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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

  • 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

  • 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

  • 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

  • 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

 

  • Tiny baby (<2 months)

  • Temperature very high

  • Trauma or other urgent surgical condition

  • Pallor (severe)

  • Poisoning (history of)

  • Pain (severe)

  • Respiratory distress

  • Restless, continuously irritable

  • Referral note (urgent)

  • Malnutrition: Visible severe wasting

  • 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.

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Last updated 21.08.2020

References

  1. WHO.https://www.who.int/elena/titles/full_recommendations/sam_management/en/index5.html. August 20.2020

  2. Tanzania Standard treatment guidline for pediatric, edition 2017

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