By ULY CLINIC team
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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:
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Emergency
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Priority
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Non-urgent
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1.1. Summary of steps in emergency triage assessment and
treatment
First, perform a proper survey as follows:
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Primary survey as shown in the table 1 below
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Secondary survey
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Take comprehensive history and examination
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Perform specific investigations to confirm the Diagnostic
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Plan and prioritize the specific management
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Key element for management of sick children
Triage
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Check for emergency sign
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if present---------------Give emergency treatment until stable
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If absent----------------Check for priority signs or conditions
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by
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History and physical examination
(including assessment of vaccination status, nutritional status and feeding
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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
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Plan and begin inpatient treatment(including supportive care)
Monitor for signs of
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Improvement
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Complications
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Failure of treatment
If the child is not improving (or new problem)
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Reassess for causes of failure of treatment
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Then
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Revise treatment
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Plan and begin outpatient treatment
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Arrange for followup if required
If improving
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Continue treatment plan
Plan discharge
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Discharge home
Arrange continuing care or followup at hospital or in the community
Table 1
Emergency sign
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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
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AIRWAY AND BREATHING
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Obstructed breathing, Or
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Central cyanosis Or
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Severe respiratory distress
Treat
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1. Do not move neck if cervical spine
injury possible
2. If foreign body aspiration
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Manage airway in a chocking child
3. If no foreign body aspiration
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Manage airway
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Give oxygen
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Make sure child is warm
Asses
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CIRCULATION
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Cold hands with:
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Capillary refill longer than 3 seconds
And check for
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Weak and fast pulse
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severe malnutrition
Treat
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1. Stop any bleeding
2. Give oxygen
3. Make sure child is warm
If no severe malnutrition:
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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:
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Give IV glucose
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Insert IV line and give fluids
If severe malnutrition and NOT lethargic or unconscious
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Give glucose orally or by NGT
tube
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Proceed immediately to full assessment and treatment
Asses
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COMA /CONVULSING
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Coma Or
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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
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SEVERE DEHYDRATION
(Only in a child with diarrhea)
plus any two of these:
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Lethargy
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Sunken eyes
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Very slow skin pinch
Treat
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1. Make sure child is warm
2. If no severe malnutrition
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Insert IV line and begin givin fluids rapidly (Diarrhoea Treatment
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Plan C in hospital)
3. If severe malnutrition:
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Do not insert IV
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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
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Burns (major)
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NOTE: If a child has trauma or other surgical problems, get surgical help or follow
guidelines
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NON- URGENT
Proceed with assessment and further treatment according to child’s priority.
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Last updated 21.08.2020
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References
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Tanzania Standard treatment guidline for pediatric, edition 2017