EMERGENCY HEALTH KIT
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- Title
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EMERGENCY
HEALTH KIT - extracted text
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DAP/87.2
DISTR. : LIMITED
WORLD
>•
HEALTH ORGANIZATION
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ORGANISATION MONDIALE DE LA SANTE
EMERGENCY
HEALTH KIT
Treatment guidelines
for
basic kit
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1
Treatment Guidelines for Basic Kit
Introduction
These treatment guidelines are intended to give simple guidance to primary
health care workers using the Basic Kit. In the dosage guidelines four age
c, groups have been distinguished. When dosage is shown as 1 tab. x 2, one tablet
should be taken in the morning and one before bedtime. When dosage is shown as
2 tab. x 3, two tablets should be taken in the morning, two should be taken in
the middle of the day and two before bedtime.
For the daignosis and treatment of diarrhoea fully detailed schedules have
been included as Annex 1 and 2. For the diagnosis and treatment of respiratory
'tract infections separate schedules are being used for children under five
The Basic Kit contains the following essential drugs:
acetylsalcylic acid (ASA)
aluminium hydroxyde
chloroquine
cotrimoxazole
ferrous sulphate + folic acid
mebendazole
oral rehydration salts
paracetamol
benzyl benzoate lotion 25%
chlorhexidine, solution 5%
gentian violet
tetracycline eye ointment 1%
tablets 300 mg
tablets 500 mg
tablets 150 mg base
tablets 400 mg sulfamethoxozole +
80 mg trimethoprim
tablets 200 mg + 0.25 mg
tablets 100 mg
sachets for 1 litre solution
tablets 100 mg
bottle 1 litre
bottle 500 ml
powder 25 g
tube 5 g
The Treatment Guidelines contain the following diagnostic groups:
Anaemia
Diarrhoea
Eye
.Fever
Pain
Prevention in pregnanct women
Respiratory tract infections
Sexually transmitted diseases
Skin conditions
Urinary tract infections
Worms
page 2
2
3
3
3
4
4
5
6
6
7
Special instructions as to the dilution of chlorhexidine and benzylbenzoate
are given as footnotes to the text.
-2-
I
DIAGNOSIS/SYMPTOM
i15 and over
0 to 11 months
1 to 4 years
5 to 14 years
ferrous sulph.
+ folic acid
1 tab. daily
ferrous sulph.
+ folic acid
2 tab. daily
ferrous sulph. !ferrous sulph.
+ folic acid
j+ folic acid
3 tab. daily
|3 tab. daily
ANAEMIA
ANAEMIA
moderate (pallor and
tiredness)
ANAEMIA
severe (oedemas, dizzi
ness, shortness of breath)
Refer
DIARRHOEA
DIARRHOEA
no dehydration
Continue (breast)feeding , give more fluids than usual,
Return to health worker in case of frequent stools,
increased thirst, sunken eyes, fever, or when the patient
does not eat or drink normally, or does not get better.
DIARRHOEA
moderate dehydration
Treat with oral rehydration salts, 50-100 ml/kg in first A
houres, reassess the condition after 4-6 hours.
For exact dosage of ORS, see Annex 2B
For exact diagnosis
see Annex 1
500 ml
within 6 hours
DIARRHOEA
severe dehydration
Oral rehydration salts, 100 ml/kg as soon as possible,
and refer patient for nasogastric tube and/or IV treatment
DIARRHOEA
bloody stools
(check stools)
cotrimoxazole
1/4 tab. x 2
for five days
DIARRHOEA
lasting more than two
weeks, or patient mal
nourished or in poor
condition
Give ORS as in diarrhoea with moderate dehydration, and refer
1 litre
within 6 hours
cotrimoxazole
1/2 tab. x 2
for five days
2 litres
within 6 hours
cot rimoxazole
1 tab. x 2
for five days
OIA63
COMMUrrTY HZTV.TH CELL
47/1, (First iioor)3t. Marks Hoad
BANGALORE -
001
3 litres
within 6
cot rimoxazole
2 tab. x 2
for five days
-3-
DIAGNOSIS/SYMPTOM
|0 to 11 months
1 to 4 years
5 to 14 years
' 15 and over
EYE
-----------------------------
I
RED EYE (conjunctivitis)
FEVER
1---------FEVER
no chills
Apply tetracycline eye ointment 3 times a day for 5 days
If not improved after three days, or if in doubt: refer
Younger than
1 month:
paracetamol
1/4 tab. x 3
Older than
1 month:
paracetmol
1/2 tab. x 3
1 to 3 days
paracetamol
1 tab. x 3
for 1-3 days
paracetamol
2 tab. x 3
for 1-3 days
ASA
2 tab. x 3
for 1.3 days
FEVER
with chills:
assume it is
MALARIA
chloroquine
1/2 tab. once,
1/4 tab. after
6, 24 and 48h
chloroquine
1 tab. once,
1/2 tabs after
6, 24 and 48h
chloroquine
2 tab. once,
1 tab. after
6, 24 and 48h
chloroquine
4 tab. once,
2 tab. after
6, 24 and 48h
FEVER with cough
see COUGH
see LOW RESP.TRACT INFECTION
FEVER and patient
malnourished or in
poor condition, or
when in doubt
Refer
PAIN
PAIN
headache, joint pain,
toothache, etc
PAIN IN THE STOMACH
Older than
one month:
paracetamol
1/2 tab x 3
Refer
paracetamol
1 tab. x 3
paracetamol
2 tab. x 3
ASA
2 tab. x 3
aluminium
hydroxyde
1/2 tab. x 3
for 3 days
aluminium
hydroxyde
1 tab. x 3
for 3 days
-4DIAGNOSIS/SYMPTOM
0 to 11 months
1 to 4 years
5 to 14 years
15 and over
PREVENTION IN PREGNANT WOMEN
I
PREVENTION OF ANAEMIA
(for treatment, see
under Anaemia)
: ferrous sulph.
i + folic acid
1 tab. daily
in pregnancy
PREVENTION OF MALARIA
(for treatment, see
under Fever)
chloroqui'
2 tab. wee-xy
in pregnancy
4
RESPIRATORY TRACT INFECTIONS
SORE THROAT
with fever and enlarged
tender neck glands
Refer
cotrimoxazole
1/2 tab. x 2
for 5 days
cotrimoxazole
1 tab. x 2
for 5 days
cotrimoxazole
2 tab. x '
for 5 days
cotrimoxazole
1/2 tab. x 2
for 5 days
cotrimoxazole
1 tab. x 2
for 5 days
cotrimozoxole
2 tab. x 2
for 5 days
EAR
ear pain with fever or
ear discharge for less
than 2 weeks
Younger than
2 months:
Refer
Older than
2 months:
cotrimoxazole
1/4 tab. x 2
for 5 days
EAR
ear discharge for more
than 2 weeks
Once daily clean the ear by syringe without needle using
lukewarm water.; repeat untill the water comes out clean.
Dry repeatedly with absorbent paper
-5t
5 to 14 years
I
i 15 and over
COMMON COLD (children over 5 and adults)
malaise, fatigue, slight cough
no or moderate fever, no or watery sputum
ASA
1 tab. x 3
ASA
2 tab. x 3
LOWER RESP. TRACT INFECTION (children over 5 and adults)
cough with fever,
yellow sputum
cot rimoxazole cotrimaoxazole
1 tab. x 2
2 tab. x 2
for 5 days
for 5 days
DIAGNOSIS/SYMPTOM
1 to 4 years
0 to 11 months
. RESPIRATORY TRACT INFECTIONS (cont'd)
COUGH (children 0-4)
no fast breathing
no chest indrawing
child able to drink
Continue (breast)feeding, give
fluids, do not allow the child
to become too cold or too hot,
clear the nose to facilitate
breathing, avoid smoke, treat
fever if present.
COUGH (children 0-4)
fast breathing (more than
50 breaths per minute but
less than 70 per minute)
no chest indrawing
child able to drink
Younger than
2 months:
Refer
Older than
2 months:
cotrimoxazole
1/4 tab. x 2
for 5 days
COUGH (children 0-4)
fast breathing (more than
70 breaths per minute)
or chest indrawing
or child unable to drink
COUGH
Lasting over 30 days
cotrimoxazole
1/2 tab. x 2
for 5 days
Refer
Refer
SEXUALLY TRANSMITTED DISEASE
VENERAL DISEASE
(syphilis, gonorrhoea)
Refer
-6DIAGNOSIS/SYMPTOM
0 to 11 months
1 to 4 years
i
5 to 14 years
15 and over
SKIN CONDITIONS
WOUNDS
limited and superficial
WOUNDS
extended, deep or on face
Clean with diluted chlorhexidine solution (1)
Apply gentian violet once daily
Refer
BURNS
mild, moderate
Immerse immediately in cold water, or use a cold wet cloth
Continue until pain ceases, then treat as WOUNDS
BURNS
severe (on face or very
extensive)
Treat as for MILD BURNS, and refer
BACTERIAL INFECTION
mild
BACTERIAL INFECTION
severe (with fever)
FUNGAL INFECTION
SCABIES
SCABIES
infected
Clean with diluted chlorhexidine solution (1)
Apply gentian violet two times daily
If not improved after 10 days: refer
Refer
Apply gential violet once daily for five days
Apply diluted
benzyl benzoate (2)
Bacterial infection:
Apply benzyl benzoate 25%
clean with diluted chlorhexidine (1)
Apply gentian violet twice daily.
When infection is cured, apply benzyl benzoate
URINARY TRACT INFECTION
URINARY TRACT INFECTION
Refer
-7-
DIAGNO SIS/SYMP TOM
0 to 11 months
1 to 4 years
5 to 14 years
15 and over
ROUNDWORM (as ca ri s)
PINWORM (enterobius)
mebendazole
2 tab. once
mebendazole
2 tab. once
mebendazole
2 tab. once
HOOKWORM, OTHER WORMS
TAPEWORM (taenia)
mebendazole
2 tab, x 2
for 3 days
mebendazole
2 tab. x 2
for 3 days
mebendazole
2 tab. x 2
for 3 days
WORMS
1 Chlorhexidine 5% must always
_ be diluted before use: take the one-litre plastic bottle
supplied with the kit. Fill
f’’1 20 ml of chlorhexidine solution into the bottle by using the
10 ml syringe supplied with the kit (20 ml is two full syringes),
, • Fill up the bottle with
boiled or clean water.
2 Dilute by mixing one half litre benzyl benzoate 25% with one half litre clean water in the
one litre plastic bottle supplied with the kit.
HOW TO ASSESS YOUR PATIENT
FOR DEHYDRATION
B
C
Less than 4 liquid stools per day
4 to 10 liquid stools per day
More than 10 liquid stools per day
VOMITING
THIRST
URINE
None or a small amount
Normal
Normal
Some
Greater than normal
A small amount, dark
Very frequent
Unable Io drink
No urine lor 6 hours
CONDITION
Well, alert
Unwell, sleepy or irritable
TEARS
EYES
MOUTH and
TONGUE
Present
Normal
Wet
Absent
Sunken
Dry
Very sleepy, unconscious,
Hoppy or having Ills
Absent
Very dry and sunken
Very dry
BREATHING
Normal
Faster than normal
Very last and deep
SKIN
PULSE
A pinch goes back quickly
Normal
A pinch goes back slowly
Faster than normal
FONTANELLE
(m infants)
Normal
A pinch goes back very slowly
Very fast, weak, or you cannot
feel it
Sunken
Very sunken
1 ASK ABOUT DIARRHOEA
2 LOOK AT
3 FEEL
FOR OTHER PROBLEMS
A
Longer than 14 days duration
Blood in the stool
Severe undernulnlion
4 TAKE TEMPERATURE
Fever-38 5°C (or IO1°F) or greater
5^
r.7
5 WEIGH IF POSSIBLE
6 DECIDE
Loss ol less than 25 grams
lor each kilogram of weight
Loss of 25-100 grams
for eact) kilogram ol weight
Loss ol more than 100 grams
lor each kilog^m of weight
The patient has no signs of
dehydration
II the patient has 2 or more
ol these signs, he has some
dehydration
II Hie patient has 2 or more
ol these danger signs, he has
severe dehydration
Use Plan A
Use Plan B
IF YOUR PATIENT HAS:
Blood in the stool and
diarrhoea lor less than
14 days
Use Plan C
Source: Treatment of diarrhoea; WHO/CDD,
1987
Q.
Diarrhoea for longer
than 14 days with or
without blood
THEN:
Treat with an appropriate oral
antibiotic for shigella dysentery
II this child is also
- dehydrated.
- severely undernourished.
or
- less than 1 year of age.
reassess Itie child's progress
in 24 - 48 hours.
For the severely undernourished
child, also reler lor treatment
ol severe undernutrihon
Continue feeding
and
reler lor treatment
Severe undernulnlion
Fever - 38 5°C
(or lOTF) or greater
k
Show the mother how to cool
the child wiih a wet cloth and
fanning
Look for and treat other
causes (lor example,
pneumonia, malaria)
>
n>
Annex 2A
TREATMENT PLAN A
TO TREAT DIARRHOEA
EXPLAIN THE THREE RULES FOR TREATING DIARRHOEA AT HOME:
1. (GIVE YOUR CHILD MORE FLUIDS THAN USUAL TO PREVENT DEHYDRATION.
SUITABLE FLUIDS INCLUDE:
“
• The recommended home fluid or food-based fluids, such as oruel. soup, or rice water
• Breastmilk or milk feeds prepared with twice the usual amount of water.
2. GIVE YOUR CHILD FOOD
• Give freshly prepared foods. Recommended foods are mixes of cereal and beans, or cereal
and meat or fish. Add a few drops of oil to the food, if possible.
• Give fresh fruit juices or bananas to provide potassium.
Offer food every 3 or 4 hours (6 times a day) or more often for very young children.
• Encourage the child to eat as much as he wants.
Cook and mash or grind food well so it will be easier to digest.
• After the diarrhoea stops, give one extra meal each day for a week, or until the child has
regained normal weight.
3'
To THE HEALTH WORKER IF THE CHILD HAS ANY OF
I rib FOLLOWING]:
• passes many stools ]
• is very thirsty
These 3 signs suggest youPchild is dehydrated.
• has sunken eyes
• has a fever
• does not eat or drink normally
• seems not to be getting better.
TEACH THE MOTHER HOW TO USE ORS SOLUTION AT HOME. IF:
• The mother cannot come back if the diarrhoea gets worse.
It is national policy to give ORS to all children who see a health worker for diarrhoea
treatment, or
Her child has been on Plan B, to prevent dehydration from coming back.
SHOW HER HOW TO MIX AND GIVE ORS
SHOW HER HOW MUCH TO GIVE
50-100 ml (1/4 to 7z large cup) of ORS solution after each stool for a child less than 2 years old.
• 100-200 ml (72 to 1 large cup) for older children.
• Adults should drink as much as they want.
TELL HER IF THE CHILD VOMITS, wait 10 minutes. Then continue giving the solution
but more slowly - a spoonful every 2 - 3 minutes.
GIVE HER ENOUGH PACKETS FOR 2 DAYS
Note: While a child is getting ORS, he should be given breastmilk or dilute milk feeds and should
be offered food. Food-based fluids or a salt and sugar solution should NOTbe given in addition to ORS.
EXPLAIN HOW SHE CAN PREVENT DIARRHOEA BY:
Giving only breastmilk for the first 4-6 months and continuing to breastfeed for at least the first
Introducing clean, nutritious weaning foods at 4 - 6 months.
Giving her child freshly prepared and well-cooked food and clean drinking water.
Having all family members wash their hands with soap after defecating, and before eating or
preparing food.
Having all family members use a latrine.
Quickly disposing of the stool of a young child by putting it into a latrine or by burying it.
Annex 2B
TREATMENT PLAN B
TO TREAT DEHYDRATION
1. AMOUNT OF ORS SOLUTION TO GIVE
Patient's age *
2
Patient s weight
in kilograms
Give this
much
solution
for 4-6
hours
4 6 8 10 12 18 2
— months------ - —
5
in ml
200-400
IN FIRST 4 TO 6 HOURS
4 6
• years
8
15
15
20
[ ! I II ! ! | I !
I
30
7
9
11
3
13
adult
40
I
50
J
400-600 I 600-800 | 800-1000 I 1000-2000 I 2000-4000
in local
unit of
measure
Use the patients age only when you do not know the weight.
NOTE: ENCOURAGE THE MOTHER TO CONTINUE BREASTFEEDING.
If the patient wants more ORS.. give
g-c ~
more.
If the eyelids become puffy, stop3 ORS
> and give other fluids. If diarrhoea continues,
use ORS again when the puffiness iis gone.
If the child vomits, wait 10 minutes and then
— ...v..i continue giving ORS. but more slowly.
2. IF THE MOTHER CAN REMAIN AT THE
HEALTH CENTRE
Show her how much solution to give her child.
• Show her how to give it - a spoonful every 1 to 2 minutes.
Check from time to time to see if she has problems.
3. AFTER 4 TO 6 HOURS, REASSESS THE
ASSESSMENT CHART. THEN CHOOSE THE SUITA^LE TR^TMENT
•
L. /"A I’t.
NOTE: If a child will continue on Plan B. tell the mother to offer small amounts of food.
If the child is under 12 months, tell the mother to• continue breastfeeding or
• if she does not breastfeed, give 100-200
mis of clean water before continuing ORS
4. IF THE MOTHER MUST LEAVE ANY TIME
BEFORE COMPLETING
TREATMENT PLAN B
enoug
S packets for 2 days and show her how to prepare the fluid.
• Show her how much ORS
a to give to finish the 4-6 hour treatment at home.
• Tell her to give the child
as much ORS and other fluids as he wants after the 4-6 hour
treatment is finished.
• Tell her to offer the child small amounts of food every 3-4 hours.
• Tell her to bring the child back
----- J to the health worker if the child has any of the following:
- passes many stools
- is very thirsty
These 3 signs suggest the child is dehydrated.
- has sunken eyes
- has a fever
- does not eat or drink normally
- seems not to be getting better.
Annex 2C
TREATMENT PLAN C
TO TREAT SEVERE
DEHYDRATION QUICKLY
Follow the arrows. If the answer to the questions
is ‘yes', go across. If it is no', go down
START HERE
Can you give
intravenous (IV)
fluids?
1. Give IV fluids (preferably
Ringers lactate). Note: If
child can drink, give ORS
until IV is begun.
2. After 3 hours, reassess
the child, and if
appropriate, begin ORS.
3. After 1-3 more hours,
reassess the child and
choose the suitable
treatment plan.
YES S
NO
Can the child
drink?
1. Start treatment with ORS
solution, as in Treatment
Plan B.
YES
7
2. Send the child for IV
treatment.
NO
Are you trained
to use a naso
gastric tube for
rehydration?
<
1. Start rehydration using
the tube.
YES 3
2. If IV treatment is
available nearby, send
the child for immediate
IV treatment.
NO
URGENT: Send
the child for
IV treatment.
NOTE: If the child is above 2 years of age and cholera is known to be currently
occunng in your area, suspect cholera and give an appropriate oral
antibiotic once the child is alert.
BCR 1 84
CARO No.
HEALTH CARD
CARTE DE SANTE
CARTE No
DATE GF REGISTRATION
DATE D ENREGISTREMENT
SITE
LIEU
FAMILY name
DATE OF ARRIVAL AT SITE
SECTION/HABITATION No.
DATE D ARRIVES SUR LE HEU
GIVEN NAMES
NOMDEFAM1LLE
PRENOMS
I
date of birth or age
Date DE NAISSANCE OU AGE
C
SECTION/HOUSE No.
OR
YEARS
SEX
OU
ANS
SEXE
M/F
FATHER S NAME
NOMDELAMERE
NOM OU PERE
I
L
HEIGHT
D
HAUTEUR
Cm
WEIGHT
Kg
PERCENTAGE WT/HT
POIOS
POURCENTAGE POlDS'HAUT.
R
E
N
j
NOM D USAGE HABlTUEL
----------------
MOTHER'S NAME
H
NAME COMMONLY KNOWN BY I
FEEDING PROGRAMME
E
PROGRAMME D ALIMENTATION
N
F
i
IMMUNIZATION
MEASLES
DATE
DPT
ROUGEOLE
A
DATE
1
2
OTP
N
T
*
IMMUNISATION
POLIO
S
W
BCG
OTHERS
DATE
AUTRES
F
O
E
M
M
E
M
N
DATE
3
PREGNANT
YES/NO
No. OF PREGNANCIES
No. OF CHILDREN
ENCEINTE
OUl/NON
No. DE GROSSESSES
LACTATING
YES/NO
No. D'ENFANTS
ALAITANTE
OUl/NON
TETANUS
DATE
FEEDING PROGRAMME
TETANOS
GENERAL
PROGRAMME D'ALIMENTATION
(Family circumstances
living conditions etc.)
GENERALES
(Circonstances fammales
HEALTH
(Brief history present conomon)
MEDICALES
(Brel resume ces conditions actueiies)
COMMENTS
OBSERVATIONS
conditions de vie etc.)
CONDITION
TREATMENT
COURSES
(Signs/symptoms/diagnosis)
OBSERVATIONS
(Medicatioo/dose time)
(Medication due/
(Change in conoitiony
given
NAME OF HEALTH WORKER
DATE
A
I
)
ETAT
TRAITEMENT
(Signes/symptOmes diagnostic)
APPLICATION
(MddicatiorVdose durde)
OBSERVATIONS
(Medication requisa/
(Changement d etaty
effectuee)
NOM DE LAGENT DE SANTE
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