Module 4: Facilitator Instructions for Coma and Convulsion Skills Station

Transcription

1 Module 4: Facilitator Instructions for Coma and Convulsion Skills Station 1. Preparation a. Assemble equipment beforehand. b. Make sure that you have what you need and that it is functioning properly. 2. Equipment a. Glucometer and test strips (if available) b. For administration of rectal medications i. Tuberculin syringes ii. Lubricant iii. Manikin c. Job aids for calculating glucose and anticonvulsant doses 3. General principles a. Begin by demonstrating the equipment/skill. Each student should practice using the equipment and performing each skill. b. Give each student immediate, constructive feedback. c. You may use case scenarios to illustrate important points. 4. Record keeping: complete participant evaluation forms 5. Specific skills a. Skill 1: Recovery position 1. Demonstrate recovery position ii. Technical/teaching information: The recovery position protects the child s airway. ETAT provider manual, page 37 b. Skill 2: Check blood glucose 1. Learn how to perform heel stab 2. Learn how to use a glucometer ii. Technical/teaching information 112

2 ETAT provider manual, page 37 c. Skill 3: Administer rectal medications 1. Learn how to give rectal medications ii. Technical/teaching information 1. Draw appropriate dose of medication into a tubercullin syringe. (Diazepam and paraldehyde can be given rectally). 2. Remove the needle. 3. Insert the syringe into the child s rectum (about 3 to 5 cm, depending on the child s size). 4. Inject the medication and remove the syringe. 5. Hold the child s buttocks together for 2 to 3 minutes. d. Skill 4: Calculating medication doses (glucose, lorazepam, diazepam, phenytoin, and phenobarbital) 1. Learn how to calculate the dose of glucose to correct hypoglycemia. 2. Learn how to calculate lorazepam and diazepam doses for a child with seizures. 3. Learn how to calculate the loading dose of phenytoin for a child with seizures. 4. Learn how to calculate the loading dose of phenobarbital for a child with seizures. ii. Technical/teaching information: Use the tables below to conduct the drill for practicing medications. 113

3 Hypoglycemia: Amount of glucose (ml) to give as bolus by age or weight Age/weight 10% glucose (5 ml/kg) 50 % glucose (plus sterile water) <2 months (<4 kg) 15 ml 3 ml plus 12 ml water 2- <4 months (4- <6 kg) 25 ml 5 ml plus 20 ml water 4- <12 months (6- <10 kg) 40 ml 8 ml plus 32 ml water 1- <3 years (10- <14 kg) 60 ml 12 ml plus 48 ml water 3- <5 years (14- <19 kg) 80 ml 16 ml plus 64 ml water Adapted from ETAT manual for participants, Table 6 page 38 Lorazepam, diazepam, and phenytoin doses Age/weight Lorazepam (IV) 0.1 mg/kg Diazepam (rectal) 0.5 mg/kg (0.1 ml/kg, 10 mg/2 ml) Phenytoin (IV) 20 mg/kg 2 weeks to 2 months (<4 kg) 0.3 mg 1.5 mg (0.3 ml) 60 mg 2- <4 months (4- <6 kg) 0.5 mg 2.5 mg (0.5 ml) 100 mg 4- <12 months (6- <10 kg) 1 mg 5.0 mg (1.0 ml) 200 mg 1- <3 years (10- <14 kg) 1.2 mg 6.25 mg (1.25 ml) 250 mg 3- <5 years (14- <19 kg) 1.5 mg 7.5 mg (1.5 ml) 300 mg 114

4 Phenobarbital: dose for infants <2 weeks of age 2 kg or less 3 kg or less Initial dose of phenobarbital (200 mg/ml) 20 mg/kg Second dose (if convulsion continues) (10 mg/kg) 0.2 ml 0.3 ml 0.1 ml 0.15 ml Adapted from ETAT manual for participants, Table 8 page 40 Combined drill for practicing medication dose calculations for glucose and anticonvulsants and IV fluid bolus calculations (for well-nourished children with shock): Tell participants the child s weight. Ask them to determine (using job aids) the following: 1. Amount (ml) of D10 to treat hypoglecemia: <2.5 mmol/l (45 mg/dl) for well-nourished children, <3 mmoll/l (55 mg/dl) for severely malnourished. (Amount = 5mL/kg). 2. Amount (ml) of Ringer s lactate or normal saline for bolus for well-nourished child in shock. (Amount = 20mL/kg). 3. Amount (ml) of diazepam (10mg/mL) to give rectally for a child with seizures. (Dose/amount = 0.5mg/kg, or 0.1mL/kg of 10mL/2ml solution). 115

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