Danger Signs - WHO Clinical Care in Crisis Implementation Guide for Children v0.1.0

WHO Clinical Care in Crisis Implementation Guide for Children - Local Development build (v0.1.0). See the Directory of published versions

Questionnaire: Danger Signs

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Structure

LinkId	Text	Cardinality	Type	Description & Constraints
CHE.B7-9.LTI-DangerSigns			Questionnaire	https://fhir.dk.swisstph-mis.ch/matchbox/fhir/Questionnaire/che.b7-9.lti-dangersigns#0.1.0
ageinmonths	null	0..1	integer	Expressions: Initial Value: `ageinmonths`
LTI	Life threatening illness	0..1	group
CHE.B7.DE01	Obstructed or Absent Breathing	0..1	boolean
CHE.B7.DE01-tt	<h1>Obstructed or absent breathing <strong>If foreign body aspirated</strong> • Manage airway in choking infant (under 12 months) Figure 1 • Manage airway in choking child (12 months and older) Figure 2 <strong>If no foreign body aspirated</strong> • Manage airway Figure 3 • Give oxygen Figure 4 • Make sure the child is warm Manage airway in choking infant (under 12 months)</h1>	0..1	display	Expressions: Enable When: `%resource.repeat(item).where(linkId='LTI').repeat(item).where(linkId='CHE.B7.DE01').answer.first().value = true`
CHE.B7.DE01-tt-1m	null	0..1	display	Expressions: Enable When: `%resource.repeat(item).where(linkId='ageinmonths').answer.first().value< 12`
CHE.B7.DE01-tt-1p	null	0..1	display	Expressions: Enable When: `%resource.repeat(item).where(linkId='ageinmonths').answer.first().value>= 12`
CHE.B7.DE01-tt-ob	null	0..1	display
CHE.B7.DE01-tt-o2	null	0..1	display
CHE.B7.DE02	Convulsing Now	0..1	boolean
CHE.B7.DE02-help	<p>The child is convulsing now —> Treat immediately</p> <p>During a convulsion, the child’s arms and legs stiffen because the muscles are contracting. The child may lose consciousness or not be able to respond to spoken directions.</p> <p>If the child is convulsing now:<br /> - Turn the child to his/her side and clear the airway. Avoid putting things in the mouth.<br /> - Give 0.5mg/kg diazepam rectally<br /> - Check for low blood sugar, then treat or prevent.<br /> - Give oxygen and REFER<br /> - If convulsions have not stopped after 10 minutes repeat diazepam dose</p>	0..1	display
CHE.B7.DE02-tt-c	<p><font size="4" style="font-size: 16pt"><b>Convulsing now</b></font></p> <p lang="en-GB" class="western" style="line-height: 108%; margin-bottom: 0.11in"> <span class="caps">CHILDREN</span> 2 – 59 <span class="caps">MONTHS</span> OF <span class="caps">AGE</span></p> <p lang="en-GB" class="western" style="line-height: 108%; margin-bottom: 0.11in"> <i><b>Give Diazepam to Stop Convulsions</b></i></p> <ul> <li><p lang="en-GB" style="line-height: 108%; margin-bottom: 0.11in"> Turn the child to his/her side and clear the airway. Avoid putting things in the mouth.</p> <li><p lang="en-GB" style="line-height: 108%; margin-bottom: 0.11in"> Give 0.5mg/kg diazepam solution per rectum using a small syringe without a needle (like a tuberculin syringe) or using a catheter.</p> <li><p lang="en-GB" style="line-height: 108%; margin-bottom: 0.11in"> Check for low blood sugar, then treat or prevent.</p> <li><p lang="en-GB" style="line-height: 108%; margin-bottom: 0.11in"> Give oxygen if available and <span class="caps">REFER</span></p> <li><p lang="en-GB" style="line-height: 108%; margin-bottom: 0.11in"> If convulsions have not stopped after 10 minutes repeat diazepam dose</p> </ul> <table width="601" cellpadding="7" cellspacing="0"> <col width="286"/> <col width="286"/> <tr> <td width="286" bgcolor="#d9d9d9" style="background: #d9d9d9; border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">Age / weight</font></font></p> </td> <td width="286" bgcolor="#d9d9d9" style="background: #d9d9d9; border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2; margin-bottom: 0in"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">Diazepam given rectally </font></font> </p> <p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2; margin-bottom: 0in"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">(10mg / 2ml solution)</font></font></p> <p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">Dose 0.1 ml / kg</font></font></p> </td> </tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr valign="top"> <td width="286" style="border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">2 to < 4 months (4 to < 6kg)</font></font></p> </td> <td width="286" style="border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">0.5ml (2.5mg)</font></font></p> </td> </tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr valign="top"> <td width="286" style="border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">4 to < 12 months (6 to < 10 kg)</font></font></p> </td> <td width="286" style="border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">1.0ml (5.5mg)</font></font></p> </td> </tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr valign="top"> <td width="286" style="border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">1 to < 3 years (10 to < 14kg)</font></font></p> </td> <td width="286" style="border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">1.25ml (6.25mg)</font></font></p> </td> </tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr valign="top"> <td width="286" style="border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">3 to < 5 years (14 to < 19kg)</font></font></p> </td> <td width="286" style="border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">1.5ml (7.5mg)</font></font></p> </td> </tr> </table> <p lang="en-GB" class="western" style="line-height: 108%; margin-bottom: 0.11in"> <br/> <br/> </p> <p lang="en-GB" class="western" style="line-height: 108%; margin-bottom: 0.11in"> <br/> <br/> </p></p>	0..1	display	Expressions: Enable When: `%resource.repeat(item).where(linkId='LTI').repeat(item).where(linkId='CHE.B7.DE02').answer.first().value = true and %resource.repeat(item).where(linkId='ageinmonths').answer.first().value>=2`
CHE.B7.DE02-tt-yi	<p><font size="4" style="font-size: 16pt"><b>Convulsing now</b></font></p> <p lang="en-GB" class="western" style="line-height: 108%; margin-bottom: 0.11in"> <span class="caps">YOUNG</span> <span class="caps">INFANTS</span> <span class="caps">UNDER</span> 2 <span class="caps">MONTHS</span> OF <span class="caps">AGE</span></p> <p lang="en-GB" class="western" style="line-height: 108%; margin-bottom: 0.11in"> <i><b>Treat to Stop Convulsions</b></i></p> <ul> <li><p lang="en-GB" style="line-height: 108%; margin-bottom: 0.11in"> Clear the airway. Avoid putting things in the mouth</p> <li><p lang="en-GB" style="line-height: 108%; margin-bottom: 0.11in"> For young infants <u><b>under</b></u> <u><b>2 weeks</b></u> of age, give 20 mg/kg phenobarbital IM or IV</p> <li><p lang="en-GB" style="line-height: 108%; margin-bottom: 0.11in"> For young infants <u><b>2 weeks to 2 months</b></u> of age, give 0.5mg/kg diazepam solution per rectum using a small syringe without a needle (like a tuberculin syringe) or using a catheter.</p> <li><p lang="en-GB" style="line-height: 108%; margin-bottom: 0.11in"> Treat or prevent low blood sugar</p> <li><p lang="en-GB" style="line-height: 108%; margin-bottom: 0.11in"> Give oxygen and <span class="caps">REFER</span></p> </ul> <table width="609" cellpadding="7" cellspacing="0"> <col width="144"/> <col width="211"/> <col width="210"/> <tr> <td width="144" height="40" bgcolor="#d9d9d9" style="background: #d9d9d9; border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <br/> </p> </td> <td colspan="2" width="435" bgcolor="#d9d9d9" style="background: #d9d9d9; border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2; margin-bottom: 0in"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt"><b>Phenobarbital</b> given IM / IV</font></font></p> <p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2; margin-bottom: 0in"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">(200 mg/ml solution)</font></font></p> <p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">Dose 20 mg / kg</font></font></p> </td> </tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr> <td width="144" height="24" bgcolor="#d9d9d9" style="background: #d9d9d9; border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt"><b>Age / weight</b></font></font></p> </td> <td width="211" bgcolor="#d9d9d9" style="background: #d9d9d9; border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt"><b>Initial dose</b></font></font></p> </td> <td width="210" valign="top" bgcolor="#d9d9d9" style="background: #d9d9d9; border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2; margin-bottom: 0in"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">If convulsions have not stopped</font></font></p> <p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">after <b>30 min</b></font></font></p> </td> </tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr> <td width="144" height="15" style="border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">Under 2 weeks, 2kg</font></font></p> </td> <td width="211" style="border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">0.2 ml (40mg)</font></font></p> </td> <td width="210" style="border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">0.1 ml (20mg)</font></font></p> </td> </tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr> <td width="144" height="14" style="border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">Under 2 weeks, 3kg</font></font></p> </td> <td width="211" style="border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">0.3 ml (60mg)</font></font></p> </td> <td width="210" style="border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">0.15 ml (30mg)</font></font></p> </td> </tr> </table> <p lang="en-GB" class="western" style="line-height: 108%; margin-bottom: 0.11in"><a name="_GoBack"></a> <br/> <br/> </p> <table width="601" cellpadding="7" cellspacing="0"> <col width="164"/> <col width="197"/> <col width="196"/> <tr> <td width="164" bgcolor="#d9d9d9" style="background: #d9d9d9; border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <br/> </p> </td> <td colspan="2" width="407" bgcolor="#d9d9d9" style="background: #d9d9d9; border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2; margin-bottom: 0in"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt"><b>Diazepam</b> given rectally </font></font> </p> <p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2; margin-bottom: 0in"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">(10mg / 2ml solution)</font></font></p> <p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">Dose 0.1 ml / kg</font></font></p> </td> </tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr> <td width="164" bgcolor="#d9d9d9" style="background: #d9d9d9; border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt"><b>Age / weight</b></font></font></p> </td> <td width="197" bgcolor="#d9d9d9" style="background: #d9d9d9; border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt"><b>Initial dose</b></font></font></p> </td> <td width="196" valign="top" bgcolor="#d9d9d9" style="background: #d9d9d9; border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2; margin-bottom: 0in"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">If convulsions have not stopped</font></font></p> <p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">after <b>10 min</b></font></font></p> </td> </tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr></tr> <tr> <td width="164" height="23" style="border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">2 weeks to 2 months, < 4kg</font></font></p> </td> <td width="197" style="border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">0.3 ml (1.5mg)</font></font></p> </td> <td width="196" style="border: 1px solid #000000; padding: 0in 0.08in"><p lang="en-GB" class="western" align="center" style="orphans: 2; widows: 2"> <font face="Calibri, serif"><font size="2" style="font-size: 11pt">0.3 ml (1.5mg)</font></font></p> </td> </tr> </table></p>	0..1	display	Expressions: Enable When: `%resource.repeat(item).where(linkId='LTI').repeat(item).where(linkId='CHE.B7.DE02').answer.first().value = true and %resource.repeat(item).where(linkId='ageinmonths').answer.first().value<2`
CHE.B7.B8.B9.DE01	Continue to Assess Sick Child	0..1	choice	Options: 3 options Expressions: Enable When: `%resource.repeat(item).where(linkId='LTI').repeat(item).where(linkId='CHE.B7.DE01').answer.first().value = true or %resource.repeat(item).where(linkId='LTI').repeat(item).where(linkId='CHE.B7.DE02').answer.first().value = true`
ds	General Danger Signs – <br /> Age ≥2 months – <5 years	0..1	group	Expressions: Enable When: `%resource.repeat(item).where(linkId='ageinmonths').answer.first().value>=2 and %resource.repeat(item).where(linkId='ageinmonths').answer.first().value< 60 and %resource.repeat(item).where(linkId='LTI').repeat(item).where(linkId='CHE.B7.B8.B9.DE01').answer.where(value.code = 'CHE.B7.B8.B9.DE03').empty()`
CHE.B7.DE03	Convulsion(s) in this Illness	0..1	boolean
CHE.B7.DE03-help	The child has had one or more convulsions. During a convulsion, the child’s arms and legs stiffen because the muscles are contracting. The child may lose consciousness or not be able to respond to spoken directions. Use words the caregiver understands. For example, the caregiver may call convulsions “fits” or “spasms.”	0..1	display
CHE.B7.DE04	Number of convulsions in this Illness	0..1	choice	Options: 2 options Expressions: Enable When: `%resource.repeat(item).where(linkId='ds').repeat(item).where(linkId='CHE.B7.DE03').answer.first().value = true`
CHE.B7.DE07	Convulsion(s) last 15 minutes or more	0..1	boolean	Expressions: Enable When: `%resource.repeat(item).where(linkId='ds').repeat(item).where(linkId='CHE.B7.DE03').answer.first().value = true`
CHE.B7.DE07-help	The child has had two or more convulsions in this illness	0..1	display
CHE.B7.DE08	Unconscious or Lethargic	0..1	boolean
CHE.B7.DE08-help	<strong>A lethargic child is not awake and alert when she should be.</strong> The child is drowsy and does not show interest in what is happening around her.	0..1	display
CHE.B7.DE09	Not able to drink or breastfeed	0..1	boolean
CHE.B7.DE09-help	<p>A child has the sign not able to drink or breastfeed <strong>if the child is not able to suck or swallow when offered a drink or breast milk.</strong></p> <p><strong>When you ask the caregiver if the child is able to drink, make sure that she understands the question.</strong> If she says that her child is not able to drink or breastfeed, ask her to describe what happens when she offers the child something to drink. For example, is the child able to take fluid into his mouth and swallow it?<br /> If you are not sure about the caregiver’s answer, <strong>ask her to offer the child a drink of clean water or breast milk. Look to see if the child is swallowing the water or breast milk.</strong></p> <p>A child who is breastfed may have difficulty sucking when his nose is blocked. <strong>If the child’s nose is blocked, clear it.</strong> If the child can breastfeed after the nose is cleared, the child does not have the danger sign, “not able to drink or breastfeed.”</p>	0..1	display
CHE.B7.DE10	Vomiting	0..1	choice	Options: 3 options
CHE.B7.DE10-help	<p>The child is reported to have vomiting</p> <p>A child who is <strong>not able to hold anything down at all has the sign “vomits everything”</strong> – everything that goes down comes back up. A child who vomits everything will not be able to hold down food, fluids, or oral drugs. <strong>A child who vomits several times but can hold down some fluids has “vomiting, but not everything”.</strong></p> <p>When you ask the question, use words that the caregiver understands. Give her time to answer. If the caregiver is not sure if the child is vomiting everything, help her to make her answer clear. For example, ask the caregiver how often the child vomits. Also ask if each time the child swallows food or fluids, does the child vomit? If you are not sure of the caregiver’s answers, <strong>ask her to offer the child a drink. See if the child vomits.</strong></p>	0..1	display
timestamp	null	0..1	dateTime	Expressions: Calculated Value: `now()`
Documentation for this format

Option Sets

Answer options for CHE.B7.B8.B9.DE01

https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B7.B8.B9.DE02 ("Stabilised, continue consultation")
https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B7.B8.B9.DE03 ("End consultation")
https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B7.B8.B9.DE04 ("Entered response in error")

Answer options for CHE.B7.DE04

https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B7.DE05 ("One Convulsion")
https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B7.DE06 ("Two or more convulsions")

Answer options for CHE.B7.DE10

https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B7.DE11 ("Vomiting Everything")
https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B7.DE12 ("Vomiting but Not Everything")
https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B7.DE13 ("No Vomiting")