MDCN & West Africa (WACP)
African Emergency Clinical Triage Guide
Rapid emergency protocols for acute malaria, eclampsia, DKA, and snakebite for MDCN licensing and African clinical examinations.
Red - STAT Resuscitation
Tropical Medicine
Acute Severe Malaria in Children (Cerebral / Severe Anaemia)
Immediate Actions (ABCDE)
- Assess Airway, Breathing, Circulation (ABCDE)
- Check bedside blood glucose immediately to rule out hypoglycaemia (< 2.2 mmol/L / 40 mg/dL)
- Secure IV access; give 10% Dextrose 5 ml/kg bolus if hypoglycaemic
- Control seizures with IV Diazepam 0.3 mg/kg or rectal diazepam 0.5 mg/kg
First-Line Medications
- IV Artesunate: 2.4 mg/kg IV STAT at 0, 12, and 24 hours (use 3.0 mg/kg if body weight < 20 kg)
- Switch to full oral Artemisinin Combination Therapy (ACT, e.g. Artemether-Lumefantrine) once child can tolerate oral feeds and completes at least 24 hours of IV artesunate
MDCN Examiner Viva Pearl: Never delay artesunate for lumbar puncture if cerebral malaria is suspected. Always re-check blood glucose every 2 to 4 hours as IV artesunate and severe malaria cause recurrent hyperinsulinaemic hypoglycaemia.
Red - STAT Resuscitation
Obstetric Emergency
Severe Preeclampsia & Eclampsia in Labour
Immediate Actions (ABCDE)
- Call for Senior Help / Obstetric & Anaesthetic Emergency Call
- Left lateral tilt (15–30 degrees) to relieve aortocaval compression
- High-flow oxygen via non-rebreather mask (10–15 L/min)
- Insert wide-bore IV cannulae (16G) and insert Foley catheter with urometer
First-Line Medications
- Magnesium Sulphate (Pritchard or Zuspan regimen): 4g IV loading dose over 15 mins + 10g IM (5g into each buttock deep IM with 1ml 2% lidocaine)
- Antihypertensive: IV Labetalol 20mg over 2 mins (or oral Nifedipine 10mg) if SBP ≥ 160 or DBP ≥ 110 mmHg
- Antidote ready at bedside: 10% Calcium Gluconate 10ml IV over 10 minutes
MDCN Examiner Viva Pearl: Before each maintenance dose of Magnesium Sulphate, examiner will test your 3 clinical safety checks: 1) Respiratory rate > 16/min, 2) Patellar tendon reflex present, 3) Urine output > 30 ml/hr (or 100ml over 4 hours).
Red - STAT Resuscitation
Endocrine
Diabetic Ketoacidosis (DKA) Emergency Protocol
Immediate Actions (ABCDE)
- Confirm Triad: Hyperglycaemia (> 11 mmol/L), Ketonaemia (blood ketones > 3.0 mmol/L or urine ketones ≥ ++), Acidosis (venous pH < 7.3 or bicarbonate < 15 mmol/L)
- Start aggressive IV fluid replacement: 0.9% Normal Saline 1 Litre in 1st hour
- Continuous cardiac monitoring for hypokalaemia/hyperkalaemia
- Fixed Rate Intravenous Insulin Infusion (FRIII): 0.1 units/kg/hour soluble insulin
First-Line Medications
- 0.9% Sodium Chloride IV (1L in 1hr, 1L in 2hrs, 1L in 2hrs, 1L in 4hrs, 1L in 4hrs)
- Soluble Insulin (Actrapid / Humulin S) at 0.1 units/kg/hr IV
- Potassium chloride (KCl) replacement once serum K+ is < 5.5 mmol/L (DO NOT give insulin without potassium if K+ < 3.5 mmol/L)
MDCN Examiner Viva Pearl: Add 10% Dextrose infusion when blood glucose falls below 14 mmol/L (250 mg/dL) to prevent hypoglycaemia while continuing insulin until ketoacidosis resolves (ketones < 0.6 mmol/L, venous pH > 7.3).
Orange - Urgent (< 15 mins)
Toxicology
Snakebite Envenomation (Viper / Cobra / Mamba)
Immediate Actions (ABCDE)
- Immobilise the affected limb at heart level (DO NOT incise, suck, or apply arterial tourniquet!)
- Remove constrictive rings, bangles, or tight clothing immediately
- 20-Minute Whole Blood Clotting Test (20MWBCT) in a dry glass tube
- Monitor for neurotoxicity (ptosis, dysphagia, respiratory paralysis) or coagulopathy
First-Line Medications
- Polyvalent Snake Antivenom (ASV): Reconstituted in 5–10 ml/kg of 0.9% Saline or 5% Dextrose IV infused over 1 hour
- Pre-medication / Resuscitation: Adrenaline 1:1000 IM ready at bedside for anaphylaxis
- Tetanus toxoid vaccination booster
MDCN Examiner Viva Pearl: In African clinical exams, the 20-Minute Whole Blood Clotting Test is a classic viva question. If the blood remains liquid after 20 minutes without a clot, systemic envenomation is confirmed and antivenom is indicated immediately.