better see presentation it self which describe imnci protocol

2. ACUTE RESPIRATORY TRACT
INFECTIONS
IMNCI Protocol (WHO)
(Integrated Management Of Neonatal and
Childhood Illnesses)
Prep & Presented by Dr. Zujaja Baloch
Instructed by Lt Col Jawad Jalil

3. History
Name: XYZ (Male)
Age: 15 months
Address: Gujranwala
DOA: 10 dec 2014
DOD: 14 dec 2014
Source: OPD

4. History (Cont)
• Presenting compliants:
Rhinorrhea 7 days
Cough 6 days
Fever 4 days
Breathing Difficulty 2 days

5. History (Cont)
• Birth History :
Antenatal History: Booked Case.
Natal History: FTP & SVD, delivered in Hospital.
Post Natal: Cried after birth, no jaundice or cyanosis
• Feeding History :
Exclusively Breast fed for 6 months & weaning started.
• Vaccination History :
Vaccinated according to EPI Schedule

6. History (Cont)
• Developmental History:
Gross Motor, Fine Motor & Social Development was fine
• Family History:
Non consangious marriage.
No history of asthma, epilepsy, TB or congenital heart diseases.
• Socioeconomic history :
Middle class family.

7. Examination
• General physical examination :
Apprehensive, Irritable
Mildly dehydrated
Nasal flaring
Weight 10 kg
• Vital Signs :
Pulse : 150 / min
Respiratory Rate 64 / min
Temperature 102°F

8. Systemic examination
• Respiratory system examination :
R/R: 64 / min
Chest in drawing
Nasal flaring
Recessions
• CVS examination
• GIT examination Normal
• CNS examination

9. Investigation
• Complete Blood Picture:
Hb 11.4 g/dl
TLC 7 × 10 / L
• Chest X – Ray :
Normal findings
9

10. DIAGNOSIS
Acute Respiratory Tract Infection
(Bronchiolitis)

11. Treatment
• Anti pyretic :
Paracetamol 5 ml—(SOS)
• Nebulization:
Ipratropium (Atem) 6 hourly.
• Discharged on 3rd day

12. Case discussion

15. Epidemiology
•Each year, acute respiratory
infections cause approximately 2-3
million deaths among children <5
years old and are the leading cause of
death in this age group.

16. ARI
• ARI is the most common of the human
ailment.
• It runs a natural course and mostly settles
without treatment and complications.
• In young infants, children and elderly there is
increased morbidity and mortality.

17. TYPES
• Acute Upper Respiratory Infections.
Mild cough, cold, pharyngitis, otitis media, and
allergic rhinitis.
• Acute Lower Respiratory Infections.
Laryngotracheitis, bronchitis, bronchiolitis,
pneumonia.

19. RISK FACTORS
• Low Birth Weight
• Malnutrition
• Specific nutritional deficiencies
• Climatic conditions
• Housing (over crowding, poor housing
conditions)
• Level of Industrialization
• Socio-economic Level
• Pollution
• Smoking

21. CLINICAL ASSESSMENT
• 1.BREATHING RATE/MINUTE.
• 2.LOOK FOR CHEST INDRAWING.
• 3.LOOK AND LISTEN FOR STRIDOR.
• 4.LOOK FOR WHEEZE.
• 5.LOOK IF THE CHILD IS DROWSY.
• 6.FEEL FOR FEVER.
• 7.CHECK FOR SEVERE MALNUTRITION.
• 8. LOOK FOR CYANOSIS.

22. SIGNS OF RESPIRATORY DISTRESS

23. Nasal Flaring

24. SIGNS OF RESPIRATORY DISTRESS

25. Chest In drawing

26. CLASSIFICATION OF ILLNESS
• Child aged (0- 2 months)
→ Very severe disease.
→ Severe Pneumonia.
→ No Pneumonia: cough or cold.

27. CLASSIFICATION OF ILLNESS
• 2 months up to 5 years.
→Very severe disease.
→ Severe Pneumonia.
→ Pneumonia not Severe.
→ No Pneumonia: cough or cold.

28. O-2 Months
• PNEUMONIA :
Fast breathing without chest in drawing
• SEVERE PNEUMONIA :
Respiratory rate
60 or more/minute
Chest in drawing
Nasal flaring
Grunting
Cyanosis

29. 0-2 months
• VERY SEVERE DISEASE
→ Danger signs
Convulsions
Stridor
Stopped feeding well
Wheezing
Fever/ Low body temperatures

30. 2-5 yrs
• NO PNEUMONIA :
cough or cold
• PNEUMONIA NOT SEVERE :
Fast breathing without chest in drawing

31. 2-5 yrs
• SEVERE PNEUMONIA :
Chest in drawing
Nasal flaring
Grunting
Cyanosis
Fast breathing
• Age 2 -12 months R/R : 50 or more/ min
• Age 1- 5 years R/R : 40 or more/ min

32. 2-5 YRS
• VERY SEVERE PNEUMONIA :
Child is unable to drink
Convulsions
Strider in the calm child
Severe malnutrition

33. WHO Classification and management
NO PNEUMONIA COUGH
NO TACHYPNEA
-HOME CARE
-SOOTHE THE THROAT AND RELIEVE
COUGH
-ADVISE MOTHER WHEN TO RETURN
-FOLLOWUP IN 5 DAYS IF NOT
IMPROVING
PNEUMONIA -COUGH
-TACHYPNEA
-NO RIB OR STERNAL RETRACTION
-ABLE TO DRINK
- NO CYANOSIS
-HOME CARE
-ANTIBIOTICS FOR 5 DAYS
-SOOTHE THE THROAT AND RELIEVE
COUGH
-ADVISE MOTHER WHEN TO RETURN
-FOLLOWUP IN 2 DAYS
SEVERE PNEUMONIA -COUGH
-TACHYPNEA
-RIB AND STERNAL RETRACTION
-ABLE TO DRINK
-NO CYANOSIS
-ADMIT IN HOSPITAL
-GIVE RECOMMENDED ANTIBIOTICS
-MANAGE AIRWAY
-TREAT FEVER IF PRESENT
VERY SEVERE PNEUMONIA -COUGH
-TACHYPNOEA
-CHEST WALL RETRACTION
-UNABLE TO DRINK
-CENTRAL CYANOSIS
-ADMIT IN HOSPITAL
-GIVE RECOMMENDED ANTIBIOTICS
-OXYGEN
-MANAGE AIRWAY
-TREAT FEVER IF PRESENT

36. THANK
YOU