Pemeriksaan Demam - MTBS

Summary

This medical script provides a detailed guideline for assessing and managing pediatric fever. It covers the diagnosis and treatment of malaria based on regional endemicity, alongside identifying signs of measles and dengue. The script emphasizes important clinical steps such as evaluating travel history for malaria, checking for measles-related symptoms like skin rashes and respiratory signs, and addressing potential complications like shock or bleeding in dengue. The treatment protocols include the use of artesunate for malaria, Vitamin A for measles, and fluid management for dengue, aiming for timely referrals to advanced care when necessary.

Takeaways

• 😀 Determine whether the child has fever and assess the potential risk of malaria based on travel history and endemic status of the area.
• 😀 If the child is from a malaria-endemic area or recently traveled to one, confirm the presence of symptoms such as high fever and rigidity, and classify the disease accordingly.
• 😀 In cases of suspected malaria, administer artesunate intravenously (2.4 mg/kg body weight) three times within the first 24 hours, followed by oral artesunate if needed.
• 😀 Always provide supportive care for malaria, including monitoring blood glucose levels and using paracetamol for fever greater than 38.5°C.
• 😀 For children with a history of measles within the last three months or current measles symptoms (fever, rash, cough, etc.), examine for complications like corneal opacity or deep oral lesions.
• 😀 If severe complications of measles are present, such as pneumonia or ear infections, administer vitamin A, antibiotics, and treat with paracetamol for fever.
• 😀 For suspected cases of dengue fever, assess for high fever, abdominal pain, vomiting, and bleeding signs like nosebleeds or bruising.
• 😀 If signs of dengue shock are present (cold extremities, weak pulse), initiate intravenous fluid resuscitation with Ringer's lactate or saline and refer urgently.
• 😀 In dengue fever cases without shock, encourage oral rehydration with oralit or similar solutions, and avoid the use of salicylates or ibuprofen due to bleeding risks.
• 😀 If any of the diseases (malaria, measles, or dengue) present with severe complications, immediate referral to a healthcare facility is essential for further treatment.
• 😀 Always carefully monitor for complications in fever cases and ensure timely diagnosis and treatment to prevent further deterioration.

Q & A

What should be the first step if a child has a fever in a malaria-endemic area?

If the child has a fever in a malaria-endemic area, the first step is to determine the malaria risk based on the area. If the area is endemic, treat the child for malaria according to the prescribed protocols.

How do you classify a fever if the child has no history of traveling to a malaria-endemic area?

If the child has no history of traveling to a malaria-endemic area, the fever is classified as non-endemic malaria. The child should be monitored for any danger signs and treated accordingly.

What are the key symptoms to check for when suspecting measles in a child?

Key symptoms to check for when suspecting measles include widespread rash, red eyes, cough, and runny nose. Also, check for any mouth sores and potential complications such as pneumonia or eye issues.

How is malaria classified in an endemic area with high risk?

In an endemic area with high malaria risk, the classification of the disease depends on the severity of the fever and any associated danger signs. If the child presents with danger signs or symptoms such as neck stiffness, the disease is classified as severe, and immediate treatment is necessary.

What should be done if a child with fever has signs of a serious complication like meningitis or neck stiffness?

If a child with a fever shows signs of a serious complication, such as neck stiffness (which may suggest meningitis), the condition is classified as severe, and urgent medical intervention is required. The child should be referred to a hospital immediately.

What treatment should be given for malaria in a child with a severe form of the disease?

For severe malaria, the first dose of artesunate should be administered intravenously. The child should receive 2.4 mg per kg body weight every 12 hours for the first 24 hours, followed by 4 mg per kg body weight every 24 hours until the child can take oral medications.

When should a child with a fever be immediately referred to the hospital?

A child with a fever should be immediately referred to the hospital if they have signs of severe disease, such as persistent high fever, difficulty breathing, severe pain, or if there is a history of recent travel to a malaria-endemic area or if the child shows signs of complications such as shock or dehydration.

What are the signs to watch for when suspecting dengue fever in a child?

Signs of dengue fever in a child include sudden high fever, abdominal pain, vomiting, and bleeding symptoms such as nosebleeds or bruising. If the child has cold extremities or weak pulses, it could indicate shock.

What should be done if a child shows signs of shock due to dengue fever?

If a child shows signs of shock due to dengue fever, they should be given intravenous fluids (Ringer's lactate or Ringer's acetate) or oral rehydration solutions, and immediate medical attention should be sought. Close monitoring is crucial.

How do you manage a child with a fever and suspected measles?

For a child with suspected measles, the management includes administering Vitamin A, antibiotics for any secondary bacterial infections, and ensuring the child receives appropriate fever management with acetaminophen if the fever exceeds 38.5°C. If there is eye involvement, topical antibiotics may be used.