Page 17 - Learnwell EVS
P. 17
1. A few symptomes and syndromes
Management according to the cause
Haemorrhage 1
– C o ntro l bleed ing (co m p ressio n, to urniquet, surgical haem o stasis).
– D eterm ine blo o d gro up .
– P rio rity : resto re vascular vo lum e as quick ly as p o ssible:
Insert 2 p erip heral IV lines (catheters 1 6 G in ad ults)
Ringer Lactate o r 0.9% sodium chloride: rep lace 3 tim es the estim ated lo sses
and / o r plasma substitute: rep lace 1 .5 tim es the estim ated lo sses
– T ransfuse: classically o nce estim ated blo o d lo ss rep resents ap p ro xim ately 3 0 to
40%
o f blo o d vo lum e (2 5 % in child ren). T he blo o d m ust be tested (H I V , hep atitis B
and C ,
sy p hilis, etc.) R efer to the M S F hand bo o k , Blood transfusion.
Severe acute dehydration due to bacterial/viral gastroenteritis
Ringer Lactate o r 0.9% sodium chloride:
– U rgently resto re circulating vo lum e using IV bo lus therap y :
C hild ren < 2 m o nths: 1 0 m l/ k g o ver 1 5 m inutes. R ep eat (up to 3 tim es) if signs
of
sho ck p ersist.
C hild ren 2 -5 9 m o nths: 2 0 m l/ k g o ver 1 5 m inutes. R ep eat (up to 3 tim es) if signs
of
sho ck p ersist.
C hild ren ≥ 5 y ears and ad ults: 3 0 m g/ k g o ver 3 0 m inutes. R ep eat o nce if signs o f
sho ck p ersist.
– T hen, rep lace the rem aining vo lum e d eficit using co ntinuo us infusio n until signs o f
d ehy d ratio n reso lve (ty p ically 7 0 m l/ k g o ver 3 ho urs).
– C lo sely m o nito r the p atient; be careful to avo id fluid o verlo ad in y o ung child ren and
eld erly p atients).
Note: in severely m alno urished child ren the IV rate is d ifferent than tho se fo r healthy
child ren (see Severe acute malnutrition, p age 4 0 ).
Severe anaphylactic reaction
– D eterm ine the causal agent and rem o ve it, e.g. sto p o ngo ing injectio ns o r infusio ns,
but if in p lace, m aintain the I V line.
– A d m inister epinephrine ( adrenaline) I M , into th e antero - lateral tight, in the event o f
hy p o tensio n, p hary ngo lary ngeal o ed em a, o r breathing d ifficulties:
U se undiluted so lutio n (1 :1 0 0 0 = 1 m g/ m l) and a 1 m l sy ringe grad uated in 0 .0 1
m l:
C hild ren und er 6 y ears: 0 .1 5 m l
C hild ren fro m 6 to 1 2 y ears: 0 .3 m l
C hild ren o ver 1 2 y ears and ad ults: 0 .5 m l
I n ch ild ren, if 1 m l sy ringe is no t available, use a diluted so lutio n, i.e. ad d 1 m g
ep inep h rine to 9 m l o f 0 .9 % so d ium ch lo rid e to o btain a 0 .1 m g/ m l so lutio n
(1 :1 0 0 0 0 ) :
C hild ren und er 6 y ears: 1 .5 m l
C hild ren fro m 6 to 1 2 y ears: 3 m l
Management according to the cause
Haemorrhage 1
– C o ntro l bleed ing (co m p ressio n, to urniquet, surgical haem o stasis).
– D eterm ine blo o d gro up .
– P rio rity : resto re vascular vo lum e as quick ly as p o ssible:
Insert 2 p erip heral IV lines (catheters 1 6 G in ad ults)
Ringer Lactate o r 0.9% sodium chloride: rep lace 3 tim es the estim ated lo sses
and / o r plasma substitute: rep lace 1 .5 tim es the estim ated lo sses
– T ransfuse: classically o nce estim ated blo o d lo ss rep resents ap p ro xim ately 3 0 to
40%
o f blo o d vo lum e (2 5 % in child ren). T he blo o d m ust be tested (H I V , hep atitis B
and C ,
sy p hilis, etc.) R efer to the M S F hand bo o k , Blood transfusion.
Severe acute dehydration due to bacterial/viral gastroenteritis
Ringer Lactate o r 0.9% sodium chloride:
– U rgently resto re circulating vo lum e using IV bo lus therap y :
C hild ren < 2 m o nths: 1 0 m l/ k g o ver 1 5 m inutes. R ep eat (up to 3 tim es) if signs
of
sho ck p ersist.
C hild ren 2 -5 9 m o nths: 2 0 m l/ k g o ver 1 5 m inutes. R ep eat (up to 3 tim es) if signs
of
sho ck p ersist.
C hild ren ≥ 5 y ears and ad ults: 3 0 m g/ k g o ver 3 0 m inutes. R ep eat o nce if signs o f
sho ck p ersist.
– T hen, rep lace the rem aining vo lum e d eficit using co ntinuo us infusio n until signs o f
d ehy d ratio n reso lve (ty p ically 7 0 m l/ k g o ver 3 ho urs).
– C lo sely m o nito r the p atient; be careful to avo id fluid o verlo ad in y o ung child ren and
eld erly p atients).
Note: in severely m alno urished child ren the IV rate is d ifferent than tho se fo r healthy
child ren (see Severe acute malnutrition, p age 4 0 ).
Severe anaphylactic reaction
– D eterm ine the causal agent and rem o ve it, e.g. sto p o ngo ing injectio ns o r infusio ns,
but if in p lace, m aintain the I V line.
– A d m inister epinephrine ( adrenaline) I M , into th e antero - lateral tight, in the event o f
hy p o tensio n, p hary ngo lary ngeal o ed em a, o r breathing d ifficulties:
U se undiluted so lutio n (1 :1 0 0 0 = 1 m g/ m l) and a 1 m l sy ringe grad uated in 0 .0 1
m l:
C hild ren und er 6 y ears: 0 .1 5 m l
C hild ren fro m 6 to 1 2 y ears: 0 .3 m l
C hild ren o ver 1 2 y ears and ad ults: 0 .5 m l
I n ch ild ren, if 1 m l sy ringe is no t available, use a diluted so lutio n, i.e. ad d 1 m g
ep inep h rine to 9 m l o f 0 .9 % so d ium ch lo rid e to o btain a 0 .1 m g/ m l so lutio n
(1 :1 0 0 0 0 ) :
C hild ren und er 6 y ears: 1 .5 m l
C hild ren fro m 6 to 1 2 y ears: 3 m l
