By ULY CLINIC team
1. TRIAGE AND EMERGENCY CONDITIONS
Assess a child presenting at the health care facility using the ETAT syndromic approach. This approach classifies children in three categories:
-
Emergency
-
Priority
-
Non-urgent
1.1. Summary of steps in emergency triage assessment and
treatment
First, perform a proper survey as follows:
Primary survey as shown in the table 1 below
Secondary survey
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Take comprehensive history and examination
-
Perform specific investigations to confirm the Diagnostic
-
Plan and prioritize the specific management
Key element for management of sick children
Triage
Check for emergency sign
-
if present---------------Give emergency treatment until stable
-
If absent----------------Check for priority signs or conditions
by
History and physical examination
(including assessment of vaccination status, nutritional status and feeding
-
Check children with priority and emergency conditions first
Laboratory and other investigation if required
List and consider differential diagnosis
Select main diagnosis and secondary diagnosis
Plan and begin inpatient treatment(including supportive care)
Monitor for signs of
-
Improvement
-
Complications
-
Failure of treatment
If the child is not improving (or new problem)
Reassess for causes of failure of treatment
Then
Revise treatment
Plan and begin outpatient treatment
Arrange for followup if required
If improving
Continue treatment plan
Plan discharge
Discharge home
Arrange continuing care or followup at hospital or in the community
Table 1
Emergency sign
Assess using ABCD concept–Airway, Breathing, C’s (Circulation, Coma, Convulsion) and
Dehydration.
If any sign positive: Give treatment(s), Call for help, Draw blood for emergency investigations (Glucose, Hb, mRDT or BS)
Asses
AIRWAY AND BREATHING
-
Obstructed breathing, Or
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Central cyanosis Or
-
Severe respiratory distress
Treat
1. Do not move neck if cervical spine
injury possible
2. If foreign body aspiration
-
Manage airway in a chocking child
3. If no foreign body aspiration
-
Manage airway
-
Give oxygen
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Make sure child is warm
Asses
CIRCULATION
-
Cold hands with:
-
Capillary refill longer than 3 seconds
And check for
-
Weak and fast pulse
-
severe malnutrition
Treat
1. Stop any bleeding
2. Give oxygen
3. Make sure child is warm
If no severe malnutrition:
-
Insert IV and begin giving fluids
rapidly, If not able to insert
peripheral IV, insert an external
jugular or intraosseous line.
If severe malnutrition And lethargic or
unconscious:
-
Give IV glucose
-
Insert IV line and give fluids
If severe malnutrition and NOT lethargic or unconscious
-
Give glucose orally or by NGT
tube
Proceed immediately to full assessment and treatment
Asses
COMA /CONVULSING
-
Coma Or
-
Convulsing ( now)
Treat
1. Manage airway
2. If convulsing, give Diazepam rectally
3. Position the unconscious child (if head
or neck trauma is suspected, stabilize
the neck)
4. Give IV glucose
Asses
SEVERE DEHYDRATION
(Only in a child with diarrhea)
plus any two of these:
-
Lethargy
-
Sunken eyes
-
Very slow skin pinch
Treat
1. Make sure child is warm
2. If no severe malnutrition
-
Insert IV line and begin givin fluids rapidly (Diarrhoea Treatment
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Plan C in hospital)
3. If severe malnutrition:
-
Do not insert IV
-
Proceed immediately to full assessment and treatment
PRIORITY SIGNS (3TPR- MOB):
These children need Prompt Assessment and Treatment
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Tiny baby (<2 months)
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Temperature very high
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Trauma or other urgent surgical condition
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Pallor (severe)
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Poisoning (history of)
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Pain (severe)
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Respiratory distress
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Restless, continuously irritable
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Referral note (urgent)
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Malnutrition: Visible severe wasting
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Oedema of both feet
-
Burns (major)
NOTE: If a child has trauma or other surgical problems, get surgical help or follow
guidelines
NON- URGENT
Proceed with assessment and further treatment according to child’s priority.
Last updated 21.08.2020
References
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Tanzania Standard treatment guidline for pediatric, edition 2017