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AAFP JOURNAL REVIEW MAY 1, 2011

AAFP JOURNAL REVIEW MAY 1, 2011. Presented by: Praharsha R. Menon , PGY3 Emory Family Medicine 08/04/2011. TOPICS. Acute rhinosinusitis in adults Croup: an overview Urticaria: evaluation and management GBS screening: updated CDC guidelines. Acute Rhinosinusitis in Adults.

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AAFP JOURNAL REVIEW MAY 1, 2011

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  1. AAFP JOURNAL REVIEWMAY 1, 2011 Presented by: Praharsha R. Menon, PGY3 Emory Family Medicine 08/04/2011

  2. TOPICS • Acute rhinosinusitis in adults • Croup: an overview • Urticaria: evaluation and management • GBS screening: updated CDC guidelines

  3. Acute Rhinosinusitis in Adults • Subtypes of rhinosinusitis: • Acute : Up to 4 weeks • Subacute : 4 to </= 12 weeks • Recurrent acute: >/= 4 episodes/ year with complete resolution between episodes; each episode lasts at least seven days • Chronic: >/= 12 weeks

  4. Etiology • Viruses: Rhino Adenovirus Influenza virus Parainfluenza virus • Bacteria: Streptococcus pneumoniae Haemophilus influenzae Staphylococcus aureus Moraxella catarrhalis

  5. Diagnosis The American Academy of Otolaryngology–Head and Neck Surgery and the American College of Physicians

  6. Would you like to order an X Ray Doc?

  7. Radiographic imaging is NOT recommended for evaluating uncomplicated acute rhinosinusitis • Xray air-fluid levels in sinuses • CT sinus reveal anatomic complication • MRI sinustumor of fungal sinusitis

  8. When do you use antibiotics? S P I T • Symptoms or signs do not improve within seven days • SxS that worsen at any time • Moderate to severe pain • Temperature of 101°F (38.3°C) or higher • Imunocompromised

  9. Duration of treatment: 10 days • Rx failure: Sx worsen despite 7 days of Rx Relapse within 6 wks Non-bacterial/ Drug resistance • What to do? - change A/B to BSA - refractory to this ENT referral

  10. ADJUNCTIVE THERAPY

  11. Croup: An Overview • http://www.youtube.com/watch?v=Qbn1Zw5CTbA&NR=1 • 15 percent of Pediatric ED visits due to respiratory disease in children in the United States • Boys > girls • Usually between 6 and 36 months of age, peaks during the second year of • Incidence peaks during the fall season

  12. SORT: KEY RECOMMENDATIONS FOR PRACTICE • Humidification therapy does not improve croup symptoms in patients with mild to moderate disease in the emergency department setting. A • Treatment of croup with corticosteroids is beneficial, even with mild illness. A • A single dose of an oral corticosteroid is effective in patients with mild croup. B • Nebulised epinephrine improves outcomes in patients with moderate to severe croup. A A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series.

  13. Physical exam • Xray: lung to r/o PNA lat neck to r/o epiglottitis • Bronchoscopy: in recurrent croup

  14. Humidification therapy • Corticosteroids • Epinephrine

  15. Urticaria: Evaluation and Management • Well-circumscribed, intensely pruritic, raised wheals (edema of the superficial skin) typically 1 to 2 cm in diameter,

  16. SORT RECOMMENDATIONS

  17. Mast cells in superficial dermishistamine urticariaMast cells in deep dermis, S/C histamine angioedema Immunoglobulin E mediated • Aeroallergens • Contact allergen • Food allergens • Insect venom • Medications (allergic reaction) • Parasitic infections Nonimmunoglobulin E mediated • Autoimmune disease • Cryoglobulinemia • Infections (bacterial, fungal, viral) • Lymphoma • Vasculitis

  18. Nonimmunologically mediated: • Elevation of core body temperature • Food pseudoallergens • Light • Medications (direct mast cell degranulation) • Physical stimuli (cold, local heat, pressure, vibration) • Water

  19. Just doing a spot check to see what you are doing ….

  20. Treatment • Avoidance of known triggers • Avoid aspirin, alcohol, and possibly NSAID’s • When avoidance is impossible, no trigger is identified, or symptomatic relief is still required despite avoidance, antihistamine medications are first-line pharmacotherapy. • H1 blockers add H2 blockers  corticosteroids

  21. Treatment of chronic urticaria

  22. GBS Screening: Updated CDC Guidelines • Published in 1996 • Updated in 2002 and again in 2010 • 2010: - laboratory methods and thresholds for GBS identification - change to the recommended dose of penicillin G for antibiotic prophylaxis - updates on prophylactic regimens for patients who are allergic to penicillin

  23. When to screen for GBS? • 35 to 37 weeks' gestation for vaginal-rectal GBS colonization • GBS uria at any GA do not need T3 screening

  24. Special Considerations: • Unknown GBS status and no intrapartum risk factors at the time of testing at term: nucleic acid amplification testing (NAAT) • Subsequent development of an intrapartum risk factor: antibiotic prophylaxis regardless of intrapartum NAAT results • Threatened preterm delivery: if GBS unknown or positive in past five weeksA/B ppx, screen if not done; if not in labor, then A/B at onset of labor • PPROM: 2 g of intravenous ampicillin, followed by 1 g every six hours for 48 hours

  25. IntrapartumAntiobiotic Prophylaxis for GBS Disease Prevention

  26. Secondary Prevention of Early-Onset GBS Disease in Newborns

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