Seeing Paediatric Patients in OPD Prof Pushpa Raj

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Seeing Paediatric Patients in OPD Prof. Pushpa Raj Sharma

Seeing Paediatric Patients in OPD Prof. Pushpa Raj Sharma

Why it is special? n n n n Common problem: fever (90%) Limited time

Why it is special? n n n n Common problem: fever (90%) Limited time Large number of patients. Not to miss the serious ones. Not to over prescribe drugs. Parents satisfaction Ethical

Serious conditions n n n n Not able to suck, swallow Unconscious, drowsy, lethargic

Serious conditions n n n n Not able to suck, swallow Unconscious, drowsy, lethargic Convulsion in this episode Neonate Chest indrawing Oedema Tachypnoea

History taking in OPD n n n Write main presenting complaint Start examining while

History taking in OPD n n n Write main presenting complaint Start examining while asking questions around the presenting complaint Commonest complaints n n Fever Loss of appetite Diarrhoea cough

Examples of questions for fever n n n n n For how long? Usually

Examples of questions for fever n n n n n For how long? Usually 1 -3 days Does he/she coughs? Any diarrhoea: blood in stools Any rash Any body at home/hostel having similar problem Ear discharge Any convulsion Any swelling or wound Any joint problem

Looking a child with fever n n n Congested eyes Runny nose Congested throat/ulcers/enlarged

Looking a child with fever n n n Congested eyes Runny nose Congested throat/ulcers/enlarged tonsils Rash Tachypnoea observation Spleen and liver

Fever diagnostic appraoch Toxic look without any localising signs Paracetamol/ if more than 2

Fever diagnostic appraoch Toxic look without any localising signs Paracetamol/ if more than 2 days ask for culture/TLC and DLC n Follow up day with report Localising signs (red eyes/ runny nose/ congested throat. ) n Paracetamol n Follow-up after 2 days Localising signs (liver/spleen_ n Enteric/hepatitis/malaria/viral n

Final prescription n n Presenting complaint and duration Principle findings: toxic/localizing signs n n

Final prescription n n Presenting complaint and duration Principle findings: toxic/localizing signs n n Paracetamol Antibiotics n n Formulations costs

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