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This update provides information on the management of upper respiratory tract infection, dyspnea, abdominal pain, urticaria, and pediatric drug dosing. It also includes guidelines for fever management.
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Update Management in common disease 28/10/59 , 31/10/59 รพ.กะเปอร์ นพ.ทวิพัฒน์ วัชโรทยางกูร
Outline • Upper Respiratory tract symptoms • Dyspnea • Abdominal pain • Urticaria • Pediatric drug • Fever • Update CPG Leptospirosis
Upper Respiratory tract infection • Common cold (acute nasopharyngitis) • Pharyngitis • Tonsillitis • Sinusitis • Most common cause is VIRAL.
Upper Respiratory tract infection • History taking • fever , cough , runny nose ,nasal discharge , sore throat
Upper Respiratory tract infection • Physical examination
Upper Respiratory tract infection • Diagnosis : dominant symptoms, examination • Nasal symptoms: Rhinitis, sinusitis ,nasopharyngitis • Nasopharyngeal symptoms: pharyngitis, nasopharyngitis • Pharyngeal symptoms: pharyngitis ,sinusitis • URI?
Upper Respiratory tract infection • Management • Advice : Rest, fluid intake, keep warm • Medication : supportive treatment • Avoid transmission. • When to use Antibiotics?
Dyspnea • Dyspnea ≠ Tachypnea
Dyspnea • Physical examination : • Vital sign : Temp. ,BP ,PR ,RR • Retraction • Lung sound • Stridor • Wheezing • Crepitation • Secretion sound • Rhonchi
Management in dyspnea • Reliable on severity and diagnosis(lung sound) • Maintain airway • O2 supply • Definite treatment
Abdominal pain • Localizing pain • Physical Examination
RUQ+Epigastrium pain • What organ? • Differential diagnosis • Dyspepsia • Gastritis • Hepatitis • Billiary colic • Cholecystitis • Cholangitis • Pancreatitis • Peptic ulcer
RUQ +Epigastrium pain • History taking • Characteristic of pain ,onset ,duration ,timing ,severity ,cause ,factor ,radiation ,associate symptoms • Liver+biliary system : Jaundice , dark urine, pale feces • Stomach : Nausea/vomiting , meal/food, • Pancrease : alcohol • Intestine : diarrhea, constipation
RUQ +Epigastrium pain • Physical examination • Inspection : distend/scaphoid • Palpation: soft/guard , tender? • Purcussion : tympanic/dullness
RUQ +Epigastrium pain • Differential diagnosis • Dyspepsia • Gastritis • Hepatitis • Billiary colic • Cholecystitis • Cholangitis • Pancreatitis • Peptic ulcer Tender
Lt.side Abdominal pain • What organ? • Differential diagnosis • Dyspepsia • Gastritis • Pancreatitis • Peptic ulcer • Enteritis • AGE
RLQ Abdominal pain • What organ? • Differential diagnosis • Appendicitis • Enteritis • AGE • Cystitis • KUB stone • PID • Ovarian cyst • Ectopic pregnancy
RLQ Abdominal pain • History taking • associate symptoms • Appendicitis : fever ,Migratory pain, anorexia, N/V(Avarado score) • Intestine : diarrhea, constipation • KUB : hematuria ,dysuria • Gyne : leucorrhea, LMP • PE : Tender?
RLQ Abdominal pain • Differential diagnosis • Enteritis • AGE • KUB stone • Cystitis • PID • Rupture Ovarian cyst • Ectopic pregnancy • Appendicitis Tender
Urticaria • Definition : Raised, itchy areas of skin that are usually a sign of an allergic reaction. • DDx : Dermatitis, Anaphylaxis
Urticaria • History taking : • Duration, Allergen?(contact,eating) ,Hx.of allergy • Rule out anaphylaxis : Shortness of breath ,chest discomfort ,collapse ,nausea/vomitting
Urticaria • Physical examination • Vital signs : Temp., BP ,PR ,RR • Heart & Lungs & Abdomen • Skin ,mucosal
Urticaria • Management • Antihistamine : Chlorpheniramine • Steroid? • Topical agent : calamine lotion • Advice for observe allergen and avoidance
Pediatric drug • Antibiotics • Amoxycillin • Erythromycin • Co-trimoxazole • Acetaminophen • Supportive drugs • Glycerylguaiacolate • Chlorpheniramine • Salbutamol • Domperidone • Dicyclomine
Pediatric drug • 10 Kg/ 1tsp(5ml) • Antibiotics • Amoxycillin • Erythromycin • Co-trimoxazole • Acetaminophen • 20 Kg/ 1tsp(5ml) • Supportive drugs • Glycerylguaiacolate • Chlorpheniramine • Salbutamol • Domperidone • Dicyclomine
Fever • Definition : Core Body temperature ≥ 100ºF (37.8ºC) • Grading : Low 100-101ºF (37.8-38.3ºC) Moderate 101-102ºF (38.3-38.9ºC) High > 102ºF (38.9ºC) • Variation by air temp.,location,timing • Caused by inflammation/infection
Fever • History taking • Acute/chronic • Characteristic of fever : timing,grading,duration,response • Specific organ symptoms : Repiration,GI,GU,Softtissue,CNS • Systemic symptoms : Malaise,fatigue,myalgia,anorexia • Personal history : travel, camping