Common errors in diagnosis and management
The common errors in the diagnosis and management of severe
malaria are listed below.
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Errors in diagnosis
Failure to do a malarial blood film Failure to take a travel
history Misjudgement of severity Faulty parasitological diagnosis and
laboratory management Failure to diagnose other associated
infections Missed hypoglycaemia Failure to carry out an ophthalmoscopic
examination for the presence of retinal haemorrhages Misdiagnosis (e.g.
influenza, viral encephalitis, hepatitis, scrub typhus, etc.) |
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Errors in management
Inadequate nursing care Errors of fluid and electrolyte
replacement Delay in starting antimalarial therapy Use of an inappropriate
drug (e.g. chloroquine in areas of resistance) Unjustified withholding of an
antimalarial drug Dosage not correctly calculated Inappropriate route of
administration (see front cover flap) Failure to elicit a history of recent
chemotherapy Unjustified cessation of treatment Failure to control the
rate of intravenous infusion Failure to prevent cumulative effects of
antimalarial drugs Failure to switch patients from parenteral to oral therapy
as soon as they can take oral medication Unnecessary continuation of
chemotherapy beyond the recommended length of treatment (see front cover
flap) Unnecessary endotracheal intubation Failure to prevent or control
convulsions Failure to recognize and treat severe anaemia Use of
potentially dangerous ancillary therapies Delay in considering obstetrical
intervention in late pregnancy Failure to recognize and manage pulmonary
oedema, aspiration pneumonia, and metabolic acidosis Delay in starting
peritoneal dialysis or haemodialysis Failure to review antimalarial treatment
in a patient whose condition is deteriorating |