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Update Management in common disease

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

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  1. Update Management in common disease 28/10/59 , 31/10/59 รพ.กะเปอร์ นพ.ทวิพัฒน์ วัชโรทยางกูร

  2. Outline • Upper Respiratory tract symptoms • Dyspnea • Abdominal pain • Urticaria • Pediatric drug • Fever • Update CPG Leptospirosis

  3. UPPER RESPIRATORY TRACT INFECTION

  4. Upper Respiratory tract infection • Common cold (acute nasopharyngitis) • Pharyngitis • Tonsillitis • Sinusitis • Most common cause is VIRAL.

  5. Upper Respiratory tract infection • History taking • fever , cough , runny nose ,nasal discharge , sore throat

  6. Upper Respiratory tract infection • Physical examination

  7. Upper Respiratory tract infection

  8. Upper Respiratory tract infection

  9. Upper Respiratory tract infection • Diagnosis : dominant symptoms, examination • Nasal symptoms: Rhinitis, sinusitis ,nasopharyngitis • Nasopharyngeal symptoms: pharyngitis, nasopharyngitis • Pharyngeal symptoms: pharyngitis ,sinusitis • URI?

  10. Upper Respiratory tract infection • Management • Advice : Rest, fluid intake, keep warm • Medication : supportive treatment • Avoid transmission. • When to use Antibiotics?

  11. Dyspnea

  12. Dyspnea • Dyspnea ≠ Tachypnea

  13. Dyspnea • Physical examination : • Vital sign : Temp. ,BP ,PR ,RR • Retraction • Lung sound • Stridor • Wheezing • Crepitation • Secretion sound • Rhonchi

  14. Normal Breath sound

  15. Wheezing

  16. Wheezing

  17. Wheezing

  18. Rhonchi

  19. Stridor

  20. Stridor

  21. Crackle /Rales /Crepitation

  22. Crackle /Rales /Crepitation

  23. Test

  24. Management in dyspnea • Reliable on severity and diagnosis(lung sound) • Maintain airway • O2 supply • Definite treatment

  25. Abdominal pain

  26. Abdominal pain • Localizing pain • Physical Examination

  27. RUQ+Epigastrium pain • What organ? • Differential diagnosis • Dyspepsia • Gastritis • Hepatitis • Billiary colic • Cholecystitis • Cholangitis • Pancreatitis • Peptic ulcer

  28. 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

  29. RUQ +Epigastrium pain • Physical examination • Inspection : distend/scaphoid • Palpation: soft/guard , tender? • Purcussion : tympanic/dullness

  30. RUQ +Epigastrium pain • Differential diagnosis • Dyspepsia • Gastritis • Hepatitis • Billiary colic • Cholecystitis • Cholangitis • Pancreatitis • Peptic ulcer Tender

  31. Lt.side Abdominal pain • What organ? • Differential diagnosis • Dyspepsia • Gastritis • Pancreatitis • Peptic ulcer • Enteritis • AGE

  32. RLQ Abdominal pain • What organ? • Differential diagnosis • Appendicitis • Enteritis • AGE • Cystitis • KUB stone • PID • Ovarian cyst • Ectopic pregnancy

  33. 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?

  34. RLQ Abdominal pain • Differential diagnosis • Enteritis • AGE • KUB stone • Cystitis • PID • Rupture Ovarian cyst • Ectopic pregnancy • Appendicitis Tender

  35. Avarado’s score

  36. URTICARIA

  37. Urticaria • Definition : Raised, itchy areas of skin that are usually a sign of an allergic reaction. • DDx : Dermatitis, Anaphylaxis

  38. Urticaria • History taking : • Duration, Allergen?(contact,eating) ,Hx.of allergy • Rule out anaphylaxis : Shortness of breath ,chest discomfort ,collapse ,nausea/vomitting

  39. Anaphylaxis

  40. Urticaria • Physical examination • Vital signs : Temp., BP ,PR ,RR • Heart & Lungs & Abdomen • Skin ,mucosal

  41. Urticaria

  42. Urticaria

  43. Urticaria • Management • Antihistamine : Chlorpheniramine • Steroid? • Topical agent : calamine lotion • Advice for observe allergen and avoidance

  44. Pediatric drug dose

  45. Pediatric drug • Antibiotics • Amoxycillin • Erythromycin • Co-trimoxazole • Acetaminophen • Supportive drugs • Glycerylguaiacolate • Chlorpheniramine • Salbutamol • Domperidone • Dicyclomine

  46. Pediatric drug • 10 Kg/ 1tsp(5ml) • Antibiotics • Amoxycillin • Erythromycin • Co-trimoxazole • Acetaminophen • 20 Kg/ 1tsp(5ml) • Supportive drugs • Glycerylguaiacolate • Chlorpheniramine • Salbutamol • Domperidone • Dicyclomine

  47. Pediatric drug

  48. FEVER

  49. 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

  50. 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

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