Airway: Check patency of airway, ensure nothing is blocking the airways (foreign object, tongue, secretions) provide some relief using chin lift and jaw thrust.
Breathing: Ensure child is breathing and note respiratory rate and signs of respiratory distress. CPAP or use ambubag in neonates.
Circulation: Check pulse, if less than 60 or if absent start chest compressions. Check capillary refill, if more than 3 seconds, its indicative of shock (Dopamine and Dobutamine can be administered)
Malnourished children are given Ringers lactate in 5% dextrose solution at a slow rate.
Convulsions: Course of management;
1. Diazepam(0.5mg/kg or 0.1mL/kg)per rectum OR (0.25mg/kg or 0.05mL/kg)IV over 1 minute.
If convulsions persist after 10 minutes, the dose is repeated after which the drug is changed if still convulsing.
2. Phenobarbital: 20mg/kgwhich can be repeated after 10 mins if convulsions persist.
***In neonates, diazepam is not the first line***
1st Line:Phenobarbital at 20mg/kg
2nd Line: Phenytoin at 18mg/kg
Dehydration:Assess using WHO parameters;
- Level of consciousness
- Eagerness to drink
- Sunken Eyes
- Skin Turgor
They are then classified into
No dehydration (<5% of body weight lost)
WHO Tx Plan A: the child should be given
50-100mL of ORS (if below 24 months)
or 100-200mL of ORS (if ≥ 24 months) after every loose stool passed
Some dehydration (5-10% lost)
WHO Tx Plan B: the child should be given 75mL/kg over 4 hours and then reassessed to move to plan A or plan C
Severe Dehydration (>10% lost)
WHO Tx Plan C:
the general principle is that 100mL/kg is to be provided over 3 or 6 hours, depending
on the child’s age. If below 12 months, start with 30mL/kg over 1 hour and move to 70mL/kg over 5 hours
If over 12 months, start with 30mL over 30 minutes and then if positive assessment is made, move to 70mL/kg over 2.5 hours
**In malnourished children, IV fluids should not be given, Resomal is given per os
If child dehydrated due to diarrhea, Zinc must also be given 10mg/day for 10-14 days if below 6 months and 20mg/day for 10-14 days if above 6 months
If the child needs fluid replacement over 24 hours, the amount of fluid per 24 hrs is calculated using;
1st 10kg X 100
2nd 10kg X 50
Remaining kg X 20
Children who need to be transfused
30mL/kg of whole blood
20mL/kg of packed RBCs
10mL/kg of FFP
Check for hypoglycemia
Below 2.2mmol/L in older children
Below 2.6mmol/L in neonates
Below 3mmol/L in malnourished children