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) Age Heart Blood Respiratory Rate Pressure Rate Prematu 120-170 55-75/35-45 40-70 re 0-3 mos 100-150 65-85/45-55 35-55 3-6mos 90-120 70-90/50-65 30-45 680-120 80-100/5525-40 12mos 65 1-3yrs 70-110 90-105/5520-30 70 3-6yrs 65-110 95-110/6020-25 75 6-12yrs 60-95 100-120/6014-22 75 12yrs 55-85 110-135/6512-18 85
>70/min >50/min >35/min . Complian t caregiver 3. Ability to feed 6. Comorbid illness 2. 2004) Variables 1. RR: 2-12 mos 1-5 years > 5 years PCAP A None Yes Possible None Able >11 mos. ≥50/min ≥40/min ≥30/min PCAP B Present Yes Possible Mild Able >11mos ≥50/min ≥40/min ≥30/min PCAP C Present No Not Possible Moderate Unable <11mos. >60/min >50/min >35/min PCAP D Present No Not Possible Severe Unable <11mos. Ability to follow-up 4. Presence of DHN 5.Pediatric Community Acquired Pneumonia (CPG in the evaluation and management of PCAP. Age 7.
Grunting e. Signs of respiratory failure a.Lethargic or unconscious .Give fluid for severe dehydration (Plan C) OR If child also has another severe classification: .Sunken eyes . Retractio n b. Complica tions None OPD Follow up at end of treatment None OPD Follow up after 3 days Present Admit to regular ward 10.Not able to drink or drinking poorly .8. Headbob bing c.Skin pinch goes back very slowly Sever Dehydration If child has no other severe classification: .Sensorium None None None None None Awake None None None None None Awake Intercostal/ subcostal Present Present None None Irritable Supraclavicul ar/ Intercostal/ Subcostal Present Present Present Present Lethargy/ Stupurous/ Comatose Present Admit to critical care unit Refer to specialist 9.Action Plan Dehydration Classification 2 of the following signs: . Apnea f. Cyanosis d.
Skin pinch goes back slowly Some Dehydration Give fluid and food for some dehydration (Plan B) If child also has a severe classification: . thirsty .Drinks eagerly.Restless.Refer URGENTLY to hospital with mother giving frequent sips of ORS on the way.Refer URGENTLY to hospital with mother giving frequent sips of ORS on the way. Advise the mother to continue cholera If child is 2 years or older and there is cholera in your area.Sunken eyes . Advise the mother to continue breastfeeding Advise mother when to return immediately Follow-up in 5 days if not improving . give antibiotic for cholera 2 of the following signs: . irritable .
the fold of skin will be in a line up and down the child’s body and not across the child’s body. When to Return . To do the skin pinch. look to see if the skin pinch goes back: — very slowly (longer than 2 seconds) — slowly (skin stays up even for a brief instant) — immediately If the skin stays up for even a brief time after you release it. Do not use your fingertips because this will cause pain.Not enough signs to classify as some or severe dehydration No Dehydration Give fluid and food to treat diarrhea at home (Plan A) Advise mother when to return immediately Follow up in 5 days if not improving How to test for skin turgor Locate the area on the child’s abdomen halfway between the umbilicus and the side of the abdomen. Pinch the skin for one second and then release it. 4 Rules of Home Treatment: Give Extra Fluid. Continue Feeding. Give Zinc Supplements. Firmly pick up all of the layers of skin and the tissue under them. use your thumb and first finger. When you release the skin. decide that the skin pinch goes back slowly. Place your hand so that when you pinch the skin.
but more slowly Continue giving extra fluid until the diarrhea stops o 2. Give Extra Fluid Breastfeed frequently Give ORS or clean water in addition to breastmilk Teach the mother how to mix and give ORS. Show the mother how much fluid to give in addition to the usual fluid intake: o Up to 2 yrs – 50 to 100 ml after each loose stool and between them 2 yrs or more – 100-200 ml after each loose stool and between them o - Tell mother to o o Give frequent small sips from a cup If the child vomits. Give Zinc supplements Tell the mother how much Zinc to give o o Up to 6 mos – 10mg elemental Zn per day for 14 days 6 mos or more – 20mg elemental Zn per day for 14 days Remind the mother to give Zn supplements for the full 14 days 3. Continue Feeding .Treatment Plan A 1. wait 10 minutes. Then continue.
0 16.4 (2..5 15.6) 31 32 33. 9) 45 47 51 118.4(1 1) 14.2 (106.7) 18. When to return.4. Treatment Plan B Give in-clinic recommended amount of ORS over 4-hour period 75ml/kg body weight Reassess the child after 4 hours and reclassify the child for dehydration then select appropriate plan to continue treatment If the mother must leave before completing treatment o o Show how to prepare ORS Show how much ORS to give to finish 4-hour treatment at home Give enough ORS packets to complete rehydration Explain 4 rules of Home treatment - o o Age-Specific Blood Cell Indices MCHC(g /dL RBC) WBCs (x103/ uL) Platel ets (103/u L) 254 (180327) 275 290 290 Age Hb(g/ dL) HCT (%) MCV( fL) Reticuloc ytes 26-30 wk gestati on 28 wk 32 wk Term 13..5 (34.7 ) 120 118 108 37.1 (5-10) (3-10) (3-7) .5 41.9 (30.0 - 4.
5 (14.1) 12.0) MCHC(g /dL RBC) (1.5) 7.0 (31.5 43 (36) 41 (37) 47 88 (78) 90 (78) 90 34.5-1.8-4.5) 7.5-1.4) 12.0 (10.0 (30.6 (6-17) 8.5 (13) 14.7) - 2 mo 6 mo 6mo2yr 2-6yr (0.0) 31.4 (5-20) 10.(cord) 1-3 day 2 wk (13.9 (0.5 (11.0) 34.8 (0.9 (10.5) Reticuloc ytes WBCs (x103/ uL) (150350) (150350) (150350) Platel ets (103/u L) 192 - 252 1 mo (0.0) (4.0) Age Hb(g/ dL) HCT (%) MCV( fL) 1218yr Male 14.7) 33.5) 12.0) 33.0 (31.2 (9.6 (11.434) 11.0 (32.8 (28.0 (31.5) 11.5-1.4 (150350) (150350) (150- Female Adult Male .5 (11.5 (515.6 (13.5) 16.4) 13.513.1) 31.5) 10.5) 8.1-1.0 7.513.0) (4.5-1.0 (31.5) (42) 56 (45) 53 (41) 44 (33) 35 (28) 36 (31) 36 (33) 37 (34) 40 (35) (98) 108 (95) 105 (88) 101 (91) 95 (84) 76 (68) 78 (70) 81 (75) 86 (77) (30.0) 34.0 (29.5) (0.8 (0.7-2.9 (9.513.5) 13.0) 6-12yr (0.3) 35.6) (9-30) 18.5) 18.3) (617.0) 34.0 (12) 15.8-2.7) 11.8 (419.1 (4.1) 31.0) 34.8 (28.4 (28.
2 Lengt Growth in Recommen ded Daily Circumfer ence (cm/mo) 2. A total of 6 or more items from 1.5 1.25 1cm/yr 100 90-100 30 20 15 12 2 lbs 1.25 lb 1 lb 13 oz Growt h h (cm/m o) 3.5 2.0 3cm/yr 0.(13.0 1.8-2.50 0. 2.0) 34.4 (0. and 3.5) (4.511) 350) (150350) Female Growth and Caloric Requirements Ag e Approxim ate Weight gain (g) Approxim ate monthly weight gain 0-3 mo 3-6 mo 6-9 mo 912 mo 1-3 yr 4-6 yr Autistic Disorder A. with at least 2 from 1 and 1 each from 2 and 3: 8 6 8 oz 6 oz 1.00 1.0 (31.0 (12) (41) 41 (36) (80) 90 (80) (31.0) (4.50 Allowance (Kcal/kg/d ay) 115 110 100 100 in Head .5) 14.511) 7.00 0.
Qualitative impairments in communication.1. Qualitative impairment in social interaction. such body as eye-to-eye and gaze. gestures regulate social interaction b. interests. Lack of spontaneous seeking share enjoyment. or pointing out objects of interest) d.g. marked impairment in ability to initiate or sustain a conversation with others c. expression. Marked impairment in the use of multiple nonverbal behaviors. facial to postures. as manifested by at least 2 of the following: a. or achievements with other people (e. as manifested by at least 1 of the following: a. Failure to develop peer relationships appropriate to developmental level c. Lack of varied. such as gesture or mime) adequate speech. In individuals through with alternative modes of communication. Sterotyped and repetitive use of language or idiosyncratic language d. or total lack of. by a lack of showing. bringing. Lack of social or emotional reciprocity 2. spontaneous make-belive play or social imitative play appropriate to developmental level . develppment of spoken language (not accompanied by an attempt to compensate b. Delay in.
or (3) symbolic or imaginative play C. (2) language as used in social communication. and stereotyped patterns of behavior. repetitive. The disturbance is not better accounted for by Rett disorder or childhood disintegrative disorder Table 1. with onset < age 3yr. Encompassing preoccupation with >/= 1stereotyped and restricted pattern of interest that is abnormal in either intensity or focus b. Apparently inflexible adherence to specific. hand or finger flapping or twisting or complex whole body movements) d. (1) social interaction. and activities. Steroetyped and receptive and repetitive motor mannerisms (e.3.g. Persistent preoccupation with parts of objects B. interests. as manifested by at least 1 of the following: a. nonfunctional routines or rituals c. Comparison of the Current WHO/PPS Case Definition and Case Classification for Dengue with the Proposed 2009 WHO Case Classification . Delay or abnormal functioning in at least 1 of the following areas. Restricted.
(+) tourniquet test b. Petechiae. AND Supportive serology ( a reciprocal HI antibody titer >1280. manifested by at least one of the following: a.CURRENT WHO Case Definition of Dengue and Levels of Severity (1997) as adapted by the PPS Clinical Practice Guidelines on Dengue 2008 Case Definition for Dengue Fever Probable: an acute febrile illness with 2 or more of the following: Headache Retro-orbital pain Arthralgia Rash Hemorhagic manifestations Leukopenia. vomiting • Rash • Aches and pains • Tourniquet test positive • Leukopenia Laboratory-confi rmed dengue (important when no sign of plasma leakage) . Sins of plasma leakage such as pleural effusion. GIT. ascites and hypoproteinemia PROPOSED WHO Classification and Levels of Severity 2009 Nonsevere Dengue without Warning signs Probable dengue: live in /travel to dengue endemic area. A drop in the hematocrit following volume replacement treatment equal to or greater than 20% of baseline c. and population b. Fever and 2 of the following criteria: • Nausea. Hematemesis or melena 3. Fever.000 cells/mm3 or less) 4. lasting for 2-7 days. sex. purpura c. Bleeding from the mucosa. Thrombocytopenia ( 100. Hemorrhagic tendencies evidenced by at least one of the following: a. a comparable IgG assay ELISA titer or (+) IgMantibody test on a late or acute convalescent phase serum specimen Confirmed: A case confirmed by laboratory criteria Case Definition for Dengue Hemorrhagic Fever (DHF) The following must all be present: 1. Evidence of plasma leakage due to increased vascular permeability. or history of fever. A rise in the hematocrit equal to or greater than 20% above average for age. ecchymosis. injection sites or other locations d. occasionally biphasic 2.
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