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Clinical characteristics of infectious diseases in children
Infectious diseases in children are one of the common reasons for seeking emergency care. In these conditions, in addition to providing assistance, you have to decide on the need for hospitalization.
Absolute indications for hospitalization of children in the presence of infectious diseases:
1) all infectious diseases in newborns;
2) all infectious diseases in children of the first two years with severe intoxication;
4) typhoid-paratyphoid diseases;
5) especially dangerous infections;
6) meningococcal infection;
7) meningitis of various etiologies;
8) intestinal infections with intestinal toxicosis and exicosis;
9) viral hepatitis.
With other variants of the course of infectious diseases, the question of hospitalization is decided on an individual basis.
In infectious diseases, the leading syndromes requiring emergency care are:
1) hyperthermic syndrome;
2) intestinal toxicosis syndrome;
3) neurotoxicosis syndrome.
Emergency care for hyperthermic syndrome
Emergency care (necessary only at temperatures above 38.5 ° C):
1) remove warm clothing from the patient, remove excess blankets, leave only a light blanket or sheet;
2) apply cold wipes to the head and inguinal areas, it is possible on the stomach and axillary areas, to the vessels of the neck;
3) moisten the entire body, except the face, with a 20-30% alcohol-water solution. Immediately after the skin dries, repeat the procedure several times. It is advisable to avoid drafts;
4) water the patient plentifully with non-hot liquids;
5) inject an intramuscular lytic mixture: analgin 50% - 1-2 ml and diphenhydramine, suprastin, tavegil or pipolfen - 1 ml, a solution of papaverine hydrochloride 2% - 1 ml. For children, these drugs are administered at the rate of 0.1 ml per year of life. It is permissible to use these drugs, as well as aspirin, paracetamol and others in the form of tablets inside, as well as the use of rectal suppositories with antipyretic substances.
Diphenhydramine is not prescribed for the elderly because of the danger of developing psychotic reactions;
6) it is forbidden to make compresses, put mustard plasters, soar feet and other thermal procedures;
7) if the patient initially has a marked pallor of the skin (spasm of peripheral vessels) or an increase in blood pressure, antispasmodics (dibazole, papaverine, magnesia, etc.) can be added.
The completeness of these activities depends on the severity and stability of hyperthermia. But at least it is necessary not to wrap the patient, drink plenty of water, moisten the skin with easily evaporating liquids, introduce a lytic mixture. Repeat if necessary up to 4-6 times a day.
Emergency care for intestinal toxicosis
Replenishment of the volume of circulating blood. The basis of emergency care for intestinal toxicosis is early-started and rationally conducted rehydration in the form of intravenous administration of water-salt solutions. The total volume of injected fluid for children: up to 1 year - 150-200 ml / kg; 1-2 years - 120-150 ml / kg; older than 2 years - 80-100 ml / kg. This volume rises by 10 ml / kg for every degree of temperature increase. At least 4/5 of the calculated volume of fluid should be administered intravenously. The remaining volume of liquid is prescribed in the form of drinking saline solutions (rehydron) in small portions, but often.
Symptomatic Therapy With cardiovascular failure, cardiac glycosides are administered in age-related doses intravenously. With hypokalemia, potassium solutions are added to the infusion medium (at the rate of 1-2 ml of a 4% potassium solution per 1 kg of weight). In severe toxicosis with exsicosis, corticosteroid drugs are prescribed (prednisone at a rate of 1-2 mg / kg). With hyperthermia, physical and drug cooling methods are used.
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