Acute Respiratory Illness(Ari)
-
Upload
parth-guragain -
Category
Documents
-
view
2.725 -
download
0
Transcript of Acute Respiratory Illness(Ari)
ACUTE RESPIRATORY ILLNESS
DR.PARTH GURAGAIN
ACUTE RESPIRATORY ILLNESS(ARI)
Most common Major cause of mortality and morbidity. Can affect anywhere from nose to alveoli. Can be classified into ALRI(Epiglottitis, laryngitis, laryngotrachietis,
LTB, bronchitis, bronchiolitis, pneumonia) AURI(Common cold, pharyngitis,otitis media) In less developed countries measles and
whooping cough are major cause of Respiratory tract infection.
PROBLEM STATEMENT
ARI in young children is responsible for 3.9 million death world-wide.
Bangladesh,India,Indonesia and Nepal together account for 40% of global mortality.
90% of ARI death is due to pneumonia. Most is bacterial in origin. Incidence of pneumonia in developed
countries 3-4%, in developing countries 20-30%
ARI in below 5yrs child is responsible for 30-50% of hospital visit..
20-40% of hospital admission. It is leading cause of deafness as result
of otitis media.
EPIDEMIOLOGICAL DETERMINANTS
Agent factors Bacteria - Bordetella pertusis - Coryneabacterium diptheriae - Haemophilus influenzae - Klebsiella pneumonia - Staphylococcus pyogenes.
Virus - Adenoviruses-endemic
types(1,2,5),epidemic type (3,4,7) - Enterovirus (ECHO and Coxsackie) - Influenza A,B,C - Measles - RSV
Others - Chlamydia type B - Coxiella burnetti - Mycoplasma pneumoniae
HOST FACTORS
Small children are most vulnerable Fatality more common in young infants,
malnourished children, elderly. In developing countries fatality more due
to malnutrition and LBW. URTI is more common in children than
adults. Illness rate more common in younger
children and decreases with increasing age.
At third decade of life there is surge in infection due to cross infection from their children.
Women are more affected due to their exposure to small children.
RISK FACTORS
Climatic condition Housing Level of industrialization Overcrowding Poor-nutrition LBW Indoor smoke pollution Maternal smoking
Mode of transmission
Air borne route
Person to Person
CONTROL OF ARI
By improving primary medical care service
Developing better method for: Early detection Treatment If possible prevention Education of mother can be effective
tool in reducing mortality and morbidity from ARI.
CLINICAL ASSESMENT - Access the child condition - Ask for: Age Duration of cough Is child able to drink (2mth-5yrs) Has child stopped feeding (<2mths) Had child suffered from any illness (e.g.: measles) Does child have fever Is child excessively drowsy Did child have convulsion Is there irregular breathing Short period of not breathing(apnea) Has child turned blue Any H/O T/t
PHYSICAL EXAMINATION
Count the breathing in 1 min. Fast breathing present if: RR 60b/min or more for <2mths. RR 50b/min or more for 2mths to
12mths. RR 40b/min or more for 12mths to 5yrs.
Phy. Exam: contd…..
Look for chest indrawing Look and listen for Stridor (is the sound
produced while breathing in aka croup) Look for Wheeze (sound produced when
breathing out is difficult) Abnormally sleepy and difficult to wake. Feel for fever or low temperature. Check for severe malnutrition Look for cyanosis.
CLASSIFICATION OF ILLNESS
A. Child aged 2mths -5yrs 1. Very severe disease 2. Severe Pneumonia 3. Pneumonia 4. No Pneumonia- cough, cold
VERY SEVERE DISEASE SIGNS Not able to drink Convulsion Abnormally sleepy or difficult to wake Stridor in calm child Severe malnutrition CLASSIFY AS-VERY SEVERE DISEASE TREATMENT Refer urgently to hospital Give 1st dose of antibiotics T/t of fever if present T/t of wheezing if present If cerebral malaria give anti malarial
SEVERE PNEUMONIA SIGNS Childs RR(if exhausted child’s RR may not be raised) Chest indrawing plus wheezing OTHER SIGNS -Nasal flaring -Grunting (sound made with voice if difficulty in
breathing) -Cyanosis CLASSIFY AS –SEVERE PNEUMONIA
TREATMENT Refer urgently to hospital First dose of antibiotics T/t of fever T/t of wheezing
PNEUMONIA SIGNS Fast breathing Absence of chest indrawing CLASSIFY AS-PNEUMONIA
TREATMENT Home care Antibiotics T/t of fever T/t of wheezing Advice for re-assessment after 2days or if
condition of child worsen
NO PNEUMONIA
Cough/cold If cough more than 30 days needs
assessment Look for ENT problem Home care T/t for fever T/t for wheezing
B.CLASSIFYING THE ILLNESS IN YOUNG INFANTS(<2MTHS)
Signs may be difficult to find in young children
Non-specific signs as poor feeding, fever,low body temperature,further mild chest indrawing may be present in young infants.
CLASSIFIED AS Very severe disease Severe pneumonia No pneumonia
VERY SEVERE DISEASE SIGNS Stopped feeding well Convulsion Abnormally sleepy or difficult to wake Stridor in calm child Wheezing Fever or low body temperature
TREATMENT Refer urgently to hospital Keep warm Antibiotics
SEVERE PNEUMONIA
Severe chest indrawing RR 60 OR more
TREATMENT Refer urgently Keep warm Antibiotics
NO PNEUMONIA
SIGNS No severe chest indrawing No fast breathing
TREATMENT Keep warm Breast feed Return if sick , ↑RR, Difficulty in feeding
TREATMENT Treatment for 2mths to 5yrs (Pneumonia)
Age/weight Paed tab Paed syp. Sulpha 100mg 5ml: Sulpha-200mg Trim 20mg Trim-40mg <2mths 1tab BD Half spoon (3-5kgs) 2.5ml BD
2-12mths 2tab BD One spoon (6-9kgs) 5ml BD
1-5yrs 3tab BD One and half spoon
(10-19kgs) 7.5ml BD
SEVERE PNEUMONIA(CHEST IND)
ANTIBIOTICS
DOSE INTERVAL MODE
A. In 1st 48hrsBenzyl penicillin or
50000 IU per kg/dose
6hrly IM
Ampicillin 50mg/kg /dose
6hrly IM
Chloramphenicol
25mg/kg/dose
6hrly IM
B1.IF CONDITION IMPROVES ,THEN FOR NEXT 3 DAYS
Procaine Penicillin OR
50000 IU/KG(MAX UPTO 4 lac IU)
Once IM
Ampicillin or 50 mg/kg/dose 6hrly Oral
Chloramphenicol
25 mg/kg/dose 6hrly Oral
B.2.IF NO IMPROVEMENT THEN FOR NEXT 48 HRS
Change antibiotics If Ampicillin –Change to Chloramphenicol IM If Chloramphenicol-Change to Cloxacillin
25mg/kg/dose 6hrly with gentamycin 2.5mg/kg/dose 8hrly
If condition improves continue t/t orally C. Provide symptomatic t/t for fever and
wheezing D. Monitor fluid and food intake E. Advice mother on home management
VERY SEVERE DISEASE
Should be treated in centre with respiratory support
Chloramphenicol IM is drug of choice If condition improves Oral Chloramphenicol for 10 days If condition worsen Inj Cloxacillin plus inj gentamycin
B.<2mths child
Drug Dose Age <7DAYS Age 7-2 mths
Inj Benzyl Penicillin or
50000IU/KG/DOSE
12 Hrly 6Hrly
Inj Ampicillin and
50mg/kg/dose 12 Hrly 8Hrly
Inj Gentamycin 2.5mg/kg/dose 12 Hrly 8Hrly
NO PNEUMONIA
Symptomatic t/t Home care No antibiotics
PREVENTION
Improve living condition Better nutrition Remove smoke pollution indoor Better MCH Immunization