essential clinical symptoms & signs - kenya paediatric
TRANSCRIPT
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Essential Clinical Symptoms & Signs
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Objectives
• Define key symptoms of common, serious diseases
• Define and demonstrate key clinical signs of common, serious diseases
• Improve communication between professionals
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The most useful symptoms & signs
• Observed commonly in common illnesses
• Help assessment of nature and severity of illness
• Indicate risk of death
• Useful for monitoring progress
• Differentiate diseases
• Easy for everyone to observe and learn
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Choosing the ‘best’ symptoms & signs
• WHO and others investigating this for 30 years
• Sound evidence base for most common disorders of children
• Included in the IMNCI approach
• Best signs are the foundation of the whole week
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Symptoms 3
Cough for more than TWO weeks is not acute pneumonia
5
5
3
Why is it important to document the duration of fever? of cough?
Why is history of contact with TB /chronic cough important.
What does ‘contact’ mean?
Why ‘last 12months’?
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Symptoms 4
Vomiting everything means no oral medicines and is a danger sign
Convulsion >1 or Partial convulsions suggest meningitis – a danger sign. Requires LP
2
Why do we need to ask whether there is diarrhoea >14 days or whether it is bloody?
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Airway / Breathing• Airway
• Stridor (inspiratory)
• Breathing adequacy• Respiratory Rate – Counted for 1 minute in a calm child!• Oxygen saturation (pulse oximetry) • Central cyanosis• Head nodding• Grunting • Indrawing• Acidotic / deep breathing• Wheeze / crackles
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Central Cyanosis
Gums / Tongue NOT fingers Lips unreliable Problem detecting
cyanosis if the child has severe anaemia
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Indrawing
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Deep/Acidotic Breathing
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Respiratory distress Signs Grunting: abnormal, short, deep, hoarse sounds on exhalation
Grunting is the body's way of trying to keep air in the lungs so they will stay open
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Pulse oximeter Saturation <90% give
oxygen
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Signs 2 – Circulation & Dehydration
• Pulse• Weak (or absent)• Rate
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Capilllary refill time
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Capillary Refill in Immediate Newborn Period
• Assess centrally over sternum
• Normal range 1 to 3 secs
• Abnormal begins at 4 secs and longer
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Pallor
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Sunken Eyes
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Skin Pinch
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Disability
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AVPU Scale
• A = Alert
• V = Responds to a voice / sound appropriately
• P = Responds appropriately to pain
• U = Unresponsive / Unconscious
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Alert?
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Responds to voice
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Responds to Pain
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Ability to Drink / Breastfeed?
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Bulging fontanelle and stiff neck• Fontanelle should be examined with the infant lying down
at rest (i.e. not crying)
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General Condition / Nutrition?
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Jaundice
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Oedema
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Mid Upper Arm Circumference (MUAC)• MUAC is the recommended
measure for assessing nutritional status in children
aged 6 – 59 months• MUAC is a single linear
measurement that does not require arithmetic, table look-up or plotting data on growth charts
• A colour-coded tape is used to determine the level of severity of malnutrition
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Length measurement • Children up to 87 cm (or
<2 years) are measured while lying down
• Classification of nutritional status based on WHZ score is used in infants <6 months
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Definitions of Malnutrition
MUAC cm(6-59 months)
WHZ(<6months)
None >13.5 >-1
At Risk 12.5 to 13.4 -2 to -1
Moderate 11.5 to 12.4 -3 to -2
Severe<11.5 <-3
Oedema of severe malnutrition
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QUESTIONS?
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Summary
• Simple symptoms and signs will help guide basic treatment in 80-90% of children admitted.
• A common approach to interpreting clinical signs helps clinical communication.
• Always be on the look out for additional important signs