Acces to health care in pediatrics.pptx
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Introduction to Medicine and History of Medicine Access to health care in pediatrics Anita Kolobarić, MD, pediatrician Clinic for Children's Diseases, University Clinical Hospital Mostar, School of Medicine University of Mostar Health is a state of complete physical, mental and social well-being...
Introduction to Medicine and History of Medicine Access to health care in pediatrics Anita Kolobarić, MD, pediatrician Clinic for Children's Diseases, University Clinical Hospital Mostar, School of Medicine University of Mostar Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Health system consists of all organization's, people and actions whose primary intent is to promote, restore or maintain health. (WHO) The ability to obtain, needed, affordable, convenient, acceptable, and effective personal health services in a timely manner. (Shi & Singh, 2008) 2 What is meant by "pediatrics"? • From birth to 18 years • Children are not smaller versions of adults • Early Interventions • Prevention Of Childhood Illnesses 3 Article 24 of the UN Convention on the Rights of the Child prescribes the obligation of the states parties to recognize the child's right to enjoy the highest possible level of health and to benefits in terms of healing and recovery. States Parties shall endeavor to ensure that no child is denied his or her right of access to health services. 4 The state parties will strive for the full realization of this right and, in particular, will take appropriate measures in goal: a) reducing the mortality of newborns and children; b) providing the necessary health care and medical care to every child; c) suppression of diseases and malnutrition within the framework of primary health care and ensuring adequate nutrition and purified drinking water, bearing in mind the dangers and risks of environmental pollution. 5 • d) insurance of prenatal and postnatal health care for mothers; • e) providing information on education and assistance in the use of basic knowledge about children's health and nutrition, the benefits of breastfeeding, personal hygiene and environmental cleanliness, and accident prevention to all levels of the community, especially parents and children; • f) development of preventive health care, counseling centers for parents and education and family planning services. 6 According to the analysis, there are a number of obstacles to exercising the right to access health care, and children are often required to complete various administrative procedures, such as issuing certificates of school attendance, parental health insurance, etc. These procedures are in contradiction with the provisions of the Convention, which regulates the issue of health care, and this protection must be provided to every child up to 18 years of age. 7 8 The most common health problems in pediatrics 9 Initial impression A – Airway B – Breathing C – Circulation D – Disability (AVPU scale (Alert, Responsive to Voice, Responsive to Pain, Unresponsive)) E - Exposure 10 Approach to a Child with Respiratory Distress 11 12 General management • Keep the child in the position of comfort and minimize agitation. • If upper airway obstruction is suspected, then perform manual airway measures such as head tilt - chin lift • Suctioning of nose or mouth if secretions are present. • Provide oxygen • Monitor heart rate, respiratory rate, blood pressure and SpO2. • Establish vascular access (for fluid therapy and medications as indicated) 13 When to refer: • Tachypnea, tachycardia • Chest indrawing • Severe cough • Cyanosis • Too sick to feed 14 Approach to a child with acute gastroenteritis and dehydration 15 16 What can you do? • • • • Give a probiotic Give ORS No routine use of antibiotics No anti-secretory agents (e.g., Racecadrotil, loperamide) 17 When to Refer: • Persistent/chronic diarrhea • Malnourished child • No clinical improvement after 3 h of ORT/IV fluids • Persistent vomiting, lethargy, electrolyte imbalance • Poor general condition of the child 18 Approach to a child with shock Suspect a child in shock if: 1. Presence of tachycardia 2. Quiet tachypnea (fast breathing without increased effort) 3. Cold, pale skin 4. Delayed capillary refill (> 3 s) 5. Weak peripheral pulses 6. History of decreased urine output 7. Changes in level of consciousness (irritable, lethargy) 19 Initial Shock Management 1. Position the child: If the child seems stable then allow the child to remain in the most comfortable position. If the child is unstable then make him lie supine, with head 30° below the feet. 2. Start high flow oxygen 4. Establish vascular access for fluid resuscitation and administration of medications. 5. Give fluid bolus 6. Monitor heart rate, SpO2, blood pressure, level of consciousness, temperature and urine output. 7. Take initial blood samples for basic laboratory studies. 8. Identify and correct hypoglycemia and hypocalcemia early. 9. Refer to pediatric facility with intensive care monitoring for further management. 20 Approach to a child with suspected anaphylaxis Suspect anaphylaxis when: Acute onset of an illness (minutes to several hours) involving the skin, mucosal tissue, or both (e.g. generalized rash, pruritus or flushing, swollen lips, tongue, uvula) and at least one of the following: 1. Respiratory compromise- difficulty in breathing, wheeze, bronchospasm, reduced peak expiratory flow, hypoxemeia or 2. Reduced blood pressure or associated symptoms and signs of end organ hypoperfusion e.g. syncope (collapse), hypotonia or 3. Persistent GI symptoms (e.g. abdominal pain, vomiting, diarrhea) 21 Management Assess ABC: Establish airway (A) if necessary, start 100% oxygen with respiratory support (B) as needed, (C): Assess circulation and establish large bore IV access. Place on cardiac monitor. GIVE Adrenaline (The wonder drug): • 0.01 ml/kg (1:1000) IM (maximum dose 0.5 ml). • Administer at the anterior-lateral thigh for maximal absorption. • Repeat every 15 min as needed. Admit all patients with anaphylaxis; Will require observation for late-phase symptoms. 22 Cardiopulmonary resuscitation of the newborn 23 The compromised baby may exhibit 1 or more of the following clinical findings: • Low muscle tone • Bradycardia • Cyanosis • Respiratory depression (apnea/gasping) 24 Steps in resuscitation Warmth and stimulation and assessment for 1st 30 seconds Rapidly assess: • Tone • Colour • Respiratory effort 25 Steps in resuscitation - ABCDE AIRWAY • Clear airwy (suction) • Positioning (head in neutral or slightly extended position) 26 27 Steps in resuscitation - ABCDE BREATHING • Assesment of respiratory effort and colour • Indications for oxygen administration (cyanosis, respiratory distress) • Indications for PPV (apnoea, HR<100/min, persistent cyanosis despite 100% O2) 28 • Watch for rise of chest • Rate 40-60/min 29 Indications for endo-tracheal intubation • Prolonged PPV required • Inadequate chest expansion • If chest compressions required: intubation may facilitate coordination and efficiency of ventilation • Tracheal suction required 30 Steps in resuscitation - ABCDE CIRCULATION • Assesment of heart rate and response to previouse measures 31 Chest compressions • HR <60 bpm despire adequate ventilation with 100% O2 for 30 seconds 2 tehniques: 1. 2 thumb 2. 2 finger 3:1 ratio 1/3 of AP diametar 32 Coordinate compressions and ventilations to avoid simultaneous delivery. There should be a 3:1 ratio of compressions to ventilations, with 90 compressions and 30 breaths to achieve approximately 120 events per minute. Thus, each event will be allotted approximately 1/2 second, with exhalation occurring during the first compression following each ventilation. 33 Steps in resuscitation - ABCDE DRUGS • Adrenalin (0.01-0.03 mg/kg iv or 0.05-0.1mg/kg E.T), repeat dose if no response after 60s • Volume expanders (normal saline 10-20 mL/kg) 34 35 36 Approach to a child with seizure (convulsions) Paroxysmal alteration of behavior and/or EGG changes resuting from abnormal, excessive activity of neurons. Epilepsy is recurrent, unprovoked seizures from known or unknown causes. Status epilepticus is continuous or intermittent seizure activity, greater than 10 minutes, without improvment of consciousness. 37 Types • Partial seizure – involves a focal area of the brain and therefore affects a specific portion of the body. The clinical presentation of the partial seizure at onset indicates the location of the epileptic focus in the brain. • Generalized seizure – affects the whole body and involves the entire cerebral cortex. 38 Etiology Symptomatic seizures can be caused: CNS Infection CNS Trauma Cerebrovascular Hypoxic Metabolic Neurologic effects of systemic disease Toxic Tumour Congenital CNS malformations Fever Idiopathic seizures occur in the absence of any underlying CNS pathology. 39 How to differentiate seizure and syncope? 40 Management A = Support airway B = 100 % oxygen, assess breathing, O2 saturation monitor C = Cardiorespiratory monitor, check pulse / blood pressure Establish intravenous (IV) access: Two IV lines if possible. Investigations: Rapid glucose test, critical labs Ongoing monitoring: for respiratory depression, hypotension, arrhythmias Place patient in a safe position, do not restrain. Bolus 0.5 g/kg glucose if glucose is ≤ 2.6 mmol/L 41 Medications (single dose) are recommended for seizures lasting longer than 5 minutes. Note: Early pharmacological intervention improves outcome. 42 Still having seizure after 5 minutes? Repeat first-line medication once, 5 minutes after first dose is given. If ≥ 2 doses of first-line medications have been given, and the seizure persists for more than 5 minutes after the last dose of benzodiazepine, then proceed to second-line medications (Fosphenytoin, Phenobarbital, Levetiracetam, Valproic acid) 43 44 Thank you! Have a good day 45
