV administration of artesunate or qu
The document provides an overview of Nepal's malaria control program from its inception in 1954 up until the present. It details how the program launched in 1958 to eradicate malaria but later shifted to control after global eradication efforts failed. It was revised in 1992 and again supported by global funds starting in 2004. The current strategy aims for malaria elimination in Nepal by 2025. The document also outlines the life cycle of malaria, clinical features, diagnosis methods, treatment approaches for uncomplicated and severe cases, chemoprophylaxis, and management of complications.
diagnosis and treatment of malaria according to National Malaria Treatment Protocol Nepal 2019: includes treatment of vivax and falciparum malaria, and chemoprophylaxis
- Malaria is caused by Plasmodium parasites, with P. falciparum and P. vivax being the most common in India. P. vivax is more prevalent in plains while P. falciparum is more common in forested and hilly areas.
- Symptoms include fever, chills, headache, vomiting and more. Microscopy and rapid diagnostic tests are used to diagnose malaria by detecting parasites or antigens.
- For uncomplicated cases, P. vivax is treated with chloroquine while P. falciparum requires artemisinin combination therapy. Severe malaria requires parenteral artesunate or quinine in a hospital setting. Preventing relapse in
This document provides information on severe and complicated malaria. It begins by defining malaria and describing the different species of Plasmodium that cause it. It then distinguishes between uncomplicated and severe malaria. Severe malaria is defined as malaria illness that threatens a patient's life, with features like cerebral malaria, severe anemia, respiratory distress, hypoglycemia, or circulatory collapse. The document outlines groups at high risk of severe malaria and describes diagnosing and managing severe malaria cases, including giving parenteral antimalarial treatment like artesunate immediately, managing complications, and providing supportive care.
This document discusses the diagnosis and treatment of malaria. It covers diagnostic tools such as blood film examination, rapid diagnostic tests, and PCR. Microscopic examination of thick and thin blood smears remains the gold standard for diagnosis. Treatment depends on the species, with ACTs recommended for P. falciparum and chloroquine for P. vivax infections. Severe malaria requires initial parenteral treatment with artesunate or quinine. Prevention involves vector control, chemoprophylaxis, and ensuring radical treatment with primaquine to reduce transmission.
This document provides an overview of malaria, including:
- Malaria is caused by Plasmodium parasites transmitted via mosquito bites and is a major public health problem in Kenya. Plasmodium falciparum causes most cases and severe disease.
- Clinical manifestations range from mild flu-like symptoms to severe complications like cerebral malaria, respiratory distress, and low blood counts. Diagnosis involves microscopy or rapid tests to detect the parasite.
- Treatment depends on disease severity. Uncomplicated cases are treated orally with artemether-lumefantrine as first line or dihydroartemisinin-piperaquine as second line. Severe malaria requires parenteral artesunate
This document discusses malaria, including its lifecycle, clinical features, treatment guidelines, and recent updates. It describes the pre-erythrocytic and erythrocytic stages of malaria's lifecycle. It outlines the symptoms and stages of malaria infection. It provides treatment guidelines for Plasmodium vivax, Plasmodium falciparum, severe malaria, and chemoprophylaxis. It also mentions drug resistance and the RTS,S malaria vaccine currently in clinical trials.
The document provides an overview of Nepal's malaria control program from its inception in 1954 up until the present. It details how the program launched in 1958 to eradicate malaria but later shifted to control after global eradication efforts failed. It was revised in 1992 and again supported by global funds starting in 2004. The current strategy aims for malaria elimination in Nepal by 2025. The document also outlines the life cycle of malaria, clinical features, diagnosis methods, treatment approaches for uncomplicated and severe cases, chemoprophylaxis, and management of complications.
diagnosis and treatment of malaria according to National Malaria Treatment Protocol Nepal 2019: includes treatment of vivax and falciparum malaria, and chemoprophylaxis
- Malaria is caused by Plasmodium parasites, with P. falciparum and P. vivax being the most common in India. P. vivax is more prevalent in plains while P. falciparum is more common in forested and hilly areas.
- Symptoms include fever, chills, headache, vomiting and more. Microscopy and rapid diagnostic tests are used to diagnose malaria by detecting parasites or antigens.
- For uncomplicated cases, P. vivax is treated with chloroquine while P. falciparum requires artemisinin combination therapy. Severe malaria requires parenteral artesunate or quinine in a hospital setting. Preventing relapse in
This document provides information on severe and complicated malaria. It begins by defining malaria and describing the different species of Plasmodium that cause it. It then distinguishes between uncomplicated and severe malaria. Severe malaria is defined as malaria illness that threatens a patient's life, with features like cerebral malaria, severe anemia, respiratory distress, hypoglycemia, or circulatory collapse. The document outlines groups at high risk of severe malaria and describes diagnosing and managing severe malaria cases, including giving parenteral antimalarial treatment like artesunate immediately, managing complications, and providing supportive care.
This document discusses the diagnosis and treatment of malaria. It covers diagnostic tools such as blood film examination, rapid diagnostic tests, and PCR. Microscopic examination of thick and thin blood smears remains the gold standard for diagnosis. Treatment depends on the species, with ACTs recommended for P. falciparum and chloroquine for P. vivax infections. Severe malaria requires initial parenteral treatment with artesunate or quinine. Prevention involves vector control, chemoprophylaxis, and ensuring radical treatment with primaquine to reduce transmission.
This document provides an overview of malaria, including:
- Malaria is caused by Plasmodium parasites transmitted via mosquito bites and is a major public health problem in Kenya. Plasmodium falciparum causes most cases and severe disease.
- Clinical manifestations range from mild flu-like symptoms to severe complications like cerebral malaria, respiratory distress, and low blood counts. Diagnosis involves microscopy or rapid tests to detect the parasite.
- Treatment depends on disease severity. Uncomplicated cases are treated orally with artemether-lumefantrine as first line or dihydroartemisinin-piperaquine as second line. Severe malaria requires parenteral artesunate
This document discusses malaria, including its lifecycle, clinical features, treatment guidelines, and recent updates. It describes the pre-erythrocytic and erythrocytic stages of malaria's lifecycle. It outlines the symptoms and stages of malaria infection. It provides treatment guidelines for Plasmodium vivax, Plasmodium falciparum, severe malaria, and chemoprophylaxis. It also mentions drug resistance and the RTS,S malaria vaccine currently in clinical trials.
Malaria is caused by Plasmodium parasites transmitted through the bites of infected Anopheles mosquitoes. It affects tropical and subtropical regions below 1500 meters in altitude. The life cycle involves the parasite replicating in both the human and mosquito hosts. In humans, the parasites multiply in the liver and blood, causing symptoms like fever, chills and anemia. Untreated P. falciparum malaria can progress to severe complications involving multiple organ systems. Diagnosis involves blood smear microscopy and treatment depends on the Plasmodium species and severity of infection. Prevention involves antimalarial drugs, insect repellents and mosquito nets.
The document provides guidance on managing common conditions in sick young infants, including hypoglycemia, sepsis, meningitis, jaundice, and tetanus neonatorum. It outlines appropriate fluid management, monitoring, treatment with antibiotics and other supportive care, including phototherapy or exchange transfusion for pathological jaundice. The document emphasizes the importance of careful monitoring to guide treatment and detect any worsening in the infant's condition.
Malaria is caused by a parasite transmitted through the bites of infected Anopheles mosquitoes. It presents with fever and flu-like symptoms such as headache and chills. In children, vomiting and diarrhea are also common. The disease is particularly dangerous in developing countries, where it can lead to severe complications and death. Diagnosis involves a blood test to detect the parasite. Treatment depends on the severity of symptoms and parasite species, but generally involves antimalarial drugs like artemether-lumefantrine or quinine. Prevention focuses on reducing mosquito exposure through nets and insecticides as well as antimalarial prophylaxis for high-risk areas.
1) The document provides guidelines for the diagnosis and treatment of malaria in India, outlining recommendations for diagnosing and treating both uncomplicated and severe malaria.
2) Diagnosis is primarily done through microscopy of blood smears, with rapid diagnostic tests and other tests also used. Uncomplicated malaria is generally treated with chloroquine or artemisinin combination therapy depending on the malaria species.
3) Severe malaria requires hospitalization and management of complications along with parenteral antimalarials such as artesunate or quinine. Drug resistance is an ongoing challenge requiring close monitoring.
- Malaria is caused by Plasmodium parasites and spread by Anopheles mosquitoes. It is a major public health issue, with hundreds of millions of cases annually.
- The document discusses the epidemiology and transmission of malaria, symptoms, diagnosis, treatment including for severe and drug-resistant cases, prevention through vector control, and the use of artemisinin derivatives like artesunate which have improved treatment outcomes.
This document provides an overview of emerging topics in clinical toxicology. It discusses new therapies for toxicological emergencies such as high-dose insulin for calcium channel blocker overdose. Intralipid emulsion is emerging as a treatment for local anesthetic toxicity. Methylene blue shows promise for ifosfamide-induced encephalopathy. Commonly encountered toxins like quetiapine now cause more ICU admissions. "New drugs" like synthetic cannabinoids can cause unpredictable effects. Recommendations for snake antivenom and redback spider antivenom use have also changed in recent years. The document emphasizes that a risk assessment approach is key to managing poisonings.
Dr. Ankit Gajjar is a critical care physician at Asutosh Hospital. The document discusses malaria, including what causes it, the species that cause malaria in humans, epidemiology in India, pathophysiology, clinical features, diagnosis, treatment for uncomplicated and severe cases of P. falciparum and other species, treatment in specific populations, monitoring and follow up, relapse vs recrudescence, and various artemisinin-based combination therapies.
Severe malaria is caused by Plasmodium falciparum and can lead to life-threatening complications if not treated promptly. It is characterized by impaired consciousness, generalized convulsions, respiratory distress, circulatory collapse, abnormal bleeding, and hypoglycemia. Diagnosis involves blood smears or RDTs to detect the parasite. Treatment consists of intravenous artesunate or quinine along with antibiotics, anticonvulsants, and supportive care. Complications like cerebral malaria, renal failure, shock, and severe anemia also require specific management to prevent high mortality rates.
This document provides information on malaria case management training in Ghana. It discusses the objectives of training participants on describing malaria pathogenesis, assessing suspected cases, conducting investigations, and providing appropriate treatment. It also defines uncomplicated malaria and provides guidelines on history taking, clinical assessment, laboratory investigations, antimalarial treatment including artemisinin-based combination therapy, and supportive care.
This document provides guidance on the initial management of seizures in adults. It discusses the diagnosis and evaluation of seizures, including detailed history, physical exam, tests like EEG and brain imaging. It describes seizure risk stratification and factors that guide medication choice, such as seizure type and side effect profiles. The effectiveness of common anti-seizure medications like valproate, lamotrigine, levetiracetam, and carbamazepine are reviewed based on trials. Lifestyle factors that can affect seizures are also addressed, as well as genetics influences on treatment. The document concludes by outlining the evaluation and treatment for a sample patient presenting with a first generalized tonic-clonic seizure.
The document provides guidelines for the management of severe traumatic brain injury. It discusses epidemiology of TBI, definitions, methods used to develop the guidelines, and makes recommendations on various treatment, monitoring and threshold topics based on levels of evidence. The guidelines are intended to be a living document that is continuously updated as new evidence emerges.
This document discusses acute gastroenteritis, also known as infectious diarrhea. Some key points:
- Acute gastroenteritis is a common illness that causes vomiting, diarrhea and dehydration. It affects millions of people worldwide annually and is responsible for many child deaths.
- Diagnostic testing is generally not needed for typical cases but may be indicated for severe cases, food handlers, or outbreak investigation. Oral rehydration is the main treatment along with continued feeding and zinc/probiotic supplementation in children.
- Antibiotics are only recommended for specific cases like cholera, bloody diarrhea, or persistent symptoms. Management involves rehydration and continued monitoring for complications like dehydration or electrolyte abnormalities
This document discusses nutrition for critically ill patients. It outlines nutritional risk assessment tools, energy and protein needs, and enteral feeding protocols. For the case, it recommends starting enteral nutrition as soon as hemodynamically stable, with a calorie target of 25-30 kcal/kg ideal body weight per day, or 1250-1500 kcal for a 50kg man. Locally available formulas like Plumpy'Nut and Mumbai formula are options for enteral feeding in the ICU.
malaria guidelines - a case of tropical fever ppt.ssuser4326621
A 26-year-old male presented with fever, headache, and an episode of unresponsiveness after recent travel to Africa. On examination, he had fever and tachycardia. Laboratory tests found pancytopenia and a positive malaria smear. He was diagnosed with Plasmodium falciparum malaria, the most severe and life-threatening form. After initial treatment at an outside hospital, he was given intravenous artesunate and oral artemether-lumefantrine in accordance with treatment guidelines. His liver and kidney function improved and he was discharged after recovery.
This document provides information on the diagnosis and treatment of uncomplicated and severe malaria. It defines uncomplicated malaria as a fever with symptoms like headache and joint pains. Uncomplicated malaria is diagnosed through blood smear microscopy and treated with Coartem over 3 days. Severe malaria involves additional symptoms like impaired consciousness and is treated with intravenous or intramuscular artesunate or quinine. Laboratory confirmation is required and differential diagnosis of other illnesses should be considered.
The document provides information on malaria, including:
1. Malaria is a potentially fatal disease spread by mosquito bites and caused by Plasmodium parasites. It was previously known as marsh fever due to its link to marshes.
2. Key events in the history of malaria include the discovery of the parasite in 1880, identification of mosquito transmission in 1881, and establishment of the WHO's eradication campaign in 1955 and Roll Back Malaria partnership in 1998.
3. Malaria remains a major global health problem, with over 200 million cases and 600,000 deaths estimated in 2021. Children under 15 and pregnant women are most vulnerable to infection and severe disease.
This document provides guidance on diagnosing and treating severe malaria. It discusses:
- Diagnosing severe malaria through taking a medical history, physical exam, parasitological testing, and ruling out other infections.
- Criteria for severe malaria including laboratory abnormalities and clinical symptoms.
- First line treatments of IV or IM artesunate, IM artemether, or IV quinine depending on availability.
- General management of severe malaria patients including addressing hypoglycemia, seizures, fluid balance, and potential complications.
- Contraindicated treatments for severe malaria patients and special considerations for groups like pregnant women and HIV patients.
Presentation TS neocone fluid and electrolyte dr hemant - Copy - Copy.pptxssuser00be96
This infant presented at 9 days of age with loose stools, refusal of feeds, lethargy, respiratory distress, and shock. On examination, the infant was severely dehydrated, bradycardic, tachypnic, and in shock. Laboratory findings showed severe metabolic acidosis, hyponatremia, hyperkalemia, and elevated blood urea. The differential diagnosis includes congenital adrenal hyperplasia, Bartter syndrome, and renal tubular acidosis. Close monitoring and management of fluid, electrolyte, and acid-base abnormalities is needed.
Chikungunya definition and it managementMuniraMkamba
This document discusses integrated health services and rural health services in Kenya. It defines integrated health services as the organization and management of health services so that people receive continuous care when and where they need it. Rural health services in Kenya comprise health centers and dispensaries that offer basic promotive, preventive, and curative services. Outreach activities, mobile clinics, and school health services further aim to improve access and continuity of care for rural populations.
Meningitis , types and it's management both medical and nursingMuniraMkamba
Mood disorders, also known as affective disorders, are characterized by depression, mania, or both. They are common and can have high morbidity and mortality. Major types include major depressive disorder, bipolar disorder I and II, dysthymia, cyclothymia, and premenstrual dysphoric disorder. Treatment involves pharmacotherapy such as antidepressants and mood stabilizers. Nursing care focuses on ensuring safety, meeting basic needs, promoting appropriate behaviors, managing medication, and providing education to clients and their families.
Malaria is caused by Plasmodium parasites transmitted through the bites of infected Anopheles mosquitoes. It affects tropical and subtropical regions below 1500 meters in altitude. The life cycle involves the parasite replicating in both the human and mosquito hosts. In humans, the parasites multiply in the liver and blood, causing symptoms like fever, chills and anemia. Untreated P. falciparum malaria can progress to severe complications involving multiple organ systems. Diagnosis involves blood smear microscopy and treatment depends on the Plasmodium species and severity of infection. Prevention involves antimalarial drugs, insect repellents and mosquito nets.
The document provides guidance on managing common conditions in sick young infants, including hypoglycemia, sepsis, meningitis, jaundice, and tetanus neonatorum. It outlines appropriate fluid management, monitoring, treatment with antibiotics and other supportive care, including phototherapy or exchange transfusion for pathological jaundice. The document emphasizes the importance of careful monitoring to guide treatment and detect any worsening in the infant's condition.
Malaria is caused by a parasite transmitted through the bites of infected Anopheles mosquitoes. It presents with fever and flu-like symptoms such as headache and chills. In children, vomiting and diarrhea are also common. The disease is particularly dangerous in developing countries, where it can lead to severe complications and death. Diagnosis involves a blood test to detect the parasite. Treatment depends on the severity of symptoms and parasite species, but generally involves antimalarial drugs like artemether-lumefantrine or quinine. Prevention focuses on reducing mosquito exposure through nets and insecticides as well as antimalarial prophylaxis for high-risk areas.
1) The document provides guidelines for the diagnosis and treatment of malaria in India, outlining recommendations for diagnosing and treating both uncomplicated and severe malaria.
2) Diagnosis is primarily done through microscopy of blood smears, with rapid diagnostic tests and other tests also used. Uncomplicated malaria is generally treated with chloroquine or artemisinin combination therapy depending on the malaria species.
3) Severe malaria requires hospitalization and management of complications along with parenteral antimalarials such as artesunate or quinine. Drug resistance is an ongoing challenge requiring close monitoring.
- Malaria is caused by Plasmodium parasites and spread by Anopheles mosquitoes. It is a major public health issue, with hundreds of millions of cases annually.
- The document discusses the epidemiology and transmission of malaria, symptoms, diagnosis, treatment including for severe and drug-resistant cases, prevention through vector control, and the use of artemisinin derivatives like artesunate which have improved treatment outcomes.
This document provides an overview of emerging topics in clinical toxicology. It discusses new therapies for toxicological emergencies such as high-dose insulin for calcium channel blocker overdose. Intralipid emulsion is emerging as a treatment for local anesthetic toxicity. Methylene blue shows promise for ifosfamide-induced encephalopathy. Commonly encountered toxins like quetiapine now cause more ICU admissions. "New drugs" like synthetic cannabinoids can cause unpredictable effects. Recommendations for snake antivenom and redback spider antivenom use have also changed in recent years. The document emphasizes that a risk assessment approach is key to managing poisonings.
Dr. Ankit Gajjar is a critical care physician at Asutosh Hospital. The document discusses malaria, including what causes it, the species that cause malaria in humans, epidemiology in India, pathophysiology, clinical features, diagnosis, treatment for uncomplicated and severe cases of P. falciparum and other species, treatment in specific populations, monitoring and follow up, relapse vs recrudescence, and various artemisinin-based combination therapies.
Severe malaria is caused by Plasmodium falciparum and can lead to life-threatening complications if not treated promptly. It is characterized by impaired consciousness, generalized convulsions, respiratory distress, circulatory collapse, abnormal bleeding, and hypoglycemia. Diagnosis involves blood smears or RDTs to detect the parasite. Treatment consists of intravenous artesunate or quinine along with antibiotics, anticonvulsants, and supportive care. Complications like cerebral malaria, renal failure, shock, and severe anemia also require specific management to prevent high mortality rates.
This document provides information on malaria case management training in Ghana. It discusses the objectives of training participants on describing malaria pathogenesis, assessing suspected cases, conducting investigations, and providing appropriate treatment. It also defines uncomplicated malaria and provides guidelines on history taking, clinical assessment, laboratory investigations, antimalarial treatment including artemisinin-based combination therapy, and supportive care.
This document provides guidance on the initial management of seizures in adults. It discusses the diagnosis and evaluation of seizures, including detailed history, physical exam, tests like EEG and brain imaging. It describes seizure risk stratification and factors that guide medication choice, such as seizure type and side effect profiles. The effectiveness of common anti-seizure medications like valproate, lamotrigine, levetiracetam, and carbamazepine are reviewed based on trials. Lifestyle factors that can affect seizures are also addressed, as well as genetics influences on treatment. The document concludes by outlining the evaluation and treatment for a sample patient presenting with a first generalized tonic-clonic seizure.
The document provides guidelines for the management of severe traumatic brain injury. It discusses epidemiology of TBI, definitions, methods used to develop the guidelines, and makes recommendations on various treatment, monitoring and threshold topics based on levels of evidence. The guidelines are intended to be a living document that is continuously updated as new evidence emerges.
This document discusses acute gastroenteritis, also known as infectious diarrhea. Some key points:
- Acute gastroenteritis is a common illness that causes vomiting, diarrhea and dehydration. It affects millions of people worldwide annually and is responsible for many child deaths.
- Diagnostic testing is generally not needed for typical cases but may be indicated for severe cases, food handlers, or outbreak investigation. Oral rehydration is the main treatment along with continued feeding and zinc/probiotic supplementation in children.
- Antibiotics are only recommended for specific cases like cholera, bloody diarrhea, or persistent symptoms. Management involves rehydration and continued monitoring for complications like dehydration or electrolyte abnormalities
This document discusses nutrition for critically ill patients. It outlines nutritional risk assessment tools, energy and protein needs, and enteral feeding protocols. For the case, it recommends starting enteral nutrition as soon as hemodynamically stable, with a calorie target of 25-30 kcal/kg ideal body weight per day, or 1250-1500 kcal for a 50kg man. Locally available formulas like Plumpy'Nut and Mumbai formula are options for enteral feeding in the ICU.
malaria guidelines - a case of tropical fever ppt.ssuser4326621
A 26-year-old male presented with fever, headache, and an episode of unresponsiveness after recent travel to Africa. On examination, he had fever and tachycardia. Laboratory tests found pancytopenia and a positive malaria smear. He was diagnosed with Plasmodium falciparum malaria, the most severe and life-threatening form. After initial treatment at an outside hospital, he was given intravenous artesunate and oral artemether-lumefantrine in accordance with treatment guidelines. His liver and kidney function improved and he was discharged after recovery.
This document provides information on the diagnosis and treatment of uncomplicated and severe malaria. It defines uncomplicated malaria as a fever with symptoms like headache and joint pains. Uncomplicated malaria is diagnosed through blood smear microscopy and treated with Coartem over 3 days. Severe malaria involves additional symptoms like impaired consciousness and is treated with intravenous or intramuscular artesunate or quinine. Laboratory confirmation is required and differential diagnosis of other illnesses should be considered.
The document provides information on malaria, including:
1. Malaria is a potentially fatal disease spread by mosquito bites and caused by Plasmodium parasites. It was previously known as marsh fever due to its link to marshes.
2. Key events in the history of malaria include the discovery of the parasite in 1880, identification of mosquito transmission in 1881, and establishment of the WHO's eradication campaign in 1955 and Roll Back Malaria partnership in 1998.
3. Malaria remains a major global health problem, with over 200 million cases and 600,000 deaths estimated in 2021. Children under 15 and pregnant women are most vulnerable to infection and severe disease.
This document provides guidance on diagnosing and treating severe malaria. It discusses:
- Diagnosing severe malaria through taking a medical history, physical exam, parasitological testing, and ruling out other infections.
- Criteria for severe malaria including laboratory abnormalities and clinical symptoms.
- First line treatments of IV or IM artesunate, IM artemether, or IV quinine depending on availability.
- General management of severe malaria patients including addressing hypoglycemia, seizures, fluid balance, and potential complications.
- Contraindicated treatments for severe malaria patients and special considerations for groups like pregnant women and HIV patients.
Presentation TS neocone fluid and electrolyte dr hemant - Copy - Copy.pptxssuser00be96
This infant presented at 9 days of age with loose stools, refusal of feeds, lethargy, respiratory distress, and shock. On examination, the infant was severely dehydrated, bradycardic, tachypnic, and in shock. Laboratory findings showed severe metabolic acidosis, hyponatremia, hyperkalemia, and elevated blood urea. The differential diagnosis includes congenital adrenal hyperplasia, Bartter syndrome, and renal tubular acidosis. Close monitoring and management of fluid, electrolyte, and acid-base abnormalities is needed.
Chikungunya definition and it managementMuniraMkamba
This document discusses integrated health services and rural health services in Kenya. It defines integrated health services as the organization and management of health services so that people receive continuous care when and where they need it. Rural health services in Kenya comprise health centers and dispensaries that offer basic promotive, preventive, and curative services. Outreach activities, mobile clinics, and school health services further aim to improve access and continuity of care for rural populations.
Meningitis , types and it's management both medical and nursingMuniraMkamba
Mood disorders, also known as affective disorders, are characterized by depression, mania, or both. They are common and can have high morbidity and mortality. Major types include major depressive disorder, bipolar disorder I and II, dysthymia, cyclothymia, and premenstrual dysphoric disorder. Treatment involves pharmacotherapy such as antidepressants and mood stabilizers. Nursing care focuses on ensuring safety, meeting basic needs, promoting appropriate behaviors, managing medication, and providing education to clients and their families.
Hypertension and its management actual vs idealMuniraMkamba
Affective disorders are characterized by periodic alterations in mood between mania and depression. The central symptoms involve changes in mood, thinking, perception, physical signs and behaviors. Etiology may involve genetic and biological factors. Major types of depression include major depression, dysthymia, seasonal affective disorder, and postpartum depression. Mania is characterized by elevated mood, irritability, impulsiveness, and other mental and physical changes. Bipolar disorder involves alternating episodes of mania and depression. Treatment involves pharmacological interventions like lithium, antidepressants, antipsychotics as well as psychological and social support. The course of illness may be chronic with risk of recurrence without treatment. Prognosis is generally fair with treatment
Hello syndrome slideshare and managementMuniraMkamba
The document summarizes a Sunday church service. It includes the preacher, Bible verses from Waefeso 2:8-9 and John 6:70, and the theme of salvation by grace through faith in God's power. Additionally, it mentions that Christians are chosen to bear fruit pleasing to God from John 15:16 and that acknowledging brings righteousness before God. It lists calling and meditating on God's word day and night as important, along with recognizing, bearing fruit, and how long certain tasks take.
Hellp syndrome slideshare definition and managementMuniraMkamba
The document outlines the recommended immunization schedule in Kenya. It recommends polio and BCG vaccines at birth, and at 6 weeks adding pentavalent, PCV, and rotavirus vaccines. It further recommends continuing with polio, pentavalent, PCV and rotavirus vaccines at 10 weeks and 14 weeks, and adding the IPV vaccine at 14 weeks. It provides instructions on injection sites for different vaccines and notes the time periods certain vaccines are considered valid. It also lists some common illnesses and their treatments.
This document provides an overview of a 22 hour course on gastrointestinal and biliary tract disorders. It covers the anatomy and physiology of the gastrointestinal tract, common manifestations of gastrointestinal disorders, assessment of patients with gastrointestinal issues, and diseases and conditions of the gastrointestinal tract and biliary system including their management. Specific topics discussed include the esophagus, stomach, liver, gallbladder, pancreas, and large intestine. Diseases like achalasia, gastroesophageal reflux disease, and cancer of the esophagus are described in detail.
This document discusses various drugs used to treat gastrointestinal conditions. It covers drugs that act on the gastrointestinal tract like antacids, H2 receptor blockers, proton pump inhibitors, cytoprotectants, antidiarrheals, and antibiotics for H. pylori eradication. It discusses their mechanisms of action, uses, and side effects. Laxatives are also covered, with classifications and mechanisms of different types.
An embolism occurs when a particle or blood clot obstructs blood flow. Common types include pulmonary (lung) and brain embolisms. Pulmonary embolisms are usually caused by blood clots that break off and travel to the lungs from deep veins in the legs. Risk factors include prolonged immobility, recent surgery or injury, smoking, oral contraceptives, and obesity. Symptoms include shortness of breath, chest pain, and coughing up blood. Diagnosis involves blood tests, CT scans, ultrasound, and angiograms. Treatment focuses on anticoagulants and thrombolytic drugs to dissolve clots along with managing pain and oxygen levels.
This document discusses gynecological emergencies, which require urgent management. Common presentations include pelvic pain, abnormal vaginal bleeding, discharge, and swelling. Potential causes are infections like pelvic inflammatory disease, ruptured cysts, ectopic pregnancy, and hemorrhage from fibroids. Evaluation involves history, exam, and potential imaging and labs. Management depends on the underlying cause but often involves antibiotics, pain management, and monitoring for potential surgery or complications. Sexual assault victims require counseling, testing/prevention for STIs and pregnancy, and treatment of injuries.
This document discusses drugs used to treat gastrointestinal disorders. It covers proton pump inhibitors, H2 receptor antagonists, prostaglandin analogues, mucosal protectants, antacids, laxatives, and antidiarrheal drugs. The goals of treatment for peptic ulcer disease are to reduce acid secretion, protect the mucosal lining, and use antibiotics to treat Helicobacter pylori infections. Common proton pump inhibitors include omeprazole and pantoprazole, while ranitidine and cimetidine are H2 receptor antagonists. Sucralfate and bismuth compounds protect ulcers. Laxatives include bulk formers like psyllium while antidiarrhe
The document discusses several endocrine disorders and conditions involving hormone imbalances. It covers disorders of the pituitary gland like gigantism and acromegaly caused by excess growth hormone, as well as diabetes insipidus caused by excess antidiuretic hormone. Disorders of the thyroid like Graves' disease, and of the adrenal glands like Cushing's syndrome and Addison's disease are also outlined. The effects and roles of various hormones produced by these and other endocrine glands like the pancreas and gonads are described.
This document outlines the course for a gynaecology course. It will cover anatomy and physiology of the female reproductive system, gynaecological assessment, and various gynaecological disorders. Specific disorders that will be discussed include menstruation disorders, abortion, ectopic pregnancy, endometriosis, infertility, and cancers of the reproductive organs. Each disorder will be defined, types/classes described, causes/risk factors explained, pathophysiology outlined, signs and symptoms detailed, management strategies provided, and potential complications noted. The course will provide an in-depth review of female reproductive health and common gynaecological issues.
This document discusses sexually transmitted infections and gynaecologic infections. It begins by defining lower genital tract infections and outlining their causes and management. Specific infections discussed include trichomoniasis, candidiasis, gonorrhea, chlamydia, bacterial vaginosis, herpes, HIV, and pelvic inflammatory disease. The document emphasizes the importance of screening, case management using a syndromic approach, and targeted interventions to control sexually transmitted infections.
This document outlines the course content for a gynaecology course. It will cover topics such as anatomy and physiology, gynaecological assessment, common disorders including menstrual disorders, abortions, pelvic congestion syndrome and ectopic pregnancy. Specific conditions like dysfunctional uterine bleeding, threatened abortion and septic abortion will also be described in terms of definition, causes, signs/symptoms, management and complications.
This document provides an overview of hematological disorders and the anatomy and physiology of blood cells. It discusses hematopoiesis, the constituents of blood including erythrocytes, leukocytes, and platelets. Erythrocytes are red blood cells that carry oxygen and carbon dioxide without a nucleus. Leukocytes are white blood cells that help fight infection, and come in two types: granulocytes with granules and lymphocytes/monocytes without. Platelets are disk-shaped cell fragments involved in clotting. The document also reviews the formation and functions of red blood cells, white blood cells, and platelets in more detail.
This document discusses bleeding disorders and specifically hemophilia. It defines hemophilia as a hereditary bleeding disorder caused by a deficiency in clotting factor VIII or IX. Males are typically affected as it is an X-linked trait. Symptoms include prolonged bleeding after injury or surgery and spontaneous bleeding into joints and muscles. The condition ranges from mild to severe depending on level of clotting factor deficiency. Treatment involves replacing the missing clotting factor through transfusions or concentrates. Nursing care focuses on education to prevent injury and bleeding episodes as well as pain management during episodes.
This document provides information on iron deficiency anemia, including its definition, causes, clinical features, diagnosis, and treatment. It defines iron deficiency anemia as a type of anemia that occurs when the supply of iron is inadequate to support optimal red blood cell production. The main causes listed are poor diet, increased demand, blood loss, and decreased iron absorption. Clinical features include general anemia symptoms as well as pale skin and abnormalities of the mouth, tongue, and nails. Diagnosis involves blood tests to check hemoglobin and iron levels. Treatment focuses on iron replacement through supplements or injections as well as treating the underlying cause.
The document discusses immunization and vaccination programs in Kenya, including definitions of key terms, descriptions of vaccine-preventable diseases, immunization schedules, the roles of healthcare workers in immunization, and strategies for maintaining vaccine potency and the cold chain necessary to deliver effective immunization services. Proper administration and storage of vaccines like BCG and measles are outlined to ensure optimal protection against tuberculosis and other illnesses.
This document provides information on domiciliary midwifery care and home visiting. It discusses the requirements for home visiting kits, principles of home visiting, procedures for home visits, record keeping, and advantages and challenges of home visits. The key aspects are providing midwifery care to pregnant women in their homes, including antenatal, intranatal and postnatal care and management. Regular planned home visits allow midwives to monitor pregnancies and provide health education and counseling.
This document discusses budgeting for food and factors that influence food budgeting. It outlines steps in food budgeting such as establishing the amount of money available, listing food items needed, and calculating costs. The document also covers food habits and patterns, roles of community health nurses, measurements of food security, pillars of food security, and challenges to achieving food security such as climate change and food waste. Safe food preparation and storage techniques are also summarized.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Nsaids
1. Division of National Malaria Programme – Komesha Malaria, Okoa Maisha
Ministry of Health
Module 2: Learning Unit 2
Management of Severe Malaria
Training of Malaria Case Management
Master trainers
2. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Learning Unit 2:
Management of Severe
Malaria
3. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Learning objectives
By the end of the learning unit, the participants will be
able to:
1. Identify signs and symptoms of Severe malaria
2. Diagnose Severe malaria
3. Describe pre-referral management of severe malaria
4. Describe management of severe malaria
4. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Signs and symptoms of Severe Malaria
Severe malaria is a life threatening condition defined as Peripheral parasitaemia in the
presence of the following clinical or laboratory features
• Prostration,
• altered consciousness,
• respiratory distress,
• multiple generalized convulsions,
• severe anaemia (Hb<5g/dl),
• hypoglycaemia (<2.2mmol/l),
• jaundice
• NB- features may occur singly or in combination,
5. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
What are the signs and symptoms of
severe malaria
(Brainstorm)
GROUP
BRAINSTORMING
What are the signs
& symptoms of
severe malaria?
14
6. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Conjugate deviation of the eyes to the left or upwards
6
16. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Role of laboratory diagnosis in severe
malaria
• Parasitological confirmation is recommended
• Presumptive treatment should be started immediately
while waiting for parasitological confirmation
• Antimalarial treatment should not be withheld if
parasitological diagnosis is not possible or delayed
• Other investigations to determine severity and prognosis
should be undertaken where feasible
• (HB, Blood sugar, Urea and electrolyte)
• Positive slides do not rule out other causes of severe
disease
17. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Clinical Manifestations of Severe Malaria
• Cerebral Malaria
• Severe Anaemia
• Hypoglycaemia
18. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Assessment Tasks For Cerebral malaria (1)
i. Clinical assessment
• Assess level of consciousness using coma score.
• Determine the presence of severe anaemia
• Determine presence of respiratory distress
19. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Assessment Tasks For Cerebral malaria cont’d
• Determine hydration status
• Assess for renal insufficiency
• Assess for evidence of Disseminated Intravascular Coagulopathy (DIC)
• Assess for stiff neck and do lumbar puncture
20. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Assessment Tasks For Cerebral malaria cont’d
ii. Laboratory Tests
• In children with altered consciousness, start treatment for both malaria and
meningitis until lumbar puncture results exclude meningitis
• Do blood glucose to rule out hypoglycemia
21. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Assessment Tasks For Severe Anaemia (1)
i. Clinical assessment
• Examine for pallor on the palms and conjunctiva
• Determine presence of respiratory distress
• Assess for shock
• Assess for evidence of Disseminated Intravascular Coagulopathy
• Assess for evidence of cardiac failure
• Pulmonary oedema
22. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Assessment Tasks For Severe Anaemia (2)
ii. Laboratory test.
• Determine haemoglobin levels, blood group and cross match where applicable
23. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Assessment Tasks For Hypoglycaemia
i Clinical assessment
• Assess the level of consciousness
ii Laboratory test
• Determine the blood glucose level
24. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Part 2
Pre-referral management
25. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Pre-referral treatment (1)
• Treatment for suspected severe malaria provided at the
peripheral facility where IV infusion cannot be given as
patient waits for referral
• Initiate treatment with IM artesunate
• If patient has altered consciousness, administer
antibiotic for meningitis (e.g. Ceftriaxone)
Pre-referral Treatment
• Treatment for suspected severe malaria
provided at the peripheral facility where IV
infusion cannot be given as patient waits for
referral
• If patient has altered consciousness, administer
antibiotic for meningitis (e.g. Ceftriaxone)
• Initiate treatment
with IM artesunate
44
Pre-referral Treatment cont’d
Transport child lying on the side
Health worker should accompany patient
Investigate mode of transporting patient
All attempts should be made to refer patients
• Give clear referral note with clinical
picture and medications given and doses
• If investigations were done, send results
or slides along with patient
45
ARTESUNATE PRODUCT DESCRIPTION
• Artesunate dispensed as
Artesunic powder
• Dissolved in sodium
bircarbonate (5%) to form
sodium artesunate
• Solution then dissolved in
5mls of normal saline or
5% dextrose
• USE OF WATER FOR INJECTION
NOT RECOMMEDED
Artesunate
powder
Bicarbonate
ampoule
Saline
Solution
+
47
26. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
• Administer treatment in the following order of
preference depending on availability:
IM artesunate
Rectal Artesunate (suppositories)
IM Quinine
IM Artemether
ARTESUNATE PRODUCT DESCRIPTION
• Artesunate dispensed as
Artesunic powder
• Dissolved in sodium
bircarbonate (5%) to form
sodium artesunate
• Solution then dissolved in
5mls of normal saline or
5% dextrose
• USE OF WATER FOR INJECTION
NOT RECOMMEDED
Artesunate
powder
Bicarbonate
ampoule
Saline
Solution
+
47
Pre-Referral dosage of IM
artesunate
• Administer 3.0mg/kg for children < 20kg ,
then refer
• Administer 2.4mg/kg for children > 20kg
and adults, then refer
48
27. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Rectal Artesunate
• Rectal artesunate is presented as suppositories
• Administer a single dose
• If expelled before 30 mins, insert a second one
• For young children hold the buttocks for 10 mins to
retain the suppository
• For patients above 6 yrs, Rectal artesunate is not
recommended
28. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Dose of IM quinine
• Quinine must be diluted to a maximum of
• 50mg/ml in children
• 100mg/ml in adults before IM administration
• Loading dose for IM quinine is 20mg/kg in ALL age groups ( to a maximum of
1200mg)
• A maximum of 3ml to be injected at one site
29. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Disadvantages of IM quinine
• Risk of sterile abscesses
• Relatively poor absorption of quinine (less drug available) compared to IV or
oral quinine – the illness may worsen
30. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
IM Artemether
• IM artemether is fat soluble
• It is provided in dilution form
• Administer as a stat dose
• Administer IM 3.2mg/kg/body wt
• Refer patient after administration
31. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Part 3
In patient management of severe malaria
32. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
IM Artemether
• IM artemether is fat soluble
• It is provided in dilution form
• Administer as a start dose
• Administer IM 3.2mg/kg/body wt
• Refer patient after administration
STEP 1. WEIGH
THE PATIENT
STEP 2. CHECK
VIALS NEEDED NOTE:
• Each vial require separate reconstitution,
dilution and administration
• Reconstitute immediately before use 54
33. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
STEP 3: RECONSTITUTE
A
B
C
D
STEP 4: DILUTION
C
B
A
D
VOLUME FOR DILUTION IV IM
Bicarbonate Solution Volume 1ml 1ml
Saline Solution 5ml 2ml
Total Volume 6ml 3ml
Artesunate 60mg solution
concentration
10mg/ml 20mg/ml
55
34. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
STEP 5. CALCULATE DOSE
Less than 20 kg(IV) Less than 20kg (IM)
More than 20 kg(IV) More than 20kg (IM)
56
35. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Part 3
Inpatient management of Severe Malaria
STEP 1. WEIGH
THE PATIENT
STEP 2. CHECK
VIALS NEEDED NOTE:
• Each vial require separate reconstitution,
dilution and administration
• Reconstitute immediately before use 54
STEP 3: RECONSTITUTE
A
B
C
D
STEP 4: DILUTION
C
B
A
D
VOLUME FOR DILUTION IV IM
Bicarbonate Solution Volume 1ml 1ml
Saline Solution 5ml 2ml
Total Volume 6ml 3ml
Artesunate 60mg solution
concentration
10mg/ml 20mg/ml
55
STEP 5. CALCULATE DOSE
Less than 20 kg(IV) Less than 20kg (IM)
More than 20 kg(IV) More than 20kg (IM)
56
6. ADMINISTER
• 3 parenteral doses over 24 hrs
• Continue parenteral treatment (1 dose
daily) until patient can take oral medication
(Max 7 days)
• Mandatory full 3-day course of ACT as soon
as patient can take oral medication
– 1st dose of ACT btwn 8 & 12 hrs after last
injection
• Evaluate patients progress continuously
7. DOSING SCHEDULE
57
36. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Quinine administration in children
• Loading dose of 20mg/kg in 15ml/kg of 5% dextrose or normal saline to run
over 4 hours
• Omit loading dose if any quinine has been given in the previous 24 hours
• 8 hours from commencement of initial dose, give 10mg/kg quinine in 10ml/kg
of 5% dextrose or normal saline to run over 4 hours
• Repeat 10mg/kg infusion every 8 hours until the patient is able to sit up and
take oral medication
37. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Quinine administration in adults
• Loading dose of 20mg/kg (maximum of 1200mg)in 5% dextrose or normal
saline to run over 4 hours
• Omit loading dose if any quinine has been given in the previous 24 hours
• Maintain with 10mg/kg (maximum of 600mg) infusion 8 hourly until the
patient is able to take oral medication
38. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Follow on treatment after IV quinine
• Once all patients are able to take oral medication:
• Give a full course of artemether-lumefantrine
OR
• Continue oral quinine at 10mg/kg (max 600mg) 8 hourly for a total of 7 days of
treatment
39. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Supportive treatment
• Hypoglycaemia – IV or oral glucose (10% glucose 5
ml/kg)
• Convulsions
• diazepam 0.3mg/kg IV or 0.5 mg/kg rectally
• Phenytoin or phenobarbitone
• Severe anaemia – transfuse
• Fluid and electrolyte balance
• Fever and nursing care
40. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Frequent questions
1. Would you give Artesunate / IV Quinine to a child with severe malaria and
Hb of 3g/dl?
2. Would you give fluid to a child with Hb of 3g/dl before giving a blood
transfusion?
41. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Answers
1. Yes, Artesunate or quinine must be given as soon as possible while waiting
for blood transfusion.
2. Yes, children with severe malaria and severe anaemia can be given fluids
while waiting for blood transfusion.
43. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Case study 1
• A 2-year-old girl from an area with stable malaria develops fever and soon
has a brief convulsion. The family lives in a remote community away from
the city. Initially the mother gave the child a teaspoonful of herbal
concoction. Later, on the evening of the same day, the child's speech
became less comprehensible and shortly afterwards she was no longer
responding to any call. It took the mother 4 hours to get to the nearest
hospital and the child remained unconscious until they got there. In
addition to the loss of consciousness, she was found on examination to be
severely pale with a temperature of 38.5°C.
• What key information is provided in this history?
• What signs of severe disease can you identify?
• How should this child’s illness be classified
• What urgent treatment would you give
• List 4 important laboratory tests to be done.
• What specific treatment would you give this child?
44. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Case history 2
• The place: a rural clinic in a hyper endemic P. falciparum area.
Various antimalarial drugs are available, but intravenous infusions
cannot be given.
• A child aged 20 months became feverish two days ago and has
vomited several times today. One hour ago the child had a
convulsion, described by the mother as a repetitive twitching of
the limbs and mouth, followed by unresponsiveness for a few
minutes. The child is now febrile (39°C), conscious, and withdraws
promptly from any painful stimulus. A thick blood film shows P.
falciparum rings “860/200”WBC. The child repeatedly vomits any
antimalarial drug given by mouth.
45. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Case study 2 cont’d
• Does the child have cerebral malaria? Why?
• What should you do about the convulsions?
• What treatment will you give? State dose & route of
administration.
On the second day of treatment, the child was brought back to the
clinic. There was little change; he was still febrile and the
parasitaemia was similar to the previous day.
• Does this suggest that the child has drug resistant malaria?
The child went on to complete a full course of AL. By the 3rd day, he
was well and aparasitaemic.
At the end of 7 days a further blood test showed gametocytes.
• What should be done about the gametocytes present in the blood
after treatment?
46. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
…Case study 3 cont’d
i. What are the differential diagnoses?
ii.Was the patient right to think he was immune to malaria?
iii.The thick blood film shows P falciparum 3900/200 WBC and
the thin blood film shows that 26% of the red cells are
parasitized. What else would you look for in the thin blood
film?
iv.What else would you do to investigate the bleeding tendency?
v.What treatment is needed for the bleeding?
47. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Case study 3
• 4. A four-year-old girl is brought to the outpatient department of your hospital by her mother, late in the
evening. The child was well until yesterday morning (36 hours ago), when she began to have fever. Yesterday
she took meals but seemed restless; today she has refused food, and only drank a little. The mother says the
child had a “fit” this morning; she regained consciousness immediately. For the past few hours the child has
been increasingly drowsy, and for the last hour has been unconscious.
• On examination the child is well nourished, unconscious and not dehydrated. The axillary temperature is
40.2°C; pulse 120 beats/min, regular; blood pressure 90/70 mmHg. No neck stiffness. Some yellowish sticky
fluid is seen filling the external part of the left ear. There was no rash.
48. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Case study 3
i. What essential laboratory tests will you perform to guide your
management of the patient?
ii. Why does the blood glucose test have priority in this case?
iii.Should you wait for the blood glucose test if it will take more than 2 hours?
iv.So what should you do?
In this child, a stix test on finger-prick capillary blood revealed a glucose level
of 1.0 mmol/L (18 mg/dl). 50% dextrose was given intravenously but the
child remained unconscious. What does this suggest?
• The child has P falciparum parasitaemia 465/200 WBCs with
hypoglycaemia.
49. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Case study 3 cont’d
v. Does this exclude a diagnosis of meningitis?
vi. If stiff neck is absent is it necessary to do a lumbar puncture?
vii. Does clear & colourless cerebrospinal fluid exclude
meningitis?
viii. what antimalarial drug will you give the patient? Give the
dose and route.
ix. If haemoglobin is 6.3.mg/dL. What will you do?
x. At what point would you give a blood transfusion?
xi. If blood transfusion is necessary, how would you give the
blood?
50. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
xii. What clinical observations would you maintain during
management?
xiii. What laboratory tests would you repeat, and frequency?
xiv. What should be looked for after the child has recovered?
51. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Case study 5
• The place: A country where P. falciparum malaria is transmitted in forested
areas but not in the main cities.
• A woman aged 25 years is brought to the outpatient department of the
central hospital in the capital. She is a local resident, the wife of a business
executive, and is in the seventh month of her pregnancy.
• The patient became ill five days ago, with chills, sweating and headache. An
antibiotic was prescribed and her condition seemed to improve, but
yesterday she developed rigors and persistent vomiting. A blood film at the
local clinic revealed malaria parasites, and oral quinine (600 mg every 8
hours) was prescribed. She took two doses.
• Today she has been referred to your hospital because of confusion.
Examination reveals a semiconscious woman who is unable to talk. She
withdraws her hand from a painful stimulus but cannot localize a stimulus
applied to the sternum or forehead. There is no neck stiffness, jaundice,
pallor or rash. Axillary temperature is 39°C, pulse 90 beats/min, blood
pressure 110/70 mmHg. The uterine fundus is palpable (26 - 28 weeks) and
the foetal heart can be heard.
52. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
…Case history 5
i) What other questions would you ask the patient’s relatives?
ii) What tests are urgently required?
ii) If the blood glucose is 1.2 mmol/L, what treatment will you give?
iii) If the blood film shows P falciparum 465/200 WBCs, and the cerebrospinal fluid is normal except for low
glucose, what antimalarial drug would you administer and by what route?
iv) Would you prefer an alternative to quinine because of the pregnancy?
v) Would you give a loading dose of quinine?
vi) What nursing procedures are important during this treatment?
53. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
Case history 5 cont’d
i. What other questions would you ask the patient’s relatives?
ii. What important tests should be done?.
• a)
• b).
• c).
• d).
iii.If the blood glucose is 1.2 mmol/L, what treatment will you give?
iv.If the blood film shows P. falciparum 465/200 WBCs, and the cerebrospinal
fluid is normal except for low glucose, what antimalarial drug would you
administer and by what route?
54. National Malaria Control Programme – Komesha Malaria, Okoa Maisha
v. Would you prefer an alternative to quinine because of the
pregnancy?
vi. Would you give a loading dose of quinine?
vii. What nursing procedures are important during this
treatment?
After 6 hours, the patient becomes increasingly restless. The
respiratory rate increased to 40/minute. The blood glucose
level is normal. Under these conditions, what special
observations would you make?
• a)
• b)
56. Division of National Malaria Programme – Komesha Malaria, Okoa Maisha
Malaria Free KENYA
Elimination
SMEOR
Case Mgmt SBC
Vector Control
MIP
Prog
Mgmt
56
Editor's Notes
Self introduction
Purpose of the presentation.
Opisthotonos. There is also posturing of the arms in various positions. These features indicate severe cerebral dysfunction.
White conjunctiva: Anaemia
Palmar Pallor: Anaemia
All we do is to achieve a malaria – free Kenya.
Invite brief Q&A.