The Supportive Care, First Aid Measures, and Basic

Emergency Care Section:

aims to provide guidance on the advice that can be taught to adults and their households about self-
monitoring and self-testing, supportive therapies, general first-aid measures, and basic emergency care
for Hems Responders

General Principles

Encourage all asymptomatic adults to seek consultation with their primary care provider at least

annually.

Encourage all adults experiencing symptoms to consult at the nearest primary care facility or

healthcare provider for proper assessment and management.

Teach adults how to properly perform self-testing and self-monitoring and how to use appropriate

supportive therapies for applicable conditions.

each adults how to perform first-aid measures and seek basic emergency care as necessary.

Self-monitoring and Self-testing

Teach adults how to check and monitor their vital signs at home and do home tests or self-tests for
certain

conditions.

Vital signs

○ Blood Pressure. Home blood pressure monitoring in patients with suspected or

confirmed hypertension or for monitoring response to BP-lowering drugs

1-3 or in pregnant

patients who are diagnosed with gestational hypertension or preeclampsia

○ Pulse rate. Pulse rate determination, if clinically indicated, in patients who experience

palpitations, in patients who are suspected or diagnosed with rhythm abnormalities (e.g.

atrial fibrillation), or in patients who are maintained on heart-rate lowering drugs (e.g.

beta-blockers).

○ Temperature. Temperature monitoring in patients who feel febrile or to monitor response

to treatment (e.g. fever lysis)

○ Oxygen saturation. Peripheral oxygen saturation monitoring (SpO2) in patients who are
considered suspect, probable, or confirmed COVID-19 cases who are on home isolation, or

in patients with cardiopulmonary diseases (such as COPD and pulmonary hypertension)

who are on oxygen home therapy.

Home tests/maneuvers for certain conditions.

○ Self-monitoring of blood glucose using home glucose meter/glucometer: for diabetic

patients, especially if they are on insulin as maintenance medication or are pregnant and

have chronic diabetes or gestational diabetes.

Self-monitoring and Self-testing

○ Pregnancy testing using home pregnancy kits: for women of reproductive age who are

experiencing signs and symptoms such as late menstrual period, breast tenderness,

nausea or vomiting, weight change, fatigue, mood changes, changes in eating habits and

frequent urination.

Breast self-awareness: for women to familiarize themselves with the normal appearance

and feel of one’s breasts. Immediately consult with a healthcare provider if any change

(e.g. pain, a mass, new onset of nipple discharge, or redness) is noticed

○ Self-administered COVID-19 antigen testing using FDA-approved kits: for symptomatic

individuals, within 7 days from onset of symptoms, especially if the capacity for timely

RT-PCR results is limited or not available.

○ HIV Self-testing: for at risk individuals.

Supportive Therapies and Symptomatic Relief

Teach adults how to properly use supportive therapies and symptom-relieving medications, such as the

following, when applicable:

Non-pharmacologic supportive therapies.

Adequate rest/sleep

Proper diet and nutrition

Increased water intake/oral hydration if ill and if without water intake restrictions due to a

medical condition (e.g. congestive heart failure, dialysis-requiring chronic kidney

disease);
Tepid sponge bath for fever

Cold compress for contusion

Non-prescription or over-the counter (OTC) medications.

○ Provide guidance and teach necessary precautions to patients regarding the use of the

following common non-prescription/over-the-counter (OTC) medications for symptom

relief to avoid underdosing/overdosing, minimize adverse effects, and prevent drug

interactions:

Antipyretics for fever

Paracetamol 325 to 650 mg orally or rectally every four to six hours (the

maximum total daily dose is 4 g per day).

11,12

Analgesics for pain relief (observe caution when using non-steroidal

anti-inflammatory drugs (NSAIDs) in patients with kidney disease or

gastrointestinal bleeding; avoid in patients with allergies to NSAIDs)

Paracetamol 325 to 650 mg orally or rectally every four to six hours (the

maximum total daily dose is 4 g per day).

11,12

Oral Ibuprofen 200 mg every 4 to 6 hours as needed; if no relief, may

increase to 400 mg every 4 to 6 hours as needed; maximum dose: 1.2

Supportive Therapies and Symptomatic Relief

g/day. Use for >10 days is not recommended unless directed by the

healthcare provider.

Mefenamic acid 500 mg orally once then 250 mg orally every 6 hours as

needed; usually not to exceed 1 week.

Cold medications for nasal congestion

Phenylephrine 10 mg orally every 4 hours with a maximum dose of 60 mg

per 24 hours
15

, usually in combination with chlorpheniramine

12 and/or paracetamol.

Mucolytics or antitussives for cough

Oral Ambroxol with daily dose of 30 mg to 120 mg taken in 2 to 3 divided

doses

16 as mucolytic Carbocisteine orally with an initial 2,250 mg daily in divided doses, may

be decreased to 1,500 mg daily in divided doses when a satisfactory

response is obtained

17 as mucolytic

Oral Butamirate as 50 mg tablet, 2 or 3 tabs daily at intervals of 8 or 12

Hours 12,18 as antitussive

First-aid and Basic Emergency Care

Teach adults about the recognition of signs and symptoms needing immediate consultation with a

healthcare provider, the proper way of providing first-aid care, and the administration of basic
emergency care by trained individuals.

Signs and symptoms needing immediate consultation. Advice adults to consult at the nearest

health facility upon experiencing the following symptoms or conditions, which may be life- and/or

limb-threatening:

○ Any of the following signs and symptoms

Acute neurologic symptoms such as loss of consciousness, altered mental

status, dizziness, facial asymmetry, slurring of speech, and new-onset weakness

or loss of sensation, seizure, or convulsions Agitated and/or aggressive behavior or suicidal

ideation/behavior
Acute vision loss

Eye injury/foreign body

Acute chest pain

Acute dental pain

Any other severe pain

Difficulty in breathing

Chest retractions

Contractions, pain, or bleeding in late pregnancy

○ Any of the following, accompanied by fever

First-aid and Basic Emergency Care

Living in an area where malaria is endemic; History of travel to a malaria endemic area; History of
recent malaria infection in the previous months Documented history of Plasmodium vivax infection;
History of blood transfusion in the previous month(s) or any dental or surgical procedure

Headache

Body malaise

Myalgia (lower back, arms, and legs)

Arthralgia

Retro-orbital pain

Anorexia

Nausea

Vomiting

Diarrhea

Flushed skin

Rash (petechial, Hermann's sign)

Abdominal pain

Open wounds

Any of the three cardinal signs of leprosy

Hypopigmentation of the skin; Thickening of peripheral nerves with loss of sensation; or Positive slit-
skin smear upon screening.

○ Any of the following TB signs and symptoms

At least 2 weeks of cough;

Unexplained fever;

Night sweats;

Unexplained weight loss.

○ Any of the following signs and symptoms of sexually transmitted diseases:

Vaginal/penile/anal discharge characterized by: presence of foul odor persistent pruritus

burning sensation during urination greenish (pus-like) appearance painful intercourse (dyspareunia)

post-coital bleeding Painful or painless genital sores Oral viral and fungal infection (leukoplakia,
candidiasis, herpes zoster) Inhalation, ingestion, and/or exposure to harmful substances

○ Trauma and associated injuries or symptoms such as the following

First-aid and Basic Emergency Care

Loss of consciousness, altered mental status, or seizures

Difficulty of breathing Bleeding, expanding hematoma, or signs of shock (e.g., pallor, cold extremities)
Traumatic dental injuries that result in subluxation, extrusion, lateral luxation, intrusion, avulsion of
permanent teeth, and root fracture caused by sporting events, falls, motor vehicle accidents, or
interpersonal violence Abdominal pain and/or enlargement Pain or limitation in motion of neck or
extremities Burns especially those involving the head and neck, hand, feet or groin area

First aid care kit. Encourage all adults and their respective households to prepare and maintain a

first-aid kit with the following contents

○ First aid manual

○ Plasters, sterile gauze dressings, sterile eye dressings, cotton balls and cotton-tipped

swabs, bandages, safety pins, disposable sterile gloves, tweezers, scissors, antiseptic

solution, antiseptic cleansing wipes, antiseptic cream, sticky tape, thermometer

(preferably digital), painkillers such as paracetamol (or infant paracetamol for children),

aspirin (not to be given to children under 16), or ibuprofen, antihistamine cream or tablets,

distilled water for cleaning wounds, eyewash, and eye bath;

○ Personal or maintenance medications

○ Epinephrine autoinjector or Epinephrine vial with appropriate syringe for individuals who

are at risk of anaphylaxis

First aid measures. Teach adults to administer first-aid measures for the following conditions:

○ Animal bites (e.g., dog bites)

29

Immediately perform proper wound care, including washing with soap and water.

Seek consultation at the nearest DOH - Certified Animal Bite Treatment

Center/Animal Bite Center for safe and effective post-exposure anti-rabies

vaccination, anti-tetanus vaccination, antibiotics, and health education.

○ Dental Injuries.

Rinse avulsed permanent tooth gently in milk, saline, or saliva and take care not

to touch the root with fingers. If unable to replant the tooth, place in physiologic

storage medium like milk, saliva or saline and seek immediate dental treatment.

27

Seek immediate medical attention for uncontrolled or profuse bleeding of a tooth

extraction site.

○ Minor closed wounds (e.g., bruise/contusion).

Apply a cold compress or cold pack to the area for at least 10-20 minutes.

Elevate the injured area to a tolerable level to prevent swelling.

○ Minor open wounds (e.g., abrasion, superficial laceration/cuts).

Apply direct pressure while wearing gloves if there is external bleeding from

wound. Rinse with running water then wash with soap and water once the bleeding stops.

Apply antibiotic ointment, cream, or gel, as prescribed by a primary care provider.

First-aid and Basic Emergency Care

Cover with a sterile gauze pad or an adhesive bandage.

Consult at the nearest health facility if the wound is deep, extensive, persistently

bleeding, or at high risk of infection (e.g., puncture wound from a nail).

Minor, superficial or first-degree non-chemical burns.

Stop the burning by removing the person from the source or removing the source

from the person. Cool the burned area with cool or cold water (but not direct ice or ice water

application) for at least 10 minutes. Avoid removing the cover of the blister to protect the burnt skin.

Cover with loose sterile dressing. Apply silver sulfadiazine, as prescribed by a primary care provider, for

non-infected burns, if without allergy to sulfonamides and if the medications are

available. Consult at the nearest health facility if the burn is deep, extensive, involves

critical areas (hands, feet, groin, head, face, circumferential burns), a dirty wound

is sustained, there are signs of infection (e.g. fever, purulent discharge) or there

is associated difficulty of breathing.

Rest: Limit the use of the injured part.

Immobilize: Apply a splint or elastic bandage to limit motion.

Apply cold compress to the area for at least 10-20 mins every 6-8 hours in the

first 24 hours after injury.

Elevate the injured body part to a tolerable level to reduce swelling.

Consult at the nearest health facility if any of the following are present: difficulty

of breathing, an open fracture, deformity, abnormal movement or inability to

move, coldness or numbness, involvement of the head, neck or spine, or the

injury is suspected to be significant due to its cause (e.g. fall, vehicular accident).

○ Poisoning and Chemical burns

Eye exposure. Immediately irrigate the affected eye with clear running tap water,

occasionally lifting and lowering the lids then seek medical attention.

Avoid rubbing the eyes.

Inhalation. Remove the victim from the source of the hazardous substance and

bring him/her to an open space with fresh air.

If the victim vomits, turn him/her to his/her side to avoid choking.

Seek medical attention immediately.

Ingestion. Do not induce vomiting.

Seek medical attention immediately.

Skin exposure.

First-aid and Basic Emergency Care

Inspect and note all areas of the body that came into contact or have

been contaminated by the substance, removing the clothes if necessary.

Wash or irrigate all contaminated areas with clear running tap water and

seek medical attention immediately.

○ Disasters.

If trained in Psychological First-Aid (PFA), facilitate and/or coordinate the

provision of PFA and other psychosocial services to disaster-affected

populations following the key principles of PFA (a sense of safety, calming, a

sense of self, and community efficacy, connectedness, and hope, etc.).

Safe provision of basic emergency care, cardiopulmonary resuscitation (CPR), and

psychosocial assistance. Teach adults to recognize the following emergencies and how to provide

help safely:

Common emergencies.

Cardiac arrest: sudden loss of consciousness and unresponsiveness and absence

or abnormal breathing (e.g., gasping), and absence of pulse.

Possible acute stroke: unilateral weakness of face (e.g., drooping), arm, grip or

speech disturbance

Possible acute coronary syndrome: acute nontraumatic chest pain

Respiratory distress: shortness of breath, gasping, rapid shallow breathing,

painful or uncomfortable breathing

Life-threatening bleeding

Shock: drowsiness or altered mental status, excessive thirst, palpitations,

difficulty of breathing, weakness, cold extremities, pallor

Drowning

Vehicular accidents

○ Safe provision of help to emergency victims.

Seek opportunities to learn or participate in first aid and basic emergency care
training, including lay Basic Life Support (BLS), cardiopulmonary resuscitation

(CPR), and basic disaster risk reduction and management from qualified experts

or trainers.

Always check for the safety of the scene to the self before extending help to

others.

Immediately call for help and activate emergency services upon witnessing any

emergency to facilitate the transport of the victim to the nearest healthcare

facility.

If trained, perform lay BLS on victims in cardiac arrest after ensuring that the

scene is safe and calling for help.

Help for violence/abuse victims. Advise adults to do the following when encountering or

witnessing interpersonal violence or abuse:

Immediately call 911 for help.

Talk to a friend, a family member, a trusted teacher, a doctor, or a counselor.

First-aid and Basic Emergency Care

■ Familiarize and access existing referral mechanisms in the locality

■ Collaborate with the Multidisciplinary Team (MDTs)

Condition First Line Medications First Line Procedures

Minor open ● Antiseptics Wound care
wounds ● Pain medications
Minor Thermal ● Pain reliever (eg. Paracetamol or ● Apply cool water or saline-soaked
Burn NSAIDs) gauze.
● Clean using mild soap and water.
● Avoid removing the cover of the
 blister to protect the burnt skin.
● Cover loosely with a sterile dressing
(American Red Cross, 2016)
Minor Chemical ● Antiseptics Flush the area thoroughly with large
burns ● Pain medications amounts of cool water for at least 15

minutes (American Red Cross, 2016)

Major trauma ● IV fluids if bleeding or in shock Rapid assessment (ABCDE) and basic
wounds emergency care, proper
immobilization
(e.g., cervical spine immobilization)
● If with profuse or life-threatening
bleeding - Direct manual pressure
application if a manufactured
tourniquet is not immediately
available or fails
to stop bleeding; tourniquet
application with a manufactured
tourniquet is
available (Pellegrino et.al., 2020,
AHAARC 2020)
Closed Fracture Pain medications Splint/Immobilization
● Refer to higher level care
Cardiac Arrest Epinephrine, intravenous (IV) fluids ● BLS/CPR, including bag-valve
ventilation (WHO-ICRC, 2018)

● Refer to higher level care

Difficulty of Oxygen Support Rapid assessment (ABCDE), quick
breathing (DOB) focused history taking and PE, basic
Other medications depending on emergency care (including bag-valve-
suspected mask ventilation if
cause of difficulty of breathing (e.g. unconscious)(WHO-ICRC, 2018)
Epinephrine for anaphylaxis, short- ● Refer to higher level care
acting
beta-agonist (SABA) for asthma
exacerbation,
aspirin for suspected ACS, naloxone for
opioid
overdose) (WHO-ICRC, 2018)
Shock IV fluids appropriate for the patient’s ● Rapid assessment (ABCDE), quick
age and focused history taking and PE, basic
condition (Ringer’s lactate if with normal emergency care including IV access
nutritional status) (WHO-ICRC, 2018) and fluid resuscitation(WHO-ICRC,
● Hydration via nasogastric tube if no IV 2018)
fluid ● Refer to higher level care
available
● Oxygen support
 ● Other medications depending on the
cause of
shock (e.g. oxytocin for postpartum
hemorrhage, aspirin for suspected heart
attack,
epinephrine for anaphylaxis)
Altered Mental Oxygen support Rapid assessment (ABCDE), AVPU
Status ● IV fluids assessment to check level of
● IV glucose for hypoglycemia consciousness, GCS to check trauma
● Other medications depending on the patients, quick focused history taking
cause of and
altered mental status (e.g., naloxone for PE, capillary blood glucose
opioid measurement, basic emergency care
overdose, benzodiazepine for active (WHO-ICRC,
seizure/convulsion, magnesium sulfate 2018)
for ● Refer to higher level care
suspected eclampsia, glucose and
benzodiazepine for alcohol
withdrawal)(WHO-ICRC, 2018)
Anaphylaxis Epinephrine Basic emergency care
● Refer to higher level care
Snake bite Antidote if available Basic Emergency Care,
● IV fluids and oxygen support as Decontamination
needed ● Refer to higher level care
Chemical Antidote if available Basic Emergency Care,
poisoning ● IV fluids and oxygen support as Decontamination
needed ● Refer to higher level care
Acute Coronary Aspirin loading dose Basic emergency care
Syndrome ● Statin ● Refer to higher level care
● Sublingual nitroglycerin or nitrate (e.g.
isosorbide dinitrate or ISDN) for pain
relief.
Note: the absence or presence of
response to
nitroglycerin or nitrate administration
should not be
used to diagnose the absence or
presence of acute
coronary syndrome
Possible Stroke Check Vital signs q5 minutes Basic emergency care (WHO, 2018)
● Refer to higher level care
Hypertensive Vital signs q15 minutes ● IV Access
Emergency/ ● Refer to higher level care
Hypertensive Intravenous Nicardipine or Labetalol
Crisis (severe BP (Whelton
elevation et al., 2018)
accompanied by
new or
worsening target
organ damage
or dysfunction)
Hypertensive Vital signs q15 minutes Not applicable
Urgency (severe ● Refer to higher level care
BP elevation in a ● Adjust/intensify maintenance
stable patient medications,
WITHOUT acute ensure adherence to therapy, and
organ damage arrange
or change in follow-up within a short period
baseline target (Whelton et
organ al., 2018)
damage or
dysfunction)
Asthma SABA: 4-10 puffs by pMDI + spacer, While waiting for transfer, give:
Exacerbation repeat ● Give medications and oxygen as
indicated
every 20 minutes for 1 hour
(GINA, 2022)
● Prednisolone: 40-50 mg ● Refer to higher level care/acute care
● Controlled oxygen (if available): target facility
saturation 93-95%
● *Continue treatment with SABA as
needed.
Assess response at 1 hour (or earlier)
(GINA, 2022)
COPD Give nebulized SABA + SAMA 1 nebule While waiting for transfer, give:
Exacerbation every 20 minutes for 1 hour, or via ● Give medications and oxygen as
metered-dose inhaler with spacer, 4 indicated
puffs ● Insert IV line
every 20 mins. for 1 hour. ● Refer immediately to at least a Level
● Give oxygen by face mask, if available 2 health facility, preferably with ICU
● Continue previous COPD medications (Philippine College of Chest Physicians
● Alternative option: Oral - Council on COPD and Pulmonary
Methylxanthine Rehabilitation, 2021)
(GOLD, 2022)
Active ● Intravenous proton pump inhibitor ● Fluid resuscitation
gastrointestinal (e.g. ● NGT insertion (for decompression)
bleeding Omeprazole) ● Refer to higher level care
(hematochezia/
hematemesis)
Acute ORS ● NGT insertion if unable to tolerate
gastroenteritis oral intake
with severe ● IV access and hydration if unable to
dehydration tolerate NGT
● Refer to higher level care
Uncontrolled or Tranexamic acid Suturing of the extraction site
profuse bleeding
after tooth
extraction
Traumatic dental Pain reliever and antibiotics Tooth splint
injuries ● Refer to higher level care
Behavioral Emergencies
Medically Serious Refer to the Medications section for Place the person in a secure and
Act of pharmacological interventions in the supportive environment (do not leave
Self Harm/ management of concurrent Mental them
Imminent Risk Health alone)
of Self-Harm / conditions ● Remove access to means of self-
Suicide harm
● Ensure continuity of care
● Include the carers if the person
wants their support during
assessment and
treatment
● Refer to a mental health specialist
or to higher level of care
(WHO, 2016)
Aggressive or No specific first line medication. Evaluate for possible underlying
agitated Medication is causes and rule out other possible
behavior (WHO, provided as necessary (e.g. sedation to causes:
2016) prevent 1. Check blood glucose. If low, give
injury or agitation due to psychosis) glucose
2. Check vital signs, including
temperature and oxygen saturation.
Give oxygen
if needed.

3. Rule out delirium, medical causes

including poisoning, drug and alcohol
use,
and agitation due to psychosis or
manic episodes in bipolar disorder.
4. Sedate as appropriate to prevent
injury.
a. For agitation due to psychosis or
mania, consider use of haloperidol
2mg
po/im hourly up to 5 doses (maximum
10 mg). Cautiously check for
dystonic reactions from high doses of
haloperidol. Biperiden may be
used to treat acute reactions.
b. For agitation due to ingestion of
 substances, such as alcohol/ sedative
withdrawal or stimulant intoxication,
use diazepam 10-20 mg po and
repeat as needed.
c. In case of extreme violence, seek
help from police or staff, use
haloperidol 5 mg im, repeat in 15-30
mins if needed (maximum 15 mg),
and consult a specialist.
Epilepsy ● Antiepileptic Drugs: Carbamazepine, ● Initiate antiepileptic medications
Phenobarbital, Phenytoin, Sodium ● Refer to a neurologist or to higher
Valproate level of care
(WHO, 2016) Additional interventions once acute
problem is resolved:
● Provide psychoeducation to the
person and carers
● Promote functioning in daily
activities
Disorders due to Naloxone if with suspected opioid If with sedative intoxication (e.g.
Substance overdose alcohol, opioids, other sedatives), drug
Use: Alcohol ● Benzodiazepine (e.g Diazepam) if with overdose, or withdrawal - Check
intoxication, suspected alcohol, Benzodiazepine or Airway, Breathing, Circulation (ABC),
Opioid Overdose, other provide initial respiratory support,
Alcohol or sedative withdrawal. give oxygen, provide basic emergency
Sedative ● Thiamine 100 mg daily for five days if care
Withdrawal, with as needed (WHO - ICRC, 2018)
Stimulant suspected alcohol withdrawal ● Refer to a higher level of care
Intoxication, ● Diazepam for acute stimulant Additional interventions once acute
Delirium intoxication; problem is resolved:
Associated with Haloperidol if not responding to ● Psychoeducation
Substance Use Diazepam ● Motivational Interviewing
● Haloperidol if with suspected alcohol ● Strategies for Reducing and
or Stopping Use:
sedative withdrawal and delirium ● Identify triggers for use and ways to
● Methadone or Buprenorphine for avoid them
opioid ● Identify emotional cues for use and
withdrawal; if either is not available - ways to cope with them
use ● Encourage the person not to keep
another opioid e.g. Morphine Sulphate substances at home
or an
alpha agonist e.g. Clonidine or
Lofexidine
(WHO, 2016b)

G. Palliation
1. All primary care providers shall incorporate the principles of palliative care in

primary care management, by preventing and relieving the most common and

severe types of suffering associated with serious or complex health problems, such

as the following:

a. Cancers;

b. Complicated Tuberculosis;

c. HIV-AIDS;

d. Other debilitating infections;

e. Chronic debilitating non-communicable diseases;

f. Any other end-stage disease;

g. Advanced age;

2. Primary care providers shall offer palliative care measures such as but not limited

to the following (Republic Act No. 11215: “An Act Institutionalizing a National

Integrated Cancer Program and Appropriating Funds Therefor”; DOH, 2015e):

a. Medications that help relieve specific symptoms or types of suffering (e.g.

morphine for severe pain; haloperidol for nausea, vomiting, agitation, delirium

and anxiety; fluoxetine for depressed mood or persistent anxiety, etc.)

b. non-pharmacologic interventions to help alleviate suffering and improve

quality of life such as:

i. Applying dressings on chronic wounds (e.g., pressure sores) and advising

the purchase of appropriate mattresses/beddings.

ii. Inserting nasogastric tubes for vomiting refractory to medicines and for

the administration of medicines or fluids.

iii. Inserting urinary catheters (to manage bladder dysfunction or outlet

obstruction).

3. Primary care providers shall coordinate with the LGU, community support groups,

or partner/advocacy organizations regarding the provision of psychosocial support

(e.g. basic needs, in-kind support) and spiritual support to patients.

64

ANNEX D. OMNIBUS HEALTH GUIDELINES FOR THE ELDERLY

4. Primary care providers shall advise patients properly about home-based palliative

and hospice care (Republic Act No. 11215: “An Act Institutionalizing A National

Integrated Cancer Program and Appropriating Funds Therefor”; DOH, 2015e)

and shall refer to palliative care specialists as needed.

5. Primary care providers shall observe the proper legal procedures in securing

advanced directives from patients.

Emergency Care for Children

Condition First Line Medication First Line Procedure or procedures that can

be done at primary care

Cardiac Arrest Epinephrine, IV Fluids High-quality cardiopulmonary resuscitation
(AHA, 2020)
Acute Asthma Inhaled Short Acting Rapid assessment (ABCDE), quick focused
Exacerbation Beta2 Agonist, Oxygen history taking and PE, Pulse Oximetry
(GINA, 2022;
WHO and ICRC,
2018)
Acute Bacterial IV Ceftriaxone (loading Rapid assessment (ABCDE), quick focused
Meningitis dose) history taking and PE, IV access
(WHO, 2017b)
Dengue with IV Fluids Rapid assessment (ABCDE), quick focused
Shock (PIDSP, history taking and PE, IV access
2017)
Severe IV Fluids Rapid assessment (ABCDE), quick focused
Dehydration history taking and PE, IV access
(DOH and
PSMID, 2017)
Poisoning or Antidote if available, Rapid assessment (ABCDE), quick focused
Envenomation IV fluids and oxygen history taking and PE, External
(WHO and ICRC, support as needed decontamination, Wound cleaning as
2018) applicable
Severe Acute IV Fluids Rapid assessment (ABCDE), quick focused
Malnutrition IM/IV Benzyl Penicillin history taking and PE, IV access
with signs of and IM/IV Gentamicin
shock (loading
or severe dose) if with infection
dehydration
(WHO, 2013;
WHO, 2017b)
Acute Severe Short acting Rapid assessment (ABCDE), quick focused
Hypertension antihypertensive history taking and PE, blood pressure
(AAP, 2017c) measurement
Severe Pediatric Unless with known Rapid assessment (ABCDE), quick focused
Community- hypersensitivity to history taking and PE, IV access
Acquired penicillin, loading
Pneumonia dose of:
regardless of ● Penicillin G if with
immunization complete Haemophilus
status against influenzae
Streptococcus type b (Hib) vaccination
pneumoniae Or Ampicillin if no or
(PAPP, 2021) incomplete Hib
vaccination
● Cefuroxime Or
Ampicillin-sulbactam in
settings with
high-level penicillin
resistant
microorganisms
● Add Clindamycin
when suspecting
Staphylococcal
pneumonia
IV Fluids if with shock
or severe dehydration
Oxygen if with difficulty
of breathing
Acute Ischemic IV Fluids if with Rapid assessment (ABCDE), quick focused
Stroke in dehydration history taking and PE, IV access
Neonates Seizure control
(Ferriero DM et
al, 2019)
Childhood Insulin for Rapid assessment (ABCDE), quick focused
Stroke - Acute hyperglycemia history taking and PE, IV access, Blood
Ischemic Stroke Antipyretics for fever glucose test
 (Ferriero DM et control
al, 2019) Seizure control
Childhood IV Diazepam or Rapid assessment (ABCDE), quick focused
Seizure (WHO, Lorazepam (non- history taking and PE, IV access, blood
2017b) parenteral routes when glucose test

IV access is not
available)
Neonatal IV Phenobarbital Rapid assessment (ABCDE), quick focused
Seizure (WHO, history taking and PE, IV access, blood
2017a) glucose test
Neonatal Sepsis Ampicillin and Rapid assessment (ABCDE), quick focused
(WHO, 2017a) Gentamicin (loading history taking and PE, IV access
dose)
IV fluids if with shock
or severe dehydration
Physical Abuse IV fluids and oxygen Rapid assessment (ABCDE), quick focused
with trauma or support as needed history taking and PE, Wound cleaning as
injuries (AAP, applicable
2015)

Palliation

1. Primary care providers shall refer newborns, infants, and children needing special

procedures, management of complications, palliative and hospice care to the next

level of care.

2. Primary care providers shall advise anticipatory guidance and provide emotional

support to expectant parents of an unborn child in utero diagnosed with a serious

illness.

3. Primary care providers together with the parents and/or caregivers are

encouraged to support children with serious illness, chronic diseases or

life-threatening conditions to access and to actively participate in

decision-making about treatment, palliative care and hospice care (National

Coalition for Hospice and Palliative Care, 2018).

4. Parents and/or caregivers are advised to provide home-based care on nutrition,

emotional support, spiritual support, and symptom management of children with

serious illness, chronic diseases or life-threatening conditions.

5. An interdisciplinary palliative care team shall provide spiritual and psychosocial

care with active compassion, and support for patient/family values and beliefs

that inform decision-making about health care and quality of life.

6. Parents and/or caregivers are encouraged to consult health care providers and

legal services for advance care directives. All health facilities shall honor the

advance directive provided. It must be signed, dated, and notarized. An advance

directive may be revoked by a new and notarized advance directive.