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Pocket Emergency Paediatric Care - part 5

Cấy máu và IV kháng sinh nhất định. Ampicillin / penicillin và một aminoglycoside (hoặc một cephalosporin thế hệ thứ ba). • Ngực x ray. • Tránh ăn uống: IV glucose 10% (60 ml / kg / ngày) là an toàn nhất, thiết bị ngoại vi tĩnh mạch hoặc nếu không có thể UVC. Nếu không có cơ sở cho IV, sữa mẹ hoặc glucose 10% (lên đến 60 ml / kg / ngày) bằng ống orogastric. | GASTROINTESTINAL LIVER RENAL 79 USE either low-sodium ORS containing 40-60 mEq L of sodium or ORS containing 75-90 mEq L of sodium with an additional source of low-sodium fluid for example breastmilk formula or clean water . Oedematous eyelids usually indicate over-rehydration but may indicate malnutrition. If this develops stop ORS and give breastmilk plain water and food. Do not give diuretic. When the oedema has gone resume ReSoMaL or low Na ORS. WHO ORS bicarbonate solution Low Na ORS solution for example Dioralyte ReSoMal Na 90 60 45 K 20 20 40 Cl- 80 60 HCO3- Citrate 30 10 Glucose 111 90 125 mmol L Home made ORS to 1 litre clean water add 8 level teaspoons sugar 1 level teaspoon salt Fruit juice for taste Severe malnutrition Principles of treatment Phase 1 1-7 days Transition 3-4 days Phase 2 usually 14-21 days Treat or prevent dehydration hypoglycaemia hypothermia Treat infection Treat helminths Continued 80 POCKET EMERGENCY PAEDIATRIC CARE Phase 1 1-7 days Transition 3-4 days Phase 2 usually 14-21 days Correct electrolyte imbalance Do NOT give iron Do not give iron Correct nutrient deficiencies and iron deficiency DIET maintenance intake Moderate intake High food intake Stimulate child Stimulate child Stimulate child Provide physical activities Prepare for discharge General points Protect from infections in warm room 25-30 C without draughts. Wash minimally and with warm water and immediately dry. Mother to stay with child especially at night. Avoid IV infusions as high risk of heart failure. Only indication is unconsciousness due to circulatory collapse. Only indication for blood transfusion is when anaemia is life threatening. IV cannulae removed immediately after treatment. NG feeding if anorexia with intake of 70 kcal kg severe dehydration with inability to drink cannot drink and eat because of weakness or clouded consciousness painful or severe mouth or oesophageal lesions herpes candida cancrum oris repeated very frequent vomiting try not to tube feed