Check for General danger signs
Dr .Shazia Memon
Associate Professor

Learning objectives
• Identify general danger signs.
• How to check the child for general danger
signs
• Know the D/D of child with convulsion,
lethargy or coma.
• To give pre referral treatment.
• Base line investigations.

A general danger sign is present if:
• The child is not able to drink or breast feed
• The child vomits every thing
• The child has had convulsions during current
illness
• The child is lethargic or unconscious
• The child is convulsing now.

Assess For General Danger Sign
Ask:
•Is the child
not able to
drink or feed?
•Does the child
vomit every
thing ?
•Has the child
has
convulsions?
Look:
•See if the
child is
lethargic or
unconscious.
•See if the
child is
convulsing
now.
CHECK FOR GENERAL DANGER SIGNS

WHEN YOU CHECK FOR GENERAL
DANGER SIGNS
ASK:
• Is the child not able to drink or breast feed?
• A child has the sign “not able to drink or breast feed” if he child is not able
to suck or swallow when offered a drink or breast milk.
Causes:
• CNS infections .
• Acute gastroentritis with severe dehydration.
• Sepsis
• Throat abscess

DOES THE CHILD VOMITS EVERY THING?
• A CHILD WHO IS NOT ABLE TO HOLD ANY
THING DOWN AT ALL HAS THE SIGN ”VOMITS
EVERY THING”
CAUSES
• Lethargic/unconscious
• Acute gastroenteritis with severe dehydration
• Intestinal obstruction
• sepsis

HAS THE CHILD HAD CONVULSIONS ?
• CONVULSION: Paroxysmal, time limited
change in motor activity and/or behaviour
that results from abnormal electrical activity
in the brain
• CAUSES:
Causes In favour
Meningitis •History of high grade fever
•Recurrent history of otitismedia
•Neck stiffness
•Signs of meningial irritation
•Petachial rashes (meningiococal meningitis)
•Tense or bulging fontenelle
•Abnormal posture
•CSF suggestive of

Encephlitis •Reccent history of gastroentritis
•Irritibility/behavioural changes
•Raised ICP
•Csf
T.B meningitis •Hx of contact with t.b patient
•Hx of weight loss
•Low grade fever
•Loss of appetite
•Focal neurologicalsigns
•Cranial nerve palsy
•Labs: CXR ,Sputum AFB, montoux test,
Febrile convulsions •Age 6 months to 5 years
•High grade fever
•No loss of consciousness
•Positive family Hx
Head trauma

Poisoning •Hx of poison ingestion or drug over dose
Hypertensive Encephalopathy •Hx of head ache
•Vomiting
•Irritibility
•Raised blood pressure
Diabetic ketoacidosis •Hx of polydypsia, polyphagia, polyurea
•Hx of weight loss
•Acidotic breathing
•Labs:
High blood sugar
Urinary ketones

Approach to child with convulsion
or coma

Why convulsion is selected as general
danger sign.
• If occur with underlying disease indicate
morbidity and mortality.
• If uncontrolled will lead to brain damage.

Fever and convulsion/coma
• History.
• Examination
• Investigation
• Provisional diagnosis
• Final diagnosis.

Child with convulsion

Child with coma

Investigation
• Lumber puncture
conditioncondition colorcolor TLCTLC proteinprotein sugarsugar
NormalNormal ClearClear 0-50-5
lymphocytelymphocyte
20-20-
45mg/dl45mg/dl
50-70mg/dl50-70mg/dl
(75%of(75%of
blood sugarblood sugar
SepticSeptic PurulentPurulent 100-60000100-60000
PMNPMN
100-2000100-2000
mg/dlmg/dl
<40 mg/dl<40 mg/dl
TBMTBM OpalescOpalesc
entent
10-50010-500
LymphocyteLymphocyte
100mg-100mg-
5gm/dl5gm/dl
<40 mg/dl<40 mg/dl
ViralViral
encephalitisencephalitis
ClearClear <1000<1000
lymphocytelymphocyte
20-10020-100
mg/dlmg/dl
NormalNormal

Common cuases of convulsions
• CNS Infection
• Febrile convulsions
• Epileptic convulsions
• Metabolic. Hypoglycaemia
• Head injury
• Hepatic encephalopathy
• DKA.
• AGN ( hypertensive encephalopathy.
• Most common causes are febrile convulsions and CNS
infections.

Community or outpatient department.
• History : check for general danger signs.
• Classify the illness.
• Identify the treatment.
• Give the pre-referral treatment
• Write down the referral note.
• Refer the child to inpatient department.

Management process of the sick child
• The first step in assessing children referred to a
hospital should be triage – the process of rapid
screening to decide to which of the following
group(s) a sick child belongs:
• Those with emergency signs require immediate
emergency treatment .
• Those with priority signs should alert you to for
immediate assessment and treatment.
• Children with no emergency or priority signs are
treated as non-urgent cases.

Emergency signs:
• Obstructed breathing
• Severe respiratory distress.
• Central cyanosis.
• Signs of shock
• Coma
• Convulsions
• Signs of severe dehydration

priority signs:
Sick child < 2 months
Temprature : child very hot
Trauma or other urgent surgical
Pallor
Poisoning
Pain
Respiratory distress
Lethargic/ irrtibility
Severe malnutrition/visible wasting
Edema on both feet.
Burns.

Assessment of child with
convulsion or comaIntroduction to AVPU scale

Child presenting with coma or convulsion
• History
• Fever
• Head injury
• Drug overdose or toxin ingestion
• Duration: how long do they last?
• Previous history of febrile convulsion or
epilepsy?

Examination
General:
• Juandice and Severe Palmar Pallor.
• Preipheral edema
• Level of consciousness
• Petechial rash/ purpuric spots.
Head /neck
• Stiff neck
• Signs of head trauma or other injury
• Pupil size and reaction to light.
• Tense or bulged fontanelle
• Abnormal posture.

Assessment of child with convulsion or
coma
• AVPU scale.
• Alert
• Response to vocal commands.
• Response to pain
• Un-concouscious .

Lab investigation
• CSF
• CBC and MP
• Blood glucose.
• Assessment of blood pressure
• Urine microscopy.
• Other investigations according to presentation

THANK-YOU!
THANK-YOU!