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Seeing Paediatric Patients in OPD

Seeing Paediatric Patients in OPD. Prof. Pushpa Raj Sharma. Why it is special?. 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. Not able to suck, swallow

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Seeing Paediatric Patients in OPD

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  1. Seeing Paediatric Patients in OPD Prof. Pushpa Raj Sharma

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

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

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

  5. Examples of questions for fever • 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

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

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

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

  9. Role play of seeing patietnt in OPD

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