Cholera: Click To Edit Master Subtitle Style
Cholera: Click To Edit Master Subtitle Style
Cholera: Click To Edit Master Subtitle Style
Guidelines and Protocols for Management. Click to edit Master subtitle style
4/29/12
Definition
Cholera is an acute diarrhoeal disease, which results from colonization of the small intestine by vibro.cholerae 01 (classical or EL Tor biotypes) The disease is characterized by the sudden onset of profuse, effortless watery diarrhea, followed by vomiting, rapid dehydration, muscle cramps and suppression of urine. 4/29/12
Important Information
Transmission: Oral faecal route through contaminated water, food or direct contact with the contaminated hands. Incubation Period is from few hours up to 6 days. Reservoir of infection is the human being that is cases or carriers. Cases range from in apparent infections to 4/29/12 severe ones.
Clinical Features
Evacuation phase: abrupt onset of watery or rice watery diarrhoea w or w/o vomiting. If untreated leads to the next stage: Collapse Phase: cold clammy skin, tachycardia, Low BP, Peripheral cyanosis, Sunken eyes, low urine output (less than 25mls per hour. Occasionally renal failure may occur, and in children convulsion from hypoglycaemia. Recovery Phase: If the patient survives collapse phase they start to recover gradually and this takes from 1 to 3 days.
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Diagnosis
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Management
Assess dehydration status and classify patient. DEHYDRATION MILD TO MODERATE SEVERE i) Patients Thirsty: alert restless appearance Normal rate and ii) Radial pulse volume iii) Skin elasticity Pinch retracts immediately or slowly (<2sec) iv) Tongue Moist v) Anterior fontanelle 4/29/12 Normal Drowsy; limp, cold, sweaty; may be sleepy, unconscious. Rapid, weak, sometimes not felt. Pinch retracts very slowly (more than 2 sec) Very dry Very sunken
Management (contd)
For suspected cases with no dehydration: Give ORS to maintain normal hydration, Monitor for 6 hours All suspected cases with mild or moderate dehydration: Give ORS as per chart below Note: Give more ORS if patient asks for it, if patient vomits wait 10 minutes Age continue slowly <4 months4-11 12-23 2-4 years 5-14 years >14 years and months months Weight <5kg 5-8 kg 8-11kg 11-16kg 16-30kg >30kg
400-600
600-800
R H D A IO P O O O F R A U T F W H R F R E Y R T N R T C LS O D L S LO C A T O S V R LYD H D A E P T N S EEE E Y R T D A IE T
G e1lit int efirst1 m ue iv re h 5 in t s A dM n o p lse n o it r u .
IsP ls >0 /m ? u e 1 0 in
Ye s N o
YS E
N O
Re e t 1lit RL IVin1 pa re 5 m ue in t s Co t u m n o gp lse nin e o it rin u a dre id t n n h raio
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Age
W eight
st 1 hour
Continuation phase
New born
3 kg
90 m l 30 drops/m in
210 m l 14 drops/m in
18 m l/hour 6 drops/m in
6m onths
6 kg
180 m l 60 drops/m in
420 m l 28 drops/m in
36 m l/hours 12 drops/m in
9m onths
8kg
240 m l 80 drops/m in
560 m l 37 drops/m in
48 m l/hour 16 drops/m in
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Ae g 1 er ya
Wgt eh i 9g k
Fs 3 m t 1 i t0 i o r n hu 3 m g or 0 lk / 20 luc u t b 7 m no n l ae
Fl o i g o w 2 12 hus7 l n / or 0 mg lk / 60 l= D p/ i 3 m 7 r sm 0 o n uc ut b no n l ae
2 er yas
1k 2g
30 luc u t b 6 m no n l ae
80 lu c u t b 4 m no n l ae
7 m o r2 do sm 2 lhu 4 r p/ i / n
5 er yas
1k 5g
40 luc u t b 5 m no n l ae
15 m u c ut b 00 l no n l ae
9 m or 0 lh u / 3 do sm 0 r p/ i n
1 yas 5 er
3k 0g
90 luc u t b 0 m no n l ae
2 lte . ir s 1 uc ut b no n l ae
1 0 lh u 8 m or / 6 do sm 0 r p/ i n
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If the patient is in shock First 15 minutes = 20 ml/kg.IV Next 4 hours = 50ml/kg. IV After initial 20ml/kg, pulse should be stronger. If not, continue 20ml/kg IV for another 15 min.
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They are indicated only for very severe cases and after good IV rehydration, Antibiotics can reduce liquid losses and carriage time of vibrio, but can induce a false sense of security. Most patients are cured by good rehydration and do not need antibiotics. Remember that if not well rehydrated, the patient will die even if antibiotics are given.
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Monitoring Cases
The following must be checked regularly and assessment made to regulate therapy. *consciousness of the patient. *Pulse *Respiration air hunger ( Kussmals breathing) suggests acidosis. *Temperature : patient is usually
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Absence of vomiting during last 12 hours ORS started for 2 hours or more , while IV kept at slow rate.
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Keep with only ORS and under observation for 6 hours Discharge when no more sings of dehydration and less than 3 liquid stools during 6 hours Advice the patient to come back to the health center immediately if
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Vomiting restarts
For all patients, after each stool despite the level of dehydration, the stools should be disinfected with chlorine before being disposed. All clothing should also be soaked in chlorine after use. Caretakers must wash hands and feet before leaving the room where patients are being managed.
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1. Wash hands with water and disinfectant after attending each patient. 2. Leave items used there i.e. pens, gloves and gowns in the isolation wards 3. Wash hands after leaving the isolation ward 4. The isolation ward should be 4/29/12 disinfected with chlorine after