Check for General danger signs

Dr .Shazia Memon Associate Professor

Learning objectives

• Identify general danger signs.• How to check the child for general danger

signs • Know the D/D of child with convulsion,

lethargy or coma. • To give pre referral treatment.• Base line investigations.

A general danger sign is present if:

• The child is not able to drink or breast feed• The child vomits every thing • The child has had convulsions during current

illness• The child is lethargic or unconscious• The child is convulsing now.

Assess For General Danger Sign

Ask:•Is the child not able to drink or feed?•Does the child vomit every thing ?•Has the child has convulsions?

Look:•See if the child is lethargic or unconscious.•See if the child is convulsing now.

CHECK FOR GENERAL DANGER SIGNS

WHEN YOU CHECK FOR GENERAL DANGER SIGNS

ASK:• Is the child not able to drink or breast feed?• A child has the sign “not able to drink or breast feed” if he child is not able

to suck or swallow when offered a drink or breast milk.Causes:• CNS infections . • Acute gastroentritis with severe dehydration.• Sepsis• Throat abscess

DOES THE CHILD VOMITS EVERY THING?

• A CHILD WHO IS NOT ABLE TO HOLD ANY THING DOWN AT ALL HAS THE SIGN ”VOMITS EVERY THING”

CAUSES• Lethargic/unconscious • Acute gastroenteritis with severe dehydration• Intestinal obstruction• sepsis

HAS THE CHILD HAD CONVULSIONS ?

• CONVULSION: Paroxysmal, time limited change in motor activity and/or behaviour that results from abnormal electrical activity in the brain

• CAUSES: Causes In favour

Meningitis •History of high grade fever•Recurrent history of otitismedia•Neck stiffness•Signs of meningial irritation•Petachial rashes (meningiococal meningitis)•Tense or bulging fontenelle•Abnormal posture•CSF suggestive of

Encephlitis •Reccent history of gastroentritis•Irritibility/behavioural changes•Raised ICP•Csf

T.B meningitis •Hx of contact with t.b patient •Hx of weight loss•Low grade fever•Loss of appetite•Focal neurologicalsigns•Cranial nerve palsy •Labs: CXR ,Sputum AFB, montoux test,

Febrile convulsions •Age 6 months to 5 years•High grade fever•No loss of consciousness•Positive family Hx

Head trauma

Poisoning •Hx of poison ingestion or drug over dose

Hypertensive Encephalopathy •Hx of head ache •Vomiting •Irritibility•Raised blood pressure

Diabetic ketoacidosis •Hx of polydypsia, polyphagia, polyurea•Hx of weight loss•Acidotic breathing•Labs: High blood sugar Urinary ketones

Approach to child with convulsion or coma

Why convulsion is selected as general danger sign.

• If occur with underlying disease indicate morbidity and mortality.

• If uncontrolled will lead to brain damage.

Fever and convulsion/coma

• History.• Examination • Investigation • Provisional diagnosis• Final diagnosis.

Child with convulsion

Child with coma

Investigation• Lumber puncture

conditioncondition colorcolor TLCTLC proteinprotein sugarsugar

NormalNormal ClearClear 0-50-5

lymphocylymphocytete

20-20-45mg/dl45mg/dl

50-50-70mg/dl70mg/dl

(75%of (75%of blood blood sugarsugar

Septic Septic PurulePurulentnt

100-100-6000060000

PMNPMN

100-100-20002000

mg/dlmg/dl

<40 <40 mg/dlmg/dl

TBMTBM OpalesOpalescentcent

10-500 10-500

LymphocLymphocyteyte

100mg-100mg-5gm/dl5gm/dl

<40 <40 mg/dlmg/dl

Viral Viral encephalitencephalitisis

ClearClear <1000 <1000 lymphocylymphocytete

20-10020-100

mg/dlmg/dlNormalNormal

Common cuases of convulsions

• CNS Infection• Febrile convulsions• Epileptic convulsions • Metabolic. Hypoglycaemia • Head injury• Hepatic encephalopathy • DKA. • AGN ( hypertensive encephalopathy.• Most common causes are febrile convulsions and CNS

infections.

Community or outpatient department.

• History : check for general danger signs. • Classify the illness. • Identify the treatment.• Give the pre-referral treatment • Write down the referral note.• Refer the child to inpatient department.

Management process of the sick child

• The first step in assessing children referred to a hospital should be triage – the process of rapid screening to decide to which of the following group(s) a sick child belongs:

• Those with emergency signs require immediate emergency treatment .

• Those with priority signs should alert you to for immediate assessment and treatment.

• Children with no emergency or priority signs are treated as non-urgent cases.

Emergency signs:

• Obstructed breathing • Severe respiratory distress.• Central cyanosis.• Signs of shock• Coma • Convulsions• Signs of severe dehydration

priority signs:

Sick child < 2 months Temprature : child very hot Trauma or other urgent surgicalPallorPoisoningPainRespiratory distressLethargic/ irrtibility Severe malnutrition/visible wastingEdema on both feet.Burns.

Assessment of child with convulsion or coma

Introduction to AVPU scale

Child presenting with coma or convulsion

• History • Fever • Head injury• Drug overdose or toxin ingestion• Duration: how long do they last?• Previous history of febrile convulsion or

epilepsy?

Examination

General: • Juandice and Severe Palmar Pallor.• Preipheral edema• Level of consciousness• Petechial rash/ purpuric spots.Head /neck • Stiff neck• Signs of head trauma or other injury• Pupil size and reaction to light.• Tense or bulged fontanelle• Abnormal posture.

Assessment of child with convulsion or coma

• AVPU scale.• Alert• Response to vocal commands.• Response to pain • Un-concouscious .

Lab investigation

• CSF • CBC and MP• Blood glucose.• Assessment of blood pressure• Urine microscopy. • Other investigations according to presentation

THANK-YOU!

THANK-YOU!