GHANA-STG-2017-1

Republic of Ghana Ministry of Health GRvN}voDPbP}Puu ~GNDPZ SvTuvG]o]vb Ministry of Health th SvR]}v E ~w ZUw i Standard © 2017 Ministry of Health (GNDP) Ghana Aoo]PRbX b N}}(R]bo]}vu˙}U}b ]v v˙ ]o ˙bb uU } vbu]' ]v v˙ (}u } ˙ v˙ uvbU o}v]U uRv]oU R}}}˙]vPU }]vP vl} }R`]bU `]R}]}`]'vu]bb]}v}(RM]v]b˙}(HoRX EbvoDPbL]bN}voF}uo˙`]RTRG]o]vbU st ]}v E Uı EbvoDPbL]bN}voF}uo˙`]RTRG]o]vbU nd ]}v E Uıı EbvoDPbL]bN}voF}uo˙`]RTRG]o]vbU rd ]}v E Uııv SvTuvG]o]vb SvTuvG]o]vb SvTuvG]o]vb SvTuvG]o]vb U th ]}v E U Uæth ]}v E U Uv th ]}v E U Uw th]}v E Uw ISBN 978-9988-2-5787-3 For all enquiries write to the publishers: GRvN}voDPbP}Puu~GNDPZ Ministry of Health PXOXB}˘MBræUU A GRvUWbA(] ToPA=~Zvwl F˘PA=~Zvı ru]o E PPvePRvX}P Wb]P```XPRvX}P Legal Disclaimer Rb C vlv}}v.uR˙}(R]v(}u}vbv v } b] Pvoo˙ bX H}Ù R R}bU ]}b v o]bRb v} b}vb]o (} }b v }u]bb]}vb } v˙}vbvb(}uo]}v}(R]v(}u}v]vR]b}}lov ul v} `v˙U ˘bb } ]uo]U `]R b } R }vv }( Ro]}vX Printed by: YuvbPbbL]u]UPXOXB}˘AFwUA ToPr ru]o E P˙uvbbo]u]ePu]oX}u Cover Design: QrouvbL]u]UA ToPrwıUvrv ru]o E PerouvbPRvX}u ii Tableofonte C nts P( �� ˘]] Alv}òPuv �� ˘]]] Introduction �� 1 H}`}bR]b}}l �� Pb]]vP(}NHIS]ubuv �� N}b}v}br+vbb �� Referral�� ]}vb A �� Pb]}v`]vP �� æ D}b]vPvu]}vb}vAPv}˙`]PR]vR]ov �� w PRu}]P]ovvbDP A vE R}vP �� w Iu}v}vb �� Chatep rX Disorsof der theGatrs ointetina s lTrcta �� 11 X D]R} �� X R}]bD]bbvD]R} �� X C}vb}v �� ı X PUoD]bb �� æX Gb}r}b}RPoRG˘D]bb �� æ vX P]vO]P]vvP(}uROb}RPb �� wX Hu}R}]b �� ı C tep rX ha Disorsof der theLiver �� 33 X Au}]L]Ab �� ıX Jv] �� æ X HbA �� w X CR}v]Hb �� X HEvRo}R˙ �� X Ab]b �� v X V}u]vP �� æX H}ooo]v}u C �� æ vX DPbvRL] �� ææ C tep rX ha NutritionalDisorsder �� 58 wX Mov]}v �� æ C tep rX ha HaematologicalDisorsder �� 62 wX Avu] �� v X Bo]vPD]b}b �� væ ıX S]loCooD]bb �� vı X PobuCooM˙o}u �� w X Llu] �� wæ X Mo]PvvL˙uR}u �� w C tep ræX ha ImmunisableDissea �� 80 iii Standard Chatep rvX Chatep rwX Chatep rX Chatep rıX Chatep rX T G X X æX v X w X X ıX 30. 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C}vb}v Iv PvoU }vb}v (b } }ò u}uvb R ]v(v } }}ob b R ]8o } bX TR ]b P ]v]]o ]}v ]v v}uo }ò R]bV R(} uRb]b bR}o o] }v RvPb]vR}òR]X D]R} ovvP `]R }vb}v u˙ ]v] oP }ò v b]oo˙ ]v R}b P ˙b v }X Iv R]ov v R oo˙UR]bu˙]v]R}v]}vb}v`]Rb]}b]R}X TRR]ob}(o˘b]b˙}uu}v]vR}uuv]˙XTR]b ub]b}P}}]R˙}lou]v]b}vbvbX sueCa Medical yy D].]v]v}PRP yy IPv}]vPRP}(XPX}]uu}]o]˙ yy H˙}R˙}]]bu yy I]o}ò˙v}u b yy H˙ou] yy DPb XPX }]v U }]v U u}R]v ı U ]˙o] vbbvbU v*Constiption a *v N}r Pv}vP T`}~}bZ }( b R}]b ]vU P]vrv `lbU]b+]vv ]vP }]b ]R}X TR v }b bR}o P]v ˙ v `lbU v v} oRv`lbXR}]b]v]bv}`vo˙P]vb}(}v ]uuv]}v]vGRvX~Sb}v}vRIuuv]b}v[ZX Standard Trtme ae ntGuidelinesUwthEditionUw ]b}˙u] yy L˙}ò(}uR}v]o˘b]vo]vPRRo[}vb yy Ll}(˘]b yy DR˙}v v}v b ~oo˙]vR]ovZ Surgical yy Gb}]vbvo}b}v yy Avo.bvb }R]v(o]voob]}vb yy ]v}u C }(Ruvb]Pu}]}o}v yy F}]Pv}˙]vRP yy Po]ubbXPX.}]U(}b yy APvPo]}v]v]uP}o}v yy Pb}r}ò }b}v ~OP]o] ˙v}u b (}uv˙b v*Constiption a *v Symptoms yy Iv]o]˙}u}}òb yy Pbb]vPR}}ob b yy Iv(vb]vP}(}}ob b yy S]v]vP}}}ob b yy Fo]vP}(]v}uo}v}(}ò yy Iv]o]˙ } b GbU }o]l˙ }u]vo ]v `]R } `]R} }u]vP Signs yy Fv R]PR ]R }ò b}vb r b uRv]o }ò }b}v yy bv A }òb}vbro˙ b ]ob yy S]Pvb }( ]}v]b ~Pvo]b vvbbU P]vP v }v vvbbU(}]b}vZrbbPvPv}b}ò Invtiga se tions yy D]P]o o ˘u]v}v ~ub ] } ]v oo vb `]R ]Pv}b b ]b}(}vb}vZ yy Stool for occult blood yy Po]v}u]voXr˙~vb]vZ yy P}}b}˙ l}}b]Pu}]}b}˙ l}o}v}b}˙ ](]vbvo}b}v]bZb Trtme ae nt Tuv}ib yy T}]v(˙}bb]ob}(}vb}v yy T}o]}vb}v Non-pharmacological treatment yy ARv}Po˘]b yy H]PR.] yy A G] ]vl ~u]v]uu }( XL }( ` ˙ ]( v} }v]v]}vb˘]bZ Z (}oo}`]vP ]uu}]o]˙ ~ub v} }v Chatep rP *Disorsof der theGatrs ointetina s lTrcta Pharmacological treatment AX yy yy yy yy yy yy nd L]vTuv ]v E RvPPC B]b}˙o UoUuP]vRu}v]vP Or Glycerolb}b]}]bUoUPv]PR Or L]]8v U}oUruov]PR Or M]ol}(MPvb] U}oUæruo]vPobb}(ÙrR}o˙ B. MvPuv}(C}vb}v]vCR]ov st L]vTuv ]v E RvPPC yy Lo}b U}oU r˙bV ær˙bV ræ˙bV AM˙V Or yy Glycerolb}b]}]bUoU ræ˙bV AM˙V Or yy B]b}˙o UoU AN˙bV AM˙bV Or yy SennaU}oU vr˙bV rv˙bV Note 1-5 D}v}buPvb]ubob]vvb`]R]u]vo(v}vX æuoR}o˙ uoR}o˙ æuoR}o˙ XæuoR}o˙ Pv]PR Pv]PR æuP]vRu}v]vP }vu]o]}vo˙ æruou Xæruou v*Constiption a *v yy MvPuv}(C}vb}v]vAob st L]vTuv ]v E RvPPC B]b}˙o U}oUruPv]PR Or SennaU}oUæruPu~u˘]uuwruP]o˙ZXD}bb }wuPbR}o]]R}o˙ Or Lo}b U}oUæruo]o˙vob}vbURvruo]o˙ Standard Trtme ae ntGuidelinesUwthEditionUw Refeal r Criteria TR(}oo}`]vPP}]b}(vbbR}o(}P}v b P yy Pvb`]Rbv}òb}vbU}u]vP yy b]bC v}u]ouv yy Av˙P]o b b 11. PUo }v}b]vPGb Disease v*Petic p UlcerDisse*a v Po u˙ }vo } Pb]X D}vo ob }uu}v v } u} }Lv ]v ˙}vP obX Gb] ob } L u]o PX Gb] ob bR}o lv b]}bo˙ b R˙u˙uo]PvvX Pobu˙o}o](Rv]vP}uo]}vb}(o]vPU (}}vvPb]}o}b}vX sueCa yy Helicobacter pylori (H. pyloriZ]v(}v yy E˘bb]}v b }(Pb]] yy Iv }}v }( R o]v]vP }( R }uR b v }vu P]vb]Pb}v˙]vb]v yy M]]vb XPX v}vrb}]o vr]vGuu}˙ Pb ~NSAIDb }}b}]b Symptoms yy E]b}] }u]vo ]v ~}Lv PP˙ ]˙ ]v]b}vb vo](b˙oZ yy M˙u]v}]b}u(}UPv`]vPUv]vPUooR}˙ severe pain yy T˙]oo˙]v]b]vR]Pb]u}]PRR˙}R}v]u yy Ob]}voo˙ R]PR R]v R vu b } o}` }`v }v Ru]o]b yy Iv }vo oU ]v ˙]oo˙ }ub }v `Rv R v ]b RvP˙vu˙`lRv]vRu]o}(Rv]PRX yy IvPb]oU]]b˙]oo˙`}bv˙(}}Uvu˙ o]˙}u]vP yy Ibo]˙olo]bv(}}]v}voo yy V}u]vP u˙}]v}R}vovPb]obXI]bboo˙ }uo]}v]v}voo~Pb]}o}b}vu˙ Z bo(r]v]vPb]o}o]]v In children yy P]vu˙]ru]o]o Signs yy TRu˙v}}u]vob]Pvb yy W]PRo}bb~b}uub]vPb]oZ yy W]PRP]v~b}uub]v}vooZ yy Tvvbbr]Pb]uU]PRR˙}R}v]u}u]o]oP]}v u} usually ZU r Chatep rP *Disorsof der theGatrs ointetina s lTrcta AX yy yy Dyspepsia st L]vuv ]v E RvPPA MPvb]u]b]o] U}oUæuoR}o˙~]vr`vuobv u}}v}o˙bb]Z Or Aou]v]u R˙}˘]U }oU æ uP v R}o˙ ~]vr`v uob v uZ Note 1-6 }] A l]vPv]b`]R]vR}b}(}}vu]vR]]}b~PPIbZXPX}u }oUb}u}oUv}}o yy v*Petic p UlcerDisse*a v Invtiga se tions yy Hu}Po}]v yy H. pylori}}o b vPv yy Ob}RP}rPb}r}v}b}˙~v}b}˙Z yy B]uuo ~]vRbv}(v}b}˙Z yy S}}o˘u]v}v~}˘o]vbvob]bZ Trtme ae nt Tuv}ib yy T}o]]v~˙bb]ZvPb]]}v b yy To eradicate H. pylori if present yy T}}u}Ro]vP}(Ro yy To prevent recurrence of the ulcer yy T}vvuvP}uo]}vb Non-pharmacological treatment yy Avoid alcohol and tobacco intake yy }] A (}}bRPPR]v yy Aoo˙v˘]˙ and stress yy SP]o uvP (} R}v] b `]R b ]}] 'lbU (]o u]o uv v }uo]}vb XPX (}}vU Pb] }o}b}vvRu}RPZ Pharmacological treatment nd L]vuv ]v E RvPPA Ou}o U}oU Adults uP]o˙(}`lbXR}b](o]bv}(oo˙RoX BXNSAIDrbb}]}vo}Pb]ovPb}r}vo erosions ]v E RvPPA yy Eb}u}o U}oU r Standard yy yy C. yy yy Trtme ae ntGuidelinesUwthEditionUw Adults uP]o˙(}`lbXR}b](o]bv}(oo˙RoX Or Ou}o U}oU Adults uP]o˙(}`lbXR}b](o]bv}(oo˙RoX Or Pv}}o U}oU Adults ruP]o˙(}`lbXR}b](o]bv}(oo˙RoX v*Petic p UlcerDisse*a v Bleedingo ~u˙v]v]}v(}P˙ b Z ]v E RvPPA Eb}u}o UIVU Adults uP]o˙ Or Ou}o UIVU Adults uPR}o˙(}}æ˙b Helicobacter pylori Eradication Mi}]˙}(vbbvvP`]R}voo]v(`]R Helicobacter pyloriX]}v E }( H. pyloribR}oR(}}vb]vP r˙}b}(uv}vb]bvP}(PPI ob}u]v}v}( `}}(Rv]}b]v]]vRoo}`X D. ToræP) Helicobacter pylori]}v E TR˙ Helicobacter pylori]}v E R˙ PPI Eb}u}o uPR}o˙ O Ou}o uPR}o˙ O Pv}}o uPR}o˙ Av]} U}o U}o U}o Au}˘]]oo]v U }o Co]R}u˙]v U}o M}v]}o oral PR}o˙ æuPR}o˙ rrrrrrrrrrrr rrrrrrrrrrr æuPR}o˙ uPR}o˙ PR}o˙ æuPR}o˙ rrrrrrrrrr æuPR}o˙ rrrrrrrrrr uPR}o˙ rrrrrrrrrr æuPR}o˙ uPR}o˙ PR}o˙ æuPR}o˙ rrrrrrrrrr rrrrrrrrrr æuPR}o˙ uPR}o˙ }] A uvP]uvb]vo]vPAu}˘]]oo]v]vvb`]Rv]]oo]vooP˙ Refeal r Criteria R((}b]o]b`RvR]b(]o}( H. Pylori]}v U Chatep rP *Disorsof der theGatrs ointetina s lTrcta }](P˙ b ]b]v]}b X 12. Gb}r}b}RPoRG˘D]bb æ U D]u U U v*Gatrs oroeops hagealRefluxDisse*a v Gb}r}b}RPoRG˘D]bb~GORDZ]bb˙lG}`}( Pb] vl} }vo }vvb b R o}` }b}RPo bR]v ]v}R}b}RPb`]R}oR]vP}}u]vP X TR]b]bb obb].]v}`}P}b}v b v}b}˙.v]vPb b v}vr}b] Pb}r}b}RPo ]bb ~v}vr}b] GORDZ v }b] Pb}r}b}RPo ]bb ~}b] GORDZX F]o } u˙ bo]v}b}RP]b Uo}vU]bb vo˙v}]v}uX sueCa yy Ob]˙ yy Hiatus hernia yy Ivb]vr}u]voXP b X]vPvv˙ yy L}vPub}(vb}Pb] yy APvb R b o}` }b}RPo bR]v b XPX o}R}oU ]P'bU vR}o]vP]b ~XPX H˙}b]v ˙o}u] P}vRo]v }u] ZU }R Pb W M}R]v PR]]v vCo]u channel blockers yy CR]ov`]RR}v]v}o}P]o]bb~XPXoob˙Z Symptoms yy Heartburn ~`}bvb `]R ]P}}b ˘]bU v]vP (}Ù o˙]vPV o]˙v]bvb]hvP]PRZ yy D˙bb] yy o˙ E ˙b yy R}bvov]Pb]]v~u]u]bvP]v}]b˙]vP } vlU i`b v ubX TR ]v ]b `}b }v v]vP }`v XPX `]vP b Z yy P]v}vòo}`]vP b yy D]8o˙òo}`]vP b yy N}vo PP]}v ~`lb vb `]R }PR]vPU R}l]vP v.oo]vP}(Ru}R`]RRbo][Z yy Ru Ab ro]l~u˙`}bv]PRZ In children yy F]o}R]l(b]vP(}} yy V}u]vP yy C}PR]vP yy F}(oPP]}v`R]Ru˙o}b]}vvu}v] yy I}v.]v˙vu] yy WR]vP Signs yy May be none Standard yy yy Trtme ae ntGuidelinesUwthEditionUw E]Pb]vvbb}b]}voo˙ CRbb]Pvb~XPX`R]vPZ v*Gatrs oroeops hagealRefluxDisse*a v Invtiga se tions yy Ob}RP}rPb}r}v}b}˙~OGDZU]XX Pb}r]vbvo tract endoscopy yy CRbXr˙}˘o}Rb yy A}u]voob}v~}˘o}R]bbZ yy B]uòo}` b `]RG}}b}˙~b]oo˙(o b ]vR]ovZ yy Ob}RPoHu}v]}]vP~]vbR]8o}]Pv}bZ yy L}` }b}RPo bR]v uv}u˙ ~]v b R ]8o }]Pv}bZ Trtme ae nt Tuv}ib yy T}o]˙u}ub b yy T}v}uo]}vb Non-pharmacological treatment Lifestyle changes: yy EoR}(˙}Pb}bo}v]oo}`b yy }] A bo]vP`]R]vR}bLvP yy }] A }rvPvR˙uob(}u yy }] A (}}bRPP˙u}ub b XPX('˙vb]˙(}} yy }] A bu}l]vPvo}R}o yy }] A N}vrS}]oAvrIvGuu}˙DPb~NSAIDb yy Ev}Pu}˘]b yy W]PR}v]v}`]PRv}b]v]]ob yy }] A }bbU]vbò}}bo}R]vP yy SP]o uvP Fv}o]}v ~(} b bU uv (]obv}uo]}vbZ Pharmacological treatment AX yy yy yy N}vr}b]GORD ]v E RvPPB MPvb]u]b]o]U}oUæuoR}o˙~]v`vuobv u}}v}o˙bb]Z Or Av]b }v]v]vP Aou]vu R˙}˘]U MPvb]u R˙}˘]U S]uR]}vUCo]uoP]vb Or Ou}o U}oU Adults uP]o˙(}r`lb Children ANlPV uP]o˙(}r`lb rlPV uP]o˙(}r`lb ærlPV æuP]o˙(}r`lb v Z Chatep rP yy yy *Disorsof der theGatrs ointetina s lTrcta Or Eb }u}o U}oU Adults uP]o˙(}}`lb Or R}o U}oU Adults uP]o˙(}}`lb uP]o˙(}r`lb uP]o˙(}r`lb æuP]o˙(}r`lb CXS}}bE ]GORD ~`]Ro}vPZ yy Ubu]}vb]vS}vB}(}RSGORD[ Av yy M}o}u] U}oU Adults ruPvrR}o˙ Or yy D}u]}v U}oU Adults uPvrR}o˙ Refeal r Criteria R( b v} b}v]vP } R ubb } } R˙b]]v } P]o b b]o]bU b òo b b bU uv (]ob v ]v]]ob`]R}uo]}vbX 13. P]vO]P]vvP(}uROb}RPb Ob}RPo ]v ]b boo˙ v]vP ]v o]˙ v vb } o}o]b R]v Rvu b X Ob}RPo ]v u˙ b}]`]R ]8o˙]vòo}`]vP b ~˙bRP] ZXD˙bRP] }`bPPbRob b ]U w v*PainOriginatingfromtheOeops hagus*v BXS}}bE ]GORD yy Ou}o U}oU Adults ruP]o˙(}`lb Children ANlPV rlPV ærlPV Or yy Eb}u}o U}oU Adults uP]o˙(}`lb Or yy R}o U}oU Adults ruP]o˙(}`lb Standard Trtme ae ntGuidelinesUwthEditionUw `R]o R } b}o]b v v} ` bPPbb uRv]o }b}v ˙ u} } ]b X I u˙ b}uub }v(b `]R }R b }( chest pain~Sb}v}vRCRbP]v sueCa yy yy yy yy yy yy [ZX I]}v}(R}b}RPou}b˙G˘}(R]]}vvb }(R}uR b ~Gb}r}b}RPoRG˘D]bb Ob}RPov]]b]b Hiatus hernia Achalasia Sbu}(R}b}RPoubo]vb}vb}}b}vX Ob}RPou}b v*PainOriginatingfromtheOeops hagus*v Symptoms yy Retrosternal chest pain`}bv˙òo}`]vP b ~]v`}b}vo˙]vP Gu˙bPPbGORDZ yy RPP]}v}(]vPbu]o yy D]8o˙]vòo}`]vP b Signs yy Uboo˙v}v yy Pvu˙}b}o˙ b v`]PR]vRb}(GORD yy S`]PRo}bbu˙bPPbu}}v]]b]b(}u]uuv suppression yy TRu˙}ov]]b]b]vR}( b }b}RPov]]b]b Invtiga se tions yy B]uòo}` b yy Ob}RP}rPb}}v}b}˙~GIv}b}˙Z yy Ob}RPouv}u˙ `RvRob]]bb Trtme ae nt Tuv}ib yy To relieve pain yy T}]v.b Non-pharmacological treatment yy Bov(}}bvu]ol~u˙b}uubo]R]vZ Pharmacological treatment AX yy yy F}GORD st L]vTuv ]v E RvPPB Ou}o U}oU Adults uPR}o˙(}˙b Or Eb }u}o Adults ~GORDZ Chatep rP *Disorsof der theGatrs ointetina s lTrcta ruP]o˙(}˙b BXF}vbv}b}v]vP}u}v}R˙`]RPPI ]v E RvPPB yy Ou}o U}oUuPR}o˙(}˙b Or yy Eb}u}o U}oUruP]o˙(}˙b Av MPvb]u]b]o] U}oUuoR}o˙(}˙b C. X Haemorrhoids Hu}R}]b } S]ob_ voPU ]bo vo bR]}vb ](}uvP}P]vbU`R]R]u]o˙bvb`]Rvoo]vPX F]brP Ru}R}]b u]v ]v R vo voX S}vrP Ru}R}]b}obUb}vv}bo˙U`RbR]P Ru}R}]b }ob v R } o uvoo˙ } u]v }obuvvo˙voP]oo˙ b X TRR]b}˙]b˙]u}vXTRv}(Ro]vPUb}] ]v v }R ˙u}ub b Ro ]+v Ru}R}]b (}u }R u}b]v]b}v]}vbXAo`˙b}]P]oo˘u]v}v}˘o ]v}u v }R }v]}vb `Rv v }uo]vb }( ]v } o]vP(}uRvbXAo}lo}}U}o}}u]˘`]R}}ob b U bR}o]bb]]}v}(o]vPR]PR]vRu}}o}vX N} uv ]b ] (} Ru}R}]b R ˙u}u b X }] A Rb}(PbX sueCa yy Ivb ]vr}u]vo b XPX R}v] }PRU Pvv˙U ]vr}u]vo}o]u}b yy E˘bb]]v]vP b }}ob b (}u}vb}v}]R} yy Fu]o]o]b}b]}v ı v*Haemorrhoids*v For oesophageal candidiasis ]v E RvPPA yy N˙bv U}oU~b`]bR]vu}R(}ob u]vbvRvòo}` b Z Adults UrvUv]bvR}o˙(}˙bw Or yy Fo}v}o U}oU Adults uPX b Then uP]o˙(}˙b Refeal r Criteria R(}b]o]b(}}v.u}v}(]Pv}b]bvuvPuvX Standard yy yy Trtme ae ntGuidelinesUwthEditionUw CR}v]o]]bb`]R}oR˙vb]}v Av}ou}b v*Haemorrhoids*v Symptoms yy PbbP}(]PRo}}(}v yy N}u]˘`]R}}ob b yy M˙˙b R}]o}ò}}vo˙(}v}vR}]oL ov]vP yy M}]]bRP yy Sòo]vPvb yy P]vo]]}v}]R~]b v]Z yy D]b}u(}L}v]vP}òb yy Avo]v~}b]vPv'l}(}ob`]RR}u}b]bU }vPb}vv}uZ yy S˙u}ub}(vu] Signs yy M˙ v}v ~]vb}v }( R vb v ]P]oo ˘u]v}v u˙v}uoZ yy Rvv (}ob }( bl]v ~bl]v PbZ bv ]v R }b]}v }( R Ru}R}]bXS]v]vPu˙bR}`RRu}R}]b yy Sòo]vPRvb~]vR]PRu}R}]bZ yy PooR}u}b]vvoRu}R}]b}vo˘u]v}v yy S]Pvb }( }uo]}vb ~}(b o]vP `]R vu] } Ru}RP] bR}lU }obU vPo}v b U R}u}b]bU ]v(}v }o}vZ yy Poo} Invtiga se tions yy FBC yy P}}b}˙ ~RP}ovb (}]Pv}b]bZ yy S]Pu}]}b}˙ ~}˘o]v}u}(uZ Trtme ae nt Tuv}ib yy T}}vu]U](bv yy T}o]˙u}ub b yy T}v}uo]}vb Non-pharmacological treatment yy Ivb]vl}(G]v}PRP yy }] A }o}vP]v]vP b (}v yy F} }ob Ru}R}]bU o] v }`v v oR (}} v}(RXT˙Pvo]P]o}vLo]}v}(o}o vbR uX I( R]b (]obU o˙ }o }ubbX S}v }( Rvu˙] yy F}]v(Ru}R}]bUùb]Rbrub˙ yy SP]ouvP Chatep rP *Disorsof der theGatrs ointetina s lTrcta yy yy yy Rvo]P}v(}}v b rPRu}R}]bX Hu}R}]}u˙(}R]PRu}R}]bX Hu}R}]b o}]vP ]vP Pvv˙ bR}o uv P}vbo˙bu}b`]oob}oLo]˙ Pharmacological treatment AX yy yy WRvb}]`]R}vb}v ]v E RvPPC L]]8v U}oU Adults ruov]PR Or SennaPvobU}oU Adults bR`]R`Lb When associated with local itching or discomfort S}}R]vP Pv ~`]R } `]R} }]b b Z U o] } ]vb oo˙U Adults Ovb}b]}˙R}o˙(}wr˙b C. For infected haemorrhoids st L]vuv ]v E RvPPB Gvu]]v UIVU Adults ruPR}o˙(}æ}˙bw Av M}v]}o U}oU Adults uPR}o˙(}æ}˙bw yy yy yy yy nd L]vuv ]v E RvPPB C]}G}˘]v U}oU Adults æuPR}o˙ vA M}v]}o U}oU Adults uPR}o˙(}ær˙bw L]vuv ]v E RvPPB Au}˘]]oo]v U}oU Adults æuPR}o˙ r v*Haemorrhoids*v B. yy yy r Standard yy D. yy Trtme ae ntGuidelinesUwthEditionUw Av M}v]}o U}oU Adults uPR}o˙(}æ}˙bw When associated with anaemia I}v}v ~(}b boRl(uZ ~S b}v }v RAv u][Z Or yy Bo}}vb(b]}v as indicated Refeal r Criteria TRvbR}o(}(]o]˙`]Rb}b(} vo]P}v}}uv](]v]X r v*Haemorrhoids*v Chapter Disorsof der theLiver 8. Au}]L]Ab Au}] o] b ]b }oo}v }( ˙]oo˙ }`v]bR }o} G] ]v R o]U }]vP }Lv b b]vPo ubb ]v R ]PR o} v }uo]}v }( ]vbvo ]v(}v `]R Entamoeba histolyticaX LvPU R v ]v ]v(}vb v}uu}v boX Ob]}voo˙U ˙}Pv]bu˙Rb]u]oo]v]obv}vX Tuv }( u}] b bR}o ]v] `]R b Pv P]vbR}R}}](}u (}oo}`˙ ou]vo Pv} o]u]v]vrou]vo˙bbX sueCa yy Entamoeba histolytica Symptoms yy R]PR}u]vo]v(o}R]Pb]uU]PRRb }]PRbR}o yy F yy Malaise yy S`b yy C}PR yy Hiccups yy Av}˘] yy W]PRo}bb yy Jv] ~v}uu}vZ yy C}vv]R}~obbRv}vrR]}(vbZ Signs yy LPvo] yy Tvvbbvl}oP]vP]PR]v}bob yy Jv] yy Doovbb } b]}v }v R ]PR o}` Rb }vb `]R bo ]}vb yy Au}]u˙u (}oo}`]vP˘vb]}v]v}RRb]˙ yy P]}v]b~v}uu}vZ Standard Trtme ae ntGuidelinesUwthEditionUw v*AmoebicLivs*ce rA v Invtiga se tions yy A}u]voob}v yy CRbXr˙ yy FBC yy ESR yy S}}o˘u]v}v yy A}u]voCTv b yy S}o}P˙~u}]v}]bZ Trtme ae nt Tuv}ib yy To eradicate Entamoeba histolytica]v(}v yy T}v(R}v b }(o]b yy T}v(R}uo]}vb~XPX}(]v} b ooU ]]o}]}vobZ Non-pharmacological treatment yy TR b]}v u˙ ] ]v vb `]R }} response to therapy Pharmacological treatment st L]vTuv ]v E RvPPA yy M}v]}o U}oU Adults uPR}o˙(}˙b~bbPvZ Children æuP llPR}o˙(}˙b~bbPvZ Then yy D]o}˘v](} U}oU Adults æuPR}o˙(}˙b~ou]voPvZ Children vruP llPR}o˙(}˙b~ou]voPvZ yy yy nd L]vTuv ]v E RvPPA T]v]}o U}oU Adults P}v]o˙(}æ˙b~bbPvZ Children AN˙bVæuP llP~u˘XPZ}v]o˙(}æ˙b~bbPvZ Then P}u}u˙]v U}oU Adults ruP llPR}o˙(}˙bw ~ou]voPvZ Children ruP llPR}o˙(}˙bw ~ou]voPvZ Chatep rP *Disorsof der theLiver Refeal r Criteria Pvb`]RR b oP}v}b}v]vP}uv `]oov}(}b]o]bX 9. Jv] Jv] (b}˙oo}`]Puv}v}(bl]vUoubvRbo as a result of elevated levels of bilirubin ]v o}}X I u˙ ]b]o `Rv bu oob ˘ æ u]}u}olL ]v ob v u]}u}olL ]v R]ovXTR˙u}ub b vb]PvbR}uv˙iv]}Lv}] Ro(oob}Rvo˙]vPbX Iv ob v R]ovU R˙]o]]vu] u˙ bo ]v R encephalopathy ~Sb}vb}vRAvCR}v]Hb [vRH EvRo}R˙[Z XJv] in neonates can result in kernicterus (bilirubin encephalopathy}( bZ R}vbvb}(R˙]o]]vu]}v R]v}(Rv`}v X~Sb}v}vRN}voJv] [Z sueCa Aob yy Symptoms yy Yoo}`}Pv]bR]b}o}}v}(R˙b}bl]v yy D˙oo}`]b}o}}v}(]v yy IR]vP yy Po}}ob b æ v*Jaundice*v Hb r ]oU o}R}o]U Pr]v ]vo]vP oo}R] v Ro}vb yy Hu}o˙b]b r]}bb]vo]vPuo]UGo}brvrPR}bR D R˙}Pvb ~GvPD Z .]v˙ v b]lo oo ]bbU oo}R] PbvRo}vb yy CR}v] o] ]bb r }uvb ]R}b]bU ]o]˙ ]R}b]bU R}v]RbUR}ooo]v}u yy L] uo]Pvv]b r R}ooo ]v}uU ub o] disease yy H}vPb}v(}uR(]o yy Gooo]bbr}vb b U]v(}vb yy ]v}u C }(R}(vb yy Su] Children yy Hu}o˙b]b rb]looo]bbUGvPD .]v˙UPb yy Iv(}vb r uo]U RbU ]v˙ ]v(}vbU ˙R}] ( v}Ru] b ]oovbb Pregnancy (Sb}v}vRJv] ]vPPvv˙[Z Neonates ~Sb}v}vRN}voJv] [Z Standard Trtme ae ntGuidelinesUwthEditionUw v*Jaundice*v Signs yy Poo}~u˙]v]Ru}o˙b]bUR}v]]bb}uo]Pvv˙Z yy SRulb~]v]}(R}obb]bZ yy SPu }( R}v] o] ]bb ~XPX ou ˙RuU o]vPU b]v]Z yy H}uPo˙ ~u˙vZ yy Sov}uPo˙ in portal hypertension yy PooPooo yy Ascites yy Bo]vP ~RoRu}u U bPoo Ru}uU Pb}]vbvoo]vPZ yy HG~]v]}(o](]oZ Invtiga se tions AobvR]ov yy FBC yy INR yy S]lo]vPb yy GvPD status yy Bo}}.ou(}oov}uo]bUuo]b]b yy L](v}vb yy Uvo}o˙b yy Hb vb ~HBbAPU HCV Av}˙U Hb A IPMU Hb E IPMZ yy Bo}}o yy U]vo˙b]b yy A}u]voob}v yy A}u]voCTv b Trtme ae nt Tuv}ib yy T}]v(˙vb}(iv] yy T}o]˙u}ub b b}]`]Riv] yy T}v}uo]}vbb}]`]Rooob}(]o]]v in the blood Non-pharmacological treatment AobvR]ov ~Sb}v}vRHvRo}R˙[UHb[Z yy }] A o}R}ov}RR}}˘]Pvb yy EvbR˙}v Pharmacological treatment AX CR}obiv] vo˙]vP}o}P˙ st L]vTuv ]v E RvPPA with severe pruritus`R]o]vbPvP(} v Chatep rP *Disorsof der theLiver yy CR}ob˙u]v U}oU Adult PR}o˙~}b}b}vbv}ovPu˘XP v l˙Z Children and Adolescents rPR}o˙~u˘XP l˙Z Refeal r Criteria R( vb `]R v˘o]v iv] } b]o]b (} (R o}vvuvPuvX 10. HbA w XZ v*AcuteHetitis ap *v Hb ]b .v b ]vGuu}v }( R o] v Rb uoo bX I u˙bv b v ]oovbb `]R iv] v oo] (v}vbXWRv˙u}ub b Ub]Pvb}o}}˙v}uo]bb]b (}u}Rvvu}vRb]]b}vb]R}v]X sueCa yy V]bb~Hb AUU B U C DvEUYoo}`F yy DPb~oo}R]UovvRo}vbZ yy Alcohol yy }]uuv A Symptoms yy R]PRR˙}R}v]o]v yy F ~}]vP}`lb(}Riv]bZ yy Malaise yy Av}˘] yy Nausea yy V}u]vP yy Yoo}`}l}o}]v yy Po}}ob b yy IR]vP yy FP yy Confusion Signs yy Jv] yy R]PRR˙}R}v]ovvbb yy H}uPo˙ yy ]˘]b Ab Invtiga se tions yy FBC yy L](v}vb yy Hb vb ~HBbAPU HCV Av}˙U Hb A IPMU Hb E IPMZ yy AvvoAv}˙UAvrbu}}RuboAv}˙ Standard Trtme ae ntGuidelinesUwthEditionUw yy A}u]voUob}v Trtme ae nt Tuv}ib yy T}]v(˙vo]u]vR]]vPb yy T}o]˙u}ub b Non-pharmacological treatment yy Rest yy H]PRo}]G]b~b]oo˙Po}b]vlbU(]i]Uo]PR}]PU l}l}U]rÙubRlvl˙Z yy Ivv}bG]b](}ouo yy Av˙(}}RRvv}o yy Avoid alcohol Pharmacological treatment yy S}~voPb]UG]ouvUX]b Z Note 2-1 }] A R}}˘]PbbRu}o b v}bX vR]PR}bb}(v˘]}o˙rR˙ v*ChronicHetitis ap *v Refeal r Criteria R( vb `]R ]o˙ }Pbb]vP ˙u}ub b v b]Pvb } R˙b]]vb]o]bX 11. CR}v]Hb TR]b (b } R}v] ]vGuu}v }( R o] }( u} Rv v u}vRb }vU `]R b]bvo˙ o o] (v}v bX CR}v] Rb v }Pbb } o] ]R}b]bU }o R˙vb]}v `]R Pb}]vbvo o]vPU R vRo}R˙ v R}ooo ]v}uX Iuuv]b}v P]vbHb B]bv}`]oo(}R]ovv R E˘v P}Puu }v Iuuv]b}v ~EPIZ X Aob ]v vu] b]vo]vPGRvbR}o ]uuv]bP]vbHbB]v(}v L ]v]o buv }( R] ]uuv}o}P]ob P]vP ]}b ˘}b}R]bX L}vPru u}v]}]vP (} ]bb ]˙ v R}ooo ]v}uv]vP b `]Rb]˘ru}vRo˙Hb ]o B DNAv.}vU LFTbU }u]vo ob}v v oR (}}]v ]b uv}˙ (} vb`]RR}v]RbBX sueCa yy Hb B]b~HBVZ yy Hb C]b~HCVZ yy Hb E]b~Pv}˙Z r Chatep rP *Disorsof der theLiver ı Z v*ChronicHetitis ap *v Symptoms yy Uboo˙˙u}u b yy M]ov}vrb].˙u}ub b yy Recurrent fever yy ARoP] yy Malaise yy Jv] yy LRP˙ Signs SPu}(R}v]o]]bb yy Pou˙Ru yy Co]vP yy D˙v[b}v yy P}voPuv yy G˙v}ub yy Tbo}R˙ yy Spider naevi Signs of decompensated liver disease yy Jv] yy Ascites yy Encephalopathy yy P]Ro}u~R˙}ou]vu] yy P lbl]v]b]vP~}Po}R˙Z Invtiga se tions yy FBC yy LFTb yy INR yy HIV yy Bbo]vAoRrF}r}]v yy A}u]voob}vv b yy L]]}b˙ CR}v]Hb B yy Hb Bb(AvPv~HBbAPZ yy HBIPG yy Hb rBrrvPv~HBAPZAvrHB yy Hb BV]oL} CR}v]Hb C yy Hb CV]b~HCVZv}˙vP b yy HCVRNA yy HCVPv}˙]vP Trtme ae nt Tuv}ib yy T}v]b}Pb b b]}vv}uo]}vb yy T}vRvRo}R˙ Standard Trtme ae ntGuidelinesUwthEditionUw yy T}]u}˙vR b o](v}vR}PR]ob]}v yy T}vvbu]bb]}v Non-pharmacological treatment yy Pv}v }( vbu]bb]}v } vb ~XPX } ˘b U v} bR]vP}(}}RbRbvbRbUobUvobU}˙]]vPbU '}}bUoo].}v b bU]u]b]}vbXZ yy L](b˙ol]˙] yy S}blR}bR}ov]vP b Pharmacological treatment AX yy CR}v]HbA st L]vTuv ]v E RvPPA PP˙oIv(}v Or TenofovirU}oU Or EntecavirU}oU yy nd L]vTuv ]v E RvPPA Lu]]v U}oU yy yy v*ChronicHetitis ap *v B. B~HBAP}b]}HBAPvPZ o(r Uv}b b U yy Decompensated liver cirrhosis/ Fulminant Liver failure from CR}v]Hb B st L]vTuv ]v E RvPPA TenofovirU}oU Or EntecavirU}oU yy nd L]vTuv ]v E RvPPA Lu]]v U}oU yy CXPvb`]RCR}v]Hb B undergoing chemotherapy or immunosuppressive treatment st L]vTuv ]v E RvPPA yy TenofovirU}oU Or yy EntecavirU}oU yy nd L]vTuv ]v E RvPPA Lu]]v U}oU Chatep rP *Disorsof der theLiver Refeal r Criteria R( oo b }( R}v] Rb B ]v(}v } b]o]bU b]oo˙ R}b `R} R (]o .bro]v vr]o R˙ } R }vb b }vr]oR˙}Ro]ro}uo]}vb ~XPX o] ]R}b]bU o] (]oU o] ubbU b]Pvb }( }o R˙vb]}vU ascitesU ]Ro }uU R˙}ou]vu] v vb `]R Rb B }r]v(}vb ~XPX HIV b R}b ]]vP Ru}R˙ } }R ]uuv}bb] R˙ bR}oob}(}b]o]bX ZX PPvv ]v]]ob lHb CZ b òo P}br˘}b uvPuv }( RoR `}lb L }}vo ˘}b}Hb B]v(}v TorP) }}vo˘}b}Hb HCWSb P}br˘}buvPuv}(RoR`}lbL B]v(}v P}brE˘}bTbvP Source Pv P}brE˘}bP}R˙o˘]b P}brV ]v}v AvrHBb cHBIG HBV V]v}v § HBIGT`] ~Ov Month r No D}uv Responder ~AND}bb R]Z N}}v] D}uv N}vr Responder ~ALANv D}bbZ P}b] r NP r N}A}vR] Response Uvlv}`v ~ALAN D}bbZ P}b]l Uvlv}`v AMMIUluo § HBIGOv Revaccinate Yes NP AMMIUluo None Revaccinate Yes Any Result ANMIUluo N}}v] P}b]l Uvlv}`v r HBIG}v C}uo V]v}v Yes NP r None C}uo V]v}v Yes Uv]vl Iv}uo V]v}v HCWPHoR`}l cHBIGPHb v*ChronicHetitis ap *v HCW AvrHBb r AZ BIuuv}Po}o]vb}}vb}bb]o`Rv]v]~XvuollPIMZ Note 2-2 AvrHBbT]bR}o (}uru}vRbLob}b}(HBV]v }v b]b rv u}vRb LHBIG }}]}v }( b]o˙ u]v ]bAvrHBbX Rb}vPb}v`]RAvrHBbANMIUluoL}u}HBV]v}v doses r r Standard Trtme ae ntGuidelinesUwthEditionUw N}vrb}vPb}v `]R AvrHBb AM MIUluo L v } u}HBV] v}v}bbX r Note 2-3 AooHCWS`R}RAvrHbAMMIUluoUv]v}]v}uo]v }vv]v b ˘}b} b}v`R}]bHBbAPr}b]lvlv}`v HBbAPb R}o vP} HBbAP v]vP b b }}v b }bb]o L˘} vb (}oo}`vP b vu}vRbo~HBbAPA=AvrHBZX AX yy CR}v]Hb st L]vTuv ]v E RvPPA PP˙oIv(}v Or PP˙oIv(}v yy Av RibavirinU}oU yy BXCR}v]Hb v*Hetic a p Encephalopthy* a v L]vTuv ]v E RvPPA PP˙oIv(}v Or PP˙oIv(}v st yy yy r r C (Genotype 2 & 3) o(r Uv}b b U o(r Uv}b b U C~Gv}˙Z o(r Uv}b b U o(r Uv}b b U Av yy RibavirinU}oU Refeal r Criteria R( oo b }( R}v] Rb C ]v(}v } b]o]bU b]oo˙ R}b `R} R (]o .bro]v vr]o R˙ } R }vb b }vr]oR˙}Ro]ro}uo]}vb ~XPX o] ]R}b]bU o] (]oU o] ubbU b]Pvb }( }o R˙vb]}vU ascitesU ]Ro }uU R˙}ou]vu] v vb `]R Rb C }r]v(}vb ~XPX HIV b R}b ]]vP Ru}R˙ } }R ]uuv}bb] R˙ bR}oob}(}b]o]bX 12. HEvRo}R˙ TR]b }v]}v ]b }uo]}v }( ]R } R}v] o] ]bbXIbvb`]R]b}vov}b˙bb u(v}vU }]v]o]˙}(Ro]}}˘](˙uu}v]v}RRu]obX sueCa yy V]oRb yy Ao}R}o]Rb ZX PPvv ]v]]ob lHb BZ b òo Chatep rP yy yy yy yy yy *Disorsof der theLiver Cirrhosis of the liver H}ooo]v}u DPb XPX Ro}Rv U ]b}v]] U u}o }vb F'˙o]}(Pvv˙ P]]vP(}b]vv`]Rr˘]bvPo]]bbP yy F yy Hypotension yy Iv(}v yy Fo]vo}o˙]uov~˘bb]}( b o}}]bZ yy Sb yy IvbPb}]vbvo~GIT}]v Z o}XPXR˙GIT o]vPUo}R}o]]vP v*Hetic a p Encephalopthy* a v Symptoms yy Jv] yy Confusion yy D]b }vb]}bvbb `R]R }Pbb b (}oo}`bP ]b} }( boU R˙b}uv] v ]vb]}v }( bo R˙RuU R˙ v voo˙}u yy Pb}vo]˙RvPb Signs yy Cyanosis yy F}Rb yy S]Pvb}(R}v]o]]bb yy N}o}P]ov}uo]bP yy SR]u]uv yy ]˘]b Ab ~ G]vP u}Z ]v]b r}u b}bR]Pv}b]b}(vRo}R˙ yy Iv]o]˙}`}}vb}ibXPXær}]vb yy Iv}}]v}v yy LRP˙ yy Encephalopathy yy GPM]o}v(b]}vU]]oUu}Uobb b yy G P LRP] b}vbbU b ]vR]]}vbU ]b }]v}vUP]}vU]˘]b b yy GPS}}b}boUPPbb]bU]v obRvul}v(b]}v yy GPC}u Invtiga se tions yy FBC yy Bo}}Po}b yy L](v}vb yy Bo}}vo}o˙b yy Hb Brb(rAvPv yy Hb C screen }}bU Ro v }vPo˙ b r r Standard yy yy Trtme ae ntGuidelinesUwthEditionUw P}R}u]vu UINR Iv(}v vb ~o}} oU ]v REU Rb XrR˙U ]Pv}b b]Z v*Hetic a p Encephalopthy* a v Trtme ae nt Tuv}ib yy T}]v(˙v}]]vP(}b}uo˙ yy T}vo˙]vPb}(o]]bb Non-pharmacological treatment yy Po]vR}u }b]}v](v}vb]}b yy M]v]v G] v o}o˙ ov ~}] R˙}v o}o˙v}uo]bbRbR˙}lou]Z yy M}v]}uUobvb]}˙Uo}}U b ]obU]v}vo}}Po}bPoo˙ yy }] A o}R}oUu}o v}RR}}˘]Pvb yy }] A b R b v}]]vb v Pb R ]u] R }Po}v˙bb u yy PvbbR}oNOTRR]}]v]vl]b yy M]v]vv}]v]vl}(XrXæP llP˙ yy Ev}P]vl}(R]PR}R˙]˙u}R}NG Pharmacological treatment AX yy yy yy yy Mb}b }R˙}vbvv]}v ]v E RvPPA Adults ˘}b D saline ~ærA9˘}b]vXıA9bo]vZUIVUæuo R}o˙ ~}]vP}]uvbZ Av H]PR }v˙ V]u]v B U IVU ~(}uo b `} b ]obZ Ov ]}(]ob]o˙~}Po}bIVb}o}vZ Children ˘}b D saline~XA9]vXA9bo]vZUIVU Av H]PR}v˙V]u]vB UIVU~(}uob`}]ob b Z BXMb}b o}ò}}uu}v]}vv}v st L]vTuv ]v E RvPPA yy Lo}b U}oU Adults S`]Rræuo~rPZUvrR}o˙ ~R]`}b}u]v]vrbu]rb}o]}}ob b ˙Z Children and Adolescents S`]RæruovrR}o˙ ~R]`}b}u]v]vrbu]rb}o]}}ob b ˙Z Neonates and Chatep rP yy yy S`]RXæræuovrR}o˙ ~R]`}b}u]v]vrbu]rb}o]}}ob b ˙Z Or Lo}b UoU uo]o]vuo w `~]ooo}}vRrZ R} v o˙U]v]vRu(}rvu]vbX ~R]`}b}u]v]vrbu]rb}o]}}ob b ˙Z Av M}v]}o U}oU Adults uPR}o˙ Children æuP llPR}o˙ Neonates ANlPV rlPV r æuP llPR}o˙ wXæuP llPR}o˙ nd L]vTuv ]v E RvPPA R](˘]u]v U}oU Adults ææuPR}o˙ Children AN˙bV uPR}o˙ AM˙bV v}}uuv v*Hetic a p Encephalopthy* a v yy *Disorsof der theLiver CXHvRo}R˙ b}]`]Ro]vP~INR 9 }oo}vAMæ˘ /L) AobvCR]ov~o]]b`]RHu}o}P˙Z yy FbR(}vobu UIVU~(}INRANXæZ Or yy Poo}vvUIVU~oo}vAMæ˘ X D Av]}}R˙o˘]b ]vHvRo}R˙ ]R}b]bvPb}r]vbvoRu}RPZ Pvb]v`R}u}ou]v]b}v]bv}}bb]oU ]v E RvPPA yy C]}G}˘]v UIVU Adults uPrR}o˙~u]v]b}vu]vbZ Or yy L]˘}v C UIVUP]o˙(}˙bw Or yy C]}G}˘]v U}oUæuPR}o˙ Or yy N}G}˘]v U}oUuPR}o˙(}˙bw æ > 1.5 ı lLZ (associated with Standard EXHvRo}R˙ Trtme ae ntGuidelinesUwthEditionUw ]]˙]o]v(}v N}r A ]Pv}b]b }( SBP ]b o]b b R ]( R v}R]o }v ]v R b] G] ]b AN æ oobluLU o bob }b] v P]oo˙ b ob ˘ oX Pvb `]R b SBP bR}o b }v u]] v]}b ]uu] o˙Lb]G]]b}]vv]vPbobP yy yy ]v E RvPPA st L]vuv C ]}G}˘]v }vu]vbZ Then C ]}G}˘]v r r U IVU uP r R}o˙ (} ˙b ~} u]v]b U}oUæuPR}o˙(}æ˙b Note 2-5 }] A ]vvb`]R ]}G}}]v}o}v R˙bSBP}R˙o˘]b }R]b }˙}(b]bvX r nd L]vuv (}˘]u C UIVUPR}o˙(}˙bw O yy L]˘}v C UIVUP]o˙(}˙bw Refeal r Criteria R( vb ]( R }v]}v }b v} ]u}X Aoo R]ov `]R RvRo}R˙ub(}b]o]bX yy v*Acite s s*v 13. Ab]b Ascites ]b R uo}v }( ˘bb G] `]R]v R ]}vo ]˙X sueCa yy P}oR˙vb]}v}v˙ b }o]]R}b]b yy Renal failure yy NR}˙v}u b yy Cardiac failure yy A}u]voo}b]b yy Ivr}u]vo}o]uo]Pvv]b Symptoms yy A}u]vovoPuv yy A}u]vo]b}u(}}]v yy D]8o˙R]vP Signs yy D]bv}uv v Chatep rP yy yy yy yy *Disorsof der theLiver SR]L]vPoovbb Fo]R]oo A}u]vovvbb S]PvbovP}Rvo˙]vPb~S}]b}vZ Note 2-6 Ru}o}( }æo]b}(b]G]`]R}}v}u]v}oo}]]v(b]}v]b (b bR}ru}}vvvo]lo˙}RRu}˙vu]}vbvbX Pharmacological treatment AX yy C}v}o}(b]G]uo}v st L]vTuv ]v E RvPPA SpironolactoneU}oU Adults æruP]o˙ w r v*Acite s s*v Invtiga se tions yy FBC yy BUEv]v C yy LFTb yy INR yy U]vo˙b]b yy A}u]v}ro]ob}v yy CRbXr˙ yy D]Pv}bvb]b yy Appearance and colour yy Gu]v b yy Coo}vv]+vo yy B]}Ru]b˙XPXAou]v yy M]}b}˙U o~`]R b] ]v}o}v }(}] v }]o}}o}'obZ yy Acid fast bacilli yy C˙}o}P˙ Trtme ae nt Tuv}ib yy T}o]˙u}ub b yy T}]v(˙vuvPvo˙]vPb Non-pharmacological treatment yy b B yy So]}v b AMP l˙ yy Fo]]}v b }AGXæLl˙ yy }] A NSAIDrb yy Ao}R}ovv b yy TR vb]b ~b]o }u]vo Z ]( b]b vl}R]bb]}˙ubbuv is tense Standard yy Trtme ae ntGuidelinesUwthEditionUw Children XruP llP]o˙ vA F}bu] U}oU Adults ruP]o˙ Children ruP llP]o˙ B. v*Vomiting*v Massive ascites in liver cirrhosis with respiratory embarrassment ]]vPu}Rvæo]b}(G]]vP st L]vTuv ]v E RvPPA yy Sor}} Ruv ou]v b}o}v U IVU vr P o] }( b] G] drained Refeal r Criteria Pvb `]R R (}oo}`]vP }v]}vb ub ( } b]o]bXP}}b}vb}]R˙}]r(}˙b]b U }uo] ]R} b]b `]R b b}vv}b ]o ]}v]bUR}rvo˙v}u b UvRvRo}R˙X Aob}(`Rvvvo˙]vPvv} b ]v.X X V}u]vP V}u]vP v ]v˙ ]˙}(]bb}bb]vo]vP Pb}]vbvoU v}o}P]U voU˙R]] b U]}boU v}]vU ]v v R +b }( PbX TR b }b }( }v ]v ]v(˙]vP R vo˙]vP b ]b } ˙ } ]o o]v]o o}v v uvPuv ovU o}}l]vP } (} R }o}P˙U }vbvb v }vo}uo]}vb}(}u]vP X S v}v}oo }u]vP v bo ]v b]Pv].v R˙}v vo}o˙]uov}uv]˙vo}uo]}vbX Avrub bR}o b] }vo˙ `Rv R b }( }u]vP ]blv}`vbR˙u˙o˙]Pv}b]bX sueCa yy yy yy yy yy D]b}b }( R Pb}r]vbvo ~GITZ v o]P ]vbvo }b}vU oU vbU R}o˙bbU Pb}v]b U Rb N}o}P]o ]b}bP b ]vU u]P]vU ]b ]vv]o ~] b XXu}bURu}RPVuv]vP]b ZVb]bU}l b Ev}]v v u}o]P ] l}]}b]bU u]U R˙ou] U]vbvob}r}b}v Pb˙R]]Pv˘]˙ Ub]}v Uu}}vo b U b ˙R}Pv] b }u]vP DPbP v Ru}R˙U b]]v U oo}]v}oU ]P}˘]vU Chatep rP yy yy yy yy *Disorsof der theLiver ˙R}u˙]vUv}vobvbU}]}]b Iv(}vbPuo]U]v˙]v(}vb ]}b C oPu˙}]o]v(}v RvoPu](}u}R}v]l]v˙]bb M]boov}bP Pvv˙U ˙o]o }u]vP ]v(}vUo˙]vR]bU}bu] ˙v}u b U u˙}]o ı v*Vomiting*v Symptoms V}u]vP may be associated with: yy A}u]vo]v yy D]R} PPb}v]b yy A}u]vo]bvb]}vP}ò b }b}v yy HeartburnPPb b }r}b}RPoG˘]bb yy Chest pain yy Jv] PR}r]o]˙]bb yy VP} vv˙bPub Pob v}v]b yy Av˘]˙ yy b]}v D V}u]vP u˙R]Pv}bobXPXP yy V}u]vP }((}}vob R}bo]PPb}b]b}Pb]r }o}b}v yy V}u]vP `]Ro}}P}b}RPoUPb]}}voob]}v yy o˙ E u}v]vP}u]vP PPvv˙ yy Fov}u]vP P]vbvo}b}vUPb}r}o].bo yy P}ioP](˙o}]v}b b ]b Signs yy A}u]vovvbb yy DR˙}v ~ bl]v P}U ˙ }vPU R˙}vb]}vU R˙]Z yy A}u]vo]bvb]}v yy Succussion splash yy Jv] yy S]Pvb}(]}v]b~}vvvbbU]P]]˙UP]vPZ yy M]boov}bP XPX P} U v˙bPub U (}o v}o}P]o b]PvbU KbbuoR]vP~u]U]l}]}b]bZ Invtiga se tions yy FBC yy BUEvv]v C yy LFT yy Bo}}Po}b yy Suu˙ob yy U]vRE yy U]vPPvv˙b yy GCE ~](u˙}]o]v(}vZb yy A}u]voXr˙PIvbvo}b}v Standard Trtme ae ntGuidelinesUwthEditionUw yy CRb E Xr˙P}ò(}}v`]R]v]RPu Pb]bvV}u]vP : yy UPb}r]vbvov}b}˙ yy Suo]uoo yy CT scan of brain v*Vomiting*v Trtme ae nt Tuv}ib yy T}]v(˙vRvo˙]vPb yy T}vR˙}v vo}o˙]uov yy T} u]v]v v]}v ˙ vb]vP ]˙ ]vl ]vP illness yy T}u]v]vb}voR˙P]v yy T}o]u]v]v(vP}Pv]bub`R}] Non-pharmacological treatment yy M]v]v}oG]]vl~](}oZ yy M]v]vv]}v yy Povb}rPb]`Rvv yy SP]o]vv}v]v]vb b vo}b}vU]}v]b Pharmacological treatment AX yy yy SPPbAvrEub(}b]vM]P]v ]v E RvPPB M}o}u] U}olIVlIMU Adults uPR}o˙ Or D}u]}v U}oU Adults uPUR}o˙ Children AN ˙b ~B}˙ `]PR AH æ lPZV uP r R}o˙ ~u˘X uP ˙Z u}vRr ˙b ~B}˙ `]PR AG æ lPZV æ u]}PubllP r R}o˙~u˘Xwæu]}PullP˙Z Or Note 2-7 D}u]}vbR}obRo}`b+}b(}RbR}b}b b]o}vXTRu˘]uu}v}(uvbR}ov}˘˙bw ZX yy yy r Or P}uR]vUIVlIM Adults XæræuPvrR}o˙bv~u˘XuP]vR}bZ Or P}uR]vU}oU Children æ Chatep rP r˙bV }bZ AM˙bV BX yy yy yy CX yy yy X D yy XæruPvrR}o˙bv~u˘XæuP N}}uuv SPPbAvrEub(}b]vVboNb P}uR]vU}oU Adults ræuPR}o˙ Children r˙bV XæruPvrR}o˙bv~u˘XæuP }bZ AM˙bV N}}uuv Or P}uR]vUIVlIM Adults XæræuPvrR}o˙bv~u˘XuP]vR}bZ Or C˙o]]v U}oU Adults æuPR}o˙bv Children vr˙bVæuPR}o˙bv~u˘XwæuP]vR}bZ Or C]vv]]v UIVlIMU AdultsvR]ovAN˙b uPR}o˙bv Children ær˙bV æuPR}o˙bv AMæ˙bV v}}uuv SPPbAvrEub(}b]vGb}v]b M}o}u] U}olIVlIMU Adults uPR}o˙ Or D}u]}v U}oU Adults uPUR}o˙ Children AN ˙b ~B}˙ `]PR AH æ lPZV uP r R}o˙ ~u˘X uP ˙Z u}vRr ˙b ~B}˙ `]PR AG æ lPZV æ u]}PubllP r R}o˙~u˘Xwæu]}PullP˙Z SPPbAvrEub(}b]vP}brOV}u]vP M}o}u] U}olIVlIMU Adults uPR}o˙ æ vV}u]vP v*Vomiting*v yy *Disorsof der theLiver Standard yy EX yy yy v*Vomiting*v yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw O C ˙o]]v U}olIVlIMU Adults æuPR}o˙bv Children vr˙bVæuPR}o˙bv~u˘XwæuP]vR}bZ SPPbAvrEub(}b]vCRu}R˙rIv V}u]vP Ovvb}v UIVU Adults uP lXæuP llP~rRu}R˙Z]v(b}æu]vb Children ANvu}vRbV Xæ uP llP ~rRu}R˙Z ]v(b }æu]vbURv v R}bL.b}bX~u˘ ]bvuP l}bZ Or Ovvb}v U}oU Adults uPR}o˙ Children r˙bV uP u]vb (} Ru}R˙U RvuPR}o˙(}rR}bbv AM˙bV v}}uuv Or GranisetronUIVU Adults uP lu]}PullP~u]vb(}CRu}R˙Z Children rv˙bV bubob AM˙bV v}}uuv Or GranisetronU}oU Adults uPR}(}Ru}R˙URvuPR}bL}bb Or uPR}(}Ru}R˙ Children N}}uuv Or ˘uRb D }v U}olIVU Adults ruP(}Ru}R˙URvuPR}o˙(}u˙br Children N}}uuv Or L}u U}olIVU Adults æ Chatep rP *Disorsof der theLiver XæruPvR}o˙]b Children Consult a specialist FX SPPbAvrEub(}b]vPPvv˙ yy P}uR]v }oU}oU ruPR}o˙bv Or yy P}uR]v UIMU XæræuPR}o˙bv Or yy M}o}u] U}oU uPR}o˙ Or yy M}o}u] UIVlIMU uPR}o˙bv Refeal r Criteria R( oo vb ]v `R}u }u]vP }Pbb]}v ]v ]bbUvb`]R v˘o]v }b]bv}u]vPU v vb `]R b P]o b }( }u]vP (} b]o]b } P]o b buvvuvPuvX b]bb } `R} bR}` b]Pvb }( v*Hetoc a p ellulacinoma rCa *v 15. Hepatocellular Carcinoma H}ooo ]v}u C ~HCCZ ]b ]u˙ uo]Pvv˙ }( R o] oo v ub ]+v (}u uo]Pvv]b ob`R R ubb] } R o]X H}ooo ]v}u }b u} }uu}vo˙ ]v uv Rv ]v `}uv v ]b }Lv ]Pv}b ob ˙b L o]b b Ruv }( R ]v]o b }v]}vX TR ]bb Rb }} }Pv}b]b bovP (}u ub } o}oo˙ v ]bbX C}uo]}vb ]vo o] (]oU ]o o]vP } u} `]R o]vP ]v} R ]}vuX TR u} ]b }Lv b]bv } Ru}R˙X vC P]b b } v } Rb B v C ]v(}vbvo]]R}b]bv}voo˙Rov}(HCC ]vRo}vPuX sueCa yy Cirrhosis of the liver yy Alcoholic liver disease yy CR}v]RbB]b]v(}v yy CR}v]RbC]b]v(}v yy CR}v]˘}b}R]v}PvbXPXG}˘]v Symptoms yy Jv] yy IR]vP yy Av}˘] æ Standard yy yy yy yy yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw o˙ E ˙b Fo]vP}(ubb]vR}uv R]PR}u]vo]v W]PRo}bb Huub]b A}u]vo]bvb]}v B}v]v D˙bv} v*Hetoc a p ellulacinoma rCa *v Signs yy Jv] yy CR˘] yy H}uPo˙ ~]Pob(Uuoov}obUu˙vZ yy Ascites yy H] Invtiga se tions yy FBC yy LFTS yy INR yy SuAoRrF}}]v yy Hb BrS(AvPv~HBbAPZ yy Hb CAv}˙~HCVZ yy CRbXrR˙ yy A}u]voob}vv b yy CTlMRIv b ~](ob}v]v}vob]Z Trtme ae nt Tuv}ib C yy T}b(}}vo]o]˙ b Poo] yy To relieve pain yy T}o]]b}u(}(}uP}bb]b yy T}v}RvRo}R˙~Sb}v}vRH Encephalopathy [Z Non-pharmacological treatment yy SP]ob}v}(v}vrubo}o]bob]}vb yy Pvb]b(}vbb]b ~Sb}v}vRAb]b[Z yy S}~uor]u]vbouvbZ Pharmacological treatment AX yy P]v}v}o]vvb`]RH}ooo]v}u C st L]vTuv ]v E RvPPB Tu}o U }oU æ uP R}o˙ ~(R b }o} b]+Pu˘]uuuP]o˙Z Or æ r Chatep rP *Disorsof der theLiver yy MorphineboRU}oUæruPrR}o˙ Refeal r Criteria R( oo vb `]R b HCU C b]oo˙ R}b `]R buoo b}o]˙ob]}v~AMæuZ`R}u˙ }vb](}v}bo}R}o ]vi}v}P]o b b}vU}b]o]bX 16. Drugs and the Liver ææ U U v*DrugsandtheLiver*v DPrIv L] Ivi˙ ~DILIZ v } (}oo}`]vP R b }( ]˙ }( ]R b]}v } }rRr}v u]}vbX A R]PR ]v˘ }( b]]}v ]b }Lv vbb˙ ]v o]b b R]vP R ]Pv}b]bX o˙ E }Pv]}v }( P }˘]]˙ ]b ]u}v } u] `]Rò }( R }+v]vP PU buv }( ]˙ b v u}v]}]vP (} o] (]oXDPr]vo]]vi˙v}brvv}]]}b˙vX TR Rooul (} R uv }( DILI ]b o˙ `]Rò }( R }+v]vPPX sueCa yy Aoo}R] Pb ~b]}vU }rRr}vU vbR PvbU XPXu}o Uvbb U ]b}v]] U Ro}Rv U u]}}v R]}]v U u]v U Rv˙}]v U v]]v U l}}v}o Go}˘]oo]v XZ yy Ho}vb yy D]˙bouvb Symptoms yy ˙u}u Ab yy R]PRv]v yy Nausea yy Av}˘] yy Malaise yy LRP˙ yy P]b Signs yy Ob]}voo˙v}v yy Jv] yy SRulb yy B]b]vP yy ]˘]b Ab yy Aouvob yy S]Pvb}(r˘]bvPR}v]o]]bb Invtiga se tions yy FBC yy LFTS yy BUEvv]v C Standard yy yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw INR SuPo}b U]vo˙b]b Hb vb ~AUU B U C EZ(}˘ob]}v A}u]voob}vv b Trtme ae nt Tuv}ib yy T}]v(˙v`]R`R}+v]vPPv yy T} } b P v } F}} v DPb AR}]˙ ~FDAZ }uo˙ yy To assess severity of liver disease yy T}u]v]bv}`Ro]o}(b]o Non-pharmacological treatment ~Sb}v}vRHEvRo}R˙[Z Pharmacological treatment AX v*DrugsandtheLiver*v Drug-induced liver injury following paracetamol toxicity st L]vTuv ]v E RvPPA yy NrA˙o˙b]v ~S b}v }v RMvPuv oP}]Ru (} A Pu}o P}]b]}v]vP[Z Refeal r Criteria Aoo vb (]o]vP } ]u} } bR}`]vP }Pbb]}v ]v o] ]vi˙ b]`]Rò}(}+v]vPPbR}o(}b]o]bX MvPuvoP}]Ru(}Pu}o A B}˘rP) Poisioning MvPuvoP}]Ru(}Pu}o A Poisioning Co]v]obv}v Nauseav}u]vP }uu}vo˙˙u}ub b PvbRvo˙ b o}R]vi˙vRu˙˙u}u b (} R}bLv]vPb}v IvbP}vb Ivoovb`]Ru}o b }˘]]˙U}]vR(}oo}`]vPP Suu}o }vv}vUbo]vo](v}vb~ASTUALTU}o]o]]v PTvINR Uvo}o˙b Ivoovb`]R]vv}vo b }}bU}]vbubo]˙o }vv}vUub Po}bUGCE UvPvv˙]v b `}uv}(R]o]vPP TuvP]uv S]`˙UR]vPUv]o}vbvbb˙ æv ZU Chatep rP *Disorsof der theLiver G]R}o ~ACZæP}ooovbbvvP`]R]vR}b}( ]vPb}vUvob}v]v] b VCu˙ A (o b (}}r]vPbvb˙}vR}b T`]RNrA˙o˙b]v ~NACZI(P • Suu}o }vv}v`vR}b}u}Lb]vPo ]vPb}v]b}RSuv_o]v}(Ruvv}u}Pu(}u}o }]b}v]vP • Suu}o }vv}v]bv]oo}`]oov}v`]R]vR}b}( u}(]vPb}vvu}o]vPb}v]bb • T]u}(]vPb}v]bvlv}`vvbuu}o u]}Puluo~vu]}u}olLZ oo]bPRv • TR]b]v}(v˙R}}˘]]˙`]RR]b}˙}(u}o ]vPb}v • Pv}b}o]v]]v˘bb b]u}o vRb]bl(}b(}u}or]vR}}˘]]˙UvRub u}o}vv}v]bPRvu]}Puluo~vu]}u}olLZ ]vPb}vbU OoD}b]vPO(NACP v*DrugsandtheLiver*v • Oo}b]vP]bo(}v}vrPvvvb`]R(v}voGIvv} ]v}(R}}˘]]˙ • D}buP llPo}]vP}bU(}oo}`˙w}bb}(wuP llP˙R}b • I(}u]vP }b`]R]vR}}(NAC}b]vPU(ooNAC}bbR}ob rapidly as possible • TR˙u˙u]v˙}vR}bL]vPb}v](Ru}o ]bo}ù]}PubluoUvRv}bv}o}]v}(R}}˘ ]]˙vu]vbo]v]oo˙òo level r Ivv}b~IVZ}b]vP}(NACP • Ivvb`]Rv}]}Ru]o]v}(o](]o~]XXUR}b`]RINR R}IV}}}oPæuP llPo}]vP}b}vu]vbU(}oo}`˙æuP llP ]v(b}R}bU`]RR.vouP llP]v(b}Ru]v]vPvR}b AMZUb • Ivvb`]R]}Ru]o]v}(o](]o~]XXUR}b`]RINR u]v]bRR}IV}}}o~æuP llPo}]vP}b}vu]vbU (}oo}`˙æuP llP]v(b}R}bU(}oo}`˙uP llP]v(b}R v˘vR}bZ(}oo}`˙}vv}bIVNAC]v(b]}vvXæuP llPR}vo INR]bAM • IV}b]vP]bo]voob}(u}o }(}o}b]vP]vvbvo}}o}oNAC~XPXU]vo}u]vP vb`]Ru]o}v]}vo]vPu]v]b}v}(}oNA~P C U}}b] ]vPb}vUGIoZUvb`]Rb]Pv].vR}}˘]]˙~INR vb ANZU }˘]]˙UbR}ob]vb ZU ANZUvPvv AvuR˙P • M˙P]IVu}o}u]uPR}o˙ æw Chapter NutritionalDisorsder 17. Mov]}v Mov]}v }b `Rv R]b .]v˙ ]v ]vl}( bvo v]vb ~]XX }]vbU }R˙bU (bU ]u]vb v u]vobZX I ]b u}b }uu}vo˙ bv ]v R]ov obb Rv . ˙bU oo˙ L `v]vPXMov]}vR b ]v]]o[b]o]˙}.PR]bvb ]v(}vR˙]vb]vPRo]lo]R}}}(RvbvvP`]R ]R}U }u]vP U (U `}u ]v(b}vU vu}v]U o}b]bU }bu] U]v˙]v(}vXIvobUuov]}v(vo˙ }b]vb}]}v`]RR}v]o}R}o]buX P}]v vP˙ uov]}v ~PEMZU `Rv U b bvb ]v ]+v(}ubbRbubub Ul`bR]}l} }ubu]rl`bR]}l}X B]Rrb]vPU R}PR (u]o˙ ovv]vPU b òo b ˘ob] rb (]vP(}}vu}vRbU(}oo}`˙Iv}}v}(`v]vP] v u}vRb v }vv}v `]R }uo]uv˙ (}}b (} } ˙bU u˙ Ro(o ubb ]v vvP uov]}v ]v ˙}vP R]ovX Ev}P]vP ov ] (} R (u]o˙U ]vo]vP Pvv v ovP`}uvUvv]}v}v]vbR}}obv]ooPbu˙Ro Rov}(uov]}v]vR}uuv]˙X sueCa yy P}˙ yy Ivo]˙vl}v˙}((}}]vl yy S}]ovPo yy R}R}v]]v(}vb yy Repeated diarhoeal illness yy W}u]v(b}vb yy HIV Uou}v˙o}b]bUubobUb]b yy Chronic illness and cancers yy Ao}R}o]bu~obZ Symptoms yy P}}`]PRP]v yy W]PRo}bb~}}G'v]vP]v`]PR}vRR]oRoR}Z yy B}˙òo]vP b ~l`bR]}l} Z æ Chatep rP yy yy *NutritionalDisorsder CR]oo˙bobb}(ol}(vP˙ D]b]vb]v(}}v}v]vPb b æı v*Malnutrition*v Signs Marasmus yy TR]v~uboolZ yy P}u]vv}vb yy HvP]vPbl]v(}obb]oo˙}R'}lb yy Uvboo˙o yy L}}lbo]lv}ouv K`bR]}l} yy TR]vv`bub yy P+˙(voPb}}u yy }`v]b B R}]bRR] yy Fol˙bl]vbRb]oo˙}vRoPb yy S}b}vR}u}bb}(R}˙]vb yy Miserable and disinterested appearance yy D]b]vb]v(}} yy AvR}}u]ubuvb M}Mov]}v A yy M]UAuC]u(vPXærAMXæu yy W]PR(}APPAMrZrS}ANrZS} yy W]PR(}H]PRPAMrZrS}ANrZS} SMov]}v A yy M]UAuC]u(vPAMXæu~APvræıu}vRbZ yy W]PR(}APPAMrZrS} yy W]PR(}H]PRPAMrZrS} Invtiga se tions yy FBC yy Uvo}o˙b yy Suou]v yy U]vovbvb]]˙ yy Bo}}ovbvb]]˙ yy CRbXr˙ yy HIV vP b yy Gb]oP(}](b]oo] yy Sv (} }uu}v ]v(}vb bR b o}b]bU vu}v]U ]v˙]v(}vbUX~Sovb}vbZ Trtme ae nt Tuv}ib yy T}]v(˙vb}]]v(}vbv}uo]}vb yy T}}G]vo}o˙]uovv}R}uo]}vb yy T}}Rv]}vo.]v˙]vo]vPV]u]vA yy T}vv˙vPP]b yy T}o˙uvPR}v]]oovbb Standard Trtme ae ntGuidelinesUwthEditionUw Non-pharmacological treatment yy N]}voR]o]}v yy OrvC yy Mov}]bR R]ov `R} R U v } v} R v˙ } u]o }v]}vU `R]R ]b u]b b]}vU bR}o uvP b }vb `]R R˙r}r UbTRF}}~RUTF Z yy r IvrvC yy u] A ooo˙ b uov}]bRR]ov`R}Ru] o}v]}vb]]vP]vv r yy S]o]b}vPRb yy Fv(]vP`]RFwæ yy Iv}R˙rT}rUbTRF}}rRUTF yy P}Pbb]o˙v}oov(u]o˙uob yy P]}v}(vbvP]b]vv]}v }v Pharmacological treatment v*Malnutrition*v AXV]u]vA bouv}v ]v E RvPPA yy V]u]vA U}oU Children AN˙V vru}vRbV AMvu}vRbV Note 3-1 V]u]v A bouv}v RR]o]b}vRUTF ]vb]u]vAX r (children) Uv]b]o˙(}˙b Uv]b]o˙(}˙b æUv]b]o˙(}˙b bR}o P]v } o }˙ }bb U EXCEPT ]( u}]vP}WHOb].}vbU`R]Ro˙}v BXTuv}(vo˙]vP]v(}vb~R]ovZ Ivvb ]v E RvPPB yy (}˘]u C UIVUuP llPR}o˙(}rwR}b Then yy (}˘]u C U}oU u}vRbr˙bV æuP llPR}o˙(}ær˙bw Ovb ]v E RvPPB yy Au}˘]]oo]v U}oU ær˙bV æuPR}o˙(}˙b ræ˙bV æuPR}o˙(}˙b u}vRr˙V æuPR}o˙(}˙b CXIuuv]b}v (children) ~S b}v }v RIuuv]b}v v [ v N}vo E˘v P}Puu r Chatep rP }vIuuv]b}v~EPIZ *NutritionalDisorsder P]o]vbZ X D Tuv}(`}u]v(b}vb ~Sb}v}vRW}uIv(b}vb[Z Refeal r Criteria R( } }] b]o]b (} uvPuv }( R vo˙]vP bX Aob} ( } R} v CR]o HoR ~RCHZ v] (} (u]o˙ ovv]vPb]bvS}]oò(uv`]R]vRRoR(]o]˙U ]b]}P]}vX v*Malnutrition*v v Chapter HaematologicalDisorsder 17. Avu] Avu] ]b .v b }vv}v }( Ru}Po}]v (} RPv˘b }(R]v]]o~]XXo}`P lL]vouobUP lL ]vo(uobUP lL]vR]ovUvo}`XæP lL]vR`l b }(o](ZXAvu]o`˙bRbbU`R]Rub]v.v}o˙ uvPX TR b ub ]vbP (} ]v]vP uvX Iv v uPv˙U o}} buob ub lv (} ]vbP}vb (} o}}vb(b]}vX sueCa N]}vou]}v]vv]u]v.]v˙ yy I}v yy F}o]] yy V]u]vB Bleeding yy H˙uvb}v yy Hu}R}]b ~]obZ yy Po yy Iv(b}vbXPXR}}l`}uU]oR] yy S}o]}Pvuo]Pvvu}bXPX}o}v]v yy Hu}o}P]ouo]Pvv]bPXPXolu] Haemolysis yy Suo] yy Sickle cell disease yy GvPD .]v˙ yy H˙bov]bu yy }]uuv A yy DPb Bone Marrow Failure yy D]bb]v.o}vXPXolu]Uo˙uR}uUo}b]b yy Aob]W]u˙}}v˙ b XPX}˙}}˘]b Chronic Diseases yy K]v˙]bb yy Tuberculosis v Chatep rP *HaematologicalDisorsder v*Anaemia*v yy H˙}R˙}]]bu }]uuv A D]bb yy SLE yy Pv]]}bvu] Symptoms yy ˙bE (P]o]˙ yy D]]vbb yy SR}vbb}(R}v˘}v yy Po]}vb yy FbRo}}]v}}ob b yy Bol˙}}ob b ~uovZ yy Hu] yy C}oro]l]v Signs yy Pou}buuvbvoub yy AvPo}ub b yy SS}}vbR_v]P.vPv}v]ob yy SovUo]vo˙uRv}bu˙oo yy S]Pvb}(R(]o~]vvu] b Z yy Jv] ~]vRu}o˙b]bZ yy PR] and purpura~}vu}`(]oZ yy H˙]Puv}v}(oubvb}ob}(( Invtiga se tions yy FBC yy Ro}˙}vvo}}.ou}uuv yy S]lo]vPvb HBo}R}b]b](]v] yy Bo}}.ou(}uo]b]b yy K]v˙(v}vb yy Su]}vUV]u]vB and folate levels yy D]C}}u[bb yy S}}o(}R}}l`}u} yy Stool for occult blood yy U]v(}bR]b}b}u} yy S]o] b v]vP }v R b b XPX }v u}` ˘u]v}vU vvo v}˙ ~ANAZ U b v o}`GIv}b}˙ Trtme ae nt Tuv}ib yy T}vo˙]vPb}(vu] yy T}}b Ru}Po}]voob}v}uo yy T}ov]bR]}v}bb L}}v}(vu]]v]}v.]v˙ yy T} }b Ru}Po}]v } ˙b b oo ]v b]lo oo ]bb vb yy T}}vu] ]v}v ]u]v B v (}o.]v˙ v v Standard Trtme ae ntGuidelinesUwthEditionUw u]v]vv}uooobR}PR}o]( Non-pharmacological treatment yy A]b }v ov ]X RPo ]vl }( o(˙ (}}b b òo b (bR(]bvPobUvbUo]UuUPPbU.bR yy H]PR.]b}o]vP(}uRu}R}]b yy SP]ouv yy WRo]oXPXRu}R}]bUu}bUR˙bov]buX Pharmacological treatment v*Anaemia*v AXI}v.]v˙ D Avu] st L]vTuv ]v E RvPPB yy F}bboR ~]}vR˙}bZU}oU Adults uP~væuPouvo]}vZR}o˙(}rvu}vRb Children AN˙bV uPR}o˙(}rvu}vRb r˙bV uP]o˙(}rvu}vRb ærw˙bV ruPrR}o˙(}rvu}vRb r˙bV ærıuPrR}o˙(}rvu}vRb AM˙V rvuPrR}o˙(}rvu}vRb Or yy F}b(u U}oU Adults uP~væuPouvo]}vZR}o˙ Children rvuPouvo]}vllP˙(}rvu}vRb nd L]vTuv ]v E RvPPB N}r Pvo]}vRbv}vP}}o]}v}vb˘]vR b}(uob}}vX yy yy Or I}v}bb UIVU~bbo}`}ob]vi}v}ræu]vbZ Adults uP˙˙b(}æ}bb Children XæuP llP˙ `lb(} `lb~u˘X uP }bZUo ob}v}˙`]PRv]}v.]vRPH Or I}v ˘v U IVU ~b bo}` }ob } IM ˙ ]vuboZ ]v i}v Adults æruP]o˙bv Children v r r Chatep rP *HaematologicalDisorsder N}}uuv B. yy Vitamin B12 .]v˙ D ]v E RvPPB V]u]vB ~H˙}˘}}ou]vZ Adults uP˙}R˙(}v}bb Then uP˙u}vRb(}o]( Children uPX b Then uP˙u}vRb(}o]( UIMU CXF}o.]v˙ D yy F}o]A] U}oU Adults æuP]o˙ Children XæræuP]o˙ 18. Bleeding Disorders Bo]vP ]b}b u˙ bv ]R } o} o]v o](X TR o]vPu˙b}vv}b}(}oo}ù}P˙ b vu˙ }(o}}bobUoo]b}b}o}hvP(}.]v˙X Pb ]b}b }( ˘bb] o]vP XPX (}oo}`]vP ]u]b]}vU (u]o˙ R]b}˙ }( o]vP v P R˙ u˙ ]u}v ob } R ]Pv}b]bX TR 'v }( o]vP ]b Ro(o P] } ]b bX Iv oo vob òo(bUo]vP]bboo˙]v}bl]vvu}bob(b o]lR PubU v}bU Pb}]vbvo U `Rb ]v }Po}v (} .]v˙~XPXRu}R]o]ZUo]vP]b]v} bo]lR]vU i}]vbvubobX væ v*BleedingDisors*der v X D SS˙u}uAvu] yy Bo}}vb(b]}v `]Rloob Av T(} ] (]o ]( b]Pvb }( ] (]oX ~S b}v }v RH(]o[Z Refeal r Criteria R(vb`]RRu}Po}]voobR}v}]u}L`} `lb }v R } uv } `]R b vu] (}u v˙ bU `R]R bU } b]o]bX Pvb `]R b ob vu]U vu] } v}v}oo o]vPU ]vo]vP R˙ uvbo o}bbU `}oob}](o}b]o]bX Standard Trtme ae ntGuidelinesUwthEditionUw v*BleedingDisors*der v Iv v`}vb `]R ]u]v K .]v˙ ~`R]R ob } uoo }Po}v (}.]v˙Z b}vv}b o]vP }b (}u]}b b]bbRbRu]o]o}UPb}]vbvoUob v]vX sueCa yy Hu}R]o] yy V}vW]oov]bb yy L]]bb yy V]u]vK .]v˙b]oo˙]vv`}vb yy B}vu}`(]oXPXobvu]volu] yy L}òo}v(}uv˙b yy D]bbu]vIvboC}Po}v~DIC Z (}uv˙b yy DP ]v r Ro }vbU b]]v U o}]}Po ]}˘v UR]v Symptoms yy S}vv}bo]vP(}uu}buuvb}b yy ˙bE ]b]vPUo]vP(}u}].b yy E˘bb]o]vP(}ub}]v]b]}vb yy (}u D i}]vb(}uvi}]vob yy Sòo]vPb]}(o}}}oo}v~b}u}bZ yy P]vo]u]vPu}uv Signs yy Poo} yy E˘bb]o]vP yy L}o]bòo]vP b }o]vP]v}}˙bXPXJ}]vb yy Tenderness yy L]u]}v}(u}uvvi}]v(}u]b yy P UR] UR˙u}b]b Invtiga se tions yy FBCvo}}.ou}uuv yy Poo}v yy L](v}vb yy P}R}u]vu UINRUoR}u}obvu yy Bo]vP u Trtme ae nt Tuv}ib yy T}v}o]vP b yy T}]v(˙v}vo˙]vPb Non-pharmacological treatment yy Ao˙ Po b b]vP vl} ] lb } u]v]u]b o]vP`R}bb]o yy S} v˙ vlPb b}vb]o (} o]vP } `R]R u˙ PPo]vP yy E Ru}R]o]b }v R] ]bbU v}P]vP Ru } v U `(]v U Chatep rP *HaematologicalDisorsder u]v]u]b ur}v ]bU v } ]v(}u }}b }( R] }v]}v(}v˙P]o b } yy }] A vvbb˙ ]vi}vb v P]o b }b ]v oo vb ~b]oo˙UR}b`]R(u]o˙R]b}˙}(o]vPvv]bZ yy PR˙b]}R˙ }v+i}]vb yy SP˙ Pharmacological treatment AX yy yy yy Bleeding due to underlying liver disease st L]vTuv ]v E RvPPA V]u]vK UIVU Adults æruPX b Children ræuPX b Neonates~]b}(R]b}˙}(]u]vK TuV uPX b PuV æu]}PubX b Av FbRF}vPobu UIVU AdultsUChildrenUNeonates æruollP CXHu}R]o]A yy R}u]vvF}VIIIU]vv}bU ]vv}vo v] ]bb A9 }( F} VIII }v P ˙ lP }˙`]PR R]v]bAA}˙`]PR~lPZ˘b](}]b˘Xæ ~RbvZ Or yy Dbu}bb]v UIvvboUæu]}Pu˙b ]v}Rv}b]oU R}o˙XM˙(}˙b vw v*BleedingDisors*der v B. GvoMbbPG]ouv(}oo}`]vPo}} b loss S}]uCRo}] XıA9UIVU Adults ~SS}v}vRSR}l[Z Children and Neonates uollP}obX b R](R]bv}o]v]o]u}uv Av Concentrated red cell transfusionUIVU AdultsUChildren and Neonates uollP(}R˘P lLRu}Po}]v]b ]vi}vZ Standard D. yy Trtme ae ntGuidelinesUwthEditionUw Haemophilia B R}u]vvF}IX Au]v]b}v }( v]llP (} IX ~}u]vvZ Pvoo˙ ]v b(}IXoob˙}˘]uo˙XA9]vobvXwA9]v R]ovAMæ˙b}(P r E. Von Willebrand Disease yy Dbu}bb]v UIvvboUæu]}Pu˙b ]v}Rv}b]oU R}o˙XM˙(}˙b F. yy yy G. yy v*BleedingDisors*der v yy DIC Tvo˙]vPbX FbRF}vPobu AdultsUChildrenUNeonates æruollP Or C}Po}v(} Uoovoo}vvb as needed Thrombocytopaenia requiring platelet transfusion PooC}vv AdultsUChildrenUNeonates uollP~]bboo}v˙æ˘ılLZ Pv}v}(o}o.]v}o˙b]b Tv˘u]A] U}ovIVU uP llP Then uP llP Adults uP}oR}o˙ nd L]vTuv ]v E RvPPA yy yy Hu}R]o]A P].(}VIII CryoprecipitateUIVU AdultsUChildrenUNeonates XærXlbllP Haemophilia B yy P].(}IX yy FbR(}vobu Refeal r Criteria R( oo Ru}R]o]b v oo vb `]R v˘o]v ]vP o]vP ]b}b v R}b]]vPP˙ b } R R˙b]]v b]o]b } Ru}o}P]b (} ]v]o buvU uv ov v bRo }uRvb]]`X v Chatep rP *HaematologicalDisorsder 19. Sickle Cell Disease vı X TR URv v*SickleCellDisse*a v TR]b ]b v ]vR] ]bb R] ˙ R }bb]}v }( `} v}uo Ru}Po}]vbU ob }v }( `R]R ]b Ru}Po}]v SX TR ]}b ˙bU ]vo]vP HBSS U HBSC v HBS WRobbu] }bb]}v}(}vv}uoRu}Po}]v~Ru}Po}]v}PR AZ `]R}v v}uo Ru}Po}]v ~XPX AS } CZA }vb Ru}Po}]v}R˙ ]vv}b]looo]bbX TR b }( R `} Tb]loe } b] vb `]R b]lo oo ]bb ub }]X S]lo oo ]bb vb u˙ bv ]R ]vR˙b U b ]v]b}b `]R}uo]}vbXTR]b]b]b}uu}vo˙ b}r}ob]}v ]v ]b]bX OR ˙b }( ]bb ]vo Rb ˙v}u b UR˙rRu}o˙]b]bUob]b]bv}v b ]bbX Ivb}r}ob]]bbR]b }ob]}v }( buoobob˙b]lo oob b]vP ]v(}v v ]vV ]v A CRb S˙v}u ~ACSZ bvb`]Rbv}vb}(}PRU]8o˙]vR]vPv(V]v ob ]bbU ]v(}v `]R }]b b v b vu] `]Ro}ò}˙}vV]v}v b ]bbRbovvo] voP]o˙}]vP}(o}}oobX Pvb `]R b]lo oo ]bb bR}o v}P } R ]}]Rlrbb]loooo]v]X sueCa yy IvR]v}(`}v}uoRu}Po}]vPvb(}u}RvbU ob}v}(`R]R]bvSX yy Crises are typically precipitated by: yy }o`R yy R˙}v yy ]v(}v yy R˙b]o˘}v yy uvob Symptoms yy J}]vv}v]vUb]oo˙]vP}o`b}vb yy ˙bE (P]o]˙ yy Poo} yy Jv] yy D]8o˙]vR]vP`]R}`]R}Rb]v yy CR}v]oPo yy A}u]vo]vUb]oo˙]vRbov] yy S}vv}b ]v b }v `]R} ˘o b }bo ]v uo vb~Sb}v}vRP]]bu [Z Signs yy Jv] yy Poo} yy H}uPo˙ Standard yy yy yy yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw Sov}uPo˙ ~u˙bv]v}ovbZ Oo } v ].}v b ulb ˙ ]}vo RobU oo˙ }R}u]voòovi}]vb Vv}bob B}bb]vP D˙o]b~Rvv(}}˙v}u b Z Gnathopathy G}`Ro˙}ooUovl˙~ b Ru(v}][R]bZ v*SickleCellDisse*a v Invtiga se tions yy FBC yy Bo}}.ou}uuv yy Ro}˙}v yy S]lo]vPb yy Hu}Po}]vo}R}b]b yy U]v˘u]v}v yy CRbXr˙]vb}(CSA yy Bo}}v]vClS`Rv]v(}vb yy GvPD˙b Trtme ae nt Tuv}ib yy T}vRo}uv}(b]looo]bb yy To relieve pain yy T}]v(˙vuvPR]]vPb}(]bb yy T}u]v]vP}}˙b Ru}Po}]v b yy T}vo}vPu}uo]}vbv}PvuP yy T}uvPb]looo]bbv}uo]}vb}vo} Non-pharmacological treatment yy G}}R˙}vooub˙]vl]vP`lG]b yy }]v A }(}uu}v]]vPb}(]bbRbuo] ~vbXZUR˙}v UbU˘bb]˘]bUv˘}b }˘ub}(`R yy M]vvv}(P}}v]}v yy Co]v}v yy PvolP]v}v yy Gv}vboo]vP`]R}ov˙(u]o˙b]]}v b yy Gvoo]lv}òP Pharmacological Treatment AXVb}r}ob]}v]v]bb st L]vTuv ]v E RvPPB M]o}u}]v yy Pu}o Adults U}oU w Chatep rP yy yy yy æuPrPvrR}o˙ Children vr˙bV æræuPvrR}o˙ ræ˙bV ræuPvrR}o˙ u}vRbr˙V vruPvrR}o˙ Or Pu}o UoU Adults and Children D}bb} Or I}(v U}oU Adults uPvrR}o˙ Children vr˙bV ruPvrR}o˙ ræ˙bV ruPvrR}o˙ u}vRbr˙V v}}uuv Or D]o}(v U}oU Adults æuPR}o˙}uPR}o˙ Children AN˙bV æuPR}o˙ AM˙bV v}}uuv Or D]o}(v UoU Adults uP]o˙}u˘]uu}(uP]o˙]v]]}bb Children wæruP]o˙ v*SickleCellDisse*a v yy *HaematologicalDisorsder N}r I( R ]v ]b v} }v}oo ˙ R ubb } `]R]v R}bU }vbo b]o]bX PR]]v ]b v} o}vP R }uuv P }( R}]X M}R]v u˙b]o]b}vbo}v]b]X yy MorphineboRU}olIVU}vbob]o]b C rX }v C}vP o}vPuNSAIDS ~(}u}Rv `} `lbZ XPX D]o}(v profenu˙vo b ]u]uvUvPb]b yy yy yy Av ˘}b D ]vS}]uCRo}] UIVIv(b]}vU Adults æA9˘}b D ]vXıA9S}]uCRo}] rL]o˙ Children æA9˘}b D ]vXıA9S}]uCRo}] æuollP]o˙ w vI r Standard Or Adults N}uoSo]v Children N}uoSo]v B}˘rP) Trtme ae ntGuidelinesUwthEditionUw ovvP`]RæA9˘}b D rL]o˙ ovvP`]RæA9˘}b D æuollP]o˙ Fluid requirement in children according to age AM˙ æuollP ˙ uollP ˙b uollP ˙b uollP v˙b uollP ˙b ıuollP ˙b æuollP ˙b wuollP v*SickleCellDisse*a v yy yy yy yy B. yy SP]v nd L]vTuv ]v E RvPPB D ]o}(v b}]uUIMU Adults wæræuP]o˙]v]]}bb Then Codeine phosphateU}oU Adults and Children}˙b rvuPrvR}o˙ Or Tu}o U}oUæruPR}o˙ vA Bo}} vb(b]}v (packed cellsZ `Rv vU v} }vX Tvb(b]}v`]oovbb˙](Ru}Po}]voo]bAMæP lL Steady State F}o]A] U}oU Adults æuP]o˙ Children AN˙V AM˙V æuP]o˙ XæuP]o˙ w Chatep rP C. *HaematologicalDisorsder Severe Disease N}r Pvb `]R b Rb ˙v}u b Xr˙Uo}}v]vClSUo}}(}P}]vPv}bbruR]vP yy yy bR}o R v Pv Rb Au}˘]]oo]v A= Coov] A]U IVU X P v Pvo˙ vb(} ˙v H˙}˘˙u] U Ab]]v U O]b v l} CR}v] vb(b]}v R˙u˙bvb]o]b X D Pv}v}(vu}}o]v(}vb yy Pvu}}o}viP]v ~PCVZ]v}v ]v ]v(v˙U }}bv˙b Refeal r Criteria R( oo b]lo oo vb `]R o]vP ]v} R ˙U ]]buU Ru] } vo ]bb v }l b } b]o]bX TR bv }( }b}u˙o]bU b v}b]b }( R R]U Rb ˙v}u b b]bv iv] L ]v]o uvPuv b }uuv } bR}oob}`v(o}b]o]bvX Pvb `]R CNS vbU v˘o]v R]PR `R] oo v oo }vb ~u} Rv æ v æ ˘ ılL o˙ b ZU ]vo u}] ]vU ]bb } v bvu] ]v(]vP `]R R] o]bbR}o(}b]o]bX and v*PlasmaCellMyeloma*v 20. Plasma Cell Myeloma Pobu oo u˙o}u ~]}bo˙ (} b uoo u˙o}u ]bv+vPRobuoob]vR}vu}`XTRbv}uo obu oob } ]v ]vb vub v } v}uo v}vr (v}vo]uuv}Po}o]vbo]vP}]u]]o]˙}.PR]v(}vb ]v R v +U R˙]b}b]˙ v vo (]oX Iv R }v u}` R ]vb obu oob bo ]v }v ]v v}uo o}} oo }}v v }b]}v }( }v `]R bov ]Ro o}} ˙}v]bU}b}o˙ob]}vbUR}o}P]o(bvR˙ou] TR ]bb ]b}uu}vb]v R b]˘R v o}` R P}( ˙bX sueCa yy yy Uvlv}`v P}vo]]vbP yy CRu]ob XPX ]}˘]vbU (}uoR˙U v v]}vv (}v ]vb}ovbvov]vPPvb yy I}v]]vP]}v yy V]bbXPXHbV]b U]v bE rB w ZU X UHIV UHb V]b Standard Trtme ae ntGuidelinesUwthEditionUw v*PlasmaCellMyeloma*v Symptoms yy B}v]v yy ˙bE (P]o]˙ yy E˘bb]`lvbb yy Rv]v(}vb yy B}v˙òo]vPb b Signs yy Poo} yy F yy DR˙}v yy B}v˙oub yy PoP] yy Pb]b yy RvoIu]uv yy Uv}}l(b Invtiga se tions yy FBCvo}}.ou}uuv yy ESR yy Bo}}Uo}o˙bUv]v yy Pobuo]uoob yy Su]] yy B}vu}`b] yy Sloo˙b ]vo]vPblooXr˙ yy Su}]voob yy Su}]vo}R}b]b yy U]vBvJ}vb}]v Trtme ae nt Tuv}ib yy T} R vu }( v}uo obu oob } v}uo v reduce their rate of increase yy T}vu] yy To reduce bone pain yy T}uvPR}o}P]o( yy T}]u}}u]v]vP}}}vu]vovb]˙ yy T}]v(}vb yy T}vvvo}uo]}vb Non-pharmacological treatment yy PvbbR}o]vlobo]b}(G]R˙R}PR}R course of their disease yy PR˙b]}R˙ yy OR}]b}b w Chatep rP *HaematologicalDisorsder Pharmacological treatment AX T}vu}(obuoobv}(]vb ]oo A b]o]vb}vo˙ B. To reduce bone pain P]vo](~}]NSAIDSZ C. To treat anaemia Ploob transfusion and platelet transfusion`Rv]v] X D T}vvvo}uo]}vb IVv}oG]b EXT}u]Pu}o˙b]b Allopurinol}u]Pu}o˙b]b v*Leukaemia*v FXT}]v(}vb ~S}]b}vZ Refeal r Criteria Aoo vb b } R obu oo u˙o}u bR}o ( } Ru}o}P]b b]o]b ˙ v (} (R o}v v .v] uvPuvX Sbv (}oo}`r v }v˙R˙b]]vb]o]b`]RP]v(}uRRu}o}P]bX 21. Leukaemia Llu] ]b v }( R o}} oobX TR `} u]v ˙b }( olu]U `R]R o˙uR}] olu] v u˙o}] olu]X R E ˙}(olu]vobb].b~`RRv(oob bvo˙ ]ooZ v R}v] ~`R R v u˙ R v R}]vP R ]bb (} u}vRb `]R} lv}`]vPZX TRb ]v ooU R u]v ˙b }( olu]P o˙uR}] olu] ~ALLZ olu] ~CLLZ U u˙o}] olu] ~AMLZ olu]~CMLZ X ALL ]b }uu}vb ]v R]ov b]oo˙ }˙bU CLL ]b }uu}vb ]v Roo˙UAMLvCML}bbooPP}bv˘bb X TR v}uo olu] oob b]oo˙ ]v olu]U .oo R u}` vv R u}` (}u }]vP R v}uo o}} oob ]XX oobU `R] oob v oob o]vP } vu]U v}v] vR}u}˙}v]Uo˙ b X sueCa yy Uboo˙vlv}`v yy Associated factors yy V]bb XPX Ruv T o˙uR}}R] ]b ˙ ~HTLVrZ v ]v b ]b~EVB Z yy CRu]ob XPX vvU ]vb]o b}ovbU ]bb ~o]v wæ U R}v] o˙uR}] v R}v] u˙o}] r Standard yy yy Trtme ae ntGuidelinesUwthEditionUw daneZU˙bU DPbXPXol˙ovPPvbbRbuoRov I}v]]vP]}v v*Leukaemia*v Symptoms Llu] A yy F yy L˙uRv}òo]vP b yy ˙bE (P]o]˙ yy B]b]vPvv]b yy B}vvi}]v]v~b]oo˙]vR]ovZ Chronic Leukaemia yy ˙u}u Ab yy PP]vP D bvb}v~oLb]}(}uvZ yy ˙bE ˙b yy L˙uRv}òo]vP b yy W]PRo}bb yy Gvo]]R yy E˘bb]`vP b yy P]]bu yy H]vPo}bb Signs Llu] A yy Poo} yy F yy Sl]vvu}boRu}RPb yy GuR˙}R˙~AML˙b æZ yy F]uU˙Uv}vrvo˙uRv}b~o˙uR}]olu]Z yy Sov}uPo˙ Chronic Leukaemia yy Sov}uPo˙ yy W]PRo}bb yy Poo} yy Gvo]o˙uRv}voPuv]vCLL Invtiga se tions yy FBCvo}}.ou}uuv yy B}vu}`b] yy U]]oob yy LDH yy BUEvv]v yy L](v}vb yy Svb ~b]oo˙]volu]Z yy LP(}CSF˙}o}P˙~b]oo˙]vo˙uR}]olu]Z wv Chatep rP *HaematologicalDisorsder Trtme ae nt Tuv}ib yy T}]u(}]vALL]v}RR]ovvob yy T}R]u]bb]}vv}o}vPP}}o]˙o](]vAML yy T} ]u (} }uo Ru}o}P]o u]bb]}v } ]v R]ooR]}b]CML yy T} }v}o `R] oo }vbU˙u}ub b v}o}vP P}} o]˙ }( o](]vR]ooR]vPCML yy T} }] b} uv ~]v o](U vb(b]}v b}U ]v(}vbU}vboo]vPZ Non-pharmacological treatment yy EvbP}}R˙}v yy EvbP}}v]}vv(}}R˙P]v yy EvbP}}}ovb}voR˙P]v Pharmacological treatment yy S].uv ]oo A b]o]˙vb}vo˙ Refeal r Criteria R(oovb}RRu}o}P]bb]o]˙v (} }v.u}v }( ]Pv}b]b v b }( uvPuvX F}oo}`r v }vv P]}vo v ˙ R˙b]]v v R ]bv P]v }(Ru}o}P]bX 22. Malignant Lymphoma TR]b (b } P} }( ]b}b R] ˙ uo]Pvv }o](}v }( o˙uR}] b boo˙ bvvP b o˙uR v} òo]vPb b X TR ui} R]b}o}P]o ˙b ]bvP]bR ˙ R bv } bv }( R RSvP ~RSZ oo X TR u]v P}b H}Pl]v[b o˙uR}u ~RS oo bvZ v v}vrH}Pl]v[b o˙uR}u ~RSoobvZXN}P]b˘uoR}PRPvoo˙R]v]v}(v}vr H}Pl]v[b o˙uR}u ~NHLZ ]vbb `]R P v ]uuv}bb]}v `R]o H}Pl]v[b o˙uR}u ~HLZ bR}`b ]u}o lU ]v R R]b R]PR]v]v]vRR]vvR b bX Bl]' [b o˙uR}u U ˙b }( NHLU ]b }v }( R (bbP}`]vP w v*MalignantLymphoma*v AX Tuv}(Rvò˙]Pv}bv S}uv yy P]vo](~}]NSAIDSZ yy Ploob transfusion and platelet transfusion`Rv]v] yy IVv}oG]b yy Allopurinol}u]Pu}o˙b]b yy Tuv}(]v(}vb Standard Trtme ae ntGuidelinesUwthEditionUw v*MalignantLymphoma*v u}b lv}`v ]v uvX TR R o]v]o ]vb r R vu]U b}] v ]uuv}.]v˙ b}] (}ubX TR vu] (}u ]b (}v]v}]ovuo]vu]P]}vbo]lGRvv}uu}vo˙ bvb b i` òo]vP b `]R o}}bv]vP }( R b}] RX Iv GRvU ] ]b R }uu}vb R]oR}} uo]Pvv˙X I Rb l P ]v]vrw˙b`]Ruo}vvX sueCa yy OLvvlv}`v yy Ab}]}o}P]oPvb yy CR}v]vPv]uo}v b ˙ Helicobacter pylori]v(}v]v Pb]o˙uR}u yy V]bbXPXRb]bU]v b r]bUHTLVr yy CRu]obXPX]bb UR]]b yy W}}b Symptoms yy L˙uRv}òo]vP b `R]Ru˙`˘v`v yy J`òo]vP b ~]vBl]'bZ yy F yy N]PR`bb yy W]PRo}bb yy ˙bE (P]o]˙ yy A}u]vo ]bvb]}vU ]vbvo }b}v ~]v }u]vo o˙uR}ubZ Signs yy F]uU˙Uv}vrvo˙uRv}b yy Sov}uPo˙ yy S]} v ˙v}u b ~]( ol˙ u]bvo ubb bvZ yy Poo}~](u}`Rbv]v}oZ Invtiga se tions yy L˙uRv}]}b˙~}(b]Pv].vo˙voPv}Z yy F]vvob]}v~]vBl]'bZ yy FBCvo}}.ou}uuv yy CRbXr˙U}u]voUSGUCTv b `Rvvbb˙ yy B}vu}`b]vR]v]}b˙ Trtme ae nt Tuv}ib yy To provide a cure yy T} }] b} uv ~]v o](U vb(b]}v b}U ]v(}vbU}vboo]vPZ Non-pharmacological treatment yy EvbP}}R˙}v w Chatep rP *HaematologicalDisorsder yy C}vboo]vPv}v Pharmacological treatment AX Hodgkin’s Lymphoma (HL) and Non-Hodgkin’s Lymphoma (NHL) st L]vTuv ]v E RvPPA S}uv yy P]vo](~}]NSAIDSZ yy Ploob transfusion and platelet transfusion`Rv]v] yy IVv}oG]b yy Allopurinol}u]Pu}o˙b]b yy Tuv}(]v(}vb S].uv yy ]oo A b]o]˙vb}vo˙ Refeal r Criteria Aoo vb bR}o ( } Ru}o}P]b b]o]b ˙vX v*MalignantLymphoma*v wı Chapter ImmunisableDissea æ 23. Iuuv]b}v Iuuv]b}v P]vb ]v vo ]bb R}PR R v}voE˘vP}Puu(}Iuuv]b}v~EPIZ]b}v}(Ru}b + ubb }( ]vP u}]]˙U ]b]o]˙ v u}o]˙ ]v R }o}vUb]oo˙U]vR]ovX GRv vo˙ Rb ~òZ ]vb ]v R ]uuv]b}v bRoU vuo˙U GBC U }o }o]}u˙o]bU ]RR]U b]bU vbU Rb U B haemophilus influenzae ˙ U B vu}}bU }]bU ubobU oo v ˙oo}` (X N` ]vb u˙ ]v} ]v Rv(bR˙]b}v(}v+X Iuuv]b}v ]b}uuv(}R(}oo}`]vPb}vbP yy H]PR]blP}b~XPX]vP]b}l b }˙]}(]vP ˘}bZ yy Y}vPR]ov yy Elderly yy TRuov}]bR TRv bRo (}}v Iuuv]b}v (} R]ov v æ ˙b]bb(}oo}`bP ]v E RvPA ToærP) SRo(}}vIuuv]b}v}(R]ovvæ˙b P A V]v~D}bZ BIRTH GCB ~XæuoIvuoo˙Z P}o]} [O[~}bD Ooo˙Z v`lb SF]IvOv _~OPvrV]v Z~XæuoIMZ Pvu}}o~PCVZ ~XæuoIMZ P}o]} [[~}bD Ooo˙Z Rotavirus~R}]˘Z Chatep ræP *ImmunisableDissea P A V]v~D}bZ `lb SF]IvOv _~OPvrV]v PCV ~XæuoIMZ P}o]} R[~}b}oo˙Z Rotavirus~R}]˘Z Z~XæuoIMZ `lb SF]IvOv _~OPvrV]v PCV ~XæuoIMZ P}o]} R[~}b}oo˙Z Z~XæuoIMZ ıu}vRb MeasleslRoo~XæuoSC}IMZ Yoo}`F ~XæuoIMZ u}vRb Measles~XæuoSC}IMZ F] ]v Ov _ V]v } PvrV]v }v]vb D]RR] InfluenzaeBvHb BAvPvb]v}v]vX MeasleslRoo]bbv}u]v b ]vX B}˘ærP) U Pbb]b U Tvb UHaemophilus Notes on Vaccine use yy yy yy yy yy yy yy yy v*Immunistion a *v yy W}vPuR}}(u]v]b}v8˙ b yy I(Iuuv]b}v}b]b]vUbu`]RRbuv }(]vUob`]R b ]+vv yy TR v} }v]v]}vb } R ]uuv]b}v }( R b]l R]o](RlbR]bòov}PR}P}R}u yy CR]ov `]R ]R} `R} (} }o ]vbP P] }v[}vURvL`lbv}R]b}vP]v b yy D}v[ P] OPV L æ ˙b ~]bb Po ]uuv]b}v bRoZ yy D}v[P]R}]˘}bb L`lbUv}bL`lb Iuuv]b}v }(u]bP C}vb]oou]b(}(oo]uuv]b}v}bX S ]uuv]b}v ]v v u}vR L ]R ~L `lbZ ]b}(P}(u]˙XG]GBC }v]bRPX Do˙OPV]vv}vov]b]vR]bbuooRv}(vb(}( OPV]b}}R]bXHvP]OPV}v]bRP(}uvb˙ rv}`R]ooo b }vu]bb]}vX C}v]v]}vb}Iuuv]b}v : Current serious febrile illness: delay vaccine H]b}˙ }( b }v L ]}b }b ~XPX vR˙o }vZr}] }o]vP E v}o}P]o ]bb ~XPX v}v}oo ]ob˙ `R}ooob]b]v N} DPT } DPTlHBlH] } R]o `]R }vob]}v ˙b}(Ru}bv}b}(DPT}DPTlHBlH] N} DPT } DPTlHBlH] } R]o `]R v }vob]}vb } CNS]bb Z r }] lbR}l `]R]v Standard yy yy Trtme ae ntGuidelinesUwthEditionUw Yoo}` ( ]v bR}o v} P]v ]( R ]b R]b}˙ }( vR˙o˘]b `]R]vPb}v}(PP Iv]]ob `]R ˙u}u b HIV ]v(}v bR}o v} ] GBC v ˙oo}` (]vb b]v Rb o]]vbXGBC ]v vP]v]Rb]vRHIV]v(v`}v ]b˙u}u b L]]vbbR}ov}P]v}R(}oo}`]vPP PPvv`}uvr(}]bl}(}Pv]+ Pvb`]Ruo]Pvv]bbXPXolu]UH}Pl]vb]bb Mo]Pvv]bb}(Ro}v}Ro]o˙bb uU Pvb `]R ]uuv b]}vU ]vo]vP S˙u}u HIV vb yy Pvb }v Ru}R˙ ~( (} v u}vRb L }]vP b Ru}R˙uvZ H}`P yy Measles]vbR}oP]v}HIV }b]vbvR}PR ]]bo]]vbRv.}`]PRbR]bl Refeal r Criteria R(oo}oubo} Iuuv]b}v} ]]]v } EPI b]o]bX yy yy yy yy v*Mesle a s*v X Measles Measles ]b v ]v(}b ]bbU `R]R boo˙ }b ]v R]ov `v v u}vRb v ˙b `R} Rv} v ]uuv]bU }}uoR(oo]uuv]b}vbRoXI]bv˙}b}( b ubob]v}v ı v u}vRbX TR}v]}v ]b˙ ]v(}b (}u}˙bw (}U}æ˙bLUv}(RbRX C}uo]}vb ]vo }b u] U `]R } `]R} (vbbU }vR}vu}v]U }U ]R}U ]u]v A .]v˙ o]vP } ˘}RRou] v o]vvbbU uov]}v v }v }( ov o}b]bXS]}bo˙]ooubobvb]]vPu]bb]}vbR}o ]b}oX TR ]b v} b]. uv (} ubobX Av]}b v} ]U˘(}b}ub].}uo]}vbX Measles ]Pv}b]b ]b u]vo˙ o]v]oX TR ]bb ]b v}` v}uu}v }( b ]uuv]b}vXH}ÙR]PR]uuv]b}v}Pvb} u]v]v} lR ]bb v }v}oX R} oo b} R D]b]D]bbC}v}oO8(}}]}vX useCa yy Measles virus Symptoms yy Runny nose yy C}PR yy Red eyes Chatep ræP yy yy yy yy yy *ImmunisableDissea S}u}R H]PR(Ubv(}RbRb RbRrb}v(vvl D ]R} CR]o]bPvoo˙u]bo AX yy BX yy CX F}]vv( ]v E RvPPC Pu}o U}oU Adults æuPrPvrR}o˙ Children vr˙bV ræ˙bV u}vRbr˙V T}v˙}uo]}vb}V]u]vA ]v E RvPPA V]u]vA U}oU Children AN˙V vru}vRbV AMvu}vRbV F}uvPuv}(b}]]R}`]RR˙}v ~Sb}v}vRD]R}[Z v*Mesle a s*v Signs yy F yy C}viv]b yy K}o]l b}b ~`R] P]vro]l b}b }v R o u}b ˙b (}bRZ yy RbRr]R˙UPvo]buo}ro Invtiga se tions yy Uboo˙v}v yy Measles]uuv}Po}o]vM~IPMZv}˙˙b ](] Tuv}ib yy T}o]˙u}ub b yy T}u]v]vP}}v]}v yy T}vv}uo]}vb Non-pharmacological treatment yy T]b}vP]vP(}( yy Ev}P}oR˙P]v`]R(vbo]vu}R`bR yy C}vv(]vP`]Rb}LR]PRo}](}}b yy WbR˙b`]Rov` yy D]b}Pb}(RbR]ub}vbl]v Pharmacological treatment æræuPvrR}o˙ ræuPvrR}o˙ vruPvrR}o˙ .]v˙ Uv]b]o˙(}˙b Uv]b]o˙(}˙b æUv]b]o˙(}˙b Standard X D Trtme ae ntGuidelinesUwthEditionUw F}uvPuv}(b}]vu}v]v}bu] ~Sovb}vbZ EX F}o](}(bl]v]]}v yy Cou]vo}}v ~o˙o]oo˙}R`R}obl]vZ Refeal r Criteria R( vb `]R }uo]}vb bR b ol ~Ru}RP]Z bRU ]} b U vu}v]U }u U P ]8o˙ ]v vP } ]vl]vPU R˙}v }uov]}v}RR}b]oX 25. Pertussis v*Petur sis*v TR]b ]b R]PRo˙ }vP]}b ]o b]}˙ ]v(}v }uu}v]vR]ovvobXTR]v}v]}]bwr˙bX C}uo]}vb ]vo }vivo b Ru}RPU }b u] v}U vu}v]U }vR]b]bU }v }( ov o}b]bU R˙}v U (U }vob]}vbUo}obU v uov]}vX Au] }R}b]o`Rv}uo]}vbbvX Pbb]b v v ˙ R S.r]vr}v_ Iuuv]b}v }uuv(}ooR]ov~Sb}v}vRIuuv]b}v[ZX IvRv}(R]oo}]vPb]b(}]uuv]b}vUR S.]v}v_]vbR}ooo b P]v}}P]vbR(}}R ]bbX D]vP ]u]bU } `Rv R ]b o R]b}˙ }( }v ]v R]o `]RRU}]v]}b u˙ Ro R ]} }( ]v(]˙ v vbu]bb]}vX Aoo b R}o } } R D]b] D]bbC}v}oO8X useCa yy Bordetella pertussis Symptoms Ro C PRbPIv]or`lb yy L}`P( yy Nbo]bRP yy M]o}PR Paroxysmal phase: within the following 6-10 weeks yy E]b}b }( ]}ov }PR v]vP `]R ]vb]}˙ `R}} }}u]vP ~`R}}u˙bv]v]bvobZ R}˙~}vobvZRbPv˘r`lb yy Go}v]v}b}(}PR]vP Signs yy Apnoea~o}vPb]vR]vP}uu}v Z ]v]b yy Cyanosis U Chatep ræP *ImmunisableDissea Invtiga se tions yy FBCrR]PR}oo˙uR}˙}v yy CRbXr˙~}˘o}Rb}(R}v]}PRZ Trtme ae nt Tuv}ib yy T}vbu]bb]}v yy T}v}uo]}vb Non-pharmacological treatment yy F(vo˙`v}PR]vPbub yy Ev}P}oG]]vl Pharmacological treatment yy nd L]vTuv ]v E RvPC T]uR}]ulSoRuR}˘}o U}oU æ v*Petur sis*v AXPvbvo}b}vb`]R]v˙b}(}vb}(˙u}ub b st L]vTuv ]v E RvPPA yy E˙R}u˙]v U}oU Adults æuPvR}o˙(}˙bw Children r˙bV æræuPvR}o˙(}˙bw r˙bV æuP}(bvb]}vvR}o˙(}˙bw vu}vRbr˙bV æuP}(bvb]}vvR}o˙(}˙bw AMvu}vRbV v}}uuv~]bl}(˙o}] v}b b ]bZX C}vb]T]uR}]ulSoRuR}˘}o ]vbX~So}`ZX Or ]v E RvPPB yy A]R}u˙]v U}oU Adults æuP]o˙(}˙b Children uP llP}˙`]PR]o˙(}˙b ~v}}uuv(}R]ovobRv b u}vRb v }( b ]bl of pyloric stenosisZX C}vb]T]uR}]ulSoRuR}˘}o ]vbX~So}`ZX Or ]v E RvPPC yy Co]R}u˙]v U}oU Adults æuPR}o˙(}˙bw Children wXæuP llPR}o˙(}˙bw Standard Trtme ae ntGuidelinesUwthEditionUw Adults vluPR}o˙(}˙bw Children luP llPR}o˙(}˙bw B. yy OxygenR˙`Rv}˘˙Pv}v b AMıA9 O˘˙Pv U ]vvbo } ( ublU ~]( R v Rb ]8o˙ ]v R]vP}]b˙v}bZ Refeal r Criteria R(]v(vb`R}Rv]b}}(v}}˙v}b]bL]v]o b]}v}b]o]bX 26. Tetanus v*Tetanus*v Tetanus ]b ]bb b ˙ ]uU `R]R }b v}}˘]v b}vb]o (} R o]v]o (bX TRb ] o] }u]vvo˙ ]v R b}]oU b} ] ]b ˙b } P R]b ]v(}v `Rv l ]v R bl]v ]b v} ov }o˙X Tvbr}v `}vb ]vo vbU v ]vi]bU } R}b }vu]v ˙ b}]oluvU b `}vbUvR}b`]RuR]o]bvb }u}v(bX TR b }( v}vrb]o]b ]vbuvb } b]vPb }v R u]o]o } ]b}b}b v}vovbXTR]v}v]}]br˙bX Tetanus bR}o b u]o uPv˙X Tvb ]uuv]b}v]bRl˙(}v}v~Sb}v}vRIuuv]b}v useCa yy Clostridium tetani Symptoms yy D]8o˙}]v]o]˙}}vu}R yy C}vb}v yy S+}˙ yy Sbubr Rb ]v(o v ]PP˙ v}]bU ]PRo]PR} }RVb}vv}b]vbX Signs yy Uu]o]bu˙]v( yy Pbv}(`}v~u˙RRoZ yy I]]o]˙ yy Cyanosis]vPbub yy S}v]~u}l]vPZbu]o yy L}li`~vv}}vRu}RZ yy O]bR}}vb ~b+RlZ yy R]P]}uvv+ b vlvo]ub Invtiga se tions yy N}}v.u}˙~]Pv}b b ]b]bo]v]oZ v [ZX Chatep ræP *ImmunisableDissea Trtme ae nt Tuv}ib yy T}v(Rbub yy T}o]u]v Clostridium tetani}}b (R}˘]v}}v yy T}vo]b]ovP}˘]v yy T}}]R˙}vvv]}v yy T}}]b}oobub}uoo˙ b Non-pharmacological treatment yy Ao`˙bu]b}(vb yy M]v]vo]`˙ yy }] A v}]bU]PRo]PRvvvbb˙R˙b]o˘u]v}v}(R v yy Cov R ]v( u]o]b } `}v `]R b} v ` } vbb}o}v~Sb}v}vRW}vuvPuv[Z yy SP]o]uv}(R`}v`Rvvbb˙ Pharmacological treatment AX yy yy BX yy nd L]vTuv ]v E RvPPB Bv˙ov]]oo]v UIVU Adults æUv]bllPU b RvMUvR}o˙(}æ˙b Children æUv]bllPvR}o˙(}æ˙b Neonates æUv]bvR}o˙(}˙bw vA Gvu]]v UIVU~v}vb}vo˙ZUuP llPR}o˙ T}vo](]ovP}˘]v ]v E RvPPB HuvTvb Iuuv}Po}o]vUIM}IVU Adults and Children æv]bX b Neonates w v*Tetanus*v yy ]}v E }(]]vv]Pv}b}Rvb st L]vTuv ]v E RvPPA M}v]}o UIVU Adults æuPvR}o˙(}wr˙b Children ANu}vR wXæuP llPR}o˙(}wr˙ Neonates AN˙bw V wXæuP llPR}o˙ AM˙bw V wXæuP llPR}o˙ Standard Trtme ae ntGuidelinesUwthEditionUw æv]bX b Av Tetanus T}˘}]U IMU ~]vi ]+vb](}u Huv Tvb Iu uv}Po}o]v Z Adults and Children AN˙bV Xæ uo X b R r `lb ~v }bZ v vru}vRb~}bZ AM˙bV }bb}(Pvov]v ]vob}((}`lb yy C. To control spasms ]v E RvPPC Adults yy CRo}}u]v UIMUæuPrR}o˙ yy yy v*Tetanus*v yy Av D ]u U IV } IMU ~˙ bo}` IV }( v} u} Rv æ uP l u]vZUæruPrvR}o˙`Rv] Or PRv}]}v UIMU uPrR}o˙UPoo˙}v b L}`lb Children CRo}}u]v U IM } }o ~] vb}Pb] ZU Xæræ uP hourly Av D ]u UIVlIMlvb}Pb]lb}b]}˙UXuP llPrR}o˙ v `Rv]~˙bo}ÌV}(v}u}RvæuP lu]vZ Or PRv}]}v U IM } }o ~] vb}Pb] TZU uP llP X b U RvXæuP llPR}o˙ Neonates CRo}}u]v UIM}}o~]vb}Pb]ZUwXæuPR}o˙ yy yy yy Av PRv}]o ~PRv}]}v uPX b RvwXæuPR}o˙ N}vbr](bubv}}v}oo`]RR}uv yy yy A D]u ZU IM } }o ~] vb}Pb] ZU UoUXæuP llPrvR}o˙`Rv] B}˘ærP) TvbIuuv]b}v yy S Iuuv]b}v (} ]bRP (}u R}b]o ]v oo vb b vb]v(}v}bv}}]]uuv]˙P]vb(]b}b yy Av o `R} Rb ] }o }( æ }bb }( vb }˘}] ]b o]lo˙ } Ro](ro}vP]uuv]˙ r Chatep ræP *ImmunisableDissea B}˘ærP) TvbIuuv]b}v yy A }b }( vb }˘}] ]v}vb bR}o P]v } v˙ ]}bo˙ v]uuv]b v }o Rv ˙b }( PX D}bP Xæ uoU IM } SCU`lbv`lb~]u˙}bZ yy I( }u}˙b~æ}u}˙b(}R]ovo}`Pæ˙bZR obb]v]u˙}b}ob}}bUP]}}b}b}(Xæuo yy Iv vbr}v `}vb b R ]u˙ }b ]v R v}vr]uuv]b vXA}}b}bu˙ P]v](u}Rv.˙bRob since the last dose yy S]}b}(v}vovbbR}o(}oo}`Rv}uobRo(}SF]r ]vrOv_~Pvr]v Z yy P]}bo˙v]uuv]bR]ovo}`RP}(˙bbR}o] }bb}(æ]v]vob}((}`lbX yy Cu]o]o}`]R]o b ]vbuvUov`]RuR˙ob]]~o }R}oZvov} yy T}vvb ]vvb `]R }voo˙}vu]v`}vb ~ vb }v `}vZU }] `}v }]ovP ~S b}v }v RW}vb[Zvob}}]vb}R˙o˘]b yy TetanusIuuv]b}v ]vPvv˙~Sb}v}vRAvvoC r r [Z v*Poliomyelitis*v Refeal r Criteria R(vb}b]o]b](bubvv}}v}ooX 27. P}o]}u˙o]b P}o]}u˙o]b ]b]o]bbU`R]R]b˙b (or}o}}or }r}o vbu]bb]}vX Ivbv]˙ ]b}bo }( ˘ v b }( vb( ]vl]vP `}v] } R X b TR ]bb ]b R]b ˙ ˙]vPPb}(G]o˙b]bU`R]R}uu}vo˙b]bbX Po˙b]b}uu}vo˙+b}vo}ò]u v˙P}}(bloo ubobU]vo]vPRubob}(b]}vvooob]vR]v u˙+X P}o]}u˙o]b ]b }uu}vo˙ ] ]v R]oR}}X TR ]v(}v ]b }Lv bro]v]o v u˙ }vo˙ b u]o Gro]l]oovbbX Ovo˙ (` }Pb b }b o}o˙b]bXH}Ù]vi}vb]vP]}b}( R (]o ]oovbb }]`]R v ]vb ]v]v }(o˙ }o]}u˙o]bX P}o]}u˙o]b ]b vo ˙ Iuuv]b}v X Pv}v ]b ou}b ]v ]( }bb }( }o }o]} ]v P]v b ]v R EPI bRoX Ro˙ V]vrAb}] Po˙ P}o]}u˙o]b ~VAPPZ u˙ } ]v ]]vb }( }o }o]} ]vb v R] v]uuv]b }vbX TR]b ]b boo˙b}]`]R}o]}]b˙X Note 5-1 Aoob}(}o]}u˙o]bbR}o }}RD]b]D]bbC}v}oO( .(}(}oo}`rX r ı Standard Trtme ae ntGuidelinesUwthEditionUw sueCa yy v*Diphtheria*v P}o]}]b }˙b b U} Symptoms yy F yy Headache yy Sore throat yy Muscle pain yy Fo]o˙b]b Signs yy G] A o˙b]b}(+ubob yy D]u]v]bR}bvuboG˘b Invtiga se tions yy T`} (bR }}o b buob lv r R}b ~} bv }v ] }RRP]}voPo]HoRR(vL}}˙(}}v.u}vZ Trtme ae nt Tuv}ib yy T}}]b}oov}b(}u]oovbb yy T}}]}o]u]R˘v}(o˙b]b yy T}}]R]o]}v]vo˙b Non-pharmacological treatment yy b B yy }] A ]vi}vb]vP(]o]oovbb]vR]ov yy PR˙b]}R˙ yy P}]b]}v}(}]o]vb}]u}]o]˙ Pharmacological treatment yy N}b].v]ouv Refeal r Criteria R( oo vb `]R ]8o˙ ]v R]vP v òo}`]vP b (} R}b]ou]bb]}vX 28. Diphtheria TR ] b}vb]o (} R]b ]bb }b }˘]v R uPbRuv}˙bv}PvbXI}uu}vo˙+bR}vb]ob v b}uub R bl]vb]vP obX I ]b bu]vo˙ ˙b]}˙ }ob(}ub}v}b}vUvob}uu}vo˙ b R}PRbl]v}vX Iv( vb u˙ } L ]v]o ˙u}ub b v b]Pvb } o} b `lvbb v ] `]R]v vr ˙bX C}uo]}vb u˙ o}]vRo˙Rb}(R]b}b `lbobRv}uo b RvR(]oUuP}ob}(RRU}b]}˙ }b}vo]vP}RX ı Chatep ræP *ImmunisableDissea TR ]bb ]b v}` v}uu}v b }( ]uuv]b}vX H}Ù R]PR ]uuv]b}v}Pvb} u]v]v}lR]bb v}v}ob]RbR]PRu}o]˙X Note 5-2 Aoo}( b ]RR]bR}o}}RD]b]D]bC}v}o b O8X sueCa yy Corynebacterium diphtheriae AX yy Aoovbo]v]oo˙]Pv}b`]R]RR] ]v E RvPPC D]RR] v}˘]v UIV]v(b]}vU~(}oo}`]vPv]vuo}bb }(Xuo}(]v]o}v}(v}˘]v]vS}]uCRo}] Adults U}Uv]b Children AN˙bV UrUv]b ı v*Diphtheria*v Symptoms yy Sore throat yy L}bb}( yy So]PR( yy D˙bRP] yy D]8o˙]vR]vP`]R}`]R}]} b Signs yy G˙]bR`R]uuv}R]vRR}v}v}vb]ob`]R]v r˙b }( R }vb }(˙u}ub b X Muv u˙ oU }u P˙]bRPv}olX Invtiga se tions yy TR}lvbo`bb (}o(}]v˘bvo}b}vb yy R`bb Lv]}uv}b~uvu˙v }˘vZX Trtme ae nt Tuv}ib yy T}vo]bR+}(]ovPv}˘]vb(}R˙}u .˘}Rb yy T}}]b}b]}˙v(]vP`R]v] yy T}]R}Pv]bu(}uRR˙v˘ yy To prevent spread Non-pharmacological treatment yy b B yy F]vP˙vb}Pb](}vb`R}vv}òo}` b yy S]]b}o}v}(vbb Pharmacological treatment XıA9Z Standard Trtme ae ntGuidelinesUwthEditionUw AM˙bV æUrUv]b Note 5-3 R}vb }uu}v b} b]}v (]o]b bR}o ]oo ]uu] ately yy yy v*YellowFever*v yy r Av B Pv]]oo]v UIVU v˙o Adults XPvR}o˙(}R}b Children and Neonates u}vRr˙bV æuP llPvR}o˙(}R}b Then A u}˘]]oo]v U}oU Adults PR}o˙(}æ˙b Children ær˙bV æuPR}o˙(}˙b ræ˙bV æuPR}o˙(}˙b u}vRr˙V æuPR}o˙(}˙b Or A]R}u˙]v U}oU Adults æuP]o˙(}æ˙b Children uP llP}˙`]PR]o˙(}æ˙bX N}}uuv(}R]ovobbRvvu}vRbb}(]bl of pyloric stenosisX BXAooo}b}vb yy Au}˘]]oo]v U}oU(}˙b~(}b]vP}Z Or F}vb`R}u˙v}}ov]]oo]vbP yy A]R}u˙]v U}oU(}æ˙b~(}b]vP}Z Refeal r Criteria R( vb `]R o˙vPo }b}v } b]}˙ o˙b]b } vENTb]o]bX 29. Yoo}`F Yoo}` (]b b ˙ ]bvbu]'} uv ˙ b]b }( u}b]}b ~ Aedes aegyptiZ (}u ]v( u}vl˙bX TR ]bb ]b v} (}u b b}v}b}vXCobb]o˙oo}`(]bboo˙(oX AL R }vb }( ˙u}ub b U R ]b ]( u]bb]}v }( r R}bU(}oo}`]vP`R]RR˙u}ub b u˙`]RRo}uv}( ]Pb]]vUiv]Uvo]vb8]v˙U]}bo]vb]o]˙v ı Chatep ræP *ImmunisableDissea o]vP(}u]}bb]b~XPXPubvvorvb]bZX Yoo}` (]v}v ]b}P]vbR ]bb v vb }˙v˙bXYoo}`(]v}v]b]uv (}o(}uGRv}ob }v]bX N}ær Aoo b }( ˙oo}` (bR}o }} R D]b] D]bb C}v}o O( .X r sueCa yy AX yy Av]oR˙ TR]bv}b].uv ı UXZ v*YellowFever*v Yoo}`(]b Symptoms yy F yy Mbo]vUoo˙lR yy Headache yy SR]]vP yy L}bb}( yy Nausea}}u]vP yy D]R} Signs yy C}vPb}v}(R}viv yy Jv] yy Bo]vP (}u]}bb]b~R] UR˙u}b]b yy R]PR}u]vovvvbb yy S]Pvb}(vo(]o Invtiga se tions yy U]vo˙b]br}]v]v]b}]o]v}Pvoob yy L](v}vb yy Bo}}Uo}o˙bvv]v yy Bo}} buo (} ˙oo}` (]b}o}P˙ b ~ R RP]}vo Po] HoRR(vL}}˙Z Trtme ae nt Tuv}ib yy T}}]b}(}RUvov]o}˙(]o yy T}uvPo]vP]b} Non-pharmacological treatment yy I( ˙oo}` ( ]b b ]v vU u] ]uu]o˙ } v ]b}o}v` yy Foob}uv(}R(]ovvo(]o Pharmacological treatment Standard Trtme ae ntGuidelinesUwthEditionUw BXF}o]vPvb yy FbR(}vobu Refeal r Criteria R(}R}b]oU(o˙}v`]Rv]b}o}vv]X 30. Haemophilus Influenzae type b Disease v*HaemophilusInfluenzaetypebDisse*a v The Haemophilus influenzae ˙ ~H]Z ]u ]b v ]u}v b }( ]v(}vb bR b ]o uv]vP]b U vu}v]U ]Po}hbv}bu] ]vR]ovobRv b æ˙b}oXH]]b]bb v}}uu}v˙}væ˙b}(PX H] ]v(}vb vo ˙ R .r]vr}v ~vrZ ]v ~SEPIRSRo(}}vIuuv]b}v}(R]ovvæ˙b[ZX sueCa yy Haemophilus influenzae˙~H]Z Symptoms yy F yy OR ˙u}ub b b}] `]R vu}v]U }b u] uv]vP]b Uu] b Signs ~Sb]Pvbv˙u}ub b }(Rb].]bb]v}Rb}vbZ Invtiga se tions yy Cov bvb]]˙ }(}]}˙ G]b ~XPX b (}u R ]v b }b u] U }b]vo G] ]v uv]vP]b oob]]vu˙u Uo}}ZX U U Note 5-5 Bo}} o ]b }vo˙ ov ]v ]vb] ]bb v `}o v} Ro(o ]v v}uo]vu}v]bX Trtme ae nt Tuv}ib yy T}o]u]vR] yy T}}]b} Non-pharmacological treatment yy R( } ov b}vb }v R bvvP ]oovbb XPX uv]vP]b vu}v] Pharmacological treatment yy R( } ov b}vb }v R bvvP ]oovbb XPX uv]vP]b vu}v] Refeal r Criteria Aoo vb `R} (]o } bR}` ulo b]Pvb }( ]u}uv ]v ı U U Chatep ræP *ImmunisableDissea ˙b (}oo}`]vP P uvU } bv `]R }uo]}vb bR}o ((}R]PRrooX 31. Pneumococcal Disease X v*PneumococcalDisse*a v Pvu}}o ]bb bvb u} }uu}vo˙ b v}vr]vb] ]b]v b R(}u}(v}vru]vu}v]Uu]or]v(}vbU b]vb]bU } }vR]bX H}Ù ] u˙ ob} uv](b b Ivb] Pvu}}o D]bb ~IPDZ ]v R (}u }( vu}v] `]R u˙u vl}u]}uv]vP]b bo}(Ru}Pv]X b Iv o}]vP }v]bU v}vru] vu}v] b R ui}]˙ }(vu}}oRbXN]v˙]bv}˙b b Rv]v.X Pvu}}o ]bb ]b +o˙ v `]R Pvu}}o C}viPV]v~PCVZ vUv `lb(}]v(vbXPvu}}o P}o˙bR]V]v~PPSVZ ]b}uuv(}b}vb}oRv ˙b `]R vo˙]vP u]o }v]}vb bR b S]lo Coo D]bb Aob `]R ]uuv}}u}u]b]vP }v]}vbU (v}vo } v}u] bov]U }b]vo G] olbU } }Ro ]uovb bR}o ] PCV(}oo}`˙PPSVX sueCa yy Streptococcus pneumoniae Symptoms yy F yy OR ˙u}ub b b}] `]R vu}v]U }b u] uv]vP]b Uu] b Signs yy Pob(} b]Pvb v˙u}ub b }( R b]. ]bb ]v }R b}vb Invtiga se tions yy Cov bvb]]˙ }(}]}˙ G]b ~XPX b (}u R ]v b }b u] U }b]vo G] ]v uv]vP]b oob]]vu˙u Uo}}ZX U U Note 5-6 Bo}}o]b}vo˙ov]v]vb]vu}}o]bbv`}ov} Ro(o]vv}uo]vu}v]bX Trtme ae nt Tuv}ib yy T}o]u]vR] yy T}}]b} Non-pharmacological treatment ~S ov b}vb }v R bvvP ]oovbb XPX uv]vP]b vu}v]Z ıæ U Standard Trtme ae ntGuidelinesUwthEditionUw Pharmacological treatment ~S ov b}vb }v R bvvP ]oovbb XPX uv]vP]b vu}v]Z Refeal r Criteria Aoo vb `R} (]o } bR}` ulo b]Pvb }( ]u}uv ]v ˙b (}oo}`]vP P uvU } bv `]R }uo]}vb bR}o ((}R]PRrooX 32. Hb L] [Z ~S b}v }v RAv CR}v] Hb v D]b}b }( R 33. R}]bD]bb ~Sb}v}vRR}]bD]bvb D]R}[vD]b}b}( RGb}]vbvoTZ v*Hetitis ap *v ıv U Chapter ProblemsoftheNeorwb n ~NeonateZ X v Sick newborn TR u v`}v (neonateZ (b } ˙ ]v R .b u}vR }( o](X A ]R oo RoR˙ v`}vb `]R }vP b ˙X Av˙ ˙ }v]oo`]oobR}`b]Pvb}(}}]˙}u˙b]S]vP b G_ } G}˙ ]v bX TR v`}v `]R }v } u}v}uo ]o b]Pvb ]b vòoX TRb ]vo }o}U ]˙U uU b]}vU RU o}} bPU ]v }U v}( }ò u}uvbU b]Pvb }(]bb~]vZX sueCa yy yy yy yy yy yy yy B]RbR˙˘] Pu]˙ N}vo]v(}vb C}vPv]o uo(}u}vb XPX RU vo v}b˙bb uU}ò X B]R]vi˙ Mvo}v b }voPb]]vPo} M}o]XPXR˙}Po˙u]UR˙}ou] Symptoms yy Wl˙}]v]o]˙}˙ yy D]8o˙]vR]vP}v}v b }(R]vP~v}Z yy Rb}vv}bu}uvb}]vP˙G}˙ yy Refusal of feeds yy V}u]vP yy A}u]vo]bvb]}v yy Convulsions yy Bo}}]v}}ob b yy Reduced urine output Signs yy R]b}˙u~ANwXæ£C˘]oo˙Z yy L}`}˙u~AMvXæ£C˘]oo˙Z yy Poo} yy Cyanosis ıw Standard yy yy yy yy yy yy yy yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw Jv] ˙] B ~AMblu]vZ Tachycardia~ANblu]v v Z Huub Rb]}˙]bb~ANRb v lu]vURb]v`]vPZ Rb]}˙AMRblu]v Apnoea A}u]vo]bvb]}v }`b D ]vbb}v}vb]}bvbb S]b Tenderness of any part of the body v*Sickneorwb n*v Invtiga se tions yy FBC yy Rv}uo}}Po}b yy Bo}}vo}o˙b yy Bo}}ob yy U]vo yy S`}(v˙ob]}vb(}ovbvb]]˙ yy CRbXr˙ yy Po]v}u]voXr˙Uvb]v](]v] yy }bC ]voG]]}Ru]b˙vovbvb]]˙ Trtme ae nt Tuv}ib yy T}]Pv}bvvo˙]vP}]o˙ b yy T}]v(˙vPvo˙}R˙}Po˙u] yy T}vuvv}PvuP Non-pharmacological treatment yy o]b Eb R]`˙UvbR]vPv]o}v~ABC yy K˙ù]R`]v˙o}Rb}]vv]v} Pharmacological treatment ]v E RvPPA Z AX yy Oxygen Therapy O˘˙Pv ˙ ( ubl } vbo }vPbU r Llu]v ]( ]ooU ~u}v]}vu]v]v}˘˙Pv}v b `vırıæA9Z B. yy Maintenance Fluid ˘}b D A9U IVU }v ˙ }( o]˙U }blu]vllP ~v uollP l ˙Z N}uoSo]v XA9`]R˘}b D A9~vræuollP l˙L˙ Z yy CXC}}v}(H˙}Po˙u] I(R˙}Po˙u]U}~Sb}v}vRN}voH˙}Po˙u][ ı Z Chatep rvP D. yy *ProblemsoftheNeorwb n~NeonateZ For neonates having seizures (convulsions) PRv}]}v UIVlIMUuP llPX b RvæuP llPR}o˙ E. To treat sepsis (other than cord sepsis) yy Au]]oo]v UIMlIVU Neonates AN˙bw }(PV æuP llPR}o˙(}ær˙bw AM˙bw }(PV æuP llPR}o˙(}ær˙bw Av yy Gvu]]v UIMlIVUuP llP]o˙(}˙bw ~]b}(PL ]RZ yy yy yy G. yy yy yy For cord sepsis Co}˘]oo]v UIMlIVU Neonates AN˙bw }(PV æræuP llPR}o˙ AM˙bw }(PV æræuP llPR}o˙ vA Gvu]]v UIMlIVU uP llP R}o˙(}˙bw ~]b}(P L]RZ For bowel related sepsis Au]]oo]v UIMlIVU Neonates AN˙bw }(PV æuP llPR}o˙(}ær˙bw AM˙bw }(PV æuP llPR}o˙(}ær˙bw vA Gvu]]v UIMlIVUuP llP]o˙(}˙bw ~]b}(PL ]RZ vA M}v]}oUIV~}Wu]vbZ Neonate AN `lb }Pb}vo PV æ uP llP b b]vPo o}]vP }b(}oo}`LR}b˙wXæuP llP˙R}b vr`lb}Pb}voPVæuP llPb]vPoo}]vP }b(}oo}`LR}b˙wXæuP llP˙R}b AM v `lb }Pb}vo PV æ uP llP b b]vPo o}]vP ıı v*Sickneorwb n*v F. yy Or A u]]oo]v UIMlIVU Neonates AN˙bw }(PV æuP llPR}o˙(}ær˙bw AM˙bw }(PV æuP llPR}o˙(}ær˙bw vA (}˘]u C UIVUæræuP llP R}o˙(}˙bw ~]b}(P L]RZ Standard Trtme ae ntGuidelinesUwthEditionUw }b(}oo}`LR}b˙wXæuP llP]o˙ Refeal r Criteria R( R v Pvo˙ } b]o]b (} (R ]vbP}vb vuv](v}]u}uvLR}bX 35. Neonatal Hypoglycaemia v*NeonatalHypoglycaemia*v N}vo R˙}Po˙u] (b } v}u o}} Po}b oo o}`Xvuu}olL]vRv`}v X Ab R o]v]o b]Pvb u˙ ]oU } ]v bvU (} buoo } b]l]b}]v(vb}(]u}RbRv}uo}}Po}boo bR}o Rl ˙ R R}b (} R .b R}b vo ] ˙bb }Xæuu}olL(}(RR}bX N}voR˙}Po˙u]u˙bo]vR](v}}uo˙ v bR}o R(} uvP b b}}v b X b Sb(o b uv bob ]v }u b}vbX T} v R˙}Po˙u]U ]vP b bR}o v}P b}}v L ]RX I( R v}v vo } blU vb}Pb] u˙ b v ˘bb u]olP]vXI(vo(b}v]v]U]vv}bG]bbR}o ]uu]o˙ b X sueCa yy Pu]˙ yy Iv]vP}`R}v yy ˙B }v}]u}R yy Iv(}v yy AbR˙˘] Symptoms yy I]]o]˙vobb bvbb yy Tu}b yy S`vP yy S]b yy LRP˙ Signs yy S`vP yy Tu} yy Tachycardia yy S]b yy Uv}vb]}bvbb Invtiga se tions yy Rv}uo}}Po}b~RBSZ yy Ub]vPrb]Po}bu yy CRl`]R]vR}bL]RvPoR}o˙]vob in infants at risk is Chatep rvP *ProblemsoftheNeorwb n~NeonateZ yy OR]vbP}vbv}vRvo˙]vP b b Trtme ae nt Tuv}ib yy T}u]v]vo}}Po}boob`]R]vv}uoo]u]b yy T}]v(˙vvo˙]vPb}(R˙}Po˙u] yy T}v}uo]}vbXPX]vuP Non-pharmacological treatment yy Bo}} Po}b u}v]}]vP A* } R}o˙ ]v R˙}Po˙u] ]v(vb vov}uooob']v Pharmacological treatment ]v E RvPPA AXIv]ouvPuv yy ˘}b D A9UIVUuollPb}ob TovrP) v*NeonatalJaundice*v BXM]vvvuv(}oo}`]vP]uu]o˙L]v]ouv agement yy So]v XA9 ]v ˘}b D A9U vræ uollP l˙ v]vP }v R P}(Rv`}v ~Soo}`ZX M]vvvG]]uv ˙D AHæ Pu Tu vuollP l˙ æuollP l˙ ıuollP l˙ wuollP l˙ uollP l˙ ıuollP l˙ uollP l˙ uollP l˙ æuollP l˙ uollP l˙ CXA]}vouvPuv Dvb}vRvo˙]vPbX Refeal r Criteria R(} b]o]b](v}bv}b}v}uo˙]vb]}( uvX 36. N}voJv] Jv] in the neonate u˙ ]b]o `Rv R bu ]o]]v oo ˘b u]}u}olLX N}vo iv] ]b ]u}v b }(R}vbvb}(R˙]o]]vu}vR]v}(Rv`}v TR]b }v]}v ]b oo lv]b (bilirubin encephalopathyZ v u˙ R b XIv(vb`R}b]u˙Rv]`]Roob˙U vb}](vbbUuvo}vvu}}]v}}]v}vX X Standard Trtme ae ntGuidelinesUwthEditionUw v*NeonatalJaundice*v }˘]uo˙ A A9}(v`}vb`]ooiv]]vR.b`l}( o](vu}b}(R]b]bR˙b]}o}P]oXTR]b}b}v˙vob}b ˙bXTR]biv]]bu]ovR˙u]vbRoR˙X Jv] in the neonate ]b o]lo˙ } R}o}P]o ]( ] ]b bv `]R]v R .b ˙ }( o](V } }viP ~]Z ]o]]v u]}u}olLV}}o]o]]v]bu}Rvwu]}u}olL]vu v u} Rv v u]}u}olL ]v R u ]v(vV } R v}v ]b b]Pv].vo˙iv]˙}v˙b}Rbiv]`]R(X E˘RvP vb(b]}v ]b R .v] uv (} R˙]o]]vu] R Rb R R oo `R lv]b }X sueCa yy PR˙b]}o}P]o yy Hu}o˙b]b rRRbb UABO ]v}u]o]˙UGvPD .]v˙ yy Bo}}˘b}vrRoRu}u UbPooRu}u yy Sepsis yy C}vPv]o]v(}vb yy L]]bb yy M}o]]b}brPo}bu]UR˙}R˙}]]bu yy EvRv ˘ R ]o}v r GIT }b}vU ]v (]vP yy C}vPv]o(b}(]o]]v u}o]bu yy u]ol bB oiv] Symptoms yy Yoo}`˙b yy Yoo}`bl]vURvbv( yy Po}}ob b ~]o]˙b]o]lo˙Z Signs yy Jv] yy Yoo}`]Puv]vbl]v yy Yoo}òubA=lr˙oo}`b}ob}(( yy Po}}ob b ~]o]˙b]o]lo˙Z Invtiga se tions yy T}ov]bu]o]]v }vv}v yy OR]vbP}vbo}` b Uvv}vPbv}vv suspected cause: o˙ E }vb~`]R]v.bR}b}(]RZ yy Bo}}P}vRbb~RRZP}}(}R]v(vvu}R yy D]C}}ubU b Iv]C}}ubU b FBU C GvPD yy Bo}}.ou(}oov}uo]bUuo]b]b yy Cob }( o}}U ]vU v b]vo G] u˙ ]v] ˙ R R]b}˙UR˙b]o˘u]v}v}]v]oo}}˙.v]vPb P}o}vPiv]~L˙bZ yy L]Fv}vb ]b u} Rv u˙ yy yy yy yy yy yy Chatep rvP TR˙}]Fv}vb U]v(}]vPvbb U]vRlEvClS TORCH~}vPv]o]v(}vbvZb HB A}u]voob}vv b ~˘o]o]˙b]Z *ProblemsoftheNeorwb n~NeonateZ Trtme ae nt Tuv}ib yy To prevent kernicterus (bilirubin encephalopathyZ yy T}vvo˙]vPb Non-pharmacological treatment yy PR}}R˙ ~Sv}o}`}vRPR}}R˙ [Z yy E˘RvP o}} vb(b]}v ~S v} o}` }v RE˘RvP vb(b]}v[Z B}˘vrP) Phototherapy A R}}R˙ v] `]R o G}bv o]PRb ]b (X I( v]o oU `R] G}bv b u˙ bX TR ˙[b ˙b ub } bR}o ˘u]v ]o˙ (} v˙ ]v(}vX C}vv]vP b ]vP R]buXEvbG]]vlXPvR˙}Ru]}R˙Ru]X PR}}R˙ bR}o}vvoov}viP]o]]v o}`R}}R˙oob(}obR}bX B}˘vrP) ]bu}Rvwu] X r r oobu]v r Exchange transfusion Ubùo}}~w£CZU}bbruRP]vbuvov]v(vbu~v uollP}rR}bZXM}v]}RUb]}˙U]o]]v Po}b oob ]vP R }X FR ˘RvPb u˙ v ]( R ]o]]voo}vvb}]bXS}R˘RvPvb(b]}v](RR Gb˙u}Rvblu]vX and blood L}` oob }( ]o]]v than stated above should be considered for intervenr }v˙R}}R˙}˘RvPvb(b]}v]vR(}oo}`]vPbPb]l}o}` ]R `]PR ]bU } (}oo}`]vP bR˙˘]U }o}vP R˙}˘u]U ]}b]b v b]bX S]vR]bv}˘b}u]vR]bl}(lv]b oo `R]R ˘RvP vb(b]}v ]b vbb˙U R (}oo}`]vP o }( Ru Rb}(o b bP]V UvRvR v*NeonatalJaundice*v PR}}R˙ is started if: yy Jv] ]b]b]o}v˙ yy Jv] ]v}oboubvb}ob}(( yy Jv] ]vu]˙ yy AL˙Uuboo}(v}viP]o]]v }u}olL]vu}u}Rvvu]}u}olL]vuv}v Standard Trtme ae ntGuidelinesUwthEditionUw yy Su]o]]v }(u}Rvu]}u}olL]vu]v(vu}RvlP yy Ivv`}vb`]PR]vPobbRvlPUbu]o]]v ]vP`}o]˘RvPvb(b]}v yy yy yy yy yy AMlPrwu]}u}olL rlPræu]}u}olL C}HAMP lL}}]o]]v ANu]}u}olL R]}Pbb]}v}(vu]]vbv}(b}o]vPiv] Hydrops foetalis ~]b ]uu] ˘RvP vb(b]}v `]R l cellsZ Pharmacological treatment AXTuv}(vo˙]vPb]b ~Sb}v}vRRS]lN`}v[Z Refeal r Criteria R(]uu]o˙U oo ]b `R}o} iv] `]R]v R}b }(o](}`R}R}o}vPiv]}]]]vX R( oo vb ]]vP ˘RvP vb(b]}v } v }] (]o]˙X v*BirthInjuries*v 37. Birth Injuries B]R ]vi]b ]vo ˘vb] bvuU RoRu}u U bPoo Ru}RPU v ob]b v (bX TR bv}v ]b v]vP }v ˙ v b] }( ]vi˙X E˘bb] }vu˙bo]v]vi˙}RR]oo˘bvu˙b}] `]R(}]vi˙}(RRub}bR}oi}]vX sueCa yy D]8oo]˙~]vo]vP]vbuvoo]˙Z Symptoms yy Sòo]vP}(R yy Iv]o]˙}u}o]u}o˙ yy Poo} Signs E˘vb]CSvu yy D]+b òo]vP b }( RbvvP }( Ro b Ru˙˘v beyond cranial suture lines CRoRu}u yy LPòo]vP b }(Ro b R]b]b }}vRo(v}bv} ˘v˙}vRu]o]v SPooRu}RP yy D]+bòo]vP b }(Ro b `R]Ru˙bo]v]b}bR}( the head and face yy Severe pallor ˘]vPR(}oo}` r Chatep rvP yy yy yy yy yy yy yy *ProblemsoftheNeorwb n~NeonateZ Jv] N]vi]b bE Pob˙ r WR}o o]u }b v} u}X TR ]b u}uv }vo˙]vR.vPb Koul[b Pob˙ r F]vPb }( R + Rv } v} u} ~o` RvZR]bu}uv]vRuv(}u Fb Ru}uv}(+o]u Sòo]vP}(R+o]u Av}uo}b]}v}(o]u P]vvvvbb}vu}uv}(o]u v*BirthInjuries*v Invtiga se tions yy Hu}Po}]voo(}bPooRu}RP yy Su]o]]v ](iv] yy Xr˙}(ov]((]bb Trtme ae nt Tuv}ib yy T}(R b o]vP yy T}}uo]}vb}(vu]viv] yy T}rbo]bRvv}uou}uv]v+o]u yy T}}u}v}uoRo]vP}(( Non-pharmacological treatment Extensive caput succedaneum yy Reassure parents yy Lòo]vP b o}v~b}vv}bb}o}v}r˙bZ Cephalhaematoma yy Reassure parents yy Lòo]vP b o}v~b}vv}bb}o}v`]RuZ yy D}v}(}u]v]b]}vv]vP yy PR}}R˙ ](iv] Subgaleal Haemorrhage yy PR}}R˙ ](iv]oob]R]b~Sb}v}vRN}vo Jv] [Z Nerve injuries yy PR˙b]}R˙ Fractures yy M˙]bo]vvP Pharmacological treatment AX CRoRu}u T}o]vP ]v E RvPPA and Subgaleal haematoma æ Standard Trtme ae ntGuidelinesUwthEditionUw yy PR˙}uv]}v ~V]u]v K ZU IMU uPX b v ](˙] dose at birth T}}Avu] ](HAMPulo yy Bo}}vb(b]}v UæruollP Refeal r Criteria R(}b v}]b]o]b(]o]˙X 38. N}vo}viv]b v*Neonatalonju c nctivitis*v N}vo }viv]b } }RRou] v}v}u ]b v ov}viv]b]vPR.bu}vR}(o](XI]bboo˙}v (}u]v(Pv]o}vb b }(Ru}RX Cov]vP }( R v}v [b ˙b ]uu]o˙ L ]R v R o]}v }( A9 ˙o]v }]vuv ]v} R ˙bU ]b + ]v vvP R }v]}vX TR]b ub ]uouv b }o]˙ ]v oo RoR(]o]b]v`R]RR]oo]]bvlvX sueCa yy Neisseria gonorrhoea yy Chlamydia trachomatis yy Staphylococci yy Streptococci yy HbS]uo˘]b yy CRu]oXPXb]ov] Symptoms yy ˙E ]bRP yy Sòo]vP}(R˙o]b Signs yy ˙E ]bRPU`R]Ru˙ov yy Rvbbvòo]vP b }(R}viv yy Ouvvbb}(R˙o]b Invtiga se tions yy C}vivo`bb (}Gu]v]vP b vo Trtme ae nt Tuv}ib yy T}R]v(}v yy To prevent blindness Non-pharmacological treatment yy CovR˙o]b(vo˙~˙R}b`]R Z }'}v`}}o] ]v]o b bo]vb}o}vXIvRbv}(]o b bo]vb}o}vUb }]o`RRbvoL}}}o v Chatep rvP *ProblemsoftheNeorwb n~NeonateZ Pharmacological treatment AXTuv}(˙ ]v E RvPPB yy L]}v C UIM}IVUæuP llPX b ~u˘XæuPZ Or yy (}˘]u C UIMUuP llPX b yy yy yy yy yy yy C. yy yy yy Then C Ro}uRv]}o vA C Ro}uRv]}o ˙}bUXæA9o]}R˙vR}o˙ ˙}]vuvUA9o]}R˙v]PR Treatment of mother ]v E RvPPA L]}v C UIMUæuPX b Av E˙R}u˙]vU}oUæuPvR}o˙(}˙bw Treatment of mother’s partner(s) for gonorrhoea and chlamydia L]}v C UIMUæuPX b Or .˘]u C U}oUuPX b Or C]}G}˘]vU}oUæuPX b Av D }˘˙˙o]v U}oUuPR}o˙(}˙bw Or yy T˙o]vU}oUæuPvR}o˙(}˙bw Or yy E˙R}u˙]vU}oUæuPvR}o˙(}˙bw Or yy A]R}u˙]vU}oUPX b Refeal r Criteria R(oov}vb`]R}vo]v}ouvv}v}vo b }vi]b v} b}v]vP } uv } ]]]v v } v }RRou}o}P]bX yy w v*Neonatalonju c nctivitis*v B. Av E˙R}u˙]vU}oUXæuP llPvR}o˙(}˙b vA CRo}uRv]}o ˙}bUXæA9o]}R˙˙ R}b (}R}b~Lov]vP`˙]bRPrbo]v]]P}vZ Standard Trtme ae ntGuidelinesUwthEditionUw 39. Rv}ob}u v*Retinoblatoma s *v Rv}ob}u ]b }vPv]o uo]Pvv u} }]P]vvP (}u R v }( R ˙X TR]b u} u˙ R]˙U oo˙ R ]oo (}u `R]R (}ub } A9 }( bX M}b u}b R}` b}]~b}vv}bu}vZXTR]b]bRR]}uu}vbv bv u}vPb R]ov ]v GRvX M}b R]ov bv (} . ˙b }( PX I o˙ }b ]v }o R]ovX TR }Pv}b]b `]R o˙ bv}v ]b ˘oov `]R ıæA9 Rv }( o}vP u X TR ]b R]PR}(o}uv}(u}b}(}R}Pvbo]vo](]vR R]˙(}uX sueCa yy Gv~}A9}(bZ yy S}]~]v}vA9}(bZ Symptoms yy WR]U bR]v˙ b} ~ol}}]Z ]v R ]oU ob} lv}`v b R [b ˙G˘]bboo˙R.b˙u}u b ]vu}bvb yy Squint~b]bub Z yy V]boo}bb yy P}]vP˙oo yy Redness of the eye Signs yy bv A G˘ yy Tu}]vRv}v(v}b}˙ yy V]}bRu}RPvvoRuv}v(v}b}˙ yy Ivb]v}o~Po}u b Z yy O]oooo]b Invtiga se tions yy Uob}vv b }(}] yy HCT}MRIv b yy Luv(}}b]voG]˙}o}P˙ yy B}vu}`b] Trtme ae nt Tuv}ib yy T}R b }Pbb]}v}(Ru} yy T}v]bv}( b u} yy T}R]o}vPu yy T} }] b} v oo] ]v v disease Non-pharmacological treatment yy Evo}v}(R+˙]b]vRo˙Pb b yy P}bR˙]vb}v Chatep rvP *ProblemsoftheNeorwb n~NeonateZ yy LbR˙(}(}o}v}o yy R]}R˙(}o}o}( b Ru} yy C}vboo]vP}Ro}`]R˙R}o}P]o b ]u}(R]bb Pharmacological treatment AXIv}ov˘}ov}ob}u CRu}R˙ ]v E RvPPA yy V]v]bv UIVU yy EtoposideUIVU yy C}ov UIVU Or yy V]v]bv UIVU yy EtoposideUIVU yy C˙o}R}bRu] UIVU BXvA ]bb`]R]vv]oubb Poo]`]R]vv}R˙u}u b }v}o ~Sb}v}voo]Z ı v*Retinoblatoma s *v CXF}uv}(}u]vP ]v E RvPPA yy M}o}u] UIV}}oUru]}PullPR}o˙ Or yy GranisetronUIVUu]}PullP~u˘XuPX Zb M˙R}o˙](vbb˙ Or yy GranisetronU}oU u]}PullP~u˘XuP`]R]v Z R}(}}( b uv Then u]}PullPR}o˙(}}æ˙b Or yy Ovvb}v UIVU Adult æuP luX b RR}o˙](vbb˙ Children r˙bV uPX b ~]uu]o˙(}Ru}R˙Z Or yy Ovvb}v U}oU Adult uP R}o˙U u]v]b u]vb (} R b}( Ru} therapy Children r˙bV uPrR}o˙}æ˙b r˙bV uPrR}o˙}æ˙b r Standard D. yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw For treatment of febrile neutropenia L]˘}v C UIVUuP llP]o˙ Av Gvu]]v UIVUæuP llP]o˙ Av~](oo b (]oLR}bUZ Co}˘]oo]v UIVUæræuP llPvR}o˙ Av~](oo b (]oLæ˙bUZ Fo}v}o U}oUuP llP]o˙ E. For treatment of anaemia and thrombocytopenia yy Bo}}vo}}}vb(b]}vb ~Sb}v}vRBo]vP]b}b[Z Refeal r Criteria AoovbbR}o(}˙vRv+o˙ v}ob}uX X Wilms Tumour v*WilmsTumour*v W]oub u} ~vR}ob}u Z ]b uo]Pvv u˙}vo u} }( vo bX I ]b R (}R }uu}vb v u}vPb R]ov ]v GRvX A} A9 }( R]ov `]R W]oub u} bv (} æ ˙b}(PXIvbvb}}vLo]˙XIu˙ b}]`]R }vPv]o v}uo]b bR b Ru]R˙}R˙ and the absence of the iris (aniridiaZXW]oubu} Rb ˙P}}}Pv}b]b`]Rv}A9 Rv}(o}vPruX sueCa yy S}]Pvu}v Symptoms yy V]b]ov}oo}u]voubb yy F yy Bo}}]v]v Signs yy A}u]vo ubb ~o `]R } v } ]bbu]v}vZ yy Hu] ~u}b}]}u]}b}]Z yy Hypertension yy Ab}]}vPv]ov}uo]b Invtiga se tions yy A}u]voob}vv b yy A}u]voCTv b yy CRbXr˙ yy FooBo}}C}v yy Bo}}UUo}o˙bvv]v Chatep rvP *ProblemsoftheNeorwb n~NeonateZ Trtme ae nt Tuv}ib yy T}}]vo}vPu yy T}}]b}voo] Non-pharmacological treatment yy NR}u˙ yy R]}R˙}brbP˙(}vb Pharmacological treatment AXPr}uv st L]vTuv ]v E RvPPA yy V]v]bv UIVU Av yy Av}u˙]vD UIVU Av yy D}˘}]]v UIVU~](bv}(ubbZ v*WilmsTumour*v BXP}br}uv ]v E RvPPA yy V]v]bv UIVU Av yy Av}u˙]vD UIVU Av yy D}˘}]]v UIVU~v]vP}vP b v]blP}˙Z Or yy C}ov UIVU yy EtoposideUIVU yy D}˘}]]v U IVU C˙o}R}bRu] u}bZ IV ]v }u]v}v ~F} R]PR ]bl CXF}uv}(}u]vP ]v E RvPPA yy M}o}u] UIV}}oUru]}PullPR}o˙ O yy GranisetronUIVUu]}PullP~u˘XuPX Zb M˙R}o˙](vbb˙ O yy GranisetronU}oUu]}PullP~u˘XuP`]R]v Z R}(} }( b uv Then u]}PullPR}o˙(}}æ˙b O yy Ovvb}v UIVU Adults æuP luX b RR}o˙](vbb˙ Standard yy D. yy yy yy yy v*WilmsTumour*v E. yy Trtme ae ntGuidelinesUwthEditionUw Children r˙bVuPX b ~]uu]o˙(}Ru}R˙Z O Ovvb}v U}oU Adults uP R}o˙U u]v]b u]vb (} R b}( Ru} therapy Children r˙bV uPrR}o˙}æ˙b r˙bV uPrR}o˙}æ˙b For treatment of febrile neutropenia L]˘}v C UIVUuP llP]o˙ Av Gvu]]v UIVUæuP llP]o˙ Av~](oo b (]oLR}bUZ Co}˘]oo]v UIVUæræuP llPvR}o˙ Av~](oo b (]oLæ˙bUZ Fo}v}o U}oUuP llP]o˙ For treatment of anaemia and thrombocytopenia Bo}}vo}}}vb(b]}vb ~Sb}v}vRBo]vP]b}b[Z Refeal r Criteria Aoo vb bR}o (} b]o]b vb (} }] uvX r Chapter Disorsof der the Cardiovcula sa rSystem X Chest Pain CRb ]v ]b }uu}v v }uo]v v ub b u]o uPv˙ vo }v }R`]b b R ob o](r Rv]vPvo˙]vPbXTR}]}]˙]b}˘o}}uo˙ b]}b ] v v}vr] bX A P}} R]b}˙ v ˘u]v}v]b˙Ro(o]vR]bv}X sueCa Common Cardiac yy SoAvP]v yy C}}v˙ A S˙v}u yy P]]b Non-cardiac yy Gb}r}b}RPoG˘]bb yy Pou}v˙Eu}ob~PEZ yy Pvu}v] yy PUo yy Ob}RPobu yy Poo+b]}v Others to consider yy A}]bb}v yy Mitral valve prolapse~}Roo}ouZ yy C}}v˙b}bbu yy Sickle cell diseaserRb˙v}u b yy Hiatus hernia yy Ob}RPo`]Ru]bv]b yy B]o]˙]bb yy C}b}R}v]b yy N}}}ubb]}v yy Cardiac neurosislDC}b[b˙v}u b yy Hb}bZ w Standard Trtme ae ntGuidelinesUwthEditionUw Symptoms Myocardial Ischaemia A} D]bb}v P]]b Po]P]v P pain Muskulo-skeletal pain Quality of P]v CbR]vPU PRUR˙ }vro]l T]vP Sharp Sharp Bv]vP Sharp or dull S]}(P]v Central anterior chest Central Central anterior Av˙`R]v chest Central Av˙`R on chest òo R]}v T}R}U iÙub} v}`R Bl Uboo˙v} ]}v Uboo˙v}v To throat occasionr ally T}ub or around chest to back E˘}vU v˘]˙ U cold None o˙]vPb]vU E˘ by inspirar }vU}PR]vU Spicy (}}U alcohol Pbb on chest }u}]vP neck Ro]]vP F}b RbU nitrates None S]hvP (}` None Bov food and antacids Rb]}v }(u} uv Associated features NauseaU }u]vP U `vP b U ˙bv}U shock SR}lU ˙v}b]bU `vP b U]PR oLuBP ]+vU v`} PP]}v uu F Uv viral illness C}PR U Ru}˙b]bU dyspnoea and shock (in ubb]PEZ Bo}vPU `]v Pvo}}lb òo E˘ ]vPF}b r v*Chets Pain*v Signs yy SR}lUoo}U`vP b rMIUD]bbvPv˙buUPE yy D˙bv} rMI`]RLVFUPEUPvu}v] yy Bo}}b yy N}uo}R]PR yy L}`rbPPb]}Pv] b bR}l yy D]+vANuuHP`vubbPPb}b ]bb}v yy PobrR]PRUo}`}v}uoVPo}]Po yy Mubr}vb]ooR]bb yy P]]orbPPbb]]b yy UvoRb˘vb]}vrvu}v]vvu}R}˘ yy RlbvRb}vbrvu}R}˘ yy }vR]o B R]vPrvu}v] yy Poor}vb]vu}v]UPE yy A}u]vo~]Pb]vvb Z brPUo yy G]vPr(}oU]}v]b yy R}òb}vbro˙Iob yy CRbòovvbbrubo}rbloob Invtiga se tions ~Sb}vb(}b].]b}v]}vb b Z D]bb r Chatep rwP *Disorsof der theCardiovcula sa rSystem Trtme ae nt Tuv}ib yy S˙u}uo](}(Rb]v yy Rbvb }u]v]u]bv˘]˙ yy Tuv }( vo˙]vP b ~S b}vb (} b]. ]bb }v]}vbZ Non-pharmacological treatment ~Sb}vb(}b].]b}v]}vb b Z Pharmacological treatment ~Sb}vb(}b].]b}v]}vb b Z Refeal r Criteria Pb]bvv˘o]vRb]v X X Ischaemic Heart Disease STABLEANGINAPECTORIS So vP]v }]b ]b ]v } ]b}u(} R }b ]v R (}v }( R RbU v u˙ ] } R vlU bR}obU i` } ubX The chest pain ]b ˙]oo˙ ]v ˙ ˘}v } u}}vo b v o] ˙ b } Po˙˙o ]v]X Iv]]ob `R} ˘]v ob vP]v}]bR]PR]bl}(o}]vP}}v˙˙v}ub b } R 'lX R]bl (}b ]vo ]b uoo]bU R˙vb]}vU ]P' bu}l]vPU obu o]] v}uo]bU }b]˙U (u]o˙ R]b}˙ }( R ]bb vb]bvo˙ oulb }( ]vGuu}v bR b Cr}]v X R]bl (}b (} R]b }v]}v ]vo }b]˙U ]b uoo]bU R˙vb]}vUbu}l]vPUR˙o]]u]X sueCa yy Atherosclerosis`]Rv}`]vP}(R}}v˙o}}bob yy Sbub}(R}}v˙]b Symptoms yy Central or precordial chest pain yy M˙]]v}RoLuUvl}i` yy Relieved by rest yy Ro]˙Po˙˙o]v] Signs yy N}˙]ob]Pvb Invtiga se tions yy roGCE æ v*IschaemicHetar Disse*a v IbRu] R ]bb ]b }v]}v `R˙ R ]b o}} bo˙ } R R uboX I }u]bb }( ob vP]v }]b vR}}v˙˙v}ub b X Standard yy yy yy yy yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw ]C v˙ubPv]vl]vbrMB~CKrMB Bo}}Po}b Bo}}o]]}.o FBC CRbXr˙ Stress ECG R}]}PR˙ E C}}v˙vP]}PR˙ Z and troponins v*IschaemicHetar Disse*a v Trtme ae nt Tuv}ib yy T}u]v]u]b˙u}ub b yy T}v}Pbb]}v}}}v˙˙v}ub b yy T}]v(˙vuvPu}].o]bl(}b yy T}]u}o]˙}(o]( Non-pharmacological treatment yy vE vb yy HoR˙o](b˙ou}].}vb yy D] yy E˘]b yy W]PRuvPuv yy R}v]vo}R}o}vbu}v yy }] A }]bu}l]vP Pharmacological treatment AXTvPRRb]v ]v E RvPPA yy Glyceryl trinitrateUbo]vPoUæu]}PuX b Rv]b yy yy yy yy yy Av AspirinU}oUuPX b RvwæuP]o˙ Or Co}]}Po U}oUuPX b RvwæuP]o˙ Av AtenololU}oUæruP]o˙ Or B]b}}o}o U}oUæruP]o˙ Or MetoprololU}oUæruPrR}o˙ Note 7-1 }] A o}lb ]v }vR]o Ru b U ˙]U v R˙}vb]}vV }] v}o}o]vR(]oX yy O Vu]o U}oUruPR}o˙ v Chatep rwP *Disorsof der theCardiovcula sa rSystem Note 7-2 }] A ]v˙]UR˙}vb]}vv]vvbo˙}vro}lb yy yy yy Ou]b}]v]uv(}R˙vb]}v Ou]b}]v]uv(}]buoo]b Ubvbb }v}uoo}}o]]b}Poob B. If beta blockers or verapamil are contraindicated yy Ib}b}]]v] U}oUuPrR}o˙ Refeal r Criteria R(R(}oo}`]vPvb yy TR}b`]Rv}b]Pv].v]u}uv]v˙u}ub b LR]v]o uv} yy TR}b`]R`}bv]vP]bl(}b Flowchatr v*IschaemicHetar Disse*a v F]PwrP) Fo}`RPAvP]vP}]b CUTE A ORONA C RYSYNDROME A C}}v˙ S˙v}u ~ACSZ ]b u R b]b ˙u}ub b bovP (}u b u˙}]o ]bRu]X TR ]bRu] u˙U } u˙ v}U o } u˙}]o ]v(}v ~R 'lZX CSA ]b obb]. w Standard Trtme ae ntGuidelinesUwthEditionUw b ST bPuv o}v }v v o}]}Pu ~STrbPuv o}v u˙}]o ]v(}v r STEMI Z } v}vrSTrbPuvo}v u˙}]o ]v(}v ~NSTEMI Z v vbo vP]v ~v CSA `]R} o}v }( ] v˙ubZX TR ]bl (}b (} CSA ]vo } R}b (}U v ]vo]}b]b}b}(Uob vP]v}]bX R]bl (}b (} R]b }v]}v ]vo }b]˙U ]b uoo]bU R˙vb]}vUbu}l]vPvR˙o]]u]X sueCa yy Atherosclerosis}}b}v}(R}}v˙o}}bobo]vP }}v]vo}}bo˙}RRubo v*IschaemicHetar Disse*a v Symptoms yy Chest pain yy Sudden onset yy V˙]vP P }Lv b v b] b PRvbbU R]vbb}}vb]]vvX yy Pb]bvP(}u}Rvu]vb yy N}o]˙}b Po˙˙o]v] yy M˙]}RoLuURvl}i` yy Nausea yy V}u]vP yy SR}vbb }(R } (P ~R]b u˙ R }vo˙bv}v ]v ]bvRoo˙Z yy L}bb}(}vb]}bvbb Signs yy Restlessness and apprehension yy E˘bb]`vP b yy P]Ro}vo˙v}b]b yy Pobu˙R˙U(bU]PoUbo}`}v}uo yy Bo}}u˙ b R]PRUo}`}v}o~(}oo}`]vP˘vb] uP}RuboZ yy B]oo]}vb]vRRb~`]RoLv]o(]oZ yy Pbv}(R]}(}RRb}v~bPPbbR(]oZ yy Confusion in the elderly Invtiga se tions yy SvoGCE yy ]C v˙ubPCKrMB U}}v]vb yy M˙}Po}]v yy Suo]]}.o yy CRbXr˙ yy Rv}uo}}Po}b yy FBU C SR E yy Su]] yy Bo}}Uo}o˙bvv]v yy Cr}]v TvI Chatep rwP yy yy *Disorsof der theCardiovcula sa rSystem R}]}PR˙ E C}}v˙vP]}PR˙ AXIv]ouv}vu]bb]}v ]v E RvPPA yy O˘˙Pv U]vvboU˙(ubl}vbovvo Av yy AspirinU}o~RòZUuPX b Av yy Co}]}Po U}oUuPX b Av yy Glyceryl trinitrateUbo]vPoUæu]}PuX b Av yy MorphineUIVUæruPX b Av yy M}o}u] U IVU uP X b ~} v }u]vP u}R]v Z v*IschaemicHetar Disse*a v Trtme ae nt Tuv}ib yy To relieve distress and pain yy T}o]u]]v(b] yy T}vv}uo]}vb yy T}]b u}oo]vP yy T}vr]v(}v yy T}]v(˙vuvPu}].o]bl(}b yy T}]u}o]˙}(o]( Non-pharmacological treatment yy Rbvb vv}P]v b R.bR}b yy Ev}P}v b }(bu}l]vP yy Evb`]PR}v~]v}`]PRv}b]v]]ob]v Z R o}vPu Pharmacological treatment induced by BXM]vvvuv(}oo}`]vP]uu]o˙L]v]o treatment yy AspirinU}oUwæruP]o˙]v.v]o˙ Av yy Co}]}Po U}oUwæuP]o˙~vb`R}]bo]b}v R˙`]oo]uv(}}u}vRbZ CXAv}Po}v yy Ev}˘]v USCUuP llP~v]bllPZR}o˙ X D Pv}v}(]R˙Ru]bv}v}(u˙}]o workload yy AtenololU }oU ær uP ]o˙ ~}] }vo˙ ]( ro}lb }v ı r Standard yy yy yy yy yy yy yy v*IschaemicHetar Disse*a v yy Trtme ae ntGuidelinesUwthEditionUw ]v]Z Or B]b}}o}o U}oUæruP]o˙ Or MetoprololU}oUæruPrR}o˙ Av L]b]v}]o U}oUXæruP]o˙ Or L}bv U}oUæræuP]o˙ Or CandesartanU}oUrvuP]o˙ And Ivvb`]RSTEMI : F]]v}o˙ Pvb u˙ P]v b (b]}v R˙ ]v vb bvvP`]RSTEMI vb]o]bX MvP}uo]}vbbRou}v˙ b }uU]}Pv] shockv]R˙Ru]b MvP R˙Po˙u] `]R ]vbo]vX CRvP ] vb ]}bo˙}v}oR˙}Po˙u]Pvb}]vbo]v EXL}vPruuv~b}v˙v}vZ yy AspirinU}oUwæræuP]o˙]v.v]o˙ yy yy yy Av AtenololU }oU ær uP ]o˙ ~}] }vo˙ ]( ro}lb }v ]v]Z Or B]b}}o}o U}oUæruP]o˙ Or MetoprololU}oUæruPrR}o˙ F. To prevent cardiac remodelling and improve survival yy L]b]v}]o U}oUXæruP]o˙ Or yy L}bv U}oUæræuP]o˙ Or yy CandesartanU}oUrvuP]o˙ Note 7-3 }] A ]vR]]}b CEA vAvP]}v]v}o}lb]vvb`]RBPAM uuHP G. To stabilise the clot and reduce blood cholesterol levels yy }bA v U}oUruP]o˙ Or yy R}bvb U}oUruP]o˙ Or r Chatep rwP yy *Disorsof der theCardiovcula sa rSystem S]ubv U }oU r uP ]o˙X Svb ]v] ]b of lipid levels HXT}]u}}}v˙]o}vvu˙}]o`}lo} yy Ib}b}]]v] U}oUuPrR}o˙ IXC}v}o}(R˙vb]}vvR˙Po˙u]U](bv ~S}]b}vbZ Refeal r Criteria Aoovb `]R bCSA ]vPvGCE X I(GCE ]b v} ]oo}vv}]vU(]uu]o˙}R]PR(]o]˙X Pvb `]R }v.u STEMI in any facility should be referred Pvo˙ } PR˙b]]v S]o]b } ]}o}P]b C (} (b]}v R˙ ~Lv]v]o}o}b}(uP}(b]]v ZX ORvb`]RNrSTEMI vvbovP]vbR}o( } R˙b]]v b]o]b } ]}o}P]b L R ]v]o uvPuv }X X Dyspnoea sueCa yy yy yy Cardiac yy HF]o yy C}}v˙HD]bb yy VooHD]bb ru]ov}b b ]bU}v}b b ]b yy ]C AR˙Ru]b yy P]]o+b]}v Respiratory yy Pvu}v] yy Pou}v˙Eu}ob~PEZ yy Ob ovP ]bb r CR}v] Ob Pou}v˙ D]b b~COPDZ URu Ab yy Rb]ovP]bbrIvboovP]bbP˙}Pv] .}o˙b]vPo}o]bvR}}voovP]bb yy Pvu}R}˘ yy Poo+b E ]}v yy CRb òo (v}v o]u]}v r u˙}R˙U v}R˙U l˙R} scoliosis OR yy Avu] yy Pb˙R}Pv]R˙vo}v yy A]}b]brXPXu]UD]K}]}b]b v*Dyspnoea*v D˙bv} ]b v v}u(}o `vbb }( }v[b }`v R]vPX I ]b }Lv R u]v ˙u}u b }( ]}ou}v˙ ]bb oR}PR R ]+vo ]Pv}b]b ˘vb ˙}v Rb `} ˙bb ubX D˙bv} }( bv}vbbR}obu]ouPv˙X r r UP}}b Standard yy yy Trtme ae ntGuidelinesUwthEditionUw F}]Pv}˙b]}v Mbb]}u]vo]bvb]}v v*Dyspnoea*v Symptoms yy Rob B bvbb yy Quality yy }vv}b}]vu]'v yy ˘}vorbPPb]}ou}v˙ b b yy }b]}vo r bPPbb }˘˙buo v}vo ˙bv}U } thopnoea and a cardiac cause yy v}vorbPPb]b }}vR]oRu b yy T]ub]v}vbrv~Z}o}vPbv]vP~R}v]Z yy }v D }(]b}~bZ yy u]vb } R}b r bPPbb RuU vu}R}˘U o u}v˙ }uU vu}v]U ou}v˙ }uU v R˙o˘]b yy `lb } u}vRb r bPPbb oo +b]}vU ]]o +b]}vU ou}v˙ .}b]bU ovP vU v PEU ] (]oU vu]U v}ubo ]bbU culosis yy ˙brOPD C UovP.}b]b yy Associated features yy }PR~bPPbR b (]oUvu}v]Z yy buURu}˙b]b yy `R~bRuUR(]oZ yy vlo}u~RUl]v˙Uo]Z Signs yy F rvu}v]Uob}uu}vo˙ b PE yy Poo}rvu] b R(]oUPEUu˙}]o]v(}v }]}Pv]bR}l yy S`vPrR(]oUvu}v]UPEUu˙}]o]v(}v yy Co]vPr]v(}vbU˙v}}vPv]oR]bbUovP.}b]b yy CyanosisrR˙}˘]XPX]vOPD C UR(]oUPEUvu}v]X yy P]Ro}urRUo]}vo(]o yy WRrR(]o}}vR]oRu b yy oB bRRbrOPD C yy Ascites r ]U voU Pb}]vbvoU R } ]vr}u]vo lesion yy Pobr(b~bPPbR˙R˙Ru] b UPE}Z bo}`~˙R˙Ru]Z yy Bo}}rb u˙R]PRUv}uo}o}` yy HuubrooR]bb yy ORb]Pvbr(b}(vu}v]Uvu}R}˘Uoo+b]}v Invtiga se tions yy FooBo}}C}v yy UUEo}o˙bUv]v C yy CRbXr˙ r r r r Chatep rwP yy yy yy yy yy yy yy *Disorsof der theCardiovcula sa rSystem ECG Pob}˘]u˙ PlG}ùbuv ]C v˙ubU T}}v]v TU CKrMB suspected R}]}Pu E LvPFv}vTbb~b]}u˙Z CTou}v˙vP]}Pu(o b (}}v.u]vPPE ]( ]bRu] R ]bb ]b X Deep Vein Thrombosis (DVT) D V]v TR}u}b]b ~DVT Z ]b }uu}v ]bb oR}PR }Lv ˙u}u b X TR ]vb }( R o}` o]ub + u}b }uu}vo˙U R}u}b]b u˙ + }R b]bU ]vo]vP R o]ubU]vv]ovbovRv]]vbXC}uo]}vb]voou}v˙ R}u}u}o]bu U`R]Rvo](rRv]vPXI]bR(}bvo }Ro]ouR}(}o]b b R]vPRVT D ]bl}(vbv} l}b }]}R˙ouvvbb b˙XC}uu}v ]bl (}b (} VT D ]vo }b]˙U bu}l]vPU }o}vP ]uu}]o]˙ ~XPX U b o}vP Ro G]PRbZU ui} P˙ b XPX }R}]U }u]vo v o] P˙ b U Pvv˙ v R ]u U L vb b}vU uo]Pvv]bU ]vR]o}} ]b}bU }b}Pv R˙ v u]o }v]}vbU XPX }vPb] (]oU u˙}]o ]v(}vU vR}˙v}u b U}l b U˙bb u]ob˙Ru}bbX Iv b }( }v.u VT D U uv `]R v}Povb ub v} o˙vvbb]o˙vobbRb]Pv].v}v]v]}vb} R] b R b v ]vo oU b o] ]bbU oUo]vP]b}bUvR˙vb b ]}vX sueCa yy SPv}v}(o}}]vR]v yy Ivb]b}b]˙}(o}} yy IvGuu}v}(Ro}}bob]vPuP v*DepVeinThrombosis~DVTZ*v Trtme ae nt Tuv}ib yy Tvo˙]vPbrov b Rb yy M]v]v}˘˙Pv}v b }ıæA9r}v](R]bvo˙]vP OPD C UbRbvbvv}vR˙}˘]] Non-pharmacological treatment yy Bb}vvo˙]vPbX~Sovb}vbZ Pharmacological treatment yy Bb}vvo˙]vPbX~Sovb}vbZ Refeal r Criteria R(}Rv˘oo}(](vv} b ]v. Standard Trtme ae ntGuidelinesUwthEditionUw Symptoms yy Sòo]vP}.uvbb}(+o]u~boo˙v]ooZ yy P]v]vR+o]u yy Mild fever Signs yy Sòo]vP}(+o]u yy D]+voùR yy Tenderness yy Redness yy P]hvP}u yy P}u]vvb.]o]vb B}˘wrP) Well’s Scoring for DVT probability v*DepVeinThrombosis~DVTZ*v TR Woo[b }]vP b ˙bb u (} VT D VT D ]blv}]b]](}]v]vPuvX TRbv }bv }( R o]v]o (b o}` }u} P] rbvP}]o]˙ }b (} R o v `R]R ]b b } ]}] b]vbP}vvuvX }]o]˙ }i.b o]v]o b]]}v }( r yy Po˙b]bUb]b}v}R}]vP b }(o}`˘u]˙~}]vZ yy Rvo˙ ]v ~u} Rv ˙bZ } ui} P˙ b `]R]v b `lb~}]vZ yy L}o]vvbb]v]v˙bb u~}]vZ yy Sòo]vP}(voP~}]vZ yy Co(òo]vP b uPRv}RoP~ubuo}`R]o }b]˙Z~}]vZ yy P]hvP}uP]vR˙u}u b oP~}]vZ yy C}ooov}v]}bb.]o]vb~}]vZ yy vA }v`]R]vvu}vRb~}]vZ yy Aov ]Pv}b]b u} o]lo˙ Rv VT D uPU b.]o v}b R}u}b]bU }b Ro] ˙v}u b U ]vP]vo o˙uRv}R˙U˘vov}b}ubb]}vZ~r}]vbZ TowrP) ~Bl[b ˙bU ooo]bU ubo Woo[bS}Iv}v(}VT D rP}]vbP H]PR}]o]˙}(VT D rP}]vbP Moderate probability rrP}]vbP L}`}]o]˙PDrD]ub DrD]ubvoo˙ob}VT D M}} H]PR P}]o]˙P DrD]ub vb ]b}uuvX L}`P}]o]˙ ]b}uuvXL}`rb}]o]˙}u]v`]RvP X `]R ]}vo D}ol}ubb]}v ob}v Invtiga se tions yy DrD]ub yy D}oob}v yy TR}u}R]o]vb XPX}]vU C }]vSoob~]vvb`]R vVT D Z yy FBC r Chatep rwP *Disorsof der theCardiovcula sa rSystem Trtme ae nt Tuv}ib yy T}vo}}P}vvou}v˙u}o]bu yy To prevent recurrence Non-pharmacological treatment yy }]v A }(}o}vPuv˙vR˙}v yy }]v A }( ˘bb u}vb }( }+U v o}R}oU b]oo˙ }vo}vPi}v˙b yy Ivb`]vl]vPo}vPi}v˙b}]}b}(]uu}]o]˙ yy RPo˘]b]vPo}vPi}v˙bXPX}]vP b }v}i}v˙b }lòl}u}]vP}}vov]vPo}vPG]PRbvoP G˘]vP˘]bb`R]ob yy }] A }bb]vPoPb(}o}vP]}b}vo}vPi}v˙b yy Ub}(ob}ubb]}v}l]vPb b Pharmacological treatment yy yy B. yy yy Prophylaxis L]vuv ]v E RvPPA HeparinUSCU Adults æUv]brR}o˙ Children u}vRr˙bVæv]bllPR}o˙ v*DepVeinThrombosis~DVTZ*v AXVT D st nd L]vTuv ]v E RvPPA Ev}˘]v USCU Adults uP]o˙ Children u}vRbr˙bVæu]}PullPR}o˙~u˘uPZ ru}vRbV wæu]}PullPR}o˙ DVT Treatment st L]vTuv ]v E RvPPA HeparinUSCU Children u}vRr˙bVæv]bllPR}o˙ Or HeparinUIVU Adults v]bllPX b }vv`]Rv]bllPlR} Or æv]bllPUSCU}vv`]Ræv]bllPR}o˙ æ Standard Trtme ae ntGuidelinesUwthEditionUw Children r˙bVwæv]bllPX b }vv`]Rv]bllP lR} u}vRr˙Vwæv]bllPX b }vv`]Ræv]bllP lR} Neonates ~u ˙ZV wæ v]bllPX b }vv `]R æ v]bllP l hour Neonates ~AM æ `lbZV æ Uv]b llP X b }vv `]R æ v]bl lP lR} yy v*DepVeinThrombosis~DVTZ*v yy yy YA D nd L]vTuv ]v E RvPPA Ev}˘]v USCU Adults XæuP llP~æv]bllPZ]o˙ Children u}vRbr˙bV ru}vRbV NeonatesV Or Do]v USCU Adults uP llP~u˘X}(Uv]bZ]o˙ Children r˙bV ]o˙Z u}vRr˙bV NeonatesV uP llPR}o˙ XæuP llPR}o˙ XæruP llPR}o˙ v]bllP }v ]o˙ ~u˘ U v]b v]bllPR}o˙ v]bllPR}o˙ And W(]v U}oU Adults L}]vPD}b DOSE INR uP r uP r æuP CRlINR N}wr W(]v]bv}}P]v]vPvv˙X C}vv æ uP ]o˙ INR vo P INR }( } ]b R]X AL R]b R o}` u}oo `]PR R]v ]b }b v u]vvv `(]v Xæ uP } æ uP ~b}u vb u˙ ] wXæ uPZ ]b }vv P] oo ub˙PINR}(}X L}vPruuv]b}vv}v }( `(]v ]( R ]bl (} ]b u}˙ } vlv}`vX RvVT D (}bbRbR}u}R]o]u˙]o}vPruv}Po}v v dose of (}R}b]˘ u}vRb v uvv ]bl X Chatep rwP *Disorsof der theCardiovcula sa rSystem Refeal r Criteria R(}R˙b]]vb]o]b(}uvPuvvu}v]}]vPX æX Pulmonary Embolism Pou}v˙Eu}o]bu~PEbobZ (}uR}u]U}Lv(}uR ]vb}(Ro}ò]ub}o]bU`R]Rvb}]R]PRR ]v} R ou}v˙ boX LP u}o] u˙ b }b}v } o}} G}` v bo ]v o](rRv]vP R˙}˘] v R]PR u}o]˙X PE bR}oR(}uvPbu]ouPv˙X TR]bl(}bvuvPuv(}PEb]u]o}R}b(}VT D ~Sb}v}vRDVT[ZX X sueCa B}˘wrP) yy yy yy yy yy yy yy v*Pulmonayr Embolism*v ~Sb}v}vRDVT[Z Symptoms yy D˙bv} yy Po]]v yy C}PR yy Hu}˙b]b ~}ou}v˙]v(}vZ yy Pb˙v}U˙v} b }}oob~ubb]PEZ yy Uv]ooòo]vP b }(o]u Signs yy Tachypnoea yy Tachycardia~u˙Po}]PoZ yy Bo}}rb o}`lv}o~bPPbbubb]PEZUv}uo} R]PR yy Poo+b]}v yy L}`}˘˙Pv}v b }vob}˘]u˙AMıA9 yy Poo yy Cyanosis yy Uv]ooo˙`}oov b o(}R]PR}(VT D Well’s scoring for PE probability S˙u}ub}(VT D ~}]vbZ N}ov]Pv}b]b'˘o]vbR]oovbb~}]vbZ Tachycardia`]RobAN~Xæ}]vbZ Iuu}]o]}v~ANAA˙b}Z P˙ b ]vR]}b(}`lb~Xæ}]vbZ P]}R]b}˙}(VT D }ou}v˙u}o]bu~Xæ}]vbZ Pbv}(Ru}˙b]b~}]vZ Pbv}(uo]Pvv˙~}]vZ w Standard TowrP) Trtme ae ntGuidelinesUwthEditionUw Woo[bS}Iv}v(}PE S}ANvP H]PR}]o]˙ S}ANAAvAMAAvP Moderate probability S}AMP L}`}]o]˙PDrD]ub M} } H]PR P}]o]˙P DrD]u b }uuvX L}`P}]o]˙ ]b}uuvX `]R ]}vo CT Pou}v˙ vP]}Pu ]b r Invtiga se tions yy CRbXr˙ yy ECG yy DrD]u yy CTPou}v˙vP]}Pu yy R}]}PR˙ E yy D}oUob}v}(R+o]uvo]b yy FBC v*Pulmonayr Embolism*v Trtme ae nt Tuv}ib yy T}]o]b b ]}rb]}˙(v}v yy T}v(Ro}(}u}vvu}o]b}v yy T}vvvo}uv}(ou}v˙R˙vb]}v Non-pharmacological treatment yy Eo+oP}v]oo}`](VT D yy Ao˙}ubb]}v}l]vPb b rL]vb]b](VT D yy SP]oRv]bXPXu}o}u˙U]v(]}vo.obX Pharmacological treatment AXCo]v]ob]]}v}(ou}v˙u}ob st L]vTuv ]v E RvPPA yy O˘˙Pv U ˙ ( ubl } vbo }vPb } ] v}vrR ubl ~l}˘˙Pv}v b ANıæA9Z Av yy MorphineUIVUæruPX b yy yy Av E v}˘]v USCU Adults XæuP llP~æv]bllPZ]o˙ Or Do]v USCU Adult uP llP~u˘XUv]bZ]o˙ present present Chatep rwP yy *Disorsof der theCardiovcula sa rSystem W(]v U}oUb]uov}bo˙~NOT]vPvv˙Z Adults L}]vPD}b YA D DOSE INR uP r uP r æuP CRlINR Note 7-5 C}vv æ uP ]o˙ INR vo P INR }( } ]b R]X AL R]b R o}` u}oo `]PR R]v ]b }b v u]vvv `(]v Xæ uP } æ uP ~b}u vb u˙ ] wXæ uPZ ]b }vv P] oo ub˙PINR}(}X L}vPruuv]b}vv}v}(`(]v R]bl(}]bu}˙}vlv}`vXRvu}o]bubvuvv ]bl(}bbRbR}u}R]o]]bo}vPuv}Po}v dose of (}R}b]˘u}vRb]( X vX Stroke v*Stroke*v Refeal r Criteria R( oo vb `]R b ou}v˙ u}o]buU `R (]o]b v]oo (} }v.u}vU } R˙b]]v b]o]b } ]}o}P]b(}˘uvPuvL]o]b b }vX A stroke v .v b bv Po}o } (}o v}o}P]o .] bovP (}u b}vv}b Ru}RP } ]v(}v }( R vo v}b ˙bb uU `]R }i ]v }( v ]v(}v } Ru}RPU ]b }( R }v }( o]v]o ˙u}ub b X A CT } MRIvb ]b]}ulR]Pv}b]bv˘o}R]vv]o ob]}vbR}obvb]u]oo˙X A Tvb]vIbRu]'lA ~TIA Z U }v R }R RvU ]b vb]v ]b} }( v}o}P] ˙b(v}v b ˙ (}o ]vU b]vo }U } vo]bRu]XTR]bv}}i]v}( ]v(}v]vR +P]}v}(]v}vX Iv obU R˙vb]}vU ]bU ˙bo]]u]U ]o .]oo}v v bu}l]vPU ]vb R ]bl (} }lb b X Iv R]ov b]lo oo ]bb v˙v}R]b]u}v b ]bl(}b(}}lb b X PvbbR}o]oo˙Ruo]b]o]v˙X sueCa yy oC ]v(}v yy TR}u}b]b}(obo yy Eu}o]bu(}u]bvb]~XPX]o.]oo}v yy IvoRu}RP yy SRv}]Ru}RP ı Z Standard Trtme ae ntGuidelinesUwthEditionUw v*Stroke*v Symptoms yy Wlvbb}(}vb]}(R}˙]vo]vPR( yy Iv]o]˙}]b(}ub]hvP}o˙]vP}b]}v yy Sv(ool}oob yy L}bb}(bR yy L}bb}(]b]}v yy SRRvl}vl]v~bRv}]Ru}RP yy Uv}vb]}bvbb ]vb}uvb yy S]b Signs yy Po˙b]b}(o]u yy F]oo˙b]b~o}`Ro(Z yy Iv]oG]]˙}(o]ubUo]˙ b v˘PPG˘b yy Hu]v}] ~o}bb}(}vrRo(}(]bo.oZ yy Hu]rvbRb]~o}bb}(bvb}v}(}vrRo(}(}˙Z yy E˘vb}ovb}vb yy D˙bR] l˙bRb] ~o}v}(bRZ yy Nl+vb b b~]vRv}] b Ru}RP Invtiga se tions yy FBU C SR E yy Bo}}Po}b yy Suo]]}.o yy Bo}}Uo}o˙bvv]v yy U]] yy ECG yy CTv b lMRI}(RR yy CRbXr˙ Trtme ae nt Tuv}ib yy T}o]u]R}(]vuP yy T} } vb (}u R vPb }( v}vb]}bvbb v ]uu}]o]˙ yy T}vb]}v yy T}Rvo˙]vPb](}bb]o yy T} ]v(˙ v uvP u}].o ]bl (}b ~R˙vb]}vU R]PR R}ob}oU]buoo]bXZ yy T}]vbub}b ]u}(v}vo}˙ yy T} b} v R]o] vb `R} b] `]R b]o disability yy T}u]v]u]b+b b }(PR˙ Non-pharmacological treatment yy Au] v u}v]} vb ]o b]Pvb v v}o}P]o b]Pvb (vo˙~R}o˙Z Z Z Chatep rwP *Disorsof der theCardiovcula sa rSystem yy yy yy o]b Eb R]`˙]vv}vb]}bvb Sòo}`]vP]v b v]PR}b]}v~bræuo}(`Z Ivb vb}Pb] b o˙ b }bb]o (} (]vP v u]}vb ]v v}vb]}b vb } R}b `]R òo}`]vP b ]8ob}vb]}v yy Nb]vRoo}b]}v`]Rb}v]vP`Rvbb˙ yy Eo R }( } Pb } ]vv]o pressure yy Pvb}b˙Pov]vP~˙R}bZ]v yy M]v]vR˙}v yy K v ov v ˙ ˙ (v b }( vl]v }U ]bU }v}u R b ]X URo R bR}o used only if absolutely necessary yy SR˙b]}R˙b}}vob Pharmacological treatment AXIv(S}lb yy yy yy B. yy Av }bA v Adults ruP]o˙ Children N}}uuv Or R}bvb Adults ruP]o˙ Children N}}uuv s U}oU U}oU Haemorrhagic Stroke with evidence of cerebral oedema present st L]vTuv ]v E RvPPB MannitolUIVU Adults XærP llPvR}o˙~}P llP}bZ v*Stroke*v vTIA L]vTuv ]v E RvPPB AspirinU}oU Adults uPX b Then wæuP]o˙ Children ANv˙bV ub bo}b AMv˙bV v}}uuv st Standard o}`Z Trtme ae ntGuidelinesUwthEditionUw Children u}vRr˙bVXærXæP llP ~S uv G}`R (} u]o uvPuv }( }l b OrXærwXæuollP}(A9b}o}v CXC}v}o}(}ru}]]b~XPXR˙vb]}vU]bXZ ~S}]b}vbZ Refeal r Criteria Pvb `]R `}bv]vP ˙u}ub b v b]Pvb bR}o Pvo˙ ( (} b]o]b o}v v X Aoo ob vb `]R v}o}P]o.]bbR}o(}bRR]bU}}vo R]b}R˙b]}R]b}] b X Flowchatr v*Stroke*v F]PwrP) Flowchart: Stroke TowrP) TuvG}`R(}u]ouvPuv}(}l b History and ˘u]v}v Iv(˙]bl(}bUb]v˘v}(R}l b C}vb]b}b}(u}o]bu IvbP}vb FBU C U]vRlEUBUEUA=U C FbvPPo}bUFbvPR}ob}oU CTSvUCXRUGCE H˙}v A]u]vP(}}ou]~XærL˙}vPZ Ubv}uobo]v}˘}bbo]v }] A ˘}bæA9}A9vobbR˙}Po˙u]X Chatep rwP TowrP) *Disorsof der theCardiovcula sa rSystem TuvG}`R(}u]ouvPuv}(}l b Stress ulcer }R˙o˘]b G]}}vu]vR]]} Glucose control KRBS~rZuu}olL M˙v]vbo]vbo]]vPob }}v}o}bouv}o u]}vb~}]}ou}u]v](]Z P˙˘] I(ANwXæ}CuvP`]RPou}o C}vb]b}~RbU]vUuo]U}RZvuvP }]vPo˙ Bo}}b uvPuv OLv]bb]bo}(}l b vu˙oo˙'o b `]Rv}}vXI(ANluuHP]u(}Po}v }(v}u}RvA9}R}bXC}vvrb}l u]}v](]v]XDONOTUSESUBLINGUALNIFEDIPINEX Sv}v]vBPvo}˘vb]}v}(}l b X Tuv}(]v(b Start aspirinuPb}}vb]v(]v.]~}ol NGZ](v}}v]v]}vbXR}b}wæuP]o˙L `lUv}vb](Rvroou]}vX C}vb]R˙Ru}v}o(}}vbVv}Po}v M}]o]b}v}( vb o˙ E (o}(oovb}RR˙b]}R]b~v]( v}vb]}bZ Ab]}v vu}v] L}}l(}b]Pvb}(R]bPoo˙~]b]vPb]}˙U R˙]URbb]PvbZXT`]RIVAu}˘]]oo]vA=Coov] A]vIVu}v]}o(}.bR}bRv]` VT D vPou}v˙ u}o]bu P}R˙oR]v S]b Tu]vb]b}}}ob b XRPov}vobv]( u}Rv}vb]}b CRvP]v}vb]}b level UPvo˙}vb]}bb]]o]bbRbVo}ul R˙}Po˙u]lu}o]lPbRvb R]b]vPICP NbPbRUIVuvv]}oA=lr˘uRb D }v as required H]PRR}ob}o SR]PR}bvbb P]o]vb b if infarct detected on CT scan v*Stroke*v ]o A F]]oo}v }}v}o˙˘] Standard wX Trtme ae ntGuidelinesUwthEditionUw Heart Failure TR]b]b}v]}v]v`R]RRR]bvo}} ] }U v ]v b} }]vPU ]b vo } u R }˙ [b u}o] ]uvbX TR ] ˙b(v}v u˙ }u]vvo˙ ]v}o R oL } R ]PR v]o ]v]]oo˙ } }R v]ob b]uov}bo˙X TR]bob]buB]v]oF]o~BVFZ F]o~CCFZ X TR(v}voobb].}v}(R(]ob]vPRN`Y}lH Ab}]}v~NYHA ZCobb].}v ]bb]]vRoo}`X TowrP) Failure v*Hetar Failure*v sueCa N`Y}lHAb}]}v~NYHAZCobb].}v(}H CLASSI N}o]u]}v}(R˙b]o]˙XO]v˙R˙b]o]˙}bv} vb (PUo]}vU}˙bv} CLASSII So]PRo]u]}v}(R˙b]o]˙XC}u(}oU b }]v˙ R˙b]o]˙bob]v(PUo]}v}D˙bv} CLASSIII Mlo]u]}v}(R˙b]o]˙XC}u(}oU b bo]PR ]˙b(PUo]}v}˙bv} CLASSIV Uvo}˙}v˙R˙b]o]˙`]R}]b}u(}X S˙u}ub}(]]vb8]v˙bvX b I(v˙R˙b]o ]˙]bvlvU]b}u(}]b]vb yy yy yy yy yy yy yy yy yy S˙bu]]oR˙vb]}v RRuR]bb ]}u˙}R]b C Svu] IbRu]R]bb TR˙}}˘]}b]b C}vPv]oR]bb Pou}v˙]oR˙vb]}v ]C R˙Ru] Symptoms LLHF]o yy Rob B bvbb yy Ov˘}v yy Ovo˙]vPG~}R}v}Z yy v]PR A ~}˘˙buov}vo˙bv}Z yy ˙bE (P]o]˙ yy C}PR `]R(}R˙o}}rb]vbu yy WR]vP R]PRHF]o yy Sòo]vP}(R(vo}`˘u]b~u˙bv]vR]ov o}`vu}vRbZ yy A}u]voòo]vP b }C}vPb]C Chatep rwP *Disorsof der theCardiovcula sa rSystem yy æ v*Hetar Failure*v R]PRR˙}R}v]o]v(}uvvoP]vPo] Signs LLHF]o yy Tachypnoea yy Tachycardia yy Bbo]}vb yy Goo}R˙Ru yy D]bo˘ yy ]C uu yy Rhonchi R]PRHF]o yy Tachycardia yy P]hvPo}u~u˙bv]vR]ovo}`vu}vRbZ yy Ascites yy TvUbu}}RUb}LR}uPo˙ yy R]biPov}bb yy Goo}R˙Ru yy ]C uu In children yy F]o}R] yy D]8o˙]v(]vP Invtiga se tions yy FBC yy ECG yy CRbXr˙ yy Bo}} U o}o˙b v v]v v GFR ~bu Po}uo.o}vZ yy L](v}vb yy FbvPo}}bP yy FbvPo]]b yy R}]}PR˙ E yy TR˙}](v}vb yy ]C v˙ubU](u˙}]o]v(}v]bb yy C}}v˙vP]}PR˙ Trtme ae nt Tuv}ib yy T}o]˙u}ub b v]u}o]˙}(o]( yy T}R]]vPb yy T}}uo]}vb yy T}vv}(˙u}ub b yy T}v(}R}b]oru]bb]}vb yy T}u}o]˙ Non-pharmacological treatment yy Reduce salt intake Standard Trtme ae ntGuidelinesUwthEditionUw yy yy yy yy yy R`]PR]v}`]PRv}b]v]]ob Avoid alcohol }] A }]bu}l]vP Ev}Pu}˘]b ~}vo˙ bB ]vR(]o}˘}vb}(R}v]R (]oZ yy P}]v Pharmacological treatment AXR A (]o yy yy v*Hetar Failure*v r]v]ouv L]vTuv ]v E RvPPA O˘˙Pv U˙vbovvo}(ubl](R]bR˙}˘u]~SO AMıA9Z And F}bu] UIVU Adults ruPULu]vb](vbb˙ Children r˙bV ruPR}o˙bvbb˙ u}vRr˙bV Xær uP llP R}o˙ ~u˘ uP l lP l}bZ st BXR A (]o yy F}bu] Adults ruPR}o˙ Children r˙bV u}vRr˙bV lP l}bZ UIVU ru]vvvuvL]o]b b }v ruPR}o˙bvbb˙ Xær uP llP R}o˙ ~u˘ uP l CXR A (]o rvv}]u}]vPL]v]ouv yy F}bu] ~Fbu]ZUIVU Adults ruPR}o˙ Children r˙bV ruPR}o˙bvbb˙ u}vRr˙bV Xær uP llP R}o˙ ~u˘ uP l lP l}bZ Av yy MorphineUIVU Adults æruPbo}ò˙ Children N}}uuv(}R]b}v]}v(˙ b ]bv}òoo]b b R Av v Chatep rwP yy M}o}u] Adults uP}v}u]vP Children Not required *Disorsof der theCardiovcula sa rSystem UIVU X D R A (]o rv]u}]vPL]v]ouv yy F}bu] U}oU Adults ruPR}o˙ Children XæruP llPrR}o˙ w or in sinus v*Hetar Failure*v EXR A (]o rv`]R(b]o.]oo}v R˙Ru`]R˙bb }o]˙b(v}v ]v E RvPPC yy D]P}˘]v U}oU Elderly æu]}PubR}o˙(}rR}b Adults æu]}PubR}o˙(}rR}b Then æu]}Pub]o˙ Then æu]}Pub]o˙ ChildrenAN˙b XæruP]v]]}bb}R}b Then vXæræu]}Pu]o˙ Childrenr˙b ru]}PullP]v]]}bb}R}b Then ru]}PullP]o˙ ChildrenAM˙b ru]}PullP]v]]}bb}R}b Then ru]}PullP]o˙ Neonates~(oouZ u]}PullP]v]]}bb]vR}b Then ru]}PullP]o˙ Neonates~AMXælPZ æu]}PullP]v]]}bb]vR}b Pu æu]}PullP]o˙ Then æu]}PullP]o˙ Standard Trtme ae ntGuidelinesUwthEditionUw FX R A (]o rvb]v]}Pv]bR}l ˙bb }o]o}}AM b æuuHPZ`]RR˙}vb]}vv} hypoperfusion yy D}u]v UIV]v(b]}vU Adults Xæru]}PubllPu]v (adult Note 7-6 GCE bR}o u}v]}}vv}bo˙b ]v}}] Pvbvb R˙Ru]bvu˙}]o]bRu] GXP}R˙ov}Po}v against venous thrombosis yy Ev}˘]v USCU Adults XæuP llP~æv]bllPZ]o˙ Children u}vRbr˙bV uP llPR}o˙ ru}vRbV XæuP llPR}o˙ NeonatesV XæruP llPR}o˙ yy Iv(˙ v ~]( }bb]oZ ]]vP b bR b R˙vb]}vUu˙}]o]v(}vUvu]}R˙}}˘]}b]b v*Hetar Failure*v HXS˙u}uHF]o st L]vTuv yy F}bu] U}oU ]v E RvPPC Adults ruP]o˙ Children ruP llP]o˙ yy yy yy Av L]b]v}]o U}oU ~}vo˙`Rv˙bb }o]o}}AN b uuHPZ ]v E RvPPA Adults XæruP]o˙ Or Ru]]o U}oU ~}vo˙`Rv˙bb }o]o}}AN b uuHPZ ]v E RvPPA Adults XæruP]o˙ Av CarvedilolU}oU ]v E RvPPA Adults XærXæuPR}o˙~u˘]uuæuPR}o˙Z r Chatep rwP Or B]b}}o}o U}oU ]v E RvPPA Adults XæruP]o˙ Or MetoprololU}oU ]v E RvPPA Adults æruP]o˙ yy yy IX yy JX Pvb`]R(b]o.]oo}v ˙b(v}vV or in sinus rhythm with systolic A D]P}˘]v U}oU ]v E RvPPB Elderly æu]}PubR}o˙(}rR}bU Then æu]}PubR}o˙ Adults æu]}PubR}o˙(}rR}bU Then æu]}Pub}v]o˙ Children æu]}PubllPR}o˙ KXS˙u}uvbU]vb]}(R}u]}vb Av yy SpironolactoneU}oU ]v E RvPPA Adults æræuP]o˙ Refeal r Aoo vb ub ( } b]o]b `Rv o]v]oo˙ ob ı v*Hetar Failure*v Pvbv}}ovPCE]vR]]}b A ~oL]b]v}]o or Ru]]o with the following in the 1st line treatment above) L}bv U}oU ]v E RvPPA Adults æræuP]o˙ Or CandesartanU}oU ]v E RvPPA Adults rvuP]o˙ yy yy *Disorsof der theCardiovcula sa rSystem Standard Trtme ae ntGuidelinesUwthEditionUw (} R ]v.}v vuv}( R vo˙]vPb }( R R (]ov(}o}vPruu]vvvR˙X Flowchatr v*CongenitalHetar Disse*a v F]PwræP)Flowchart: Heart Failure X Congenital Heart Disease C}vPv]o uo(}u}v }( R RU }uu}vo˙ ( } b SH}or]vrH _U ]b ] }uu}v uo(}u}v `]R v ]v]v }( } }( o] ]RbX TR `} u]v P}b }( }vPv]o R ]bb vuo˙U ˙v} v ˙v}X TR ˙v} ˙b ]vo v]o ob (U ]o ob (U v b ]}bb b òo b } v}b b ]bU ou}v˙ v}b b ]b v }}v }( R }X TR ˙v} ˙b b}] `]R u]˘]vP }( }˘˙Pv o}} `]R }˘˙Pv o}} v ]vo To}P˙ }( Foo} ~TOFZ Tvb}b]}v}(RG]bA ~TGAZ X o˙ E }Pv]}v }( R b]. ˙ v }] u]o } P]o b ]vv}v ]b ]u}v ]v ]u}]vP R o]˙ }( o]( v ]vPu}]]˙(}u}uo]}vbX sueCa yy yy I]}R] Gv~R]PR]bl`]R]vb]vPuvoPZ and Chatep rwP yy yy yy yy yy yy *Disorsof der theCardiovcula sa rSystem Mvo]v(}vb}]b]v b o˙Pvv˙Uv}o˙oo Maternal diabetes Ao}R}oUbu}l]vPUvb}(Pb]vPo˙Pvv˙ E˘}b}Xr˙bv}R]}v]vPo˙Pvv˙ Pu]˙ MooPvv˙ v*CongenitalHetar Disse*a v Symptoms A˙v} yy ˙bE (P]o]˙ yy Rob B bvbb yy P}}(]vP lIv}v}(bl]vP]v]b]vP(]vP yy P}}P}`R yy C}o`b }v(}R yy P+˙˙o]bU`}oov b (~R}ÙRbv}uu}v]v]v(vbZ yy D]bv}uv yy E˘}vu˙o}Rb]vbU˙v} b }bvR C ˙v} yy Aoo˙u}ub b }(˙v}R]bbUobR(}oo}`]vPP yy Bo }vP v .vPv]ob ~˙v}b]bZ ]R } }u]vP `}b `]R˘}v]v}oR]ov yy ShvPob ub]vPo˙]v}ob Signs A˙v} yy S]Pvb}(R(]o(}u}}obb ]}vbP yy C}o`˙ b bl]v yy P+˙˙o]b yy D]bvvl]vbvvlo}u~]v yy }oR]ovZ yy Tachycardia yy Tachypnoea yy WlR˙ob yy ]}uPo˙ C yy Goo}R˙Ru yy ]}vb C UR}vR] yy H}uPo˙ yy Huu~v}o`˙bbvZ C˙v} yy S]Pvb}(R(]ob}Uob yy F]vPo]vP yy Cyanosis ~o}` ]Ro }˘˙Pv }v b ub ˙ ob }˘]u˙Z yy Huu yy H˙˙v} 'l ]XX b]}˙ ]bb `]R v]vP ˙v}b]bUo}bb}(}vb]}bvbbv}vob]}vb Standard Trtme ae ntGuidelinesUwthEditionUw Invtiga se tions yy FBC yy CRbXr˙ yy ECG yy R}]}PR˙ E Trtme ae nt Tuv}ib yy o˙ E }Pv]}v}(R}ou yy P}uuv}(R(]o yy o˙ E P]o b }}v](]v] yy Pv}v}(v}]b Non-pharmacological treatment yy EvbP}}v]}vUP}}}ovvoR˙P]v yy }] A ˘bb]R˙b]o˘}v~v}(˙vbvRbZ Pharmacological treatment v*CongenitalHetar Disse*a v AXS˙u}u}vPv]oR]bb ]v E RvPPC yy O˘˙Pv U ˙ ( ubl } vbo }vPbU Llu]v ]( ]ooU ~u}v]}}˘˙Pv}v b Z Note 7-7 F}vb]vR(]o}`]RR˙˙v}'l BXTuv}(R(]o]v˙u}u b }vPv]oR]bb ~Sb}v}vRHF]o[Z CXT}]u}o}}G}`]v}RovPb(}vb`]RTo}P˙}( Fallot yy P}v}o}o U}oU Childrenu}vRr˙b XæruP llPvrR}o˙~u˘XæuP llP]o˙Z Neonates XæruP llPrR}o˙~u˘XuP llPR}o˙Z yy P}v}o}o Ubo}ÌV`]RGCE u}v]}]vPU Childrenu}vRr˙b ær u]}PullP vr R}o˙ ~u˘X u]}PullPZ ˙vrR}b](vbb˙ Neonates ær u]}PullP ~u˘X u]}PullPZ ˙ hours if necessary X D C}vPv]oR]bb`]RR˙˙v}'l ~Sb}v}vRH˙˙v}'lA [Z Chatep rwP *Disorsof der theCardiovcula sa rSystem Refeal r Criteria R( oo R]ov `]R }vPv]o R ]bb } ]] ]}o}P]b } ]]]v (} (R o]v]o buv v uvPuvX ıX H˙˙v}'l v*Hypyacer noticttaa ck*v TR]b]bo](Rv]vP]]]uPv˙X I boo˙ }b ]v ]v(vb `]R l ]v]v `v v v u}vRbX]bb A }u˙o}o]uvbbUb]bU}bo ]v}vRXSoobu˙](~ru]vbvZ bo(r} }u˙}Pb}b U b o](rRv]vP]b}XP}u}Pv]}v ˙vbvu]o+ b ]b]u}vXTR'l]b}Lvo˙]vR u}v]vP`]Rv}vb}vXIu˙]](}oo}`]vPRU ˙}o}vP˙]vPU(}vUR˙}v U(]o]oovb}b ]v}v }(vbRb]X sueCa yy C}vPv]oR]bXP b XTo}P˙}(Foo}Uou}v˙v}b b ]bU }o }o ]PR v]oU ]b] b]U E]bvuvP ˙v}u b Symptoms yy I]]o]˙v}o}vP˙]vP yy ]D R]vP yy Ivb]˙ b }(˙v}b]b Signs yy Tachycardia yy S˙b}o]uu yy C}u yy Convulsions yy Hu]b]b Invtiga se tions yy FBC yy CRbXr˙ yy ECG yy R}]}PR˙ E Trtme ae nt Tuv}ib yy T}}Pv]bR}ouo˙ yy T}b}b}v yy T}}u}o]vPuv]vR˙}˘] b yy T}v}uo]}vbvR(}uR˙}˘] b Non-pharmacological treatment yy H}o]vlvRb}b]}v~RvbZ Standard Trtme ae ntGuidelinesUwthEditionUw yy TR } }vb ]vb ]Ro bo b]bv v Ro }˙v}b]bX Pharmacological treatment AXAooR]ov`]RR˙˙v}'l ]v E RvPPC yy O˘˙Pv ~A9ZU˙(ubl}vbo}vPbU Llu]v~u}v]}]vP}˘˙Pv}v b ]( }bb]oZr}oovb }R˙}˘] Av yy XıA9N}uoSo]v }R]vPb[L UIVUuollPU}u]vb then assess response Av yy Morphine boRU bo}` IV ~(ZU } IMU ]( IV o]v v} b] oUru]}PubllPX b v*Hypyacer noticttaa ck*v BXF}vb`]R}}b}vb}}ubbUA yy P}v}o}o U}oU Childrenu}vRr˙b æu]}PullPR}o˙~u˘XæuP llP]o˙Z Neonates æu]}PullPR}o˙~u˘XuP llPR}o˙Z CXT}}]}b]b]v˙v}vb`]Rv}]u}uvL u]vb}(}uvUA yy S}]uB]}v UIVU F}ooPP}b ruu}ollP Note 7-8 EuPv˙P]o b bRvu˙] X D M]vvvuv}vv'lbv]vP surgery yy P}v}o}o U}oU Childrenu}vRr˙b XæruP llPvrR}o˙~u˘XæuP llP]o˙Z Neonates XæruP llPrR}o˙~u˘XuP llPR}o˙Z yy P}v}o}o Ubo}ÌV`]RGCE u}v]}]vPU Childrenu}vRr˙b ær u]}PullP vr R}o˙ ~u˘X u]}PullPZ ˙vrR}b](vbb˙ Neonates ær u]}PullP ~u˘X u]}PullPZ ˙ hours if necessary r Chatep rwP Refeal r Criteria H˙˙v}'l }]]b]o]b}]}R}]P}v b *Disorsof der theCardiovcula sa rSystem ]bv]v]}v(}o˙P˙ b XR(Pvo˙ 50. P]]b P]]b ]b ]vGuu}v }( R ]]uX I u˙ ˙U .]v}bU+b]}}vb]XIu˙}R}v]~ANu}vRbZX sueCa yy yy yy yy yy yy yy yy yy V]o ]o B Tuberculous FvPo RRu( P}br]}}u˙ P}bu˙}]o]v(}v Uu] }]uuv A ]bb ~`}bvb `]R o˙]vP }`v æ v*Pericarditis*v Symptoms yy R}bvo } oL }]o Rb ]v v]u}b`]Rb]hvPvov]vP(}`Z yy Po]}v yy FP Signs yy F yy Malaise yy M˙oP] yy P]]o(]}v yy FbvPoR yy D]bvRb}vb~](R]boP+b]}vZ Invtiga se tions yy FBCvSR E yy ASO yy roGCE yy CRbXr˙ yy R}]}Pu E yy Chest CT scan Trtme ae nt Tuv}ib yy To relieve pain yy T}vo˙]vPb yy T}v]u}v Standard Trtme ae ntGuidelinesUwthEditionUw Non-pharmacological treatment bB nd P]]}vb]b~] ]`RvR]b]u}vUoP }˙u}u b ]]o+b]}vZX]v E RvPPB Pharmacological treatment AX]]b A yy v*Hypteer nsion*v yy yy st L]vTuv ]v E RvPPB I}(v U}oU Adults ruPvrR}o˙ Children wr˙bV rw˙bV r˙bV vru}vRbV rvu}vRbV uPvrR}o˙ uPvrR}o˙ æuPvrR}o˙ æuPR}o˙ æuP llPvrR}o˙ Av ColchicineU}oU Adults XæuPR}o˙ Children N}}uuv Or Pv]b}o}v U }oU ~b] } }vv b ]bb v u]]]bZ Adults uP]o˙(}˙bv}+ Children uP llP]o˙(}˙bv}+ B. For treatment of underlying cause ~S}]b}vZ Refeal r Criteria R( oo vb } ]}o}P]b C (} (R o}v L R ]v]o uvX Pvb `]R oP +b]}vb } ] u}v ]Pv]]}vb]bvR}]}PR]P]vv R˙bR}o(]uu]o˙X 51. Hypertension Hypertension } RR]PR o}} [b ]b v ]vb ]bl }( o˙R(}u}l b UR'lUR(]ovl]v˙(]o](]]b v}o˙v}o˙}v}ooXO`]vP}R]bUR(}bub v Chatep rwP *Disorsof der theCardiovcula sa rSystem }v `Rv } ]v] uvU R Rv R}` R˙vb]}v bR}o .vX S]v R }Lv v} b]. ˙u}ub b b}] `]R R˙vb]}vUR]bRv(}Poo}}~B b Pv]vP Zb ]vRo}o}v(}o˙}vX Iv R Pvo o }o}vU uv ub ]v] BP }( lı uuHP } R]PR (} ]v]]ob o}` v ˙b }( PU v ælı uuHP } R]PR ]v R}b } v ˙bX F} ]v]]ob `]R ]b uoo]b } v}vr]b `]R CR}v] K]v˙ D]bb ~CKD uv (} R˙vb]}v ub ]v] BP }( lı uuHPU ]b}(PX IvRui}]˙}(vb`]RR˙vb]}vUv}b].vo˙]vP ]bb ]v.~]u˙R˙vb]}vZXIvRb]v]]obU]vb]vP PU (u]o˙ R]b}˙U ˘bb }˙ `]PRU ol }( R˙b]o ]˙ v ˘bb] o}R}o ]vl u˙ }bb]o ]b}b]vP (}bX Iv } A9}(}( b R˙vb]}vURu˙vvo˙]vPl]v˙]bbU v}]v ]b}U vo ˙ v}b b ]b } }}v }( R } ~b}v˙R˙vb]}vZX Ov ]Pv}b]b }( R˙vb]}v ]b uU R ]v]]o bR}o o } ˘o }v˙ b b v } ]v(˙ }R ˘]bvP ]}bo ]bl (}b XPX ]bU ˙bo]]u]U R˙]u]U X v*Hypteer nsion*v B}˘wrvP) ZU ]}b C oR]blF}b yy P A ~uvAHææ˙bV`}uvAHvæZ yy Fu]o˙ R]b}˙ }( u]}bo ]bb ~uv P AM ææ ˙bV `}uvPAMvæZ yy D˙bo]]u] yy Ob]˙ ~BMIAHlP lu Z yy D]buoo]b yy Su}l]vP yy Pob~]v b Roo˙ZAHvuuHP yy M]}ou]v]}}]v] yy LLv]oR˙}R˙ yy LL vo vR o}l v }R o}]}PR] (b bPPb] }(]bRu]R]bb yy P]}b}l b }vb]v]bRu]'l yy P]o]o]bb yy Heart failure yy Coronary artery disease yy Chronic kidney disease yy vA v}R˙PRu}RPb}˘bU]oo}u sueCa yy yy r P]u˙R˙vb]}v Secondary hypertension yy K]v˙orCKD U}o˙˙bl]v˙]bb yy Ev}]v r R}R}u}˙}uU CbR]vP [b˙v}u b ˙v}u b UR˙}R˙}]]bu UR˙R˙}]]bu w U}uPo˙ U C}vv[b Standard Trtme ae ntGuidelinesUwthEditionUw yy Vborvo˙v}b b ]bU}}v}(R} Symptoms yy Uboo˙v}v yy Ob]}voo˙U yy Headaches yy Po]}vb yy D]]vbb yy ˙bE (P]o]˙ Signs yy Bo}}AH b lıuuHP yy D]bo˘ yy S]Pvb}]vvP}b].b(}}v˙ b R˙vb]}v v*Hypteer nsion*v Invtiga se tions yy FBC yy U]vo˙b]b yy Bo}}Uo}o˙bvv]v yy Bo}}Po}b yy Suo]]b yy Su]] yy CRbXr˙ yy roGCE yy Uob}v v b }( l]v˙b v vob ~]v b }v˙ b R˙vb]}vZ yy R}]}Pu E Trtme ae nt Tuv}ib yy T}o}}oob b }}uuvPbP yy AMlıuuHP(}Po}`v˙bU]bUCKD yy AMælıuuHP(}P}v˙b yy T}uvP}ru}]}v]}vbXPX}b]˙U]bUo]]bX yy T}v]}boU}bovvo}uo]}vb yy T} }u} R o](b˙o RvPb XPX bu}l]vP }v b U PoR˙b]o]˙U}v]voR}R}o]vl yy T}]v(˙vuvP}v˙ b R˙vb]}v}]o˙ Non-pharmacological treatment yy Reduce salt intake yy Rv]uo(]vl yy EvbPo(]vPo]vl yy W]PR}v]v}bv}`]PR]v]]ob yy RPo˘]bXPX]blòl]vP(}u]vbub`l yy R}v]vo}R}o}vbu}v yy }] A }]bu}l]vP Chatep rwP *Disorsof der theCardiovcula sa rSystem Pharmacological treatment AXTuv}(R˙vb]}v st L]vTuv ]v E RvPPA B}˘wrwP) N}b}vvrR˙vb]u]]vb Av˙}(R.obb}(ui}vR˙vb]Pbv b .bro]v uvXTRbP yy TR]]D]b yy Co]u CRvvoBo}lb yy AvP]}vb]vC}vvPEv˙uIvR]]}b yy AvP]}vb]vR}Bo}lb yy ro}lb B C}uoo]vP]v]}vb(}RR}]}(vR˙vb]b yy LLv]oR˙}R˙PrI CEA }ARBU(o˙ CB Auo}]]v yy M]}ou]v]PrI CEA }ARB yy Rvo˙b(v}vPrI CEA }ARBVC}vr](GFRAMæu]vluo`]R}vo ouvR˙ yy P]}b}l b PAv˙}(R.bro]vPbUb]oo˙rI CEA yy C}}v˙ ˙ ]bb ~AvP]vlM˙}]o ]v(}vZP rI CEA } ARBU B ro}lUCBX yy H(]oPrI CEA }ARBU]} C rboBrBo}lbr]b}}o}oUu} }o}oU]o}oVL}}]bUS]}v}o}v]vvR(]o yy P]Ro˙]bbPU CB rI CEA }ARB yy D]buoo]b PrI CEA }ARB yy ]o A .]oo}vPARB}rI CEA }Bro}lb C}uoo]vPC}v]v]}vb yy GoutPTR]]]b yy ro}lb B PRu Ab UvVA o}l yy CBPH(]o yy rI CEA }ARBPB]oovo˙v}b b ]bvR˙lou] yy yy TR]]D]b Bv}GuR]] Or H˙}Ro}}R]] : U}oUXæuP]o˙ U}oUXæuPræuP]o˙ AvlO ı o]u Rvvo o}lbU r v*Hypteer nsion*v Iv R Pvo ol }o}v R]] ]b } ]R b u}v}R˙ } ]v b}u }u]v}v R˙U ]b (oX AvP]} vb]v}vvPv˙uIvR]]} v} b }uuv.bb ro]vPb(} v}uo]R˙vb]}v]volvbX Do R˙ bR}o b o] `Rv R o}} b ˘b luuHPX A]}vo vrR˙vb] Pb bR}o b ]( P o}} b oob v} R]X Ar}v Pb bR}o R}bv (}u .bro]v R}]b ]vP]vu]v}uoo]vP]v]}vbv}v]v]}vbX r r Standard yy yy yy yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw Calcium Channel Blockers: Auo}]]v U}oUæruP]o˙ Or NifedipineU}oUruPR}o˙ AvlO A vP]}vb ]vr}vvPv˙u~ACEZ]vR]]}b L]b]v}]o U}oUæruP]o˙ Or Ru]]o U}oUXæruP]o˙ Or A vP]}vb ]v}o}lb L}bv U}oUæruP]o˙ Or CandesartanU}oUruP]o˙ Or Vobv U}oUrvuP]o˙ v*Hypteer nsion*v yy AvlO Beta-blockers: AtenololU}oUæruP]o˙ Or B]b}}o}o U}oUæruP]o˙ Or MetoprololU}oUæruPR}o˙ Or CarvedilolU}oUXæræuP]o˙ Or Lo}o U}oUruPR}o˙ yy nd L]vTuv ]v E RvPPC Cvoo˙vPPvb MethyldopaU}oUæuPrPrR}o˙ yy AvlO Vasodilators H˙o]v U}oUæræuPR}o˙ yy yy yy yy yy yy AvlO AoRro}lb P}b]v U}oUXæuPrR}o˙v]vb]vPPoo˙}u˘X }b}(uP AvlO Ao}b}vvP}v]bb SpironolactoneU}oUæræuP]o˙ æ Chatep rwP *Disorsof der theCardiovcula sa rSystem Refeal r Criteria R( R (}oo}`]vP P}]b }( R˙vb] vb } v appropriate specialist: yy TR}bv}R]]vPRPo}}~B b Poo Z Lob u}vRb}(uv yy TR}b }v R } u} vrR˙vb] PbU ˙ R }} BP control yy TR}b`]R`}bv]vP}(BP}(``lb}u}vRb yy TR}b`]Robuv]voob}Ro]u]}(v}uo yy TR}b`]R]buoo]b yy TR}b `]R uoo ]bl (}b ~]bU ˙bo]]u]U }b]˙U (u]o˙R]b}˙}(R]bbZ yy TR}b v} }v ]b R b]bvo˙ o}` }bb]u }v repeated blood tests yy AooR]ovU˙}vPobvPvv`}uv`]RoBP Flowchatr v*Hypteer nsion*v F]PwrP) Flowchart: Hypertension æ Standard Trtme ae ntGuidelinesUwthEditionUw 52. Hypertension in children and adolescents v*Hypteer nsioninchildrenandadolecents s *v Hypertension ]v R]ov ]b .v b v P ˙bb }o] vl} ]b}o] o}} b R ]b AH ıæR vo (} PvU PU v R]PR }v } u} b }b]}vb lv ]v R ]PR u ~]v ]` }(}bb]]o]˙}(}}v}(}ZXAv}]+b]R}b `}R]b~A0}( Z RovPR}(Ru~`vbR}ovo}`vZ v]o]vPR`R}ouUbR}obX IvPvoU o}}b}(ANlwuuHP]vR]ovPræ ˙bvANæluuHP vw ]vR}bPvr˙bvu}Rvl uuHP]v}obvb]b}vb]v}uov`}o](o }Uvo}v˙]]]vX M}b }obv v R]oR}} R˙vb]}vU b]oo˙ ]v ]v(vb v ˙}vP R]ovU ]b } }v˙ b b ~S b}v }v RH˙vb]}v ]v Aob[ZX A}obvbU R}Ù u˙ R o˙ }vb ]u˙R˙vb]}vX sueCa yy RvoXPXR}v]˙o}vR]b UR˙}vR}b]b yy VboXPX}}v}(}Uvo˙v}b b ]b yy Ev}]v XPX R}R}u}˙}u U CbR]vP [b ˙v}u b disorders yy Ob]˙ yy P]u˙R˙vb]}v Symptoms yy Chest pain yy Headaches yy D˙bv} }v˘}v yy E˘bb]`vP b yy LPòo]vP b yy Po]}vb yy Hu] yy Uv}vb]}bvbb (hypertensive encephalopathyZ Signs yy BPANlwuuHP]vR]ovPræ˙b yy ANælwvuuHP]vR]ovPvr˙b yy ANluuHP]v}obvb yy S]Pvb}]vvP}b].b(}}v˙ b R˙vb]}v Invtiga se tions ~Sb}v}vRH˙vb]}v ]vAob[Z Trtme ae nt Tuv}ib yy T}o}}~B b P}Z P}(AMıæRvo(}PU Pv v R]PR ]v R bv }( v }PvruP ~} AM ıR æ U vo Chatep rwP *Disorsof der theCardiovcula sa rSystem yy yy yy Beta blockers P}v}o}o U}oU Children r˙bV rvuPR}o˙ u}vRr˙bV æu]}PuruP llPR}o˙ NeonateV æu]}PullPR}o˙ O AtenololU}oU Children XæruP llP]o˙~u˘XuP llP]o˙Z Calcium channel blockers NifedipineU}oU Children r˙bV æruPR}o˙ u}vRr˙bV r u]}PullP R}o˙ ~u˘X uP]o˙Z æ r v*Hypteer nsioninchildrenandadolecents s *v vo](v}PvuPbvZ yy T}v}uo]}vb yy T}uvPvo˙]vP}v˙ b b yy T}v}P`]PR}v]v}bv}`]PRR]ov Non-pharmacological treatment yy TRo](b˙oRvPb yy `]PR}v}o yy Po˘]b yy o}`(]vl yy o}`b}]u] yy Po(]vPo]vl Pharmacological treatment ]v E RvPPA AvP]}vb]vr}vvPv˙u~ACEZ]vR]]}b yy EnalaprilU}oU Children r˙bV ]v]oo˙ Xæ uP ]o˙ ~]vb } u˘X r uP]o˙]vr]]}bbZ u}vRr˙bV ]v]oo˙ u]}Pub lP ]o˙ ~]v }b u˘XuP llP]o˙]vr]]}bbZ Neonate u]}PullP]o˙~]vb}u˘Xæu]}PullP]o˙]v r]]}bbZ D]b yy Bv}GuR]] U}oU Children r˙bV XæuP]o˙ r˙bV æru]}PullP]o˙ u}vRr˙bV æru]}PullP]o˙ Standard yy yy Or A uo}]]v Children r˙bV u}vRr˙bV ]o˙Z Trtme ae ntGuidelinesUwthEditionUw U}oU æruP]o˙ r u]}PullP ]o˙ ~u˘X uP v*Hypteer nsioninPrgna e ncy*v Vasodilators H˙o]v U}oU Children r˙bV æuPR}o˙]vb}bou˘Xær uPR}o˙ u}vRr˙bV æræ u]}PullP r R}o˙ ]v vbb b˙}u˘XwXæuP llP]o˙~v}˘]vPuPZ Neonate æræ u]}PullP r R}o˙ ]vb b vbb˙ } u˘X ruP llP˙R}b IVU æræ u]}PullP ]o]v uo v}uo bo]v P]v } u]vbU Rv r u]}PullP rv R}o˙ ~u˘ uP llP ]vR}bZ r AvP]}vb]vr}o}lb L}bv U}oU Children Iv]o}bV XwuPllP]o˙~u˘XæuPZ M]vvv}bV XuPllP]o˙~u˘XuPZ Refeal r Criteria Refer all cases of hypertension in children to a specialist for ]vbP}vv(RuvX yy 53. Hypertension in Pregnancy ~S b}v }v RH˙vb]}v ]v PPvv˙[ v ROb] vOb]D]b}b[Z æX Hypertensive Emergencies A R˙vb] ]b]b ]b b v }voo˙ o]( Rv]vP ]vb ]v o}} b ~BPZ `R]R u˙ bo ]v v }l b Rv}] b Ru}RP U b]b ~R˙vb] vRo}R˙ R 'lU ]bb}v }( }U R (]oU vo uP } oub] ~]vP Pvv˙ZX TR vo˙]vP b u˙ ]u˙ R˙vb]}vV R}Ù }v˙ b b }( R˙vb]}v ub ˘oX IvovbR]b}Lv}b`]RBPANluuHPU`R]o ]vR]ovR]bu˙}o}`BPoobX æ U ZU Chatep rwP *Disorsof der theCardiovcula sa rSystem ææ v*Hypteer nsiveEmeger ncies*v TRb vb v (o ˘u]v}v } ˘o P }Pv uPX R] }}v }( o}} b `]R (o u}v]}]vP } }]]]}b}]b]v]}v}PvuPX Symptoms yy Headache yy Chest pain yy Shortness of breath yy Nausea yy V}u]vP yy Confusion yy S]b yy Uv}vb]}bvbb Signs yy So˙oo}}~(} b PZ yy Uv}vb]}bvbb yy S]b yy Nl]P]]˙ yy LvP]}vb Invtiga se tions yy CRbXr˙ yy roGCE yy FBC yy U]vo˙b]b yy Bo}}Uo}o˙bvv]v yy ]v B CTv b ~(}}l b Z yy CRbCTv b `]RvP]}PR˙~(}}b ]bb}vZ yy ]C v˙ubP v]v l]vbrMB ~CKrMB vbu]vb~ASTZUbuoR˙}Pvb~LDHvZ }}v]vb ~(}}}v˙˙v}u b Z yy R}]}PR˙ E Trtme ae nt Tuv}ib yy T} o]u] (R }Pvro}uo]}vb ˙}v}oo}v }(BP yy T}}v}ovbvo˙vb]b](bv yy T}uvP]v.P}PvuP Non-pharmacological treatment yy Strict bed rest Pharmacological treatment ]v E RvPPA yy Lo}o UIVU Adults ræuPX b ~}u]v]}Z Z U bu b Standard Trtme ae ntGuidelinesUwthEditionUw Ru]v]vobU](vbb˙U}u˘X}(uP Children r ˙bV r uP X b ~} u]v ]}ZX R æ u]v]vobU](vbb˙~u˘XuPZ u}vRr ˙b ~˙ IV ]v(b]}vZV ]v]oo˙ ær u]}Pu llP }˙ `]PR l R} ib ]vob }( ob æ u]vb }]vP}b}vbXM˘XuPllP lR}X r Note 7-9 M}v]}BP˙æu]vb(}oo}`]vPR]vi}v(}ooPP}bX Lo}o Cb ]vi}vb](BPAMlıuuHPvl}obAMBPM v ]vobU ~(}R]ov}vbo]]]vZ}`R]vPv}vR}bbu}bX yy v*Arhythmias*v Or H˙o]v UIVU Adults æruPbo}ò˙~} u]v]}ZU]o`]R uoN}uo Saline~XıA9ZX Rru]v]vobU](vbb˙ Children r˙bV æruPX b R˙rvR}bU](vbb˙ u}vRr˙bV ræu]}PullP R ˙ rv R}bU ]( vbb˙V u˘X uP llP ]o˙ ~v} ˘ ]vPvuP˙Z AMu}vRV ræu]}PullP R˙rvR}bU](vbb˙Vu˘XuP llP]o˙ Note 7-10 M}v]}BP˙æu]vb(}oo}`]vPR]vi}v(}ooPP}bX D} v} b R}rvP v](]]v ~XPX bo]vPoZ ]v R uvPuv }( R˙ vb] ]bb b ] o}`b R BP }} ]o˙ v u˙ b ]bRu] }( ]o}PvbX r r Refeal r Criteria R(oovb}R˙b]]vb]o]b(}(Ro}vX 55. AR˙Ru]b AR˙Ru]b ]b}b }( ] U R˙Ru v }v}vX TR˙ v obb]. b ˙R˙Ru]b ~R AM v u]vZ vR˙R˙Ru]b~RANu]vZX ˙R˙Ru]b B include sinus bradycardiaU b]vb b v ]}v]o o}lbX TR R˙R˙Ru]b v (R obb]. ]v} v]o b v v]o R˙Ru]bU b }v R] b] }( }]P]vX TR˙R˙Ru]b ]vo ]o .]oo}v U ]o G' }˘˙buo v]o b R˙]U v]o R˙] v v]o.]oo}vX æv U Chatep rwP *Disorsof der theCardiovcula sa rSystem v*Arhythmias*v P]}}Puv}(]b R˙Ru]Uro GCE ub }v } }v.u R R˙Ru v}uo]˙X I ]b vP}b } b v vR˙Ru] P `]R} }]vP vGCE X R(˙u}u b vb } R}b]o ]uu]o˙X TR R}] }( P uv vb }vR˙}(R˙Ru]v]˙ b }(˙u}ub b X sueCa yy RRuR]bb yy ORooR]bb yy Hypertensive heart disease yy IbRu]R]bb yy TR˙}}˘]}b]b yy H˙}R˙}]]bu yy ]}u˙}R]b C yy C}uoRo}l yy Eo}o˙v}uo]boo˙R˙}lou] yy P]]o]bb yy DPb yy Su}l]vPUo}R}oU}+UUX yy Pou}v˙u}o]bu yy P}b]P˙ b yy I]}R] Symptoms yy Po]}vb yy D]]vbb yy CRb]b}u(}l]v yy FP yy D]8o˙]vR]vP yy Sudden collapse yy Sudden death Signs yy Pob yy Ru˙(bUbo}`}v}uo yy RR˙Ru RPo RPoo˙]Po IPoo˙]Po Sinus tachycardia Sinus bradycardia C}uoRo}l Supraventricular tachycardia Vv]oR˙] Supraventricular or ventricular ectopic beats ]o A .]oo}v ]o A G'~`]R]o ]}rv]oo}lZ Moov]o b } ventricular ectopic beats yy yy yy Pob .] ~]o (b Rv ]o ob V bv ]v (b]o.]oo}v }G'Z H˙}vb]}v}o}}u˙ b v}o S]Pvb}(R(]o~u˙bvZ æw Standard Trtme ae ntGuidelinesUwthEditionUw v*Arhythmias*v Invtiga se tions yy roGCE yy Suo}o˙b~]vo]vPuPvb]uUo]uZ yy TR˙}](v}vb yy CRbXr˙ yy Auo}˙GCE ~H}oZ yy R}]}PR˙ E Trtme ae nt Tuv}ib yy To control ventricular rate yy T}}b b]vbR˙Ru yy T}o]˙u}ub b yy T}]u}(v}vo]˙vo]˙}(o]( yy T}v}b}]}uo]}vb yy T}Rvo˙]vP}v]}vXPXR˙}}˘]}b]b yy To prevent stroke}˙bb u]R}u}u}o]bu yy T}u}]]˙vu}o]˙ Non-pharmacological treatment yy RbR b v yy }] A ˘bb]]vl}( o}R}oU}+} v}b bu}l]vP ~]( Rb}bb]o]]vP(}bZ yy MbbP}(R}b]vb}v}vb](}(`}vb b XTR]bu˙ u]vv'l}(}˘˙buov]o b R˙] yy Electrical cardioversion Pharmacological treatment AXFb]o.]oo}v }]oG' -for rate control st L]vTuv ]v E RvPPA yy AtenololU}oU Adults æruP]o˙ Children r˙bV æræuP]o˙ u}vRr˙bV XæræuP]o˙ Neonates Refer to a paediatrician Or yy B]b}}o}o U}oU Adults XæruP]o˙ Children Safety not establised in children Or yy MetoprololU}oU æ Chatep rwP *Disorsof der theCardiovcula sa rSystem Adults æruP}R}o˙]o˙~u˘XuP]o˙Z Children r˙bV æuP}R}o˙]o˙~u˘XuP]o˙Z AM˙bV (}]]]v Note 7-11 }] A ](ro}lb}v]v]XPX}vR]oRu b UR˙}vb]}v yy O Vu]o U}oU Adults ruPvrR}o˙~u˘XuP]o˙Z Children Refer to a paediatrician Note 7-12 }] A b]vvbo˙}vro}l BXFb]o.]oo}v }]oG' TR]b]b]}}b b]vbR˙RuX R( } ]}o}P]bU R˙b]]v b]o]b } ]]]v b }]X C. yy yy v*Arhythmias*v yy nd L]vTuv ]v E RvPPA D]P}˘]v U}oU Adults æræu]}Pub]o˙ Children Refer to a paediatrician -for rhythm control Paroxysmal supraventricular tachycardia st L]vTuv ]v E RvPPA AtenololU}oU Adults æruP]o˙ Children r˙bV æræuP]o˙ u}vRr˙bV XæræuP]o˙ Neonates Refer to a paediatrician Or B]b}}o}o U}oU Adults XæruP]o˙ Children Safety not establised in children æı Standard yy Trtme ae ntGuidelinesUwthEditionUw Or MetoprololU}oU Adults æruP}R}o˙]o˙~u˘XuP]o˙Z Children r˙bV æuP}R}o˙]o˙~u˘XuP] o˙Z AM˙bV (}]]]v r Note 7-13 }] A ](ro}lb}v]v]XPX}vR]oRu b UR˙}vb]}v yy Or Vu]o U}oU Adults ruPvrR}o˙~u˘XuP]o˙Z Children Refer to a paediatrician v*Arhythmias*v N}wr }] A b]vvbo˙}vro}l yy nd L]vTuv ]v E RvPPA D]P}˘]v U}oU Adults æræu]}Pub]o˙ Children Refer to a paediatrician X D Pv}v}(}l b or systemic thromboembolism in atrial .]oo}v }G' PvbbR}oP]vo}vPruv}Po}v X ~S }}vb (} o}vPru v}Po}v ]v b}v }v RDVT RPou}v˙Eu}o]bu [Z X Refeal r Criteria R(oovb}]}o}P]bUR˙b]]vb]o]b}]]]v (}(Ro}vvuvPuvLR]v]ouvX Aoo˙u}u b vbU b òo b R}b `R} vv} RvGCE }v}]vU}`R}bv`]RR(]oUbR}o( ]uu]o˙X Flowchatr v [} Chatep rwP *Disorsof der theCardiovcula sa rSystem v*AcuteRheumaticFever*v F]PwrıP)Fo}`RPAR˙Ru]b 56. RRu A F A Ru ( ]b v ]oovbb b ˙ v ]uuv}o}P]o }v } P} A }}o b ]v(}v }( R R}X TR }vb }( ˙u}ub b }b r `lb L v v } ]vo˙ R} ]v(}vX TR ]bb }b u]vo˙ ]v R]ov v }obvb `]R l P }( æræ ˙bX A Ru ( }Lv bob ]v obvP uP } R ob o]vP } R R}v] (}uU `R]R ]b lv}`vbRuR]bbX Iv]]ob`R}RRRu(]}bo˙u} o]lo˙}Rbv]b}bXTRbvbu˙b(R RouPXF}oo}`]vPuv}(v]b}U}v˙ b }R˙o˘]b bR}o }vv (} u]v]uu }( ˙b L R v]b}}( Ru(}voP ˙b~`R]R ]b o}vPZX F} R}b `]R b Ru R ]bb }v˙ b }R˙o˘]bbR}o}vv]v.v]o˙X RRu R ]bb ]b v ]u}v b }( R (]o v u RX Iv GRvU Ru ( u˙ u]u] uo]U typhoid feverv}R(]o}v]}vbU`R]oRi}]v˙u}ub b u˙ u]u]b]looo]bbX J}vb]]]bb(}]Pv}b]b}(Ru(X v Standard B}˘wrP) Trtme ae ntGuidelinesUwthEditionUw J}vb]](}]Pv}b]b}(RRu A F F}]Pv}b]b}(]v]oRu(P ]v E }(]vPP}}}o Ab ]v(}vU And ui}]] O ui}]]}vvu]v}]] F}]Pv}b]b}(vRu(P ]v E }(]vPP}}}o Ab ]v(}vU And ui}]] O ui}]]}vv}u]v}]] ~S˙u}ub b vS]Pvbo}`(}ui}vu]v}]]Z sueCa yy v*AcuteRheumaticFever*v G}}}o Ab ]v(}v Symptoms yy F yy Malaise yy J}]v ]v `R]R u}b (}u }v i}]v } v}R ~lvbU vlobU `]bbUo}`bZ yy Po]}vb yy ˙bE (P]o]˙ yy Chest pain yy Skin rash yy Av}uo}˙u}uvb~R}Z Signs yy FAN£C~u]v}]]Z yy S]vPoi}]vvvbbv}òo]vP b ~u]v}]]Z yy R] R ~ AN lu]vZU uuU R (]oU ]]o ~bPPb]bb Z~ui}]]Z yy Skin rash yy Sv}bv}ob}}v˙}u]vvb Invtiga se tions yy FBC yy SR E AN}Cr}]vANuP lL ~u]v}]]Z yy S]lo]vPb yy CRbXr˙ yy TR}`b (}o yy Avrb}o˙b]vO yy roGCE ~}o}vPPR]vo(}Pru]v}]]Z yy R}]}Pu E ]v}(]b~ui}]]Z v Chatep rwP *Disorsof der theCardiovcula sa rSystem Trtme ae nt Tuv}ib yy T}]}}o b R}]v(}v yy T}b]vGuu}˙b}vb yy T}vv ]b}b }( Ru (v (R R ouP yy T}R(]o](}r˘]bv Non-pharmacological treatment yy b B Pharmacological treatment yy yy Av ]v E RvPPB AspirinU}oU Adults rı uP rv R}o˙ vo i}]v˙u}ub b o]U v Poo˙ `]R`}r`lbX Children u}vRr˙bV æ uP llP v R}o˙ vo i}]v˙u}ub b o]UvPoo˙`]R`}r`lbX Or ]v E RvPPB I}(v U}oU Adults ruPvrR}o˙~u˘XuP]o˙Z v v*AcuteRheumaticFever*v AXTuv}(RRu A F st L]vTuv ]v E RvPPC yy BvR]vv˙ov]]oo]v UIMU AHlP}˙`]PRV UUUb]vPo}b AMlP}˙`]PRV vUUb]vPo}b Or yy PRv}˘˙uR˙ov]]oo]v ~Pv]]oo]vV ZU}oU Adults æuPR}o˙(}˙b Children vr˙bV æuPR}o˙(}˙b ræ˙bV æuPR}o˙(}˙b Or yy E˙R}u˙]v U}oU~(}vbooP]}v]]oo]vZ Adults æuPR}o˙(}˙b Children r˙bV æuPR}o˙(}˙b r˙bV æuPR}o˙(}˙b r˙bV æuPR}o˙(}˙b r Standard Trtme ae ntGuidelinesUwthEditionUw Children ræuP llPvrR}o˙~u˘XuPlP]o˙Z BXTuv}(RRu A F Ab]vRuv}}v[A } Av yy Pv]b}o}v U}oU Adults and Children uP llP]o˙(}`lbvRvPoo˙}+˙ræA9 `l(}r`lbX `]R]bC CXTuv}(RRu A F Ab]vRuv}}v[A } Av Tuv(}R(]o~Sb}v}vRH(]o[Z with Heart Failure v*DizzinesandBlackouts*v X D S}v˙v}v~}R˙o˘]bZ}(Ru(v RuR]bb st L]vTuv yy BvR]vv˙ov]]oo]v AHlP}˙`]PRV AMlP}˙`]PRV UIMU UUU æuP~vUUZr`lo˙ nd L]vTuv PRv}˘˙uR˙ov]]oo]v ~Pv]]oo]vV ZU}oU Adults æuPR}o˙]o˙ Children vr˙bV æuPR}o˙ ræ˙bV æuPR}o˙ Or yy E˙R}u˙]v U}oU~(}vbooP]}v]]oo]vZ Adults æuPR}o˙ Children r˙bV æuPR}o˙ r˙bV æuPR}o˙ r˙bV æuPR}o˙ Refeal r Criteria R(oovb}]]]vUR˙b]]vb]o]b}]}o}P]b bvbb˙(}(RuvPuvX yy 57. Dizziness and Blackouts D]]vbb ]b v}vb]. u R (b } v}uo bvb}v }( }˙ }]v}v } }b]}v ]v bX TRb ]vo (o]vP }( vb]vbbU o]PRrRvbb v P} v X Pvb }Lv .v Rb Chatep rwP *Disorsof der theCardiovcula sa rSystem væ v*DizzinesandBlackouts*v bvb}vb ]8o } b]X D]]vbb ]b ou}b o`˙b b}] `]R }R ˙u}ub b U R(} (o R]b}˙ v (}b R˙b]o ˘u]v}vbR}o(}u]voo}b ]v(˙RbX L]l ]]vbbU Sol}b _ ]b PU b] u ]uo˙]vP ]R o}vb]}bvbbU ]bo ]bv } bvb}v }( (oo]vPX (o A R]b}˙Uoo˙(}uv˙r`]vbbU]bbvoX Episodes of transient disturbance of consciousness and falls are }uu}v o]v]o }oubX I ]b boo˙ }bb]o } ]bvP]bR `v .~b]ZUv]b}}((]vvPv}R˙b}('l(}uR R]b}˙P]v˙RvvR}v}(v˙`]vbbX sueCa Cardiovascular yy Vb}Por~(]vvPZ yy P}boR˙}vb]}v yy Ru}RP A yy ]C R˙Ru]b yy S}v}b b ]b yy C}uoRo}l`]RS}lbrAub'lb yy V}rb]o]vb8]v˙ Cerebral yy Tvb]vIbRu]'lbA ~TIA Z yy Stroke yy Epilepsy Others yy DPr]v yy Svu] yy H˙}Po˙u] yy Middle ear disease yy Mv][b]bb yy Conversion disorder~H˙b]o(]vvP lH˙vo}vZ Symptoms yy L]PRrRvbb yy L}bb}(}vb]}bvbb yy Svb}(u}}v}b]vv]vP}(}˙ yy Uvb]vbb yy Nausea yy V}u]vP yy Tinnitus Signs yy S`vP~bPPbb}Po]b}lR˙}Po˙u]Z yy Tachycardia}˙]~bPPb]R˙Ru]Z yy Hypotension yy P}boR˙}vb]}v yy Poo} Standard Trtme ae ntGuidelinesUwthEditionUw yy N˙bPubU ˙b]}R}l]vb]bU ˘] ~bPPboo b bZ yy F}ov}o}P]ob]PvbbPPb}l b Invtiga se tions yy TRb˙v]vP}vRb yy FBC yy Rv}uo}}bP yy Xr˙}(]ob]v yy ECG U R˙}}v]U ˙bR] UTIA v*DizzinesandBlackouts*v Trtme ae nt Tuv}ib yy T} ]v(˙ v }]o˙ uvP R }bb]o vo˙]vP b~bZ Non-pharmacological treatment yy P}boR˙}vb]}vr]ù]}vb yy H˙vo}v˙v}u b rR]vP}v}o˘]b yy C}vbo]vP yy Cervical collar yy M}o]o]oo}`b Pharmacological treatment yy TRvo˙]vPbX~S}]b}vZ Refeal r Criteria R(vb } R˙b]]v b]o]b (} o}v ]( R b ]b ]8o } u]vX I( R b ]b ]v.U ( } R }] b]o]b(}(Ro}vvuvPuvX v Chapter Disorsof der the Respirtor a ySystem 58. Common Cold TR]b ]b bo(ro]u]vP ]v(}v }( R b]}˙ U oo˙ R vb}R˙vPo u}b v b]vbbX I ]b }vP]}b v b ˙ ]}v }obU b òo b (}u Rvb v }v `]R }vu]v b(bX TR ˙u}ub b b}o `]R} v]} uvUboo˙`]R]v`lX I(RR}o[obo}vP b Rv`lvR]bb]bv(v }PRU ]Pv}b]b}(]vGvu˙ }vb]XW]R]vGvU(U ˙bb u] ˙u}ub b v }b}v u} }v}vX S}v˙ ]o ]v(}v u˙ b}] `]R ov RoPu } }+vb] vbo]bRPv(X Ob]}voo˙U R }uu}v }o ]b }uo] ˙ }b u] R˙vP}}vb]oo]bUoo˙]vR]ovU]v`R]R}v b bR}o( }R}]b}vb(}uvX sueCa yy Rhinoviruses yy Corona viruses yy Rb]}˙S˙v˙oV]b~RSVZ Symptoms yy Rvv˙v}b~R]v}RZ yy Sv]vP yy Nbo}vPb}v yy Mild fever yy Headaches yy Sore throat yy Muscle aches yy C}PR yy FP yy Malaise Signs yy L}`P( yy Nbo]bRP vw and Standard yy yy Trtme ae ntGuidelinesUwthEditionUw Nbou}bv]vP W]vP}(˙b Invtiga se tions yy N}]vbP}vb] Trtme ae nt Tuv}ib yy T}o]˙u}ub b yy Rb}o}v}(]v(}v]vRbR}b}bb]ou Non-pharmacological treatment yy Rest yy Ev}PG]]vl yy GPoolùbob}o}v yy Su]vRo}v Pharmacological treatment v*Commonold C *v AXUv}uo]}uu}v}o st L]vTuv ]v E RvPPC yy Pu}o U}oU Adults ærPvrR}o˙ Children ræuP llP l}bvrR}o˙ vr˙bV ræ˙bV u}vRbr˙V yy yy yy æræuPvrR}o˙ ræuPvrR}o˙ vruPvrR}o˙ Av S}]uCRo}] XıA9Uvbo}bU Adult and Children }bU]v}Rv}b]oUR}o˙}o]}vPb}vvbb b˙ Or X˙o}u}o]v UvboU Adults~XA9}vZ r}bR}o˙]v}Rv}b]o Children~XæA9}vZ ANu}vRbV r}bR}o˙]v}Rv}b]o Av ]]v C U}oU Adults uP]o˙ Children AN˙bV vr˙bV rv˙bV uP]o˙ æuP]o˙ XæuP]o˙ v Chatep rP yy Or C Ro}Rv]u]v Adult uPR}o˙ Children vr˙bV rv˙bV r˙bV *Disorsof der theRespirtor a ySystem uoU}oU uPvrR}o˙]o˙~u˘XuP]o˙Z uPvrR}o˙~u˘XvuP]o˙Z v}}uuv Note 8-1 Av]}bv}]v](}}uu}v}oX Refeal r Criteria R(}b RubobU]vGv}}uo]}vb} ]]]v}R˙b]]v(}uvPuvX 59. Pneumonia B}˘rP) S]˙}b (}}uuv]˙]vu}v]~CURBrvæZ S]˙}b u˙}v b R(}oo}`]vPUb]Pv]vP}v}]v}R}(R (}oo}`]vP(}b~u˘]uuæ}]vbZV yy C}v(b]}vUobb bvbbU}˘bb]}`b]vbb yy Bo}}UN]}Pv~ANwuu}olLZ yy Rb]}˙~AHu]v]vobUvAHæ]vR]ovZ yy L}`BP~S˙b}o]BPAMıvl}]b}o]BPAMvuuHPZ yy PvbR˘ub}(PU~AMæ˙}AHvæ˙Z rV}vb]R}uuv rV}vb]bR}]vvR}b]o]b}v ANVu]v}vb]]vvb] vı v*Pneumonia*v Pvu}v] ]b v ]v(}v }( R ovP b b ˙ ]}b ]U ]bb } (vP]X Iv.}v }( R b }Pv]bu v Pbvb]]˙vP b ]bRl˙}}uvXH}Ùb }( R b]}b v }( R ]v(}vU v]} uv bR}o ]uu]o˙ b b}vlv}òP}(Ru}b}ob }Pv]bu v R v]}b b (} ]buvX L}o lv}òP }( P b]bv 'vb ob} lv ]v} }vX Tuv u˙ u]v]v } RvP b }v o bob v buv }( R v[b b}vb } ]v]o uvX Iv R v R R ob }( o}} } bu } vPU u]] uv ]b }vv `]R o]v]ob}vbbP]X TR]˙ b }(R]oovb]bb l˙(}]vR]b]}v(}u]bb]}vU vRR}]}(.b}}v b ro]vuvX Standard B}˘rP) Trtme ae ntGuidelinesUwthEditionUw S]˙}b (}}uuv]˙]vu}v]~CURBrvæZ Iv Rbvv˙}( R(}oo}`]vP ]}vo (}bUoob}( vu}v] `}o`vR}b]o]b}vX A]}vo(}b yy C}˘]bvP]bbRbR}v]ovP]bbUR(]o}vo]b ease yy E˘vb]]bbUuooo}b]v}o yy L}`}˘˙Pv}v b SO UAMıA9}v}}u] yy Severe tachycardia sueCa r v*Pneumonia*v Community acquired pneumonia yy Streptococcus pneumonia yy Streptococcus pyogenes yy Haemophilus influenza yy Klebsiella pneumoniae yy M˙}obuvu}v] and Legionella pneumophila (tend to occur ]v]u]bZ yy Staphylococcus aureus ~]v R]ov L ]o ]oovbb o]lubobU ]v ]b}]vRoo˙]vPRG[]u]bZ Ab]}vvu}v] yy Av}] vl} Pu vP }Pv]bub ~bb}] `]R b]}vXPX}l b Ub]bUv}vb]}bvbbZ Hospital acquired pneumonia yy GurvP]XPX Pseudomonas aeruginosa yy MRSA~MR]]oo]vb]bvZ yy VRSA~Vv}u˙]v b]bvZ yy Staphylococcus aureus Others yy Pneumocystis jiroveci vu}v] v }R (vP] ~]v ]uuv}}u}u]bbXPXRu}o}P]ouo]Pvv]bUHIV l AIDS Z yy V]bb Symptoms yy F rbR}R]b}˙ yy P}}PR yy Sur˙b }o}}]v b U˙oo}`]bRUPv]bR yy Po]Rb]v r`}b}vR]vP}}PR]vP yy Rob B bvbb yy S`vP yy Muscle aches yy Eoo˙v]uuv}}u}u]bvbu˙Ru]v]uu}v} ˙u}ub b Signs yy R]R]vP w Chatep rP yy yy yy yy yy yy yy yy yy yy *Disorsof der theRespirtor a ySystem GvvP~]vR]ovZ Ub }( b}˙ ubob }( b]}v v G]vP }( R vbo uP]vb L}`Rbòo]v`]vP~]vR]ovZ Rb]u}uv}(R+b]}(RRb~}]vZ F Rapid pulse rate Bo}}u˙ b v}uo}o}` S]Pvb}(}vb}o]}v}oo+b]}v}vRb˘u]v}v Rbobbvbb}}v(b]}vU}`b]vbb L}ò}}}˘˙Pv}v b ˙ob}˘]u˙AMıA9 w Pneumocystis v*Pneumonia*v omp C lictions a yy Poo+b]}v yy LvPb yy Eu˙u yy P]]o+b]}v l]]b yy Pvu}R}˘ oo˙ Staph. aureus ]v(}vU jirovecivu}v] yy Mv]vP]b yy Su]`]Ruo}Pv(]o yy Aob]}˙]b˙v}u b ~ARDSZ Invtiga se tions yy FBC yy Cr}]v ~CRPZ yy CRbXr˙ yy SuPu]v b vovbvb]]˙ yy Z]RorNobv]v b (}]r(b]oo]~}˘oTBZ yy Bo}}ovbvb]]˙ yy Bo}}vo}o˙b Trtme ae nt Tuv}ib yy T} ]v(˙ vb P ]bl `R} ] ]vrR}b]o uvPuv yy T}oo]˙u}ub b yy T}v]R]v(}v yy T}vvl}uvP}uo]}vb Non-pharmacological treatment yy Nb]v}u(}o}b]}vUboo˙`]RR]b yy S}vP]vP}}v}o(Ub]oo˙]vR]ovAMæ˙b~`R} ]bl}((]o}vob]}vbZ yy }o A R˙}v~](]v}oZ yy Chest physiotherapy Standard Trtme ae ntGuidelinesUwthEditionUw Pharmacological treatment AX yy yy yy v*Pneumonia*v yy yy Auo}˙vPo}`]˙ b }b AM~b}Z st L]vTuv ]v E RvPPA Au}˘]]oo]v ~Au}˘˙]oo]v U Z }oU Adults PR}o˙(}˙bw ~R]PR}bZ Children ær˙bV æuPR}o˙(}˙bw ræ˙bV æuPR}o˙(}˙bw vu}vRbr˙V æuPR}o˙(}˙bw Av A ]R}u˙]v U}oU Adult æuP]o˙(}˙bv Children uP llP]o˙(}˙bv Or E˙R}u˙]v U}oU~](v]booP]}v]]oo]vZ Adult æuPvR}o˙(}˙bw Children r˙bV æræuPvR}o˙(}˙bw r˙bV æuPvR}o˙(}˙bw vu}vRbr˙bV æuPvR}o˙(}˙bw nd L]vTuv ]v E RvPPA (}˘]u C U}oU Adults æuPR}o˙(}˙bw Children u}vRbr˙bV days AN˙bV Or D}˘˙˙o]v U}oU Adults uPR}o˙(}wr˙bv]vP}v]˙ b uP llP l˙ ]v `} ]] }bb (} w æræuPR}o˙(}˙bw Note 8-2 N} }uuv ]v Pvv˙U ovP u}Rb v ]v R]ov AM ˙b }(PX w Chatep rP *Disorsof der theRespirtor a ySystem BXH}b]o]bvPS]˙}b UAH}`]R]}vo(}b buv}v} yy O˘˙Pv U˙(ubl}vbo}vPbU Adults and Children M]v]v}˘˙Pv}v b ANıA9 Av yy IV G]b b v}uo bo]v v ˘}b bo]v } o ub insensible loss yy yy yy yy Av A u}˘]]oo]v A= Coov] A] ]u}bZ Adults XPR}o˙(}wr˙b Children u}vRbr˙bV wr˙b AMu}vRbV U IVU ~RvP} }o}`Rvv uP llP R}o˙U u˘X X P R}o˙ (} uP llPR}o˙(}wr˙b Av A ]R}u˙]v U}oU Adult æuP]o˙(}r˙bw Children uP llP}v]o˙(}r˙bw Or A]R}u˙]v UIVU Adult æuP]o˙(}˙b R}}o]R}u˙]vU`Rvo]v]oo˙ob }}uo˙bw }( uvX ~S b}v }v uv (} uo}˙ vb }ZX Children IV}v}}uuv]vR]ov(}vu}v]uv w v*Pneumonia*v yy Av Pu}o U}oU Adults æuPrPvrR}o˙ Children vr˙bV æræuPvrR}o˙ ræ˙bV ræuPvrR}o˙ u}vRbr˙V vruPvrR}o˙ Or Pu}o suppository Adults and children doses as above Standard Trtme ae ntGuidelinesUwthEditionUw Note 8-3 A]R}u˙]v ]v(b]}vbR}ov} P]v]vbR}Rv R}XIbR}ov} P]vbvIV}ob}bv]vubo]vi}vX yy yy nd o]vuv ]v E RvPPA L]˘}v C UIVU Adult P]o˙(}wr˙b Children AooPbæuP llPR}o˙~u˘XwæuP llP]o˙Z Av A]R}u˙]v UIV~b}Z v*Pneumonia*v CXTuv(}b]}vvu}v] st L]vuv ]v E RvPPB yy L]˘}v C UIVU Adult P]o˙(}wr˙b Children AooPbærwæuP llP l˙]v]]R}o˙}bb Or yy Au}˘]]oo]v A= Coov] A] U IVU ~RvP} }o}`Rvv ]u}bZ Adults XPR}o˙(}wr˙b Children u}vRbr˙bV uP llP R}o˙U u˘ X P R}o˙ (} wr˙b AMu}vRbV uP llPR}o˙(}wr˙b Or yy C]}G}˘]v UIVU~}u]v]b}vu]vbZ Adults uPrR}o˙(}˙bw Children uP llP~u˘XuPZR}o˙(}˙bw yy yy Av M}v]}o UIVU Adults æuPR}o˙(}˙bw Children wXæuP llPR}o˙(}˙bw Or Co]vu˙]v UIVU Adults rvuPvR}o˙(}˙bw w Chatep rP *Disorsof der theRespirtor a ySystem Children rvuP llPvR}o˙(}˙bw Refeal r Criteria R(} R ]]]v } R˙b]]v b]o]b ]( v} ]u}uv }b ~]XX (u]vb R]PRUv]boo b RobbU } Xr˙b bR}`}uo]}vb}v}b}o}vZX 60. }vR]o B Ru Ab wæ ~R˙(ZUu or v*Bonc r hialthma As *v Ru Ab ]b R}v] ]vGuu}˙ ]bb }( R }vR]o ]`˙bU `R]Ruv](bbv]b}b}(`RU}PRURbPRvbb v bR}vbb }( RU `R]R ]b boo˙ b]o `]R uvX I ]b R]b ˙ ]vb bvb]]˙ } uv˙ v]}vuvo PvbX Ru Ab ]b ]o v u˙ b}] `]R b}vb o]l R ]v˙ b}v } Ru'vX }vR]o B Ru b }b oo Pb lb ]v R]oR}}X I ]b obb]. b v ooP] ]bbU v u˙ b}] `]Rb}vo}(u]o˙R]b}˙}(ooP]R]v]b ooP]}viv]bX C}uo]}vb }( Ru b ]vo vu}u]bvuU vu}R}˘Uv}b b uR˙buvvu}v]X sueCa yy AooPvb XPX R}b b u]U }l}R }]vPbU PbbU }oov vv]uoR] yy Ev]}vuvo (}b XPX ] }oo}vU o]u RvPbU }vP b bvbvbu}l~]vo]vP]P'bu}lv(ubZ yy V]o]v(}vb yy E˘]b yy Eu}}vbvR˙vo}v yy DPbXPXb]]v UNSAIDSvro}lbbR}v}o}o b yy O}vo ˘}b } ]vb]o Ru]obU b v P uv(]vP Symptoms yy Episodic breathlessness yy T]PRvbb}(RRb yy C}PR r}Lvv}vo yy WR yy N}vo ˙u}ub b X Av˙ }( R } ˙u}ub b `l]vP R vv]PR Signs yy Tachypnoea~(bR]vPZ yy Ub }( b}˙ ubob }( b]}vV vl vl} }u]vo ubob yy RR}vR]l`R Standard yy yy Trtme ae ntGuidelinesUwthEditionUw S]Pvb}('lb yy Iv]o]˙}}uo(oobvvb]v}vR yy R] ob AN lu]v ]v ob v }obvb } ANl u]v]vR]ovræ˙b yy R]b]}vANlu]v]vobv}obvb}}AN ælu]v]vR]ovræ˙b yy PlE˘]}˙Fo}`R~PEFRZ]bAMæA9}(˘ ~(}PU˘b vR]PRZ S]Pvb}(o](rRv]vP'lP yy Cyanosis yy Pob}˘b b yy S]ovRb}vbo}v yy }`b D ]vbb}}v(b]}v yy E˘Rb}v yy Pl E˘]}˙ Fo}` R ~PEFRZ obb Rv A9 }( ˘ value yy SOobbRvıA9}v}}u] v*Bonc r hialthma As *v Invtiga se tions yy N}]vbP}v]]vu}bb yy FBU C u]oo˙R]PR}b]v}R]o}v yy CRbXr˙~}vo˙(}R˘ob]}v}(}R]Pv}b}b }uo]}vbZ yy S]}u˙ r}v]vFEVvFEVlFVC}`]Rb]]o]˙ u}vb L }vR}]o} b ~ v}uo b]}u˙ `v'lb}bv}˘oRu b ZX yy Tbb(}}˙rbl]v]l}b b].IPE(}}uu}vooPvb yy S}}o˘u]v}vU˘oRou]vR]b]b Trtme ae nt Tuv}ib yy T}o]}vR}bbu yy T}v}uo]}vbvv yy T}vo˙]vP]vGuu}v}]v(}v Non-pharmacological treatment yy }] A lv}`v ]PPblooPvbU bR b b ~b u]Z `R possible yy }] A bu}l]vP yy }v E }vRu b bo(uvPuvU]bvRv] Pharmacological treatment AXE˘}v A }(Ru Ab PIv]oMvPuv]vR Community ]v E RvPPC yy Sou}o ]vRoU b]vP b] u }b ]vRo ~MDIZ `]Rb Adults and Children G] r +b ] b v ubl ]( v ~XPX V}ou wv Or Chatep rP *Disorsof der theRespirtor a ySystem }Ru A U}oPobu]vo`}'oZ`]RRv l]vPrRbLR+X RL˙æru]vbu˘]uu}bbX I(R]bv}]u}uvblRoR(]o]˙`]Rv o]bX r BXM} A lSE˘}v}(Ru Ab Management in Hospital st L]vTuv ]v E RvPPA yy O˘˙Pv ˙B vbo}vPbrvLlu]v Or Fubl rLlu]v Or N}vrRubl yy yy ræLlu]v Av Sou}o Uvo]bU Adults XæræuP]v]oo˙Læru]vbURv˙rR}b vo]u} Children XæræuP˙rR}bvo]u} v*Bonc r hialthma As *v yy PIv]o And I}]u}u] Uvo]bU Adults æu]}PurvR}o˙ Children vr˙bV æu]}PurvR}o˙ ræ˙bV æu]}PurvR}o˙ ~u˘X}b(}R]ov]buP lR}bZ And H˙}}b}v UIVU Adults uPX b RvuPvR}o˙voo]v]o]u}uv Children r˙bV uPvrR}o˙ u}vRr˙bV ruP llPR}o˙ Then CXM} A lSE˘}v}(Ru Ab Treatment in Hospital yy Sou}o Uvo]bU Adults XæræuP˙vR}bvo]u} Children w : Maintenance Standard yy Trtme ae ntGuidelinesUwthEditionUw XæræuP˙vR}bvo]u} Av I}]u}u] Uvo]bU Adults æu]}PurvR}o˙ Children vr˙bV æu]}PurvR}o˙ ræ˙bV æu]}PurvR}o˙ ~u˘X}b(}R]ovuP lR}bZ N}r F}R]ovAM˙b`]R˙u}ub b }vb]V I}]u }u] U æ u]}Pu ˙ r u]vbU (} R .bR}bURvrvR}o˙bvbb˙ yy v*Bonc r hialthma As *v Av Pv]b}o}v U}oU]v]o}bP]v}vu]bb]}vvbvo˙ P]vbu}v]vP}bX~Ov}vv]b}o}vU}b IVR˙}} soneLR}bZ Adults ruP]o˙(}˙bw voob XT}+}b}]}}( `lb](vRbv}vo}vPu}]b b X Children ruP llP(}ræ˙b X D M} A lSE˘}v}(Ru Ab Tuv]vH}b]o~`Rv]boo b ]bL b r ]v]o}bb}(vo]bbou}oZ yy Au]v}R˙oo]v UIVU Adults æuPbo}`]vi}v}u]vb R L u]vb `]R }vv}b ]v(b]}v ˙ (b}U ]( vbb˙Uv}˘]vPXæuP llP lR}}R}b Or yy Au]v}R˙oo]v UIV]v(b]}vUæuP]væuo}(æA9˘}b D S}]uCRo}] UvR}o˙(}R}b Children æ uP llP } u]vb b o}` ]v(b]}v } ˙ (b} uP l lP lR}~u˘XæuPZ EXCR}v]Ru Ab rIv]ouvPuv ]v E RvPPA yy Sou}o U]vRoU Adults and children u]}PuU+bb}Lvbv yy Av ~I(]vRoSou}o ]bvu}Rv}v]o˙Z Bb}v] U]vRoU Adults w r : Maintenance }XıA9 Chatep rP yy yy *Disorsof der theRespirtor a ySystem u]}Pu~}v+R}o˙Z Children AN˙bV u]}Pu~}v+R}o˙Z AM˙bV u]}Pu~}v+R}o˙Z Or Fob}v UIvRorMDIU Adults æræu]}Pu~+bR}o˙Z Children æu]}Pu~+bR}o˙Z Or Bo}ub}v ~Bo}uRb}v ZU]vRoU Adults and Children u]}Pu~+bR}o˙Z FXCR}v]Ru Ab - Maintenance treatment yy 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]v b}]}v `]R b]}˙ ]v(}vX M}b b } v} ] v]}bU R}Ù R˙ u˙ b] ]( R v[b SPO ]b obb Rv ıA9 } ]( R ]b v vo˙]vP }ru}]]˙ o]l uov]}vU ubobU ]lbU vu]U ]b uoo]bU R}v] }vR]b}HIV lAIDS X sueCa yy V]bbXPXIvGv]b UC}}v]b ~}uu}v}oZ yy ]B XPX Streptococcus pneumoniaeU H. influenzaUMoraxella catarrhalisU Staph. aureus ~vb } b }br]vGv Rb ]v(}vbU]vo]vP}vR]bZ Symptoms yy D˙}PR yy Su}}v yy Sore throat yy Po]Rb]v yy L}`P( Signs yy F yy Rhinorrhoea yy RR}vR]~`RZ yy ]}vb C ~Z Invtiga se tions yy FBC Chatep rP yy yy yy *Disorsof der theRespirtor a ySystem SuovPu]v b Su AFBb ~ buobZ (} o}b]b ]( ˙u}ub b R ob u}Rv`lb S]vbXr˙(}R]v}b]vb]b~`]R}bvbo]}bb Z b]ob (}}o}vP}PR Trtme ae nt Tuv}ib yy T}o]˙u}ub b yy T}]o b ]v(}v](v˙ Non-pharmacological treatment yy b B yy OoG]b}lòoR˙ yy Hu]].]}ub ]vRo}v](vbb˙ Pharmacological treatment æræuPvrR}o˙ ræuPvrR}o˙ vruPvrR}o˙ æræuPvrR}o˙ ræuPvrR}o˙ vruPvrR}o˙ BXUv}uo]]v(}vbr(}]]vP}Rb˙}PRb yy Guaifenesin}v]v]vP˘}vU}oU Adult ruPR}o˙~u˘XXP˙Z Children AN˙bV ruPR}o˙~u˘XXP˙Z vr˙bV ruPR}o˙~u˘XXP˙Z ræ˙bV æruPR}o˙~u˘XvuP˙Z vu}vRbr˙bVæræuPR}o˙~u˘XuP˙Z Or yy S]uoo]vb U}oU Adults~o(}uo}vZ æuovrR}o˙ v*Acuteonc Br hitis*v AXUv}uo]]v(}vb st L]vTuv ]v E RvPPC yy Pu}o U}oU Adults æuPrPvrR}o˙ Children vr˙bV ræ˙bV u}vRbr˙V Or yy Pu}o UoU Adults æuPrPvrR}o˙ Children vr˙bV ræ˙bV u}vRbr˙V Standard yy Trtme ae ntGuidelinesUwthEditionUw Children~]](}uo}vZ u}vRr˙bV XæræuovrR}o˙ Or CarbocysteineU}oU Adult ærwæuPvrR}o˙ Children ræ˙bV vXæræuPvR}o˙ AM˙bV v}}uuv v*Acuteonc Br hitis*v CXUv}uo]]v(}vbr(}v}vr}}˙}PR yy ˘}uR}Rv D }v]v]vP}PR}vb Adult ruPvrR}o˙ Children wr˙bV æuPvrR}o˙~u˘XvuP˙Z rv˙bV wXæuPvrR}o˙~u˘XuP˙Z AM˙bV v}}uuv Or yy Codeine}v]v]vP}PR}vb Adult wXæruPrvR}o˙bv~u˘XuP˙Z Children wr˙bV rXæuP llP˙]vrv]]}bb ~u˘XvuP˙Z rv˙bV rXæuP llP˙]vr]] v }b~u˘ b XuP ˙Z AM˙bV v}}uuv X D F}}uo]]v(}vb`]R}ru}]]b}}v˙ b ]o]v(}v st L]vTuv ]v E RvPPC yy Au}˘]]oo]v ~Au}˘˙]oo]vZU}oU Adults æuPR}o˙(}ær˙bw Children vr˙bV æuPR}o˙(}˙bw ræ˙bV æuPR}o˙(}˙bw AM˙V vXæuPR}o˙(}˙bw Or yy Au}˘]]oo]vA=Coov]A] U}oU 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CR}v]}vR]b B TR]b]bR}v]]vGuu}v}(R}vR]ou}b}]]vb bR b }} bu}lX I }b L R P }( ˙b v ]b }( R˙v}u b }(R}v]}bou}v˙]bb~COPD }Pbb]`}bv]vP`]RPUvoo˙bovP]vR}v]b]}˙ (]oXI]bPP˙v]ov]o]v(}vbX O˘˙Pv R˙ ]v Rb vb ub P]v `]R }v } v }v ]}˘]v}v } b]}v G}` b u} R vo R˙}˘] ] R u]v]vb b]}˙ +}vvRu(oX sueCa yy C]P'bu}l]vP yy Ivb]ob yy CRu]o]]vb yy IvRobu}l(}ub}(]}ubb(ob~PXR}oU`}}Z ZXTR]b }( b]}vX H]PR Standard Trtme ae ntGuidelinesUwthEditionUw v*Chroniconc Br hitis*v Symptoms yy SR}vbb}(RUoo˙}v˘}v yy WR yy F yy C}PR `]R}}v}(bu(}u}b}(R˙ yy Iv( ˘}v b}] `]R ]vb v˙ }( R]l ovbu Signs yy May be none yy oB Rb yy Pbo]R]vP yy Co]vP yy Cyanosis yy Ivbb]}˙ yy Ub }( b}˙ ubob ]XX vl vl} }u]vo ubobU (} R]vP yy Hyperresonance on percussion and loss of cardiac dullness yy WR}R}vR] yy RPlE˘]}˙Fo}`R~PEFRZ Invtiga se tions yy FBC yy S]}u˙ UbR}`b ovP}oubUoo˙FEV`R]R]b v}b}br}vR}]o}u]v]b}v yy CRbXr˙ yy SuovPu]v b Trtme ae nt Tuv}ib yy T}u]v]u]b}}b }PR yy T}v}u]v]u]b`RvbR}vbb}(R yy T}v˙}(bu} yy T}v]v(˘}vb Non-pharmacological treatment yy Su}l]vP}v b yy PR˙b]o˘]b yy G}}v]}v yy Ub}((ubl]vR]PR]bl}}vb Pharmacological treatment AXSoR}v]}vR]b ]v E RvPPB yy Sou}o U]vRoU~]MDIZ Adults u]}Pu~+bZrvR}o˙]b Chatep rP yy yy Children~˙vo]b}vZ XæræuPrvR}o˙]b vA T]}}]u U]vRo~˙}`]vRoZU Adults u]}Pu~+bZ]o˙ Children AN˙bV u]}Pu~+bZ]o˙ AM˙bV v}}uuv Av Fob}v lbou}oU]vRo~]Ro}MDIZU Adults læ u]}Pu } ælæ u]}Pu } ælæ u]}PuU +R}o˙ Children r˙bV læu]}PuU+R}o˙ AM˙bV (˙ b v}o]b b R Or Bb}v] l(}u}}oU]vRo~]Ro}MDIZU Adults vlXæu]}Pur+bR}o˙ Children AN˙bV vlXæu]}Pur+bR}o˙ AM˙bV 8˙v}o]b b R BXCR}v]}vR]b`]R]v(˘}v ]v E RvPPC yy O˘˙Pv ˙B vbo}vPbUrvLlu]v Or FublUrLlu]v Or N}vrRublUræLlu]v yy yy Av Sou}o Uvo]bU Adults XæræuP]v]oo˙Læru]vbURv˙rR}b vo]u} Children XæræuPrvR}o˙ vA I}]u}u] Uvo]bU Adults æu]}PurvR}o˙Uvo]u} Children vr˙bV æu]}PurvR}o˙ æ v*Chroniconc Br hitis*v yy *Disorsof der theRespirtor a ySystem Standard Trtme ae ntGuidelinesUwthEditionUw ræ˙bV ~u˘X}b(}R]ovuP lR}bZ yy yy v*Chroniconc Br hitis*v yy yy yy yy æu]}PurvR}o˙ Av A u}˘]]oo]v ~Au}˘˙]oo]vZU}oU Adults æuPR}o˙(}wr˙b Children vr˙bV æuPR}o˙(}wr˙b ræ˙bV æuPR}o˙(}wr˙b AM˙V vXæuPR}o˙(}wr˙b Or E˙R}u˙]v U}oU Adults æuPvR}o˙(}wr˙b Children r˙bV æræuPvR}o˙wr˙b r˙bV æuPvR}o˙wr˙b vu}vRbr˙bV æuPvR}o˙wr˙b Or A]R}u˙]v U}oU Adult æuP]o˙(}˙bv Children uP llP]o˙(}˙bv Or Au}˘]]oo]vA=Coov]A] U}oU Adults PR}o˙(}wr˙b Children AN˙bV OvælæoR}o˙(}wr˙b r˙bV æuo}(læwbvb]}vR}o˙(}wr˙b r˙bV æuo}(lbvb]}vR}o˙(}wr˙b u}vRbr˙VuP llP~}(u}˘]]oo]vZR}o˙(}wr˙b AMu}vRbVæuP llP~}(u}˘]]oo]vZR}o˙(}wr˙b Av Pv]b}o}v U}oU Adults ruP(}˙bw Then uP]o˙(}æ˙bU uP]o˙(}æ˙bUæuP]o˙(}æ˙bX T]o}`v}r`lbv}b X Children ruP llP(}ræ˙bXT]o}`v}r`lbv}b X Av AcetylcysteineU}oU v Chatep rP *Disorsof der theRespirtor a ySystem Adults uoR}o˙(}ær˙bw Children~]](}uo}vZ æruoR}o˙(}ær˙bw Or yy CarbocysteineU}oU Adult ærwæuPvrR}o˙ Children ræ˙bV vXæræuPvR}o˙ AM˙bV v}}uuv Refeal r Criteria R( oo vb v} ]u}]vP }v ]v]o uvPuvU `]R ˘}vUv]v(˘}vb}]o˙]}vP} b]o]bX 63. Bronchiectasis w v*Bonc r hiectasis*v Iv }vR]b]bU R u]u v buoo b] }vR] v }vR]}ob uPX TR] ]o] ]Ro]u ]b }˙ b ˙ ]vGuu}vv]vP b U`R]R]v]]}b˙o}(]v(}vv(R ]vP b ob}uvv]o}vv}vR]oòoR]lv]vPXTR ubo]v]vP}(Rb]`˙b}u}o}v]˙]vPv }]}b u}vb }( ov v }Lv }+vb] buX TR ]bbU ]( v} ]b R] ˙ (v ]v( ˘}vb `]R }Pbb]o˙`}bv]vPovP(v}vX sueCa yy CR]oR}}vu}v]XPX`R}}]vP}PRU}bubob yy P}brou}v˙o}b]b yy CR}v]R]v}b]vb]b`]R}brvbo] yy Ru Ab vOPD C yy F]}b]vPovP]bb}(v˙bXPXRu}]ovP]bb yy Iuuv.]v˙bXPXHIV ]v(}vUPuuPo}o]vu] yy IvR] ]b}b XPX ˙b .}b]bU ]u˙ ]o]˙ ˙bl]vb] bR}o}vb]]v˙}vPR]ovbvvP`]R}vR]b]b Symptoms yy Pb]bv}PR}uv˙u}vRb yy C}]}bovbu`R]R]bb}uub}+vb] yy Hu}˙b]b ]v}}vR]}(b]vP˘}vb yy Ivu]'v˙bb u]˙u}ub b r(Uv]PR`bb v`]PRo}bb yy Chest pain yy D]8o˙]vR]vP Signs yy W]PRo}bb Standard yy yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw F Co]vP Doob]}vv} }vR]o B Rb}vb C}b]}vb v*Bonc r hiectasis*v Invtiga se tions yy FBU C SR E yy Suovbvb]]˙UPu]v b yy SuAFBb yy CRbXr˙ yy CT scan of the chest yy Pob}˘]u˙ Trtme ae nt Tuv}ib yy T}]v(}v yy T}]buov yy T}u]v]u]}PRvbu}}v yy T}v˘}vb yy T}]Pv}bvvo˙]vP]b}b Non-pharmacological treatment yy CRb R˙b]}R˙ r P}bo ]vPU Su ov techniques yy R]vP B ˘]bb yy Iu}v]}v yy Ev}PG]]vl yy Ev}PR˙b]o˘]b Pharmacological treatment AX]v( A ˘}v st L]vTuv ]v E RvPPC yy Au}˘]]oo]vA=Coov]A] U}oU Adults PR}o˙(}W˙b Children AN˙bV OvælæoR}o˙ vr˙bV æuo}(læwbvb]}vR}o˙ rv˙bV Xæuo}(læwbvb]}vR}o˙ u}vRr˙VXæuollP}˙`]PR}(æl bvb]}vR}o˙ AMu}vRV XæuollP}˙`]PR}(æl bvb]}vR}o˙ Av yy A]R}u˙]v U}oU~(}vbooP]}v]]oo]vUP]vbu}v} R˙Z r Chatep rP *Disorsof der theRespirtor a ySystem Adults æuP}v]o˙(}vr˙b Children uP llP}v]o˙(}vr˙b Refeal r Criteria R(oob} b]o]b(}}v.u}vv(R uvPuvX vX LvPbA A ovP b ]b .v b v}b]b }( R ou}v˙vR˙u v (}u}v }( ]b }v]v]vP v} b } ov G]U boo˙ b ˙ u]}]o ]v(}vX Av]} uvPuv bR}o }vb]b}}vb]]b]Pv}bU`R]o`]vP}v.u}v}(R }Pv]b b uvub}vv(}rv`lbX sueCa yy yy yy yy yy yy yy Symptoms yy F `]R`]vP]vP b ub yy C}PR U } }( }]}b u}vb }( ov (}o buoo]vP bu yy Hu}˙b]b yy Chest pain yy Rob B bvbb yy ˙bE (P]o]˙ Signs yy F yy Tachycardia yy Tachypnoea yy CRbòovvbb yy Doob]}vv} ı v*Lungs*ceAb v yy yy Ab]}v}(]v(}vb b }(}u b Ru}Rv b]}˙]vRv}vb]}b}bu]r}vb]}bvXPX]v o}R}o]bU]obUvbRb}vovb F}]Pv}˙b]}vXPX]vRovUvbU.bR}v Ivo˙ ]o vu}v] b]oo˙U Pu vP ] o]l Klebsiella pneumoniaeU v rRu}o˙ streptococci Staphylococcus aureusb]vPuooovPb PvovP]vi˙ Po}b}v}(v]`˙˙u}}o˙uRv} S u}o] (}u }R ]v(b }( R }˙ XPX ]PRb] ]ov}]b }vR]b B ]b Iv(oo]vR}v]ovP]bb Standard yy yy Trtme ae ntGuidelinesUwthEditionUw D]u]v]bRRb}vb Ivb}ob}vv Invtiga se tions yy FBC yy Suovbvb]]˙UPu]v b yy SuAFBb yy CRbXr˙ Trtme ae nt Tuv}ib yy T}]v}oo}v b yy T}vo˙]vP]v(}v yy T}]b}b]vP}v]}vb Non-pharmacological treatment yy Chest physiotherapy yy Iu}v]}vob yy EvbG]]vl yy SP]o]vP}(b Pharmacological treatment v*Lungs*ceAb v AXIv]ouv st L]vTuv ]v E RvPPB yy Co}˘]oo]v UIVU Adults æuPvR}o˙(}`lb Children ær˙bV ræ˙bV AM˙V Av yy Au}˘]]oo]vA=Coov]A] Adults XPR}o˙(}`lb Children u}vRbr˙bV AMu}vRbV yy yy æuPvR}o˙(}r`lb æuPvR}o˙(}r`lb vXæuPvR}o˙(}r`lb UIVU uP llPR}o˙Uu˘XXPR}o˙ uP llPR}o˙(}r`lb Av L]˘}v C UIVU Adult P]o˙(}`lb Children AooPbærwæuPllP˙]v]]R}o˙}bb(}`lb Or Gvu]]v UIVU Adults ı Chatep rP ruPR}o˙(}˙b Children r˙bV AM˙V yy yy *Disorsof der theRespirtor a ySystem XæuP llPR}o˙(}˙b XæuP llPR}o˙(}˙b Av M}v]}o UIVU Adults æuPR}o˙(}`lb Children wXæuP llPR}o˙(}`lb Or Co]vu˙]v UIVU Adults rvuPvR}o˙(}`lb}voo]v]o]u}uv Children rvuP llPvR}o˙(}r`lb ı v*Lungs*ceAb v BXC}vv}vuv yy Foo}˘]oo]v U}oU Adults æuPvR}o˙(}`lb Children ær˙bV æuPvR}o˙(}`lb ræ˙bV æuPvR}o˙(}`lb AM˙V vXæuPvR}o˙(}`lb Av yy Au}˘]]oo]vA=Coov]A] U}oU Adults PR}o˙(}r˙bX Children AN˙bV OvælæoR}o˙ vr˙bV æuo}(læwbvb]}vR}o˙ rv˙bV Xæuo}(læwbvb]}vR}o˙ u}vRr˙V XæuollP }˙ `]PR }( æl bv b]}vR}o˙ AMu}vRV Xæ uollP }˙ `]PR }( æl bv b]}vR}o˙ Av yy Co]vu˙]v U}oU Adult uPvR}o˙(}˙b Children ANu}vRbVæruP llP l˙U]v]]}bbU ~M]v]uu}brv}obbRvuP l˙Z Refeal r Criteria R( } b]o]b } R]PRroo (]o]˙ ]( R ]b v} o]v]o r r Standard Trtme ae ntGuidelinesUwthEditionUw ]u}uv`]R]vR.b`lb}(]v]vPv]}R˙X v*Lungs*ceAb v ı Chapter Disorsof der theCentral Neouvr sSystem ı 65. Headache Headache]b˙b }vU]bouvU]vGuu}vUbo bu } ]bvb]}v }( R ]v bvb]b ]v R R } vlX HRbRv`]v}vbvoo˙]+v(}uv˙Rv Rb ˘]v ]}bo˙ }uu}vo˙ ˙u}u b }( b]}b ]oovbb v R(} uv }u o}vX TR ]]vP (}bU b}]˙u}ub b v o]v]o.v]vPb }v˘u]v}vU}PR`]R Rbob}(}]]vbP}vbUv}]P]}Rb }(RRRX sueCa A yy SRv}]Ru}RPv}R}bo]bb yy Iv(}vbXPXuo]U˙R}]( yy Mv]vP]b }vRo]b yy Oo]b}b~Po}uU]]bU(}bZ yy P}brb]b yy P}brouv yy Hypertensive encephalopathy Subacute yy Lb]}vb}(Ru]o~}bu] yy Ivv]oubb~u}Uob Ru}uUbZ yy I]}R]]vv]oR˙vb]}v yy T]Pu]vovoP] yy P}brRvoP] yy Severe hypertension yy Atypical facial pain yy M]}v yy P}bu yy G]voou}o]b Chronic yy M]P]v yy Cluster headache yy Tension headache ı U]o]v(}vb Uub}]]bZ Standard yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw Cervical spine disease S]vb]b Dvo]bb Pb˙R}Pv]b v*Hechead *v Symptoms yy V]boXPXR}}R}]UGbRb}(o]PRUG}b yy XP A X]boU]}˙UPb}˙Uo yy }uv˙]vP A (bXPXvbU}u]vP yy S]}(]vXPX}]]oU}oUv]ooU]oo yy CR]bbXPXobvPUR}]vPUbRUoo yy Ro]]vP}˘vP(}bXPX}PRU}]bUo˙]vPG Signs yy Uboo˙v}v yy L}ovvbb yy F yy Nl+vb b b yy P}b]Kv]Pb yy Markedly elevated blood pressure yy }`b D ]vbb yy E˘bb]o]u}v yy C}vivovbb yy P]oo}u yy F}ov}o}P].]XPXv]ov.]URu]b]b Invtiga se tions yy FBC yy ESR yy SlooXr˙ yy C]oXr˙ yy Xr˙}(Rvbob]vbb yy Luv~uv]vP]b URv}] b oZ yy ˙E b~}v}u˙U(}vU(v}b}˙Z yy v]o C CTv b }MRI](`v Trtme ae nt Tuv}ib yy To relieve pain yy T}]v(˙vvo˙]vPb yy T}v}uo]}vbovP}Rvo˙]vPb yy T}]u}o]˙}(o]( Non-pharmacological treatment yy Ro˘}vRv]b yy Avoidance of stress yy Pb˙R}R˙ yy Iv.}vvo]u]v}v}(]PP(}b ı U(U}oob Chatep rıP *Disorsof der theCentralNeouvr sSystem Pharmacological treatment æræuPvrR}o˙ ræuPvrR}o˙ vruPvrR}o˙ æuPR}o˙ v}}uuv v*Hechead *v AX˙u}u bA uv}(RRb st L]vTuv ]v E RvPPB yy Pu}o U}oU Adults æuPrPvrR}o˙ Children vr˙bV ræ˙bV u}vRbr˙V Or yy D]o}(v U}oU Adults æuPR}o˙}uPR}o˙ Children AN˙bV AM˙bV Or yy I}(v U}oU Adults uPvrR}o˙ Children vr˙bV ræ˙bV u}vRbr˙V Or yy Tu}o U}oU Adults æruPrvR}o˙~u˘XuP]o˙Z Children AN˙bV AM˙bV ruPvrR}o˙ ruPvrR}o˙ v}}uuv æruPrvR}o˙ v}}uuv BXP}R˙o˘]b(}M]P]v headaches st L]vTuv ]v E RvPPB yy P}v}o}o U}oU Adults Iv]oVuPR}o˙Uu]vvvVruPR}o˙ Children Iv]oVruPR}o˙Uu]vvvVruPR}o˙ Refeal r Criteria R(vUvb}o]vP}v˘o]vRRb}b]o]b (}o}vv}]uvPuvX ıæ Standard Trtme ae ntGuidelinesUwthEditionUw 66. Seizures v*Seizs*ure v A b] ]b o]v]o v b ˙ vb]v ]bv }( ]v (v}v } v v}uo }˘˙buo v}vo ]bRP ]v R ]vX I( Rb ]b}b v `]R} v ]v.o bU R˙ }uu}vo˙ b] b ]ob˙ X TR u b ]ob ]b b (} b]bU `R]R } `]R} R v P]v]vP }vb]}bvbb `v 'lbX ~S b}v }v RE]ob˙ ]ob[ZX TR o]v]o bv}v vb }v R }( R]v +X Pvbu˙b}uubb]R`v]vPb]Pvob~u}}u }ZU`R]RR˙˘]v(}RvX]o A b]}v ˙`]vbb]bl˙X GvovbRb]vvo}vu˙]]vb v`RR]PR}bb}(v}vobvb]X sueCa yy C}vPv]oUvo}]vo]vi˙ yy FbU b]oo˙ ]v R]ov P v u}vRb } v ˙b ~(]o convulsionZ yy oC uo] yy Iv(}vbXPXuv]vP]b UTBUHIV Ub]vR]v yy M}o] bP R˙}Po˙u]U R˙}ou]U R˙}vu]U R˙}bu}o]U b u]UR(]o yy I]}R]]ob˙ ~Sb}v}vRE]ob˙ [Z yy oub E ] yy Vbo ]bbP R˙vb] vRo}R˙ U }l b ]v(}v yy S}˙]vPob]}vbPu}}uo(}u}vb}(R]v yy Hu yy DPbv}˘]vbPo}R}oUvbbvbUu}v]}oUPv o}R}o`]Rò yy DPv]bbXPXuv yy Pb˙R}Pv]P~Sb}v}vRPb˙R}Pv]S]b [Z Symptoms yy L}bb}(}vb]}bvbb yy T}vP]vP yy F}u]vPRu}R yy Iv}vvv}(}}o b vl}]v yy A ~u˙ ]vo vP b P (o]vPU b}u}bvb}˙ uv](b}vb r ]boU }o(}˙U Pb}˙ } ]}˙ XPX vP b buooblGbR]vPo]PRbZ yy Mbo`]R]vPvu}uvb`R]Ru˙(}o}Pvo] yy ALb]URvu˙}v(b~}br]o}v(b]}v}Z u˙bo(}b}uu~}br]oboZ ıv and Status U u˙}]o Chatep rıP *Disorsof der theCentralNeouvr sSystem AXS]b A yy ~]uu]uPv˙ubbZ L]vTuv ]v E RvPPA O˘˙Pv ˙B vbo}vPbUrvLlu]v Or FublUrLlu]v Or N}vrRublUræLlu]v st ıw v*Seizs*ure v Signs yy }}u A }`]R}ubu~o]bul]vPU]l]vP]ubZ yy Mbo`]R]vPvu}uvb`R]Ru˙(}o}Pvo] yy P}br]obo yy P}br]o}v(b]}v yy T}[bo˙b]b (strokero]l`lvbbZu˙o˙} yy E˘u]v (oo˙ (} ]v }( v}o}P]o o}o]]vP b]PvbU }vPo}vv]v}(u}R(}}Rb of the body Invtiga se tions yy FBU C SR E yy Bo}}Po}b yy BUE yy Co]u yy LFTb yy CRbXr˙ yy Eo}vRo}Pu~EGE Z yy CTv b ~RZ Trtme ae nt Tuv}ib yy T}}b Rb] yy T}vo˙]vPb yy T}v]vi˙ Non-pharmacological treatment yy M}bR}ibU.X`˙(}uv]vPb]b yy Evbo}R]vP}vRvl]bo}}b yy EvbR]`˙]boU`]}b}vv˙}vb b }}u]b (}uRu}R}v}bX yy D}v}(}b}}v}}vPb}]v}u}RJ yy Ru}(obR](bv yy AL }vob]}vb bU v R v ]v} bu]r}v }b]}v ˙ v]vP R v }v R b]U `]R }v oP v v R }R oP]PR b yy M}v]}.b~.bRZ Pharmacological treatment Standard yy yy v*Seizs*ure v yy yy Trtme ae ntGuidelinesUwthEditionUw Av L}u Ubo}ÌVU Adults uP b ]vPo }bU }v L u]vb ]( vbb˙X G]v]v}oP]vbo}ò˙}ræu]vbX Children r˙bV uP b b]vPo }bU }v L u]vb](vbb˙XG]v]v}oP]vbo}ò˙}ræu]v bX u}vRr˙bV u]}PullP ~u˘X uPZ b b]vPo }bU}vLu]vb](vbb˙X NeonatesV u]}PullP ~u˘X uPZ b b]vPo }bU}vLu]vb](vbb˙X Or M]}ou UIVU Adults æru]}PullPUu˙˙ræu]vb]b Children u}vRr˙bV ]v]oo˙ ær u]}PuU (}oo}` ˙ (}oo}` ˙ }vv}b ]v(b]}v }( v u]}PullP R}X M˙ ]vb ˙ v u]}Pu llP R} ˙ æ u]vb vo b] }v}oo b X~u˘Xu]}PullPR}Z NeonatesV ær u]}PullP (}oo}` ˙ }vv }b ]v(b]}v }(vu]}PullP R}XM˙]vb˙vu] }PullPR}˙æu]vbvob]b}v}ooX ~u˘Xu]}PullPR}Z Or M]}ou UoU Adults uP RLu]vb](vbb˙X A R] }b ub v} P]v b}}v Rv R}b L R b }v}bX Children vu}vRbr˙bV ræu]}PullP~u˘Xb]vPo}b uPZ RLu]vb](vbb˙X R] A }bubv}P]vb}}vRvR}b v LR}v b }b]vR]ovAMlPX nd L]vTuv D]u UIVU Adults uPbo}ò˙}ru]vb~}˘]uo˙XæuP˙ b }vbZ Children ru]}PullPbo}ò˙}ru]vbX TR]bu˙u]vbo](R.}vvbX Or r r r r r r ı Chatep rıP yy *Disorsof der theCentralNeouvr sSystem D]u UoU Children AN˙bV XuP llP vr˙bV XuP llP rv˙bV XæuP llP u}vRr˙bV XæuP NeonatesV XærXæuP TR]bu˙ u]vbo](R.}vvbX~u˘X uPZ Note 9-1 I(o(}uo}v]bv}]uu]o˙]ooU`R]vio(}u ]o˙ ]v} ˙]vP b v u]v]b ] ]v} R u ~L u}]vP R voZX Note 9-2 M˙]b R˙Ru]b](P]v(bRvæuP lu]vX C}vırX N u]˘ Rv˙}]v `]R æA9 ˘}b D IvbURv˙}]vub]vN}uoSo]v yy U } u]v]u]b R ]bl }( ˙boo]b}vX X Or PRv}]}v UIVU Adults r uP llPU }b u]v ]vob ]( vbb˙ ~u˘X }o}buP llPZ Then ~bvPR}bL]v]o}bZ ıı v*Seizs*ure v BXI(b]b}vv~SbE]ob Z yy PRv˙}]v UIVU~`]RGCE u}v]}]vPZ Adults æ uP llP bo}ò˙ v} P Rv æ uP lu]vX ~u˘X P o}]vP}bZU Then M]vvvUuPvrR}o˙ Children r˙bV]v]oo˙UuP llPbo}ò˙v}PRvæuP l u]vX Then M]vvvUæruP llP]o˙~u˘XuP]o˙Z ru}vRb v V]v]oo˙UuP llPbo}ò˙v}PRvuP l lP lu]vX Then M]vvvUXæræuP llPR}o˙ NeonatesV ]v]oo˙U uP llP bo}ò˙ v} PRv uP l lP lu]vX Then M]vvvUXæræuP llPR}o˙ Standard Trtme ae ntGuidelinesUwthEditionUw XærXæuP llPrR}o˙ Children u}vRr˙bV uP llPv}u}RvuP llP l u]vXRLæu]vb](vbb˙X Neonates Iv]oo˙UæruP llPX b M˙ }b }( ær uP llP u]v ]vob ~u˘X }o }buP llPZ Then ~bvPR}bL]v]o}bZ ruP llPR}o˙ Refeal r Criteria I( b]bu]v v}v}oo `]R]v u]vb L R˙ PvU ( ]uu]o˙ (} b]o]b 'v}vX N} R }˘˙Pv}v bR}o }vv]vPvb(X 67. Epilepsy v*Epileysp *v Epilepsy ]b ]b} }( R vo v}b ˙bb u ~CNSZU `R]R ]b R]˙b}vv}bvb]b}Rvv˙}R b]bXE]ob˙ ]bv}òbb].bGvo]~}v]Uo}v]UbvU }v]}u˙}o}v]Z`]Rvo}bb}(}vb]}bvbb}F}oX T]}voo˙U b]vPo b] Rb v P b v ]v]}v (} ]vbP}v v buvU v} (} P uv vobb R ]ubvb}(Rb]vbb]]X DPuvbR}o]vo˙}vb]L`}b]bU} ](R}v b b](}oo}`bo}bo˙(}uR.bXTR˙}(Pb vb}vR˙}(b]X DP uv }( ]ob˙ bR}o P] ˙ R (}oo}`]vP Pvo ]v]obX BP]v `]R b]vPo P R o}`b }bP vP v ]vb }b Poo˙ } R o]u] }( }bP vP } vo b]r+bU](b]bv}}v}ooX Sbvo˙U ]( b]b oo b u]v v}v}ooU RvP } ]+v P ˙ Poo˙ ]vP R }b }( R ]v]o Pv `R]o b]uov}bo˙]v}]vPRv`}vXTR]bboo˙lbr`lbX T˙ R b Pb ]v R]b (bR]}v ]( v} o]v]o b}vb ]b }bU(}b}vP}P}u]v}vbX Av}vobv Puvv }oo˙ `]R`v ~Poo˙Z ]vv`]R]ob˙ }vo˙Lr˙b]r(]}vL (ooo}vv]bb]}v`]RRvX Pvb `]R ]ob˙ should be advised not to drive a vehicle if v} . } b]r(U `]u b o}vU `}l R]PRbU } uR]vbU}}l˙}v.o}vUv}]vPbo}R}o˘bb]o˙X sueCa yy I]}R] Chatep rıP *Disorsof der theCentralNeouvr sSystem Symptoms ~Sb}v}vRS]b [Z Signs ~Sb}v}vRS]b [Z Invtiga se tions ~Sb}v}vRS]b [Z Trtme ae nt Tuv}ib ~Sb}v}vRS]b [Z Non-pharmacological treatment ~Sb}v}vRS]b [Z Pharmacological treatment v*Epileysp *v AXMvPuv}(E]ob˙ rGvo] A b]b yy PRv˙}]vUIVU Adult ræuP llPX b }ru]vb Then uPvrR}o˙PRN Children ræuP llP Or yy PRv}]o ~]o˙ZUIMU Adult vruPv]PR Children XæræuP llP]o˙˙bo}ÌV}}o Or yy Cu]v Adult ruP}v}R}o˙ Then IvbPoo˙}XrXPrR}o˙ Children u}vRr˙bV XæræuP llPv]PR}R}o˙ Ivb`Rvvbb˙ Then ~u]vvvZ æuP llPrR}o˙ Or yy S}]uo} ~R}o˙Z Adult vuP~u˘XPZ Children AN˙bV vuP~u˘XPZ u}vRr˙bV ræuP llPU]o˙}`}]]}bb Then ~u]vvvZ Standard yy yy Trtme ae ntGuidelinesUwthEditionUw æruP llP]o˙]v`}]]}bb Or Lu}]P]v Adult æræuPR}o˙ Children æræuP]o˙ Or Lu Adult æræuPR}o˙ Children æræuP]o˙ v*Epileysp *v BXMvPuv}(E]ob˙ rGvo]bvb] yy S}]uo} ~rR}o˙Z Adult vuP~u˘XPZ Children AN˙bV vuP~u˘XPZ u}vRr˙bV ræuP llPU]o˙}`}]]}bb Then ~u]vvvZ æruP llP]o˙]v`}]]}bb Or yy R}b E ˘]u] ~]o˙Z Adult æuP R}o˙U]vb˙æuP˙ær˙bw }rXæP]o˙ ]v`}]]}bb Children ANv˙bV æuP R}o˙U]vb˙æuP˙ ær˙bw }rXæP]o˙]v`}]]}bb u}vRrv˙bV æuP llP~u˘XæuPR}o˙Z CXMvPuv}(E]ob˙ yy Cu]v U}oU Adult ruP}v}R}o˙U Then IvbPoo˙}XrXPrR}o˙ Children u}vRr˙bV Ivb`Rvvbb˙ TRv~u]vvvZ æuP llPrR}o˙ yy Or S}]uo} Adult vuP~u˘XPZ Children ~rR}o˙Z rF}ob] XæræuP llPv]PR}R}o˙X Chatep rıP *Disorsof der theCentralNeouvr sSystem AN˙bV u}vRr˙bV Then ~u]vvvZ XæræuP llPR}o˙ Note 9-3 WR]oobo}òb}vb( Aoo vb `]R ]ob˙ ˙RPRu]bX vuP~u˘XPZ ræuP llPU]o˙}`}]]}bb bR}o ] }vv}b }v v }vboo]vP Refeal r Criteria R(oovb`]R]vob]b}Rb]o]b 68. TRUv}vb]}bPv sueCa yy yy yy yy yy yy yy yy yy yy yy yy Iv(}vbXPXuv]vP]b Uouo] H˙}Po˙u] ~]bro}o}R}o]vZ D]l}]}b]b SR˙vb]}v`]RvRo}R˙ }bC oA]v~CVAZ}}l b DP ]vPb}v } }}b XPX o}R}oU bo]˙obU ]bU cocaine Eo}o˙]uov Epilepsy rb]ob H]vi˙ Mi} }Pv (]oXPX R(]oUvo (]ov u˙}]o ]v(}v H˙}˘](}uvu] b P}]b}v]vPXPXl}bvU]bb UR]]b Symptoms yy Dvb}vRvo˙]vPb~S}]b}vbZ Signs yy Dvb}vRvo˙]vPb~S}]b}vbZ Invtiga se tions Tests depend on suspected cause yy FBC yy BF(}MPb yy Bo}}Po}b yy Uvo}o˙b v*TheUnconsciousPatient*v Uv}vb]}bvbb ]b}uu}vo]v]o}ouvu˙b}] `]R]b}( b ob }Pvb]vR}˙XTR}( b v}vb]}bvbb ]b }Lv v} ]uu]o˙ ]vU v ˙bb u }R } ]b ]Pv}b]bvuvPuv]bR(}]u}vXO]v]vP R}}PR R]b}˙(}u}uv˙]vPobU(]vbvR}o]]bbvoX Standard yy yy yy yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw L](v}vb Bo}}ovbvb]]˙ U]vovbvb]]˙ ECG T}˘]}o}P˙PPvb Uo}R}ooob Luv Head CT scan v*TheUnconsciousPatient*v Trtme ae nt Tuv}ib yy T}b}o](vo}vb]}bvbb]bP]v yy T}v}uo]}vbXPXb]}vUR˙}˘] yy T}u]vRvo˙]vPbvuvP]}]o˙ Non-pharmacological treatment yy EvbR]`˙]bvvo}(}vb b yy E˘u]vv]o] b R]ob]v](v˙R]b}˙}b]Pv}(]vi˙ yy R]b C vu}v]}]v}](vbb˙ yy PoRv]v }b]}v R`}ovb]}v]vb }(}u]vP }bvNG](v}}v]v]}vb˘]b Pharmacological treatment ToırP) G]}Ru}o}P]ouv}(Rv}vb]}bv C}uo]vb D]Pv}b]b A}v H]b}˙}(]bUb }(}ovr]} ]vPb}v}(o}R}o H˙}Po˙u] ~S}v b }vRH˙}Po˙u][ H]b}˙}(]vPb}v}( u]}v~ob} o]]ZXTRu˙ buoo}(o}R}o}}R substance on breath DP}}bXPX Alcohol S}b]}v Z IV˘}b D A9æruo }vR˙}Po˙u]XIv R}v]o}R}o]bXPIV ˘}b D ˙IVlIMTR]u]v uPIVURværuPIMvo P]vb}vb]}bvbb Pu}o SNr˙o˙b]v ]v]o}`Zv( IV}vv}b]v(b]}vP B}˙`]PRANlPP uo}(˘}b D æA9P]v} æu]vUF}oo}`˙ (as Chatep rıP C}uo]vb *Disorsof der theCentralNeouvr sSystem D]Pv}b]b A}v æuP llP]væuo}(˘}b D æA9}R}bX Then uP llP]væuo}(˘}b D æA9}vR}bX CR]ovAMlPP æuP llP]vuollP}(˘}b D æA9P]v}æu]vX F}oo}`˙æuP llP]vwuol lP}(˘}b D æA9P]v} R}bX TRvuP llP]vuo}( ˘}b D æA9}vR}bX D]l}]}b]b ~S}v b }vDKAZ H]PRrP(U b]bURRU vl+vb b bUo }vb]}bvbX b Mv]vP]b T`]R}]v]}b vvruo]ovo]R ]Pv}b]b}v.uX ~S}]b}vZX History of previous b]bUvb }vb }(}vob]}vbV`]R} `]R}]v}vvvX E]ob˙ G]D]u ru]vbZU}}b]b v}vv}`]R b vr]oPuvX ~S}]b}vZ Pv`]Rbv onset of paralysis of one b]}(}˙X Stroke Check blood pressure and blood Po}bX~S}]}v b Z Pv`]R R˙vb]}vU RRbUb]b Hypertensive vRo}R˙ Check blood pressure I(ANluuHPUP]}o} vovrR˙vb]} BPPoo˙ Sudden onset associated `]R]R˙Ru] }u}}vo]b]bX Syncope Uv}vb]}bvbb P}u`lv]vP}bX M}v]}]ob]PvbUGCE Reassure Cerebral Malaria æ v*TheUnconsciousPatient*v Pbv}bv }(R]b}˙}(]bV }o˙]U}o˙]b]X H˙vo}vU Po}vb}(]oovbbU ]v}(]v(}v U]vbPvl}v }b] Bo}}Po}bAN uu}olL UIV~bo}ò˙} ]bboo˙](X Standard Trtme ae ntGuidelinesUwthEditionUw C}uo]vb D]Pv}b]b A}v H]b}˙}(]vi˙U} o}R}o]buUb]Pvb}( u HIvi˙ To}vbUS]o]bC]o spine Xr˙bloo(}(bUH CT scan History of heavy alcohol ]vPb}v}uv˙ ˙bX H]b}˙}(iv] vPo}vb}( RvPb]vbvb}]u HF]o MvPbR encephalopathy D]R}b]bU}o ouu˙bl]vU`l pulses Shock H˙}}ou] Hu}RP] ]}Pv] C S ~S}]b}vbZ ~S}]b}vZ v*TheUnconsciousPatient*v Refeal r Criteria R( } b]o]b (} (R .v] uvPuv ]( v} b}v]vP}vb ubb}(b]}vX v Chapter PsychiatricDisorsder 69. 'v}v A .] D H˙]˙D]b} ~ADHD 'v}v A .] D H˙]˙ D]b} v}R]}o ]b} +vP R]ovX I u˙ bv ]v ]v(v˙ v v }vv ]v} oR}}X I +b ærA9 }( R]ov v vo˙ Rubuv˙ b }˙bP]ob b XNo˙Ro(RR]ovbvvP`]R ADHD u˙ob}Rvb}]ov]vP}ouX TR u ]b }uu}vo˙ o] `}vPo˙ } R v}uo R]o `R} ]b o`˙b }v R P} v v b]b oo b X R}Pv] b }( R˙]˙ ]v R]ov ]vo v}uo ]}vU }}u } vbuo}v } ˘bb]]v b Uov]vP]8obUbuUob]bvPb o]lo}vuURv}]}vvRv˙}]v ADHD ]b ob} `}vPo˙ '] } }} vvPU }} uR TVU }}bR}}obU}}R}uv]}vuvU˘bbP}(}}ooP]bX N} b]. b }v.u ]Pv}b]b }( ADHD v}o}P]o ˘u]v}v ub }v ]v oo bX TR R]}o .]bv˘bR b }vb]Pv}b]b}(ADHDubvb ]vuoohvPb b bRbR}uvbR}}oX sueCa yy Uvlv}`v yy Related factors: yy Hereditary yy Iuov}(v}vbu]'b Symptoms yy Iv'v}v yy R]o}Lv(]ob}.v]bRR]vPbR}bRb yy }Lv}bv}bu}o]bv yy Rb]8o˙}vvvP}vbR}}o`}l yy Iuob]]˙ yy R]o}Lv(} b R]vl]vP yy R]b}Rb`Rvb yy ]v]o]˙}`](}R]b}Rv]vPu yy vPPb ]v vP}b ]b `]R} }vb]}v }( R consequences w ) ]b R u}b }uu}v X X A (oo R˙b]o v Standard yy yy yy Trtme ae ntGuidelinesUwthEditionUw Rb]8o˙}Pv]]vP`}l~R]bv} }}Pv]]u] uvZ H˙]˙ yy R]o]b}}ob R]vPb}v yy olb]vbbvo˙U yy PPob b }b]oo b blv.Pb D]b]o]˙]b]v˙ yy v}o]bv]vP`Rvb}lv} yy v]vo]v}v}˙u yy v}]vPo}`}l]vvvo˙ yy ]b}Pv] v*AttentionDeficitHypctiv aer ityDisorder~ADHDZ*v Signs yy S]u]o}˙u}ub b } Invtiga se tions yy Uboo˙v}v Trtme ae nt Tuv}ib yy T}R˙]˙ yy T}]u}'v}v yy T}]u}}uo]v}]vb}v Non-pharmacological treatment BR]}uvPuvRv]br]v E RvPPA yy A obb Ro ]v obb} b] `]R R]o v (}b'v}v} bR}}o `}l yy PvvPob}b Rovb} yy Db]b(}uv]R˙b]o]vv}vbXPXv]vP Pharmacological treatment st L]vTuv ]v E RvPPA yy MethylphenidateU}oU Adults uPrR}o˙~u˘XvuPZ Then Ivb`lo˙˙æruPU](vbb˙U}u˘X}(uPR}o˙ Children vr˙bV XæræuPR}o˙ Ivb`lo˙˙æruPU](vbb˙U}u˘X}(uPR}o˙ rv˙bV XæuPR}o˙ Ivb`lo˙˙XæuP]o˙}u˘X}(XuP llP](vbb˙]v }]]}bbX AM˙bV v}}uuv Or yy }u}˘v A U}oU Adults r Chatep rP *PsychiatricDisorsder uP}v]o˙(}˙bw Then Ivb}]vP}b}vb}u˘X}(uP Children ANv˙b~`]PRANwlPZVuP}v]o˙(}˙bw Then Ivb}]vP}b}vb}u˘X}(uP ANv˙b~`]PRAMwlPZVæu]}PubllP]o˙(}˙bw Then Ivb}]vP}b}vb}u˘X}(XuP llP]o˙ AMv˙bV v}}uuv 70. TRo˙ A D]bPv TR o˙ ]b v bvb ]v v ˘]U P] } PPbb] X b TR u˙ ob]}vb v o RvPb o]l Roo]v}vb R }`Rou R vX D]b}]v}v v o}v ]v }vb]}bvbb }Lv }u]vv `Rv R b ]b }Pv]X TR vbboo˙}PR]v]v b ˙u}Rv}vb}v}˙ R }o]X TR}v]}v ub Pb v uPv˙ b]v (` }voo˙ b (oX sueCa ~Fv}vo A ZPb˙R]]D]b}b yy Mv]}R˙}uv] yy SR]}Rv] and like states yy OR˙R} b ]b}b yy AP]b]}v yy Acute psychosis ~OPv] A ZPb˙R]]D]b}b ı v*ThecuteA lyDisturbedPatient*v nd L]vTuv ]v E RvPPB yy Iu]u]v U}oU Adults wæuP]o˙ Then Ivb}æuP]o˙](vbb˙~u˘XuP˙Z Children vr˙bV ruPR}o˙ Refeal r Criteria R( } o]v]o ˙R}o}P]b b (} R]} uvPuvX Av }}vo R]bU u]o RU bR R]b (}oo}`]vP vbbuvX R(}b]o]b](R]bv}o]v]o]u}uvLu}vR }(R}}uuvR˙X yy Standard Trtme ae ntGuidelinesUwthEditionUw T}˘] ˙R}b b ]b }v˙ b } P ]v}˘]}v ~uRu]vbU cocaineUu]iv UR}]vXZ yy Av}uo}v}o}R}o]Iv}˘]}v yy Ao}R}o]W]RòS˙v}u~o]]uuvbZ yy Iv(b XPX ˙R}]U uo]U uv]vP]b Rb M}o] A D]b}b yy H˙}Po˙u] yy Thyroid disease yy P}R˙] Others yy Hu yy SoRu}u v*ThecuteA lyDisturbedPatient*v Symptoms ~Sovb}vb(}˙u}ub b }(b].]b}bZ yy Sleeplessness yy RbobbvbbrP]}v}uv yy Tol]vP ˘bb]o˙ v o}o˙U } o}` }vU bRU v u]vb}ub yy D]b]vR]]R]}}bR yy H]vP}b]vPS]uP]v˙ _}o}}ibX yy E˘bb]}v }( (U v b]]}vU ]v}] P]o } ] beliefs yy vbDb b Signs ~Sovb}vb(}b]Pvb}(b].]b}bZ yy EoU]]oUvP˙}bu}} yy PR˙b]oPPbb]}vUP]}v}obb bvbb yy Ll}(]vb]PR yy Pb}b bR yy H˙]˙}u}}]˙ yy D]b]vR]]}vrb}]ov˘o b yy Dob]}vb }(PvUP]o}v}] yy A]}˙Roo]v}vb yy V]bo Roo]v}vb ~b]oo˙ ]v }˘]U ]v(}b v `]Rò Zb b yy F ~]v(}v]}vbZ yy }`b D ]vbbUo}vb]}bvbb~u]vo˙]vo}R}o`]RòZ yy D]b}]v}vv}v(b]}v~u]vo˙]vo}R}o`]RòZ yy S`vP yy Tu}b~u]vo˙]vo}R}o`]RòZ Invtiga se tions yy Uboo˙v}v yy U]v vb ~(} vbb o]l uRu]vbU }]v vv]bZ U HIV U vRo]bU U R}]vU Chatep rP yy yy yy FBU C R]D]Pv}bTb v]v(}vb b Z Rv}uBo}}SP Bo}}o *PsychiatricDisorsder (}uo]b]b~`RvR]b( Note 10-1 PvbR}o`]R b }}ob}}vb}bb]o yy Then HaloperidolU}oU Adults ræuPrR}o˙~u˘XuP˙Z Children AN˙bV ˙Z r˙b~ærlPZV AM˙bV Or ræuPrR}o˙]b ~u˘XuP XærXæuP˙~u˘XXæuP˙Z v}}uuv v*ThecuteA lyDisturbedPatient*v Trtme ae nt Tuv}ib yy R]v]o]b}vr}ou}`vRv]lo˙ b }bb b]o b]vPR(bb Pb]oo`]R}vbb]o˙]v]vPbo yy T}vo˙]vPb Non-pharmacological treatment yy Rb]vv`Rvvbb˙`]R}b]vP]vi]b yy Tol}Rv]v.ub]vPuvv yy }] A o}vP]}b}(b]ovb]oo˙]vv}]vb yy Ru}v}b `˙v˙}+vb]`}vb}v}}vvX Pharmacological treatment ]v E RvPPC yy L}u UIVlIMU Adults ruPX b R}vLu]vb](vbb˙X Children AN˙bV æu]}PuruP~u˘XuPZ AM˙bV æu]}PuruP~u˘XuPZ Or yy HaloperidolUIMU Adults ræuPX b u˙]vrR}b~u˘XuP˙Z Children r˙bV ræuPrR}o˙]b vr˙bV r uP r R}o˙ b ] ~u˘X Xæ uP llP˙Z AMæ˙bV v}}uuv Standard yy Trtme ae ntGuidelinesUwthEditionUw CRo}}u]v UIMU~(}˙P]vbZ Adults æræuPX b Lru]vb](vbb˙ Children r˙bV æræuPvrR}o˙ vr˙bV æ u]}PullP vr R}o˙ ~u˘X wæ uP ˙Z rv˙bV æ u]}PullP vr R}o˙ ~u˘X uP ˙Z Note 10-2 NP]Ro}}u]v]vv}bo˙JIu˙o}R˙}vb b ]}vX yy v*ThecuteA lyDisturbedPatient*v yy yy yy Or Oov]v UIMU Adults r uP X b bv }bb }( uP u˙ P]v R}b L ]v]o }bU ]( vbb˙ v R}b L v }b ~u˘X uP˙Z Children N}}uuv Or Chloral hydrateU}o}oU Adults æuPrP Children r˙bV æuPrP u}vRr˙bV ræuP llP~u˘XPZ NeonateV ræuP llP Or D]u UIVU Adults uPbo}ò˙}ru]vb~}˘]uo˙XæuP˙ b }vbZ Children ru]}PullPbo}ò˙}ru]vbX TR]bu˙Lu]vb](vbb˙~u˘uPZ Or D]u UoU Children AN˙bV XuPllP vr˙bV XuP llP rv˙bV XæuP llP u}vRr˙bV XæuP NeonatesV XærXæuP TR]bu˙Lu]vb~u˘uPZ Note 10-3 r Chatep rP *PsychiatricDisorsder I(o(}uo}v]bv}]uu]o˙]ooU`R]vio(}u ]o˙ ]v} ˙]vP b v u]v]b ] ]v} R u ~L u}]vP R voZX D]u IV ub u]v]b `]R ]( R b }( R ]b v]bR}PR}}Pv]X r Refeal r Criteria R(ooo˙]bvb}b]o]bX 71. Psychogenic Seizures v*PsychogenicSeizs*ure v Pb˙R}Pv] b]b } b} b]b v}vr]o b]bU `R]Ru]u]]ob˙ oo˙Rvvo˙]vP˙R}o}P]o b bX Ivvb `]R R]b (}u }( ]b}U Ru˙ R]b}˙ }( R˙b]oU ˘o b } ˙R}o}P]o b bX TR ˙u}ub b u˙ ]] ˙ b v R b]Pvb }Lv ]o v u˙ ]vo b]bv } ˙ }v]vP }v ˘u]v}vX TR ]Pv}b]b ]b R]PR oo }( b]]}vb]v]]b}Lv]8o}(}u b ]ob]bv u˙U]v(}r˘]b`]R]ob˙X Symptoms yy Rv}v]o}v]ro]lb]b yy 'lbA boo˙ } }vo˙ `Rv 'v}v }( }R }o v ' yy Pvb Ro˙ P ]viU v `Rv R˙ (oo ~vo]l ]v b]bZ yy TRbvPo]u}uvb}uu}v]vPSb]_'lb yy T}vP]vPU](]}b]bboo˙R}(R}vP]vb}( Rb]bb]vb]b yy M˙R]v˙]v}vvvb]vv}uob]b Invtiga se tions yy Su}ov yy EEG Trtme ae nt Tuv}ib yy T}}b b]b yy T}}b v}uo˙ Non-pharmacological treatment yy Rbvbb UP]vbX yy C}vboo]vP yy Pb˙R}R˙ Pharmacological treatment yy Avr]ou]]vb } v} } Rv˙ v.]o+ }v(v˙}('lb Standard Trtme ae ntGuidelinesUwthEditionUw Refeal r Criteria R(oob(}o}v˙˙R}o}P]b b }˙R]]b b X 72. Insomnia v*Insomnia*v Ivb}uv] ]b .v b bi } }( ]8o˙ `]R bo ]v]}vU }vU }vb}o]}vU } o]˙ R }b b] }}v]˙(}boUvRbob]vb}u(}u}(˙u ]u]uvX Ivb}uv] ˙u}ub b } ] }uu}vo˙ ]v R Pvo }o}vX R]bl (}b (} ]vb}uv] ]vo ]vb]vP PU (uo ˘b U }ru}]]b}bbRu]o b U˙R]] b Uvb bUvbR]L `}lXPvb`]R˙R]] b vR}v]]v]b}bRoo˙ R]PRb}(]vb}uv]X sueCa yy BR]}o r bv]vP u} u ]v ]v v +} } SR _ on sleep yy Stress yy LvR]b`R]R}v}vRvbo yy C}Pv]]b}}vb~XPX](}v}bv}boR}PR}Rv]PRU }vRbv}boooZ yy M]]vb~XPX(}uv}(}uu}v}oUR˙vb]}vURu b Z yy +]v C r}v]v]vPPb~XPX}+UZ yy W]Rò (}u o}R}o v }R Pb }( b ~XPX }]v u]iv UuRu]vbZ yy M]o }v]}v ~XPX bo vU ]`˙ }b}vU o] ]bbUvo]bbUR˙}]]b}bZ yy Pb˙R}o}P]ovv]}vuvo(}b yy OR˙R]] b ]b}bbRbv˘]˙ yy To~b]oo˙}bbu}vbo]vP}ioPZ yy SR]L`}l Symptoms yy P}o}vPPu(}(oo]vPboro}vPRvu]vb yy T}obouobbRvvXæR}b yy D]8o˙(oo]vPbo yy Fv`lv]vPb yy D]8o˙v]vP}bo yy A`lv]vP}}o˙]vRu}v]vP yy SoR}bv}(oob U(bR]vP}}b yy Av]vP }} bo R}b (} uU v }u]vP u} ovv˘]}bbu}Rb yy ˙u D +b}(}}boP yy FPvbo]vbb yy M}}]bvbv}Pv]]8ob yy P}} o]˙ }( o]( ~`}bv ˙ ]vb}vo ]8obU } U vu}}]b}b Chatep rP *PsychiatricDisorsder }]v}(˙]bZ E˘}v }(}ru}]}v]}vb bR b]}v o}}U b X ˙D r}r˙]]o]˙ yy yy B}˘rP) U R]PR H]b}˙l]vPvbuv}(vb`]RIvb}uv] r u}(oobo~boo Invtiga se tions yy FBC yy BUEvv]v yy LFTb yy Bo}}Po}b yy TR˙}](v}vb Trtme ae nt Tuv}ib yy R}v}(`l]vP˙u}ub b yy Iu}uv}(˙u(v}v yy R}v}(]bb yy Tuv}(}ru}]}v]}vb Non-pharmacological treatment yy Suob}v}oR˙ ~}]uovP b bov]}vuvbbR bo]vPo]PRbUTVv]}}vZ yy Ro˘}v]v]vP yy C}Pv]BR]}TR˙ yy }]v A }(˙rubo yy }]v A }( ˘bb] uov b }vbu}v r u ~XPX æ r r v*Insomnia*v yy R]}v C }( R bo]vP v]}vuv ~}RlU o]PRllU ] lv}]b˙U}}uuUo}vl vUTV }vl}+ZUv[b b }(u]v~bo˙bX`]`lUo˘bXv˘]}bZ yy Iv(˙vPvPR]}bv}Pv]}bb yy AbSorWlSRo`]Rbo]˙P v˙ZUvu}(`lv]vPbUWluALSoOvb~WASOZUbo }v yy Assess yy R]vP B robo]b}b~bv}]vPUPb]vPU}PR]vPZ yy Soou}uv]b}b~l]l]vPUobb bvbbZ yy Pb}uv]b~R]}b}}o]}vZ yy C}ru}] u]olv}o}P]o ]b}b ~G˘U o]}vbU b]bU RRbZ yy ORR˙b]obvb}vbvu}}vbb}]`]R`l(ovb~b b R b]vUobb bvbbUv˘]˙ U(b}vUbvbbZ ˙u AbD A]bv˙u D Fv}vP yy N]vP~(v˙l˙UubU}ov˙l]v}ov˙Z yy W}l ~`}l ubU `}l ˙ bR b ]]vP } `]R vP}b }vb vbU]boUlb}vb]]o]bZ yy L](b˙o~bv˙lUR}u}vUo]PR˘}bU˘]bZ yy To~b]oo˙}bbu}vbZ yy Qo]˙}(o](v˘}v}(}ru}]]b}b Standard Trtme ae ntGuidelinesUwthEditionUw }+UUo}R}oXZ Pharmacological treatment st L]vTuv ]v E RvPPC yy L}u U}oU Adults ruPu Children N}}uuv Or yy T]}ou U}oU Adults Eoo˙V æræu]}Puu AMv˙bV æræu]}Puu Children N}}uuv v*Dsion* epr v nd L]vTuv ]v E RvPPB yy MelatoninU}oU~oo˙(}R]ovZ Adults ræuP]o˙UrR}b(}u~u˘XuPZ Children u}vRr˙bV ruPu Ivb](vbb˙Lr`lb}rvuP]o˙~u˘XuPZ Or ]v E RvPPB yy Au]]˙o]v U}oU Adult æræuPv]PR(}`}`lb Children N}}uuv Refeal r Criteria R(} o]v]o˙R}o}P]b b (} R}bvb `R} } v}b}v } R }uu}v v}vrRu}o}P]o v Ru}o}P]o ]vv}vb (} }Pv] R]} R˙X R( vb `]R vo˙]vP R˙b]o }b R}]b]o]bbX 73. Depression b]}v D ]b u}} ]b}U `R]R u˙ } ]v oo P P}bU oR}PR R ˙u}ub b u˙ ]+ ]v R]ovX I ]b oo˙ }uu}v }v]}v v Rb vv˙ }X S}u +b}vb u˙ v }}R]}o]b}U]v`R]RbU]b}b}(uv] Co]v]oo˙ b]Pv].v b]}v U ob} oo ui} b]}v v }X U ]b Chatep rP *PsychiatricDisorsder Symptoms yy bu}} D U}Lv}b(o]vPR}}(b}b[ yy L}bb}(]vb}ol}(ob]vR]vPb]}bo˙}(]vb yy S]Pv].v`]PRo}bb}`]PRP]v yy Ivb}uv] }bo]vP}}uR yy Pb˙R}u}}P]}v}}v yy FP}o}bb}(vP˙ yy Fo]vPb}(`}Robbvbb}˘bb]P]o yy Iu]R]vl]vP yy P}}}vv}vV yy ]v]b]vbbV yy `}˙]vP˘bb]o˙ yy Moo}]o˙}uo]vb yy S]]o]b}R}PRb}(R w v*Dsion* epr v `] b }uu}v ]v `}uv b ]v uvX Mv˙ + ]v]]ob bl Ro(}ub]]ov]}voRobXF}P}}}}}v}(R}b `R}P}}R}b]obUR]}v]}v]bv}}Pv]bX b]}v D ]b b]Pv].v b }( u}]]˙ oo } R `}o v u}b }o `R} 'u } (oo˙ b }uo b]] R depressionXOvbR}ov}]bu]bb}l(}Pvuvb b u ˙ vb bR b SI `v } ]_U So]( ]b v} `}R o]]vP _U } SI u ( `]R o](_X Aoo b }( 'u b]] bR}o ( } ˙R]]b b L ]v]o uvPuv }( R bvvP }uo]}v XPX bo(r]vG]]vi]b}}]b}v]vPX Recurrent depression } v]}o b]}v ]b ]+vo˙ ~`]R vbbvbZ (}u ]}ob]}vU `R]Rb}vb u}} u}}]o]b b X TR]Pv}b]](}ui}b]}v relies on the presence of ob.~æ}( Z R˙u}ub b o]b]vRb}v}v˙u}ub b o}Ù ˘]v˙˙(}ob`}`lbX Iv R uv }( b]}v U u˘]uu }oo }bb }( vbbv u]}vb ub P]v (} ob v `lb (} ]]vPou]}v]bv}+X ALv ]b} }(b]}v Uuvub }vv (} obvu}vRbUbR]bR]PR]bl}(ob`]R]vR]b]}X Avbbvb ub }b ]uu]o˙ ]( uv] `]vP b }bX Pvb `]R b]]o vv]b ub u]' v l vo}b}b}vX sueCa yy Gv yy Fu]o]o yy Ev]}vuvo yy Pb˙R}b}]o(}b yy Ev}]v]b}bXPXR˙}R˙}]]bu UCbR]vP [b˙v}u b Standard Trtme ae ntGuidelinesUwthEditionUw yy Hoo]v}vb }ob]}vb}(u}]Rub]vb In children yy Tv˙}(bo}P}}bR}}o yy P}}bR}}o(}uv yy B`hvP]v]}bo˙R˙ [R]o yy OR]}UPPbb]}v}.v yy I]]o]˙ yy RvPb A yy S}u}(RRo [˙u}ub b o]b} v*Dsion* epr v Signs yy bu}} D yy ]v E }(`]PRo}bb}`]PRP]v yy AP]}v}}v yy Hoo]v}vb Invtiga se tions yy FBC yy BUEvv]v C yy FBS yy TR˙}](v}vv}b}ooob](]v] yy Au]v]b v] b o b }( b]}v ~vRoR}vv] b ı]uo b Z Trtme ae nt Tuv}ib yy T}˙u}ub b yy T}v]b}v}v}uoo](R}uU`}l}bR}}o yy To prevent suicide Non-pharmacological treatment yy C}vboo]vP yy Pb˙R}R˙ Ub].oo˙C}Pv]BR]}TR˙ yy Electroconvulsive therapy Pharmacological treatment st L]vTuv ]v E RvPPA yy Fo}˘v U}oU Adults uP}v]o˙(}r`lbU Then Ivb](vbb˙}u˘X}(uP Children r˙bV uP}v]o˙(}r`lb Then Ivb](vbb˙}u˘XuP}v]o˙X AM˙bV v}}uuv bR b R PHQ Chatep rP *PsychiatricDisorsder N}r Ub`]R}v]vR]ov`]R]ob˙ yy yy yy Or SertralineU}oU Adults æuP}v]o˙U Then Ivb](vbb˙˙]vuvb}(æuP]vob}(ob `lU}u˘X}(uP]o˙X Children r˙bV æuP}v]o˙ Then Ivb](vbb˙˙]vuvb}(æuP]vob}(ob `lU}u˘X}(uP]o˙X vr˙bV æuP]o˙U Then Ivb](vbb˙}æuP]o˙L`lX FR]vb](vbb˙]v}( b æuP]vob}(ob }v`l}u˘X}(uP]o˙ AMv˙bV v}}uuv Or C]o}u U}oU Adults uP }v ]o˙U ]vb ]( vbb˙ ]v b }( uP ]o˙U ]vob}(r`lUu˘XuPX Children AN˙bV uP}v]o˙U Then Ivb ]( vbb˙ } uP }v ]o˙ ]v R v]vPU } r `lb~u˘X}(uP}v]o˙Z AM˙bV v}}uuv Or Iu]u]v U}oU Adults æræuP}v]o˙~o˙v]vPZU Then Ivb˙æuP˙ræ˙b}u˘X}(æuPX Children N}}uu Or Au]]˙o]v U}oU Adults æræuP}v]o˙~o˙v]vPZU Then Ivb˙æuP˙ræ˙b}u˘X}(æuPX Children ı v*Dsion* epr v yy XS}](b]}bX ANv˙bV AMv˙bV Standard Trtme ae ntGuidelinesUwthEditionUw æræuPR}o˙ v}}}uuv v*Schizophrenia*v AXMvPuv}(vb`]Rb]}v ]]vPv]PR}v b yy L}u U}oU Adults ruPrR}o˙Uu˘XuP]o˙ Children r˙bV XæuP llPR}o˙Uu˘XuP]o˙ Or yy D]u U}oU Adults æruPvrR}o˙ Children r˙bV uPR}o˙ ær˙bV æuPR}o˙ Refeal r Criteria R(vb`]R˙]o}vbo˙u}ub b UR˙b]o}R}] (bU v R}b `R} } v} b}v } vrbbv uv`]R]vu}vRbU}˙R]]b b UbR}oR]ovb }b+(}ub]}v X Pvb ]]vP C}Pv] BR]} TR˙ should be referred }˙R}o}P]b b X wX Schizophrenia SR]}Rv] ]b }o˙ R u}b b v }voo˙ ]bo]vP (}u }( uvo ]oovbb ]v ˙ }uuv]˙ `}o`]X I u˙ bv b v } R}v] ]oovbbX TR o]v]o (b ]vo R]b R}b][ } RvP[ ˙u}ub b U ]}}v ]v b}]oU `}l } ]vb}voo}vbR]b v}vv ]v }( ]b R]}(}obvu}vRbX TR o]v]o (b u˙ vu}b v v RvP } uX Pb˙R}b]b b}] `]R vb b v u}} ]b}b `]R ˙R} b (bu˙u]u]bR]}Rv]X F} R]b ]oovbbU (` }o u˙ } }uoo˙ L v ]b}}`}XTuvub}v b ˙u}ub b bvXA .v]]Pv}b]bvo]b b Ruv}(uvov]b]b } ˙ ˙R]]b b X Tuv (} ]b}b v b ˙ ˙R]]b b v(}oo}ùv}vv˙u}bRoRP]bX Tuvub(}obu}vRbLu]bb]}v}(˙u}ub b (} .b]b}XH}Ùo](o}vPuv]b}o˙RP˙ b }}]vX S] +b bR b ˘r˙u]o }vb +vb b bU u}bU ]P]]˙U ubo bub ]vo]vP }vP l]vP b ~bo}`vbbU }}o]vPU Chatep rP *PsychiatricDisorsder v*Schizophrenia*v }U vl v]vPU XZ } vb˙R}b u˙ } b]oo˙ `Rv u]v]b R]PR }bbX TRb b }vb v v }uvP`]RvR}o]vP]PvbU`R]Rubb]vPo˙b R˙u˙}v]}Ro}uv}(v}Rvb Uoo ] ˙bl]vb]U ]v R o}vP uX ~S b}v }v RAiv Tuv[ o}`Z sueCa yy LPo˙vlv}`v yy P}bb]ob}]}vbP yy B]}rGv~}}`]R}u]vv}}v]v b }bZ yy B]}rPb˙R}b}]ou]vvbVPv]b}b]}v}o `]R b ~}v}u]U ]b (u]o˙ v]}vuvbU XZ B]R (b ]v ]v b}] `]R b}v }( ]RU }bb]o ]o]v(}vbUX yy Ev]}vuvo]PPb yy Ioo]]Pb~u]iv UuRu]vbXZ SymptomslSigns RP}b][˙u}ub b yy Hoo]v}vb ~XPXR]vP}]bZ yy Dob]}vb ~bo](b`R]Rvv}vb Z yy Iv}RvbR}]oo}P]o]˙ yy O}]b}Pv]bR]} yy Pvo]bR]b}RR}PRb}v}oo˙}b](}b RNP[˙u}ub b yy P}˙ }( bR } }vv }( bR ~(` `}b } `]R o]'o vb Z yy Apathy yy Rb}]o}v}`]Rò yy Fo'v+~bR}`]vPo]'o(]o˘bb]b}vbbZ yy Dob]}vb yy M˙}˙ b UbRvb b]]}vU}}oo˙]U o]l]vP }v}oo } ]vP u } (o u}}vb } bvb }vb yy Gv]}b ob]}vb u˙ ob} } `]R} R o u}}bv]vuv]vb yy Hoo]v}vb yy }uu}vo˙]}˙~u˙]v}ov˙}(R}RbvbbZ yy A]}˙ Roo]v}vb }( uoo }]b }uuvvP }v vb[}vbUP]vP}Rvou}b]Pv}b yy M}} ]b}b o]l}b]vPU˘]uv}}b u˙ } v}bvo(}]Pv}b]b Invtiga se tions yy Uboo˙v}v](}]Pv}b]b yy Tb}b o}}Pv]b}(˙R}b b ]b yy Bbo]v(ooo}}}vUo}}bPUo]]bUo]vl]v˙(v}v r r Standard Trtme ae ntGuidelinesUwthEditionUw bU(}}bb}(P]]vPuv yy F}Oov]v and RisperidoneUvbR(bvPo}}bP Uo]]}.obUo]vl]v˙(v}v]b } ob`]˙X v*Schizophrenia*v Trtme ae nt Tuv}ib yy T}}o]bR˙u}ub b yy T}}b (v}v]vP}Ru˘]uuoo}bb]o yy To reduce the chances of recurrence yy T} u}v]} o}} Po}bU o]]}.obU o]v l]v˙ (v}v ob`]˙(}vb}v}ov]vv]b]}v Non-pharmacological treatment yy S}˙R}R˙ b yy RR]o]}v yy Fu]o˙R˙ yy Pb˙R}}v } bU }bU uvU b] +b v obv}v yy BR]} TR˙ XPX b}]o bl]oob ]v]vPU }Pbb] ubo o˘}vU}]vPbl]oobUX Pharmacological treatment st L]vTuv ]v E RvPPA AX yy yy yy MvPuv}('lb Oov]v UIM}}oU Adults æruPX b Then æruP]o˙Uu˘XuP]o˙ Children AN˙bV æruPX b Then æruP]o˙Uu˘XuP]o˙ AM˙bV v}}uuv Or CRo}}u]v UIMU Adults æræuPvrR}o˙UibvP}u˘X}(uP]o˙ Children r˙V æræuPvrR}o˙UibvP}u˘X}(uP]o˙ vr˙bV æu]}PullPvrR}o˙}u˘X}(wæuP]o˙ rv˙V æu]}PullPvrR}o˙}u˘X}(uP]o˙ Or CRo}}u]v U}oU Adults r Chatep rP yy B. yy yy æuPR}o˙}wæuPv]PR Then Aib}]vP}b}vb}wæruP]o˙ Children AN˙bV æuPR}o˙}wæuPv]PR Then Aib}]vP}b}vb}u˘X}(wæruP]o˙ vr˙bV uPR}o˙ Then Aib}]vP}b}vb}u˘X}(wæuP]o˙ rv˙bV æu]}PullPrvR}o˙ Then Aib}]vP}b}vb}u˘X}(uP]o˙ Or HaloperidolUIMU Adults ræuPX b Then RrR}o˙}]vP}b}vbU}u˘]uu}(uP]o˙ Children vr˙bV ruPrR}o˙]b AMv˙bV v}}uuv Or HaloperidolU}oU Adults XæræuPrR}o˙]o˙ Then æruPrR}o˙~u˘X}(uPZ Children AN˙bV XæræuPrR}o˙]o˙ Then æruPrR}o˙~u˘X}(uPZ r˙b}}˙`]PRærlPVXærXæuP]o˙ Then Ivb˙XæuP]o˙˙ær˙bw AM˙bV v}}uuv Maintenance RisperidoneU}oU Adults ruPrR}o˙~bo}`}bvib]o˙}]vP} vb}vbZ Or Oov]v U}oU Adults æruPUu˘XuP]o˙ v*Schizophrenia*v yy *PsychiatricDisorsder Standard Trtme ae ntGuidelinesUwthEditionUw Children AN˙bV æruPUu˘XuP]o˙ AM˙bV v}}uuv Or yy Ro}}u]v C U}oU Adults æuPR}o˙}wæuPv]PRUib}u˘X}(uPR}o˙ Children r˙bVæuPR}o˙}wæuPv]PRUib}u˘X}( uPR}o˙ AM˙bV v}}uuv Or yy HaloperidolU}oU Adults ruPR}o˙Uib}u˘X]o˙}b}(uP Children r˙bV ruPR}o˙Uib}u˘X]o˙}b }(uP r˙bV æ u]}Pub R}o˙U ib } u˘X}(æuPR}o˙ v*Schizophrenia*v CX yy yy M]vvvuv(}vb`]Rv}R}v] ]oovbb~}}vbZ FoRv]v decanoateUIMU Adults æuPu}vRo˙ Children N}}uuv Or FovR]˘}o v}UIMU Adults G]}bb }(æruPUvLob˙bw UP] uPu}vRo˙ Children N}}uuv X D Aivuv(}uvPuv}v}v}(vb˙R} Pb]+b yy T]R˘˙Rv]˙o ~BvR˘}o ZU}oU Adults XæræuPvrR}o˙u˘XuP]o˙ Children vr˙bV XæruPrR}o˙U Then Ivb˙r˙bw ˙uP]o˙}]vP}b}vb Or yy Bv}]v ~Bv}]v Z }oU U Adults Chatep rP *PsychiatricDisorsder æ v*Schizophrenia*v ruPrR}o˙ Children AN˙bV ræu]}PullPrR}o˙ Or yy ]]]v B U}oU Adults uPR}o˙U Then ib}uPR}o˙}uPR}o˙X Children v}}uuv Or yy B]]]v Ubo}ÌVlIMU Adults XæræuPib}u˘X}(uP]vR}b Or yy Bv}]v UIVlIMU Adults r uP bo}ò˙ } r u]vbU ]( ˙u}ub b b]b L rR}b Or yy D]u U}oU Adults æruPvrR}o˙ Children r˙bV uPR}o˙ ær˙bV æuPR}o˙ Or yy D]u UIVU Adults ær uP bo}ò˙ } r u]vb ~}˘]uo˙ Xæ uP ˙ }vb b Z Children ru]}PullPbo}ò˙}ru]vbX TR]bu˙u]vbX Or yy P}uR]v R˙}Ro}]U}o}IMU Adults Xæræ uP ]v]oo˙U u˙ }b ]( ˙u}ub b b]b L v hours Children ANv˙bV vXærXæuP Then R}bLvR}b AMv˙bV v}}uuv Refeal r Criteria R(oovb}˙R]]b b Lv]b}](uv Standard Trtme ae ntGuidelinesUwthEditionUw `b]v]`]R}˙R]]b b [bb]b]}vX L]l`]b ( oo vb `]R v ]b}b v R}b `R}b ˙u}ub b vv} }v}oo } ˙R]]b b (} (R P uv}Eo}}vob]TR˙X 75. Bipolar Disorder v*BipolarDisorder*v B]}o ]b} ]b (}u }( u}} ]b}X TR u (b } }v]}v ]v `R]R vb ˘]v u}} `]vPb b `v R `} ˘ub}(b]}v vuv] XB]}o]b}]b(}]v}o o] b uv]rbb] ]oovbbX I ]b ]u}v } v} R R +v boo˙ bvb `]R }v }u]vv u}} b uU]Rb]}v}uv]X A b]vPo uv] ]b} v R]b}˙ }( b]}v obb].}v]}o b ]b}XvA ]b}}(b]}v`]R} b uv] ]b} ]b v} ]Pv}b b ]}o ]b}X R b]]b}b]Pv}bvb b]}vX sueCa yy LPo˙vlv}`v yy P}bb]ob}]}vbP yy Tvv˙}v]v(u]o]b yy Gv(}b Symptoms yy Pb]bvo˙ ou}}Pr R}]U˘vb]vbbU (o]vP RR]PR[ or irritable yy O]˙ yy Tol]vP(bv˘bb]o˙ yy Gv]}bo]ub yy Reduced sleep yy Rlobbv]vPv]vP}o˙Pv}b yy S˘ovb}]o]b]vR]]}v yy A]}˙ Roo]v}vbU ]v b ~vb u˙ R }]bU }Lv]v(}]vPR]Pv]}bo](bZ yy Uvb]]}v~v}]Zu˙˘]b yy Iu]iPuv Signs yy None typical of bipolar disorder yy Su˙u}ub b } Invtiga se tions yy Uboo˙v}b].]vbP}vb yy Ro˙UR˙}}˘]}b]b u˙u]u]uv] vub˘o v qualify for Chatep rP *PsychiatricDisorsder Trtme ae nt Tuv}ib yy T}˙u}ub b }(uv] or depressionU`R]R]bbv`]R current episode yy T}Roo}(]˙]vuv] }uvPob yy T}ou}}}v}uo]v b b]}v yy T} }o]bR ˙R} b ˙u}ub b ~ob]}vb v Roo]v}vbZU ]( present Non-pharmacological treatment yy Pb˙R}R˙ yy Pb˙R}}v Pharmacological treatment w v*BipolarDisorder*v AXMvPuv}(Ruv]v yy RisperidoneU}oU Adults ruPrR}o˙U}u˘X}(uP]o˙ Children AN˙bV æu]}PubX b Then Aib ]o˙ ]v b }( æ u]}Pub r uP ]o˙ } u˘X }( v uP]o˙ AM˙bV v}}uuv Or yy Oov]v U}oU Adults æræuPrR}o˙}u˘XuP]o˙ Children r˙bV XæuP]o˙U}u˘X}(uP]o˙ AM˙bV v}}uuv O yy HaloperidolU}oU Adults æruPR}o˙}u˘X}(uP]o˙ Or yy CRo}}u]v U}oU Adults æuPR}o˙}wæuPv]PRU Then Ivb˙æuP]o˙}æruPR}o˙ Or yy S}]uo} U}oU Adults ærwæuPR}o˙~}v}ooob(oZ Children AM˙bV v}}uuv Standard yy Trtme ae ntGuidelinesUwthEditionUw Or C u]v U}oU Adults ruPR}o˙~}v}ooob(oZ Children AM˙bV v}}uuv BXMvPuv}(b]Pv].vo˙PPbb]v ~Sb}v}vRTRo˙ A D]bPv C. yy v*BipolarDisorder*v yy yy [ZX Management of the depressive phase Lu}]P]v U}oU Adults æuP]o˙(}`lb Then Ivb ˙ æ uP ˙ `lb } u˘X }( uP ]o˙ b quired Children AM˙bV v}}uuv Av L}u U}oU Adults ruPrR}o˙Uu˘XuP]o˙ Children r˙bV Or D]u U}oU Adults æruPvrR}o˙ Children r˙bV ær˙bV XæuP llPR}o˙Uu˘XuP]o˙ uPR}o˙ æuPR}o˙ Note 10-5 TR v}]]vb `]R`v b b}}v b R v ]b ouU R]b bR}o}v˙bo}ò˙]vPR}bX X D M]vvvuvPuvL}v}o}(RRb yy L]R]u U}oU Adults rvuPvrR}o˙~u˘XuP]o˙Z Children r˙bV vr˙bV AMv˙bV rvuPR}o˙~u˘XuP]o˙Z æruPllPR}o˙ v}}uuv r Chatep rP *PsychiatricDisorsder Note 10-6 L]R]u oobbR}ou}v]}R}bL}bU`]`lo˙vo}v ]}v]o]b b bURv}v˙u}vRX r Or S}]uo} U}oU Adults ærwæuPR}o˙~}v}ooob(oZ Children AM˙bV v}}uuv Or yy Cu]v U}oU Adults ruPR}o˙~}v}ooob(oZ Children AM˙bV v}}uuv Refeal r Criteria R( oo vb b+]vP .b ]b}U v} b}v]vP } uvL}vu}vRvooR]ov}˙R]]b b X yy v*AlcoholWithdal w r Syndome r s*v 76. Ao}R}oW]RòS˙v}ub TRb } (}oo}`]vP bv `]Rò (}u o}R}oX TR˙ }Lv bv } R}b L R ob ]vlU u˙ o] v `}b `v } R}b L }vbX TR]b }uu}vo˙ }b ]v vb u]' } R}b]o (} }R }oub XPX ]b]vP (}u ]vb } R˙b]o ]oovbbU `R]R lb Ru (}u ]vl]vPX TR bv}v]b(}uu]v]uou}b}}( b (ooro}`vP]}v v}v(b]}vU`R]R}voo˙(oX sueCa yy A }v b } b]Pv].v }v ]v o}R}o ]vl ]v v ]v]]o`]RR˙]vl]vP}uv˙u}vRb}˙b M]v}W]Rò Alcoholic Hallucinosis Ao}R}o]S]b Ovb }R}bL ob]vlUu˙ o]XPlb `vrR}b rRbL}v b }(]vl]vPvPvoo˙ }bb `]R]vR}b wrR}b v LR ob]vlu˙ o]X S˙u}ub Shaky hands Headaches Ivb}uv] M]ov˘]˙ NauseaU V}u]vP S`vP Svb}v}(}ib ò]vP}v}˙ vb Pvo]b b]b]v chronic alcoholic SS]vP _}ibv}oo˙ present SH]vP _v}]bb}}]b v}}˙obvRX ı Standard S]Pvb Trtme ae ntGuidelinesUwthEditionUw M]v}W]Rò Alcoholic Hallucinosis Ao}R}o]S]b Ivbob Raised blood pressure The vivid hallucinar }vb}]vo }vb]}bvbbX PobUBo}}Pbvb b]}v`]R]v v}uoo]u]b Pvo]b ]bb v*AlcoholWithdal w r Syndome r s*v Trtme ae nt Tuv}ib yy To stabilise pulse and blood pressure yy T}vR˙}v yy T}bvvP}v]}vbo]luo]X yy T}o]]vUu}bvb]b yy T}}b Roo]v}vb Non-pharmacological treatment yy Sit or lie in a quiet place yy PR˙b]o ]vb b u˙ ] u}]o˙ (} ˙ P] vb yy Ev}P]vl}(G]bvb }o}vR˙}v Pharmacological treatment st L]vTuv ]v E RvPA yy HaloperidolU}olIMU Adults æuPR}o˙]b voRoo]v}vbbX Children Refer to specialist Or yy Oov]v U}oU Adults æruPR}o˙~u˘X}(uPR}o˙Z Children AN˙bV XæræuPX b Then M˙]vb}uP~u˘XæuPR}o˙Z Refeal r Criteria R(oovb`]Ro}R}o`]Rò˙v}ub b }˙R}o}P]b b }˙R]]b b XAob}(ooR]ov}]]]vX Chatep rP *PsychiatricDisorsder 77. Ao}R}o]Do]]uTuvb v*AlcoholicDeliriumTremens*v TR]b ]bRu}bu`]Rò˙v}u b XIboo˙br ˙bL]vl]vP}bb XOvPUR˙v}u b obb˙b u˙ }vv (} uR o}vPX W]R} P}} b} v uvUDo]]uTuvb~DTZ ]bb}]`]Rb]Pv].vu}o]˙X R]bl(}b]voo}vPR]b}˙}(R˙o}R}obU]}bR]b}˙ }(TD U}vv]oovbbUb]Pv].vo}R}ooo]vP`]RòUo}vP }vb]vob]vl~}R}bZvP}˙bX sueCa yy Sv `]Rò }( o}R}o (}u o}vPru R}v] b }( alcohol Symptoms yy Restlessness yy SRl]vP}(RvbU`R}oo]ub}}˙ yy S`vP yy Confusion yy Iv}]R]} yy Uv]voo]P]obR yy M]b]v.}v yy S]vP}ol]vP}]uP]v˙}ib Signs yy Tu}b yy Pb˙R}u}}P]}v}}v yy S`vP yy V}u]vP yy D]b}]v}v yy Ivu]'v ]boU o } ]}˙ Roo]v}vb } ]oob]}vb ~V]bo Roo]v}vb (vo˙ }( buoo }ib } (]PRv]vP Rv]uob[}vòobXZ yy F AN£CX yy PobANblu]vUBo}}PbAN b vluuHP Invtiga se tions yy FooBo}}C}v yy L]Fv}vTbb yy Sv(}uo]v}uu}v]v(}vb Trtme ae nt Tuv}ib yy T}o]P]}vvouv yy T}}G]vo}o˙]uov yy T}v}uo]}vbo]lb]bUo}uv}(uvb]v encephalopathy yy T}v}uvPR}uo]}vb](bv Standard Trtme ae ntGuidelinesUwthEditionUw Non-pharmacological treatment yy Sob]}v}(Rv yy Ao]}v}(]vb b bvbb˙ yy Pb˙R}R˙ v˙R}}v b Pharmacological treatment ]v E RvPPA v*AlcoholicDeliriumTremens*v AXF}}v}o}(b]b yy L}u UIVUIM}}oU Adults ˙bD }P ruP}v]o˙ ˙bD væP ruP}v]o˙ Or yy D]u U IVU ~u]v]b bo}ò˙r} r u]vbU }˘]uo˙ XæuP˙}vb b Z Adults ˙D P ruPvR}o˙ ˙D P ruPR}o˙ ˙D P ruPR}o˙ ˙D P æruPR}o˙ ˙D æP æruPR}o˙Rv}b Note 10-7 I]b}b P]v}]]vbbvRRv}v .˘}bbR oX W]RR}o ]( v ]b bo } Rb bo bRU ˘] X b yy yy yy yy Or C Ro}]}˘] U}oU Adults æruPR}o˙]b ~u˘XuPZ Av TR]u]v U}oUIM}IVU Adults~}oUIMUIVZ uP]o˙(}˙b~(}v˙IVGo}bo}Z vA F}o]A] U}oU Adults uP]o˙bv vA ˘}b D saline~æA9Po}b]vXıA9bo]vZUIVU Adults As necessary BXF}vb`]Rb]bv}}v}oo˙v}]]vbo}v yy L}u UIVUIM}}oU r U v˙bPub or over Chatep rP yy *PsychiatricDisorsder Adults ˙bD }P ruP}v]o˙ ˙bD væP ruP}v]o˙ Or D ]u U IVU ~u]v]b bo}ò˙r} r u]vbU }˘]uo˙ XæuP˙}vb b Z Adults ˙D P ruPvR}o˙ ˙D P ruPR}o˙ ˙D P ruPR}o˙ ˙D P æruPR}o˙ ˙D æP æruPR}o˙Rv}b Av PRv}]}v Ubo}ÌV}IMU Adults XærXæuP llPR}o˙ Refeal r Criteria R(vb`R}b˙u}ub b ]8o}}v}o`]R]v˙b }`R}u]vP]b]]vP P]v} uP]u`]R]v R}b}b]o]bX R( vb } ˙R]]b b } o]v]o ˙R}o}P]b b (} }vb]}v }( }R uv }}vb } b]b o}vPru vv b vR]o]}vLRb]b}X yy Disorders Av˘]˙ ]b}uu}v˙u}u b R}b]voo˙R]] b ]b}b ]vo]vP b] ]oovbb v u}b ˙R}b b bX PR˙b]o ]bb o]l R˙R˙}]]bu U ] ]bb } R˙vb]}v u˙ ob} bv `]R v˘]˙ vR(}ub˘oX TR]}b(}ub}(v˘]˙ ]b}b~XPXPvo]v˘]˙ ]b}bUv]]b}bUR}]bU}bb]}uob]]b}U b ]b}U }b u b ]b}U XZU R }uu}v }vbvb ]vPvoPvo]v˘]˙]b}bvv] ]b}bX Iv oo b }( b v˘]˙ ]b}bU ] ]b ]u}v } b R }b }( R v˘]˙U ]vo]vP R vvbU R]} v }vbvb }( v˘]˙ (} R v R}PR v ]vR ]v]`X I ]b ob} ]u}v } bl } R bv }( }bb] R}PRb vl } }uob]}vb b Rb ]vb]vPo˙ }uu}v v v v} } }}}(ubbuv`R]Ro}uRb}vo]bbX IvR]b(b }˙R]]b b X Iv Pvo] v˘]˙ ]b}bU R ]b ˘bb] v˘]˙ v `}˙ }vb } ]bU bR b (}uv bR}}o } `}lU v*AnxietyDisors*der v 78. Av˘]˙ Standard Trtme ae ntGuidelinesUwthEditionUw }]vP}vu}b˙bU(}obvu}vRbX A v] ]b} (b } 'v }( v v˘ 'lb }( ]vvb ( } ]b}u(} } ]b ]} u} Rv ub `lX D]vP 'lb } u} }( R ˙u}ub b o]b o}` o} o˙ v R l `]R]v u]vbX Pv] ]b}b }uv] ˙ b]bv }vv } R]vP v}R 'l } `}˙]vP}]uo]}vb}(R]vPv'lX Iv R]ov b]oo˙U o }uo˘ b]b u˙ u]u] v] 'lbX M]}vb ] } v] ]b}b }vo˙ ]( R 'lb}(vo˙v}PR}b]bbX GENERALIZEDANXIETYDISORDERS sueCa yy yy yy yy MoovPo](˘]vb Ev]}vuvo(}b Pb}vo]˙] Gv]b}b]}v v*AnxietyDisors*der v Symptoms yy E˘bb] v˘]˙ v `}˙ }]vP }v u}b ˙bU (} ob v u}vRb yy Av˘]˙ }`}˙b}]`]Rob}(R(}oo}`]vPP yy Mbo vb]}v ~}Lv } b ]v ]v ]}b b o]l vlUvl}RRbZ yy ò]vP C vv]vPbvb}v}vR}˙ yy Rbobbvbb}(o]vP}vP yy B]vPb]o˙(P yy D]8o˙}vvvP}u]vP}]vPovl yy I]]o]˙ yy So ]bv ~]8o˙ (oo]vP bo } (v `lv ]vPZ yy Po]}vb Signs yy Restlessness yy S`vP yy Av˘]}bu}} yy Tachycardia yy Tu}b Invtiga se tions yy N}v}}v.uR]Pv}b]bX yy Tbb } ˘o }o ]+vo ]Pv}bb bR b R˙R˙}]]bu UR}R}u}˙}u U]R˙Ru]bX Trtme ae nt Tuv}ib yy T}v˘]˙ r Chatep rP *PsychiatricDisorsder yy T}']vo](}(b}u˙u}ub b Non-pharmacological treatment yy Reassurance about the absence of physical disease once they are ruled out yy TRo˘}vuR}b yy Ev}PPoR˙b]o˘]b](}bb]o yy Ev}PRoR˙b}]o]b yy C}Pv]BR]}TR˙ Pharmacological treatment æ v*AnxietyDisors*der v AXF}v˘]˙ `]Rb}u}uo]vb st L]vTuv ]v E RvPPB yy SertralineU}oU Adults æuPb]vPo}ov]vP}bV Then Ivb˙æuP`l]vobU](vbb˙U}u˘X}( uP Children r˙bV æuP]o˙ vr˙bV æuP]o˙ AMv˙bV v}}uuv Or yy Fo}˘v U}oU Adults uP]o˙U Then Ivb}vuP]o˙](vbb˙ Children wr˙bV uP]o˙ Then Ivb}uPLr`lb](vbb˙ Or yy Au]]˙o]v U}oU Adults æræuP]o˙~bb]vPov]vP}bZ Children AN˙bV uP]o˙~b b]vPov]vP}bZu˘X uP Or yy Iu]u]v U}oU Adults æræuP]o˙~bb]vPov]vP}bZ Children N}}uuv(}R]b]v]}v Standard B. yy Trtme ae ntGuidelinesUwthEditionUw For anxiety`]R}u]vvb}u}uo]vb P}v}o}o U}oU Adults ruPR}o˙ CXA]}vouv(}v˘]˙ `]Rb]Pv].v]bb yy D]u U}oU Adults ræ uP R}o˙ (} `lb v Poo˙ ]o }+ }R v˘ `lbX ~D}v}P](}u}Rv}vu}vR}vv}bo˙Z Children r˙bV XæræuPvR}o˙bv Refeal r Criteria R(} o]v]o ˙R}o}P]b b (} C}Pv] BR]} TR˙ }R v}vrRu}o}P]o uv u}o]bX R( } ˙R]]b b ]vbv}b}vb]}PuvX PANICDISORDERS v*AnxietyDisors*der v sueCa yy yy yy yy LPo˙vlv}`v M]b]v}v }( v}uo ]vvo }˙ uo] b ~XPX ]lv R]vbR'l}b]}b]oovbbUZX M]b]v}v }( ˘vo uo] b ~}`bU vo}b b R bu}]vPR]obUo]LbUXZb]Pvoo]vPvP C}v]vP(}bP yy Stress yy Gv]b}b]}v Symptoms yy F}(˙]vP}P}]vPR˙ [ yy Po]}vbU}v]vPR}]R yy Tuo]vP}bRl]vP yy Svb}v}(bR}vbb}(R yy Fo]vP}(R}l]vP yy CRb]v}]b}u(} yy Fo]vP]˙Uvb˙}(]v yy Nuvbb}vPo]vPbvb}vb yy CR]oob}R}GbRb yy o]b D }v ~(o]vP }( vo]˙Z } b}vo]b}v ~(o]vP R(}u}vbo(Z yy Nausea}}u]vo]bb Signs yy Tachycardia yy Tu}b yy S`vP v and Chatep rP *PsychiatricDisorsder Invtiga se tions yy N}v]Pv}b Trtme ae nt Tuv}ib yy T} }b R 'lb }( v] } ob R (v˙ v ]vvb]˙}(˙u}ub b }u]v]uu yy T}Rov}v}uo]b}(]o˙o]]vP yy T}vv}(˙u}ub b Non-pharmacological treatment yy RR]vP ]v v } }( P o}b }v o]b v v}b ~}]}o˙RvPbU˙oPvo}bZ yy Eo]u]v +]vr}v]v]vP (}}b XPX }+U U }o v R}}obU(}uR]]UbR˙v}`}bvv˘]˙ yy Ro˘}v]v]vP yy C}Pv]BR]}TR˙ Pharmacological treatment w v*AnxietyDisors*der v AXIv]ouvPuv(}vbvb}vb]}v}vr pharmacological treatment st L]vTuv ]v E RvPPB yy Fo}˘v U}oU Adults uP]o˙~bb]vPou}v]vP}bZ Then Ivb}vuP]o˙](vbb˙ Children vr˙bV uP]o˙ Then Ivb}uPLr`lb](vbb˙ Or SertralineU}oU Adults æuP]o˙~bb]vPov]vP}bZ Then Ivb}æuPL`l](vbb˙ Then æuP`lo˙}u˘X}(uP]o˙](vbb˙ Children N}}uuv O yy Iu]u]v U}oU Adults æræuP]o˙~bb]vPov]vP}bZu˘XæuP]o˙ Children Standard Trtme ae ntGuidelinesUwthEditionUw N}}uuv(}R]b]v]}v BXF}˙(vv]'lb yy L}u U}oU Adults ruP]o˙(}`lb Children r˙bV CXF}v]v˘]˙ yy L}u U}oU Adults ruPX b Children XærXæuPX b D. yy v*AnxietyDisors*der v yy yy XæuP llP]o˙(}`lb 'lb F}S˙u}u A C}v}o L}u U}oU Adults ruPrR}o˙]b ~u˘XuP]o˙Z Children N}}uuv(}R]b]v]}v Or Ao}ou U}oU Adults XærXæuPvrR}o˙ Ivb](vbb˙˙r˙bUu˘XuP]o˙ Children AM˙bV v}}uuv Or D]u U}oU Adults ræ uP R}o˙ (} `lb v Poo˙ }+ } R v˘ `lbX ~D}v}P](}u}Rv}vu}vR}vv}bo˙Z Children r˙bV XæræuPvR}o˙bv Note 10-8 }v D }(uv(}vbR}oob`lb v vbR}o }vv(}}u}vRb v }u}L'lbRu]'}v o˙obXWv}+bo}ò˙}u}vR}u}X Refeal r Criteria R( R]ov `]R ˙u}ub b bPPb }( v] ]b} } ]]]vXAob}(vb}˙R}o}P]b b (}C}Pv]BR]} Therapyv}˙R]]b b (}]}voPR˙`R]v]X Chatep rP *PsychiatricDisorsder 79. SbvUbD]b}b Ab }( vbb bR b u]iv cocaine X ]b ov ]v uv˙ }uuv]b }v R }v˙X T˙]oo˙U ]v]]ob `]R bR ]b}b b Ro }vo˙ L R˙ (} } } b} ˙ (u]o˙ uubX TR˙ u˙ ob} P]v } R `]Rò ˙u}ub b `Rv }v u]bb]}v (} b]}b R˙b]o ]oovbbX TR]b ]b b R˙ Rv} b } Rvb ]vP bX TR]b u˙ }uo] uv }( R ]u˙ ]bb (} `R]R R˙ ` u]'X sueCa yy yy yy Social factors yy P~ b XPX(u]o˙uubU(]vbZ yy Ll}(}]vPbl]oob~XPX`]Ro]([b]8obU]b}}]vP]v ub}(}oZ A ]}v T}ov~]vb]uv}(vb }u]v]vRbu (o]vPZ W]Rò+b~vobv+bo}v}PbZ Symptoms Cannabis withdrawal yy Ivb}uv] yy Shakiness yy I]]o]˙ yy Restlessness yy Av˘]˙ yy AvP yy OvbPW]R]vR}b}(Pb yy }v D Pr`lb Benzodiazepine withdrawal yy Av˘]˙ yy Headache yy Ivb}uv] yy MboR]vPv`]R]vP yy PoRvPb yy Fo]vPb}(vo]˙ yy b}vo]}v D yy S]b yy OvbPr˙b~v]vP}vRo(ro](}(PZ yy }v D Prv`lb~u˙o}vPZ Opioid withdrawal yy Av˘]˙ ı U v*Sutasb nceUseDisors*der v yy U v}]]vbU R}]v Standard yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw v*Sutasb nceUseDisors*der v ]vP C Muscle tension Muscle and bone ache Mboubv]v b }v}vb Sleep disturbance S`vP H}v}oGbRb P]o}}v Y`v]vP L]u}vvR]v}R} A}u]voub NauseaU}u]vP and diarrhoea Po]}vb Elevated pulse and blood pressure D]o]ob OvbPvrR}b~u˙o`]Ro}vPrvP}]}]bZ }v D P lb r ˙bU b ær ˙b ~u} }o}vP (} o}vPrvP}]}]bZ Pb˙R}buov`]Rò yy Crash~(PUG+U]vbboU]vPbZ yy W]Rò~GvPu}}vvP˙oobU]vPbU]b boU}}}vv}vZ yy E˘v}v~b]bv}(`]Rò(bUPoo˙b]]vPZ yy OvbPvrR}b~}]v ZVrR}b~uRu]vbZ yy }v D P So `lb (} `]Rò RbU Rv u}vRb (} ˘v}v Signs Cannabis withdrawal yy Su˙u}ub b Benzodiazepine withdrawal yy Su˙u}ub b Opioid withdrawal yy Su˙u}ub b Pb˙R}buov`]Rò yy Su˙u}ub b Invtiga se tions yy T}˘]}o}P˙vb (}vbb Chatep rP B}˘rP) *PsychiatricDisorsder Sv]vP}(vb}( b vb b PR˙b]ov yy S`vPUu}UP]}vU}ou`]R}}]v}vUP]XRRb vb v b Ru Po ]vob } u}v]} R }Pbb }( ˙u}ub b X I( ˙u}ub b ]vb]vP ]v ]˙ b U v}(˙ bv]} + b uuU}](]ooU}} r S]]]blbuv yy T} u]v R oo }( ]bl P]v u v } }] }] o]v]ovuvPuvXP}bb]ob]]oR]}]vobR]vl]vP }b]]URu]vP}vbo(}'uvPb]]X yy Sv]vP}vb b }(b]]]blP yy H R]vPb v b} oo˙ R ˙} R R}PR ˙} `}o R not be here? yy H˙}Rv˙R}PRb}(Ru]vP˙}bo(M yy ˙} A R]vl]vP}(b]]M yy D}˙}Rv˙ovb}}uu]b]]M yy H˙}]}Ru˙}bo(M yy H˙}uv˙vovbM yy D}˙}R}b v˙R]vP`]R`R]R}R˙}bo(M v*Sutasb nceUseDisors*der v Mvo˘u]v}v b yy T}u]vP yy TRv(}}R˙R}o}P]o b R]b yy C}v}u]v˙R]] b }v]}vb`R]RoRv}}Rb]bl yy TR v[b ]˙ (} ]v(}u }vbv v ]}v ]v uvovv]vP Abuv}(˙R}b b }]o(}b+vP`]Rò yy Ablv}P yy Rb}vb(}bvvP(}`]RòuvPuvR]bu yy Pb˘]vbUvlv}òPv(b}(`]Rò yy P]]o]˙}}`]R`]Ròv]buvX yy Fu]o˙b}bvb}]ov`}lb]oo(}`]RòuvP yy P}vo]b}(o b `]Rò yy }( C R]ov~b}bb b]ovPo}R˙b]o}˘o b }( b R]o v } ˘}b } bR Ru (}u }Rb v ]vv } } b b}}vb}bb]o}(}}]Pv˙Z yy DPb}(}R]vb yy vC oPo]bb yy F]vv]o}oub yy W}l}uu]uvb Trtme ae nt Tuv}ib yy T} }] b} ~]v(}u}vU b }vU vb Z yy T} R }]vP bl]oob ~o˘}v Rv]bU ]˙ P]o]vbU uR}b } ]vP (} R vb U bo ]bv uvPuvZ yy T}uvP]8oR]}~v˘]˙ UP]}vUv]vPPbb]}vZ r Standard Trtme ae ntGuidelinesUwthEditionUw yy yy T}uvP}v(b]}vU]b}]v}vvRoo]v}vb T} ov v }Pv]b ]bRPU (}oo}` v Lr}v relapse Non-pharmacological treatment yy C}Pv]BR]}TR˙ yy SbbuvPuv}]vP Pharmacological treatment AXMvPuv}(`]Rò˙u}ub b rvv]b yy R]bv}u]o]vv}v BXMvPuv}(`]Rò˙u}ub b ruovb b yy R]b}b}v}bv}]b].]vv}v v*AutisticSpctre umDisorder*v C. yy Management of withdrawal symptoms - benzodiazapines Sb `]R ]ov }b }( v}]]v (} (` ˙bU Rv}+}b}r`lb D. yy yy Management of withdrawal symptoms - opiates OoR˙}vG]b}IVG]bu˙] L}vPvPv}]]vbXPX]uU}}v}o]vb}uv]v uboub~SP}bbv}]b}vbZ Avrub XPX }uR]v XU (} vb v }u]vP P}bbv}]b}vbZ MethadoneU v}R]v and clonidine u˙ bU `R ]oov`]R}vU}R]˙ b }(˙u}ub b ~S P}bbv}]b}vbZ NSAIDb XPX]}(v U]o}(v XU(}]vo](~SP}bb v}]b}vbZ yy yy yy Refeal r Criteria R( (} b]o]b ˙R]]b b lo]v]o ˙R}o}P]b b uvPuv ]( `]Rò ˙u}ub b oo˙ ]b(o b v} v}b}v}uv}`RvRobbX R((}C}Pv]BR]}TR˙ v 80. Su Ab D]b} Abu]bv}o}uvo]b}R]˙o] ]u]uvb}]vP]vR]o(}RP}(u}vRb v U]vRl˙ bV b}]o ]v}v ~}Lv R o]b (b }( Ab Su D]b} rASD ZU}uuv]}vU]vbbv]bX TR o]v]o bv}v ]b ] v u˙ v}ubb R]ov `]R b uv](b}vb }( R } (b } `]R u} ob R]}o .]bU Rv R b }( R u Ab Su D]b} XLv]vP]b]o]˙]vR]b}v]}v]b˙}uu}vvR]bl of epilepsy]bb]Pv].vX }o]v]o˙R}o}P]b b X (See Chatep rP ASD sueCa yy yy *PsychiatricDisorsder ]b]vb]vPo˙]vP}Pv]]vGRvX N}o}o}P˙ Gv AXF}PPbb]}vU]]]o]˙}bo(ruo}v ]v E RvPPB yy RisperidoneU}oU Children v*AutisticSpctre umDisorder*v Symptoms yy bv A }( i}]v 'v}v ~]XX (]o} bR}` ]vbU (}oo}` PU ol }( b}]o bu]o]vP v o]u] b }( Pbb XPX bRl]vP RU `]vP}o]vPZ yy C}uuv]}v.] yy RP (]ob} ]ovPP} o˙b ]v vbv]vP ovPP yy E˘bb]Po˙b]vb}(ovPP yy L]u]vP}(]vbb~o]u]o˙`]R}˙bv}R}ibZ yy R]b~XPXb]vv]vP}ibZ yy Go}oo}uvoo˙b~XPXòl]vPUbRXZ yy Lv]vP]8ob yy 'v}v A .] yy So]vP]8ob yy F]vP]8ob Signs yy Ll}(}]vvP}}ib˙u}vRb yy N}b]vPo`}b˙u}vRb yy N}`}`}b}vv}bRb˙u}vRb yy L}bb}(ovPP yy Avoidance of eye contact Invtiga se tions yy Uboo˙v}v] yy Eo}vRo}Pu~EGE Z](b]bb yy ]v B CT}MRI}vo˙]vb]o]ubvbXPXv}uoR˙b]o features present Trtme ae nt Tuv}ib yy T}}b}]o}uuv]}v]8obb]vP uo]b]o]v˙ R]}ov}vo}R Non-pharmacological treatment yy Ao] BR]} Avo˙b]b ~AAB Z r R]vP b }v R U b }ub]bv}R]oUR]ob}vbv(l Pharmacological treatment Standard Trtme ae ntGuidelinesUwthEditionUw ær˙b~}˙`]PRANælPZV uP}vov˙b~u˘XuP]o˙Z ær˙b~}˙`]PRAMælPZV ˙XæuP}vov˙b~u˘XXwæuP]o˙Z AMæ˙bV B. yy Xæ uP ]o˙X M˙ ]vb ˙ Xæ XærXæ uP ]o˙X M˙ ]vb v}}uuv For sleep problems ]v E RvPPB MelatoninU}oU Children u}vRr˙bV ruP]o˙~(}uZ Then Ivb ]( vbb˙ L r `lb } rv uP ~]o˙ (} uZu˘XuP v*AutisticSpctre umDisorder*v CXF}b]Pv].vR˙]˙r]vR]ovAH˙b ]v E RvPPB yy MethylphenidateU}oU Children vr˙bV æuPrR}o˙ Then Ivb](vbb˙`lo˙]vob˙æruP ~u˘X}(uPR}o˙Z rv˙bV XæuPR}o˙ Then Ivb](vbb˙˙XæuP`lo˙]vob~u˘XXrXæuP l lPR}o˙Z Note 10-9 D]b}vv](R]bv}b}vbLu}vR Refeal r Criteria Aoo}( b bubR}o(}T˙vX r Chapter Disorsof der theSkin ]o B Sl]vIv(}vb 81. Boils A boil or furuncle ]b ]o ]v(}v }( R R] (}oo]obX A u} b.]o ]v(}v ]b u (}oo]o]bX So }]ob P} ]v v v ]bRP]vP b (}u ob }]vb ]b u voX Pvb `]R v }]ob } vob bR}o vb (} ]b uoo]b v bl]v ]b}b bR b ]bb U ]o}b]b } u `R]ovb `]R (}oo]o]b ]v R bR]vPbU XPX (vu]bbR}o}vbR]vPRv]bX sueCa yy Staphylococcus aureus Symptoms yy S]vPo}uoo]v(oòo]vPb b }vRbl]v`R]Ru˙]bRP pus yy F Signs yy Sòo]vPb r ovU ùU Gv vl} v ~]v b]vPo } uoob}(bl]vZ Invtiga se tions yy FBC yy FbvPo}}Po}b~](]bZb yy S`b(}ovbvb]]˙]vb]bv}v]v(}v Trtme ae nt Tuv}ib yy T}]v(}v yy To relieve pain yy T}]v(˙vv˙]b}b]vP}v]}v yy To prevent scars and keloids æ Standard Trtme ae ntGuidelinesUwthEditionUw Non-pharmacological treatment yy Iv]b]}vv]vPr](}]o}ubGvvoP yy W}vb]vP Pharmacological treatment st L]vTuv ]v E RvPPB AXF}}]ob}(vo}b]b yy Foo}˘]oo]v U}oU Adults æræuPvR}o˙(}˙bw Children ær˙bV ræ˙bV AM˙V B. yy v*Impetigo*v yy ]vvb`]R}v]]oo]vooP˙ æuPvR}o˙(}˙bw æuPvR}o˙(}˙bw vXæuPvR}o˙(}˙bw For boils or furunculosis]vvb`]Rv]]oo]vooP˙ E˙R}u˙]v U}oU Adults æuPvR}o˙(}˙bw Children vr˙bV æuPvR}o˙(}˙bw ræ˙bV æuPvR}o˙(}˙bw AM˙V vXæuPvR}o˙(}˙bw Av Pu}o U}oU Adults æuPrP}v R}o˙(}ræ˙b Children vr˙bV æræuP}v R}o˙(}ræ˙b ræ˙bV ræuP}v R}o˙(}ræ˙b u}vRbr˙V vruP}v R}o˙(}ræ˙b CXF}F}oo]o]b yy Mupirocin}]vuvU}]oU Adults and children R}o˙(}˙bw Refeal r Criteria R( } b]o]b ]( R vo˙]vP }v]}v ]b (R uvPuvX 82. IuP} IuP} ]bR]PRo˙}vP]}bb.]o]obl]v]v(}vXI]b }uu}v]vv}vbvR]ovvu˙b}]`]R}v]}vb bR b ]bU u U o] ]v(b}v v Rb b]uo˘ ]v(}v b v Chatep rP *Disorsof der theSkin AXM]ob~(òbb `]R}(}˙bb u]uv](b}vbZ ]v E RvPPB yy Mupirocin}]vuvU}]oU Adults and children Ao˙R}o˙(}˙bw w v*Impetigo*v }v˙ b ]v(}vX TR }v]}v }b v} b v˙ ˙u}ub b vo (} } ˙b L ]v]o ˘}bX I boo˙ ]u}b `]R]v `l }(uvX TR `} ˙b }( ]uP}X TR v}vroo}b ˙ ˙]oo˙ +b R bl]v }v R v}b v u}RU b]vP ob]}vb } o}U R ]lo˙b} o ˙oo}`r}`v X b TR }R ˙U oo}b ]uP}U˙]oo˙+bRvlb]vPG]r.ooo]bb~ooZ} o}RL b (`˙b}o˙oo}`X b B}R˙b}(]uP}u˙oR]vulb`RvRR b oURbboo˙]u}}R(}oo}`]vP˙b}`lbX Ib v}v ]v}ob P}} R˙P]vU Po Rvr`bR]vPU ]uu]vP}(.vPv]ob}l]vP}(Rbl]vR}PRR]vP b U v]b}P]vPRbR]vP}(}òbvo}R]vPX sueCa yy Staphylococcus aureus yy Streptococcus pyogenes Symptoms yy Pbr.ooo]bbvb}b}vR}˙}o b Signs yy S.]oU(P]oG]r.ooo]bb yy IPo]vP b ob`]R˙oo}`b Invtiga se tions yy OLvv}]b yy M]}b}˙ v o }( R ˘ (}u R o]bb ~˘ ]v v}bZ Trtme ae nt Tuv}ib yy T}]]v(}v yy T}vvbu]bb]}v yy T} R ]bl }( o}]vP }uo]}vb ~XPX ooo]bU u] b Z yy T}]v(˙vv˙]b}b]vP}v]}v Non-pharmacological treatment yy AvbRb(}oob Pharmacological treatment Standard BXM}}}b ˘vb]b]vvb`]R} penicillin allergy st L]vTuv yy Co}˘]oo]v UIVU Adults æuPvR}o˙(}ræ˙b Children r˙bV r˙bV AM˙bV yy yy v*Impetigo*v yy yy Then Foo}˘]oo]v U}oU Adults æuPvR}o˙(}ær˙bw Children r˙bV r˙bV AM˙bV Or Au}˘]]oo]vA=Coov]A] Adults væuPR}o˙(}æ˙bw Children r˙bV vr˙bV ræ˙bV AM˙V nd o]vuv ]v E RvPPB (}˘]u C IVU Adults wæuPR}o˙(}ræ˙b Children u}vRr˙bV Then (}˘]u C U}oU Adults æuPR}o˙ Children r˙bV r˙bV u}vRbr˙bV CXM}}}b ˘vb]b]vvb`]Rv]]oo]v allergy: yy A]R}u˙]v U}oU Trtme ae ntGuidelinesUwthEditionUw æræuPvR}o˙(}ræ˙b æræuPvR}o˙(}ræ˙b vXæræuPvR}o˙(}ræ˙b æræuPvR}o˙(}ær˙bw æræuPvR}o˙(}ær˙bw vXæræuPvR}o˙(}ær˙bw U}oU væuPR}o˙(}ær˙bw æwuPR}o˙(}ær˙bw uPR}o˙(}ær˙bw uPR}o˙(}ær˙bw uP llPR}o˙(}ræ˙b æuPR}o˙ æuP llPR}o˙Uu˘XæuPR}o˙ uP llPu˘XæuPR}o˙ Chatep rP *Disorsof der theSkin Adult æuP]o˙(}ræ˙b Children uP llP}˙`]PR]o˙(}˙b AMvu}vRbV v} }uuv b }( ]bl }( ˙ loric stenosis Refeal r Criteria R((}R}b]ovuv](]vP b ]o˙}ooo]bU }b}u˙o]b}u] b o}bX 83. Cooo]b r and Erysipelas ~Sb}v}vRCooo]b[]vD]b}b}(RMbo}bloo˙bb uZ X Bo]Uo Trtme ae nt Tuv}ib yy T}o]u]R˘v}(}v b ı v*CellulitisandysEr ipelas*v TR]b ]b R}v] ]vobb v}b]vP o `]R vu]v PbU `R]Rvo}]o]vPbl]vvb}L]v(}v b vuvv ]b.PuvXWR]o]]blv}`vRR]bo]bb˙]uU R u} }( vbu]bb]}v u]vb voX H}Ù uU ]vb ] v]vRo}vRvbPPbX WRvo˙URui}]˙v `]R }u]v}v }( v]}bX TRbU o˙ ]v.}v v }] uvPuv u}]]˙v]b]o]˙(}uR]b}v]}vX sueCa yy Mycobacterium ulcerans Symptoms yy P]vobv}b b v}o yy P]vobòo]vP b }(RoPbUub}( yy E˘vb]bl]vo}v Signs yy N}oP P]vobb .u ob]}v r u ]v ]u b] ]v R v}b b bv'R}Rbl]v yy D]+b]vobòo]vP b }(RoPbUub}( yy LP]vob}( b ]v}v yy E˘vb]bl]vo}v Invtiga se tions yy W}v`b (}AFBbU]oobvbvb]]˙ yy Sl]v]}b˙(}R]b}R}o}P˙ Standard Trtme ae ntGuidelinesUwthEditionUw yy To prevent disability yy T}}R]u˙v}v˙ b ]o]v(}v Non-pharmacological treatment yy C}uo ˘]b]}v }( v}obU (o˙ `]R ]u˙ o}b ]( possible yy Sl]vPL]vP}(ob]((]o]b]oo Pharmacological treatment st L]vTuv ]v E RvPPA yy R](u]]v U}oUuP llP]o˙(}`lb Av yy S}u˙]v UIMUæuP llP]o˙(}`lb nd L]vTuv ]v E RvPPC yy R](u]]v U}oUuP llP]o˙(}`lb Av yy Co]R}u˙]v U}oUwXæuP llPR}o˙(}`lb Refeal r Criteria R(}vb`]R˘b(}uvP]vPo]o v*Yas*w v 85. Y`b Y`b ]b R}v] ]v(}v ˙ ]u R +b u]vo˙ R bl]vU}vvoPXM}b}o+R]ovvæ˙b }( P ob v} ˘uX I ]b vbu]' u]vo˙ R}PR bl]v }v`]Rv]v(b}vXb]vPo A bl]vob]}vo}bR}]v }( v˙ }( R ]u L `lbX W]R} uvU uoo ob]}vb oo } R }˙X TR ]bb ]b o˙ (oU R}` ] v o}R}v] ]b.Puvv ]b]o]˙ ]v } A9}(+ ]v]]ob ]( oL vX Tuv `]R v]}b ]b v ob]bX O}`]vPU }} b}vo R˙P]v v }} bv]}v (]o]R}( b R]bbX sueCa yy Treponema pertenue Symptoms yy Raised skin lesions yy P]vobbl]vo yy B}v]v Signs yy Pobl]vob]}vb yy P]vobbl]vo`]Rb yy (}u]b D }(Rv}bU}vb æ X Chatep rP *Disorsof der theSkin yy Pou}ovbl]vR]lv]vP Inve ti s gations yy VDRL Trtme ae nt Treatment }i es yy T}]R}Pv]buvvb yy T}v}( b R]v(}v yy T}vo}vPu}uo]}vb Non-pharmacological treatment yy None Pharmacological treatment ]v E RvPPA BXF}N}vrb}vb}N}vr]o]o]˙}(A]R}u˙]v yy BvR]vPv]]oo]v UIMU Adults Xu]oo]}vv]bX b Children AN˙bV XMUX b AM˙bV vv]bX b Refeal r Criteria R(]vo}b Ru}o}P]bX FvPoSl]vIv(}vb æ v*Yas*w v AXS]vPoD}bTuv(}Y`b yy A]R}u˙]v U}oU Adults uP llP}˙`]PR~u˘XPZb]vPo}b Children ANæ˙bV P ræ˙bV XæP vrı˙bV P vu}vRbrv˙bV æuP~b˙(oZ AMvu}vRbV v}}uuv Standard Trtme ae ntGuidelinesUwthEditionUw 86. S.]oFvPoSl]vIv(}vb TRb(vPo]v(}vbR+R}o˙b}(Rbl]vUR v]obvR]XWRvG}]U]u˙b}]`]R]uuv}bb]}v bRb]v]bv}]o]v(}vv}}b}]bX sueCa yy Du}R˙b ~vZ ]XX u]}b}u trichophyton yy Ybb]XXv] Uuob]b Symptoms yy IR˙o˙ b ]vPbRbR}vRbl]v yy Scaly bald patches of the scalp yy D]b}U]b}o}.vP}}v]ob yy IR˙vb}bl]v(}ob yy So˙Rb}(bl]v`]Ro]Puv}v U ]u}R˙}v v*SuperficialFungalSkinInfections*v Signs yy R}v o˙ b Rb `]R R]lv Pb v o v }v R skin yy Scaly bald patches of the scalp yy D]b}]b}o}v]ob yy Ao ]Puv}v }( bl]v ~R˙}]Puv } }`v]bR vZ yy PbobR]vRG˘b Invtiga se tions yy Sl]v]vPb b (}u]}b}˙vo~u˙}o}P˙Z yy N]ovl}R]o]]vPb(}u]}b}˙vo yy FBS v HIV b ~]( ]v(}v ]b G}] vl} }o v]]b]b bvZ Trtme ae nt TuvluvPuv}ib yy T}]]v(}v yy T}vvbu]bb]}v yy T}]v(˙vv˙]b}b]vP}v]}vb Non-pharmacological treatment yy G}}b}voR˙P]v yy Ub}(o}}bo}R]vP yy Ov(}}` Pharmacological treatment AXDu}R˙]v(}v}(ob ~v]b ]v E RvPPC st L]vTuv yy GriseofulvinU}oU ) æ U Chatep rP Adults æuP]o˙~}o]v]v(}v b Z(}`lb Children u}vRr˙bV `}]]}bb(}`lb r˙bV ~u˙}o]v]v(}vb b Z(}`lb yy nd L]vTuv T]v.v U}oU Adults N}}uuv Children Children}˙V B}˙`]PRANlPV B}˙`]PRrlPV B}˙`]PRrlPV *Disorsof der theSkin uP llP ~u˘X æ uPZ }v ]o˙ } ]v æ uP }v ]o˙ } ]v `} ]] }bb æuP}v]o˙(}`lb æuP}v]o˙(}`lb vXæuP}v]o˙(}`lb yy nd L]vTuv GriseofulvinU}oU Adults æuP]o˙~}o]v]v(}v b Z(}`lb Children r˙bV ZU]vu~v ) Zv(~v]b ~WR]]o[b}]vuv }v } `} `lb L R ob æ uP }v ]o˙ } ]v `} ]] }bb æ ZU}]oU v*SuperficialFungalSkinInfections*v BXDu}R˙]v(}v}(}˙~v}}]b crurisZURvb~vuvu ]v E RvPPC st L]vTuv yy Bv}]A]}u}v}]vuv Adults and children Ao˙ `] ]o˙ } Rb } visible rash has cleared Or yy Co}]u}o A9U}]oU Adults and children Ao˙`]]o˙}Rb}}v}`}`lbLob]b]o rash has cleared Or yy M]}v}o A9U}]oU Adults and children Ao˙`]]o˙}Rb}}v}`}`lbLob]b]o rash has cleared Or yy C]o}]}˘ }ou]v A9U}]oU Adults and children Ao˙`]]o˙}Rb}}v}`}`lbLob]b]o rash has cleared Standard yy yy v*SuperficialFungalSkinInfections*v ~u˙}o]v]v(}vb b Z(}`lb u}vRr˙bV `}]]}bb(}`lb Or I}v}o U}oU Adults uP}v]o˙}R}o˙(}˙bw Children ˙br˙bV u}vRr˙bV ˙b}˙b~(}v]b Or T]v.v U}oU Adults æuP]o˙(}rv`lb Children Children}˙V B}˙`]PRANlPV v`lbru}vRb]vv]o]v(}vb B}˙`]PRrlPV B}˙`]PRrlPV Trtme ae ntGuidelinesUwthEditionUw uP llP ~u˘X æ uPZ }v ]o˙ } ]v uP]o˙(}˙bw ræ uP llP ~u˘X uPZ }v ]o˙ (} æ vuvuZ æuP}v]o˙(}`lbU æuP}v]o˙(}`lb vXæuP}v]o˙(}`lb CXDu}R˙]v(}v}(v]ob~}v˙R}u˙}b]b ]v E RvPPC st L]vTuv yy I}v}o U}oU Adults uP r R}o˙ (} w ˙bU }bb L ˙b ]v o~u˘X}(}bb(}.vPv]obv}bb(}}v]obZ Children ˙br˙bV uP R}o˙ (} w ˙bU }bb L ˙b ]vo ~.vP v]ob }bbU } v]ob }bbZ ˙r˙bV æ uP llP ~u˘ uPZ ]o˙ (} w ˙bU }bbL˙b]vo~.vPv]ob }bbv} v]ob}bbZ Or yy T]v.v U}oU Adults uP]o˙(}v`lbru}vRb Children Children}˙V B}˙`]PR}lPV æuP}v]o˙(}v`lbWu}vRb B}˙`]PRrlPV æuP}v]o˙(}v`lbWu}vRb B}˙`]PRrlPV vXæuP}v]o˙(}v`lbWu}vRb yy nd L]vTuv GriseofulvinU}oU æ ) r r Chatep rP Adults æuP]o˙~}o]v]v(}v b Z(}`lb Children r˙bV ~u˙}o]v]v(}vb b Z(}`lb u}vRr˙bV `}]]}bb(}`lb D. yy yy yy E. æ uP }v ]o˙ } ]v `} ]] }bb uP llP ~u˘X æ uPZ }v ]o˙ } ]v For Candida intertrigo ]v E RvPPC Bv}]A]}u}v}]vuv Ao˙ `] ]o˙ } Rb } ]b]obRRboX Or Co}]u}o A9U}]oU Ao˙`]]o˙}Rb}}v}`}`lbLob]b]o rash has cleared Or M]}v}o A9U}]oU Ao˙`]]o˙}Rb}}v}`}`lbLob]b]o rash has cleared Or C]o}]}˘ }ou]v A9U}]oU Ao˙`]]o˙}Rb}}v}`}`lbLob]b]o bRRboX ~WR]]o[b}]vuv }v } `} `lb L R ob ZU}]oU v*PityriasisVesic r olor*v yy *Disorsof der theSkin For Oral candidiasis and Pityriasis versicolor Pob(}b}v}v}ov]]b]bv]˙]b]bb]}o} Refeal r Criteria R(}u}o}P]b](v(]ob}b}v}uvX 87. Pityriasis Versicolor P]˙]b]bb]}o} ]b}uu}v˙b]v(}v}(Rbl]vU]v`R]R Gl˙ ]b}o}Rb }v R Rb v lX I ]b b}uub oo vb]}o}XI ]bu}}uu}v]vR}o]ubUv}Lv+b }oRb]R]o˙X I]b]b}}(RRoR˙G}]b bv]vR]uuv}bbRbR}b`]R]buoo]bU HIV lAIDS v}]o}] b bX sueCa yy Pityrosporum orbiculare yy Pityrosporum ovale (malassezia furfurZ Symptoms yy ˙u}u Ab yy M]oo˙IR˙ ææ Standard Trtme ae ntGuidelinesUwthEditionUw yy v*PityriasisVesic r olor*v Po}lbl]vRb Signs yy H˙}]Puvuobvl}Rb yy WR]o˙ b Rb Invtiga se tions yy Sl]v]vP b (}u]}b}˙ yy FbvPo}}Po}b~(}G}]bZ yy R}bv~(}G}]bZ Trtme ae nt TuvOib yy T}]]v(}v yy T}vvbu]bb]}v yy T}]bb }b]vP(}b Non-Pharmacological Treatment yy G}}b}voR˙P]v yy }] A bR]vPR}òbUb}vPbvo}R]vP Pharmacological Treatment AXF}M]oT]v Versicolor ]v E RvPPC yy M]}v}o UA9U}]oU Adults R}o˙(}`lb Children AN˙bV R}o˙(}`lb AM˙bV R}o˙(}`lb Or yy Co}]u}o UA9U Adults R}o˙(}`lb Children AN˙bV R}o˙(}`lb Or yy WR]]o[b}]vuv U}]oU Adults R}o˙(}`lb Children N}}uuv Or yy Sov]uboR] UbRu}}XæA9U}]oU Adults Ov ]o˙ (} ærw ˙b ~`bR }+ L u]vb } v ] ]}vZ Children Ov]o˙(}ær˙bw æv r Chatep rP AMæ˙bV B. yy *Disorsof der theSkin v}}uuv For Severe Tinea Versicolor ]v E RvPPB I}v}o U}oU Adults uP]o˙(}˙bw Children AN˙bV uP]o˙(}˙bw u}vRr˙bV ræuPllP]o˙(}˙bw C}vrX Ub}(]}v}o]bb}]`]R}voo˙o](rRRv]vPo]r}˘]]˙X M}v]}o](v}v`R]o}vo}vPuR˙X Refeal r Criteria R(]vo}b u}o}P]bX 88. HbS]uo˘Iv(}vb TRb bo(ro]u]vP ]o ]v(}vb }( R bl]v v u}b uuvb bovP ]v o]b]vP }vb boo˙ bv }v R ( (called “cold sores_}Z RPv]o]XRv]b}uu}v}v]}bo˙ +bl]vvb ]b}}o](}v}(]b`]R]vR]u]b }( R +u}uX E˘vb]ob]}vb u˙ b}]`]R v ]uuv}}u}u]b}b }˙X sueCa yy Hbb]uo˘]b ˙ yy Hbb]uo˘]b ˙ Symptoms yy F yy T]vPo]vPU]b}u(}U}]v(obvb}v}+bl]v yy G}buooo]bb yy Gvouo]b Signs yy F yy TvP}b]ob yy RP]}voo˙uRv}R˙ yy Genital ulcers yy Ooob Invtiga se tions yy Uboo˙v}v æw v*HesSimp rpe lexInfections*v V]oSl]vIv(}vb Standard yy yy Trtme ae ntGuidelinesUwthEditionUw D]Pv}b]b]bu]vo˙o]v]o HSV}o}P˙ b ~](vbb˙Z Trtme ae nt Tuv}ib yy T}o]]vv]b}u(} yy T} o]u] ˘v }( ]bb b ]v R ]uuv}}u}u]b v }]u vb yy T}v}v˙ b ]v(}v Non-pharmacological treatment yy N}b].ubb Pharmacological treatment v*HesSimp rpe lexInfections*v AXP]}o}Pv]oob]}vb ]v E RvPPB yy AcicloviruæA9U}]oU Adults R}o˙~.ub]o˙Z(}ræ˙b Children R}o˙~.ub]o˙Z(}ræ˙b Note 11-1 S]uu]o˙Ru}v]}˙˙u}ub b (o}`]R]vR}b}(}v X b BXF}]u˙ b ]v(}vbU]bbu]vRbb]uo˘U (vvbv]uuv}bvbb yy AciclovirU}oU Adults uPR}o˙~.ub]o˙Z(}ær˙bw Children AN˙bV days u}vRr˙bV days Av yy Pu}o U}oU Adults æuPrPvrR}o˙(}ræ˙b Children vr˙bV ræ˙bV u}vRbr˙V r uP R}o˙ ~. ub ]o˙Z (} ærw uP R}o˙ ~. ub ]o˙Z (} ærw æræuPvrR}o˙(}ræ˙b ræuPvrR}o˙(}ræ˙b vruPvrR}o˙(}ræ˙b Refeal r Criteria R(}uo]}b u}o}P]bX æ Chatep rP *Disorsof der theSkin 89. Herpes ZosterIv(}vb TR]b ]b v ]v(o o]b]vP ]o ]v(}v }( R bl]vX I v } ]v R]oR}} ]b uR u} }uu}v ]v obU b]oo˙ R oo˙U b]l } ]uuv}bbX TR ]u˙ ]v(}v bvb b R]lv}˘ (varicellaZU boo˙ ]vP R]oR}}X L]lRb b]uo˘U R ]bb]bboo˙]vRv]}R}voob(}]]bXP}br R voP] ]b }uu}v }uo]}v v .v b]bv }v}(]vu}Rvu}vRLR}vb}(bR]vPobX sueCa yy v*HeossZrpe terInfections*v V]oo r}b]b Symptoms yy F yy Severe pain over areas involved yy Headache yy Bo]bb Signs yy F yy Tvb]ob`]R]v b }v}u}u}ubv]ooo˙ yy RP]}voo˙uRv}R˙ Invtiga se tions yy Uboo˙v}v yy HIV vb ~(}vvl}uoru}uobZ Trtme ae nt Tuv}ib yy To provide adequate pain relief yy T}v}v˙ b ]o]v(}v yy T}o]u]˘v}(]b]v b ]uuv}r}u}u]bvb yy T}v}uo]}vb Non-pharmacological treatment yy b B Pharmacological treatment ]v E RvPPB AXM]oHb}bZ Iv(}v yy AcicloviruæA9U}]oU Adults R}o˙~.ub]o˙Z(}ræ˙b Children R}o˙~.ub]o˙Z(}ræ˙b Note 11-2 S]uu]o˙Ru}v]}˙˙u}ub b (o}`]R]vR}b}(}v X b r æı Standard yy yy yy B. yy v*HeossZrpe terInfections*v yy yy yy Trtme ae ntGuidelinesUwthEditionUw Av D ]o}(v U}oU Adult æuPR}o˙(}˙bw Or I}(v U}oU Children æruP llPvR}o˙(}˙bw Av P}]}v]}]v A9U}]oU Adults Ao˙}o]bb]o˙ooob]}vbb}o Children Ao˙}o]bb]o˙ooob]}vbb}o Severe Herpes ZosterIv(}v ]v E RvPPB AciclovirU}oU Adults uPR}o˙~.ub]o˙Z(}ær˙bw Children AN˙bV uPR}o˙~.ub]o˙Z(}ær˙bw vr˙bV uPvR}o˙(}ær˙bw rv˙bV uPvR}o˙(}ær˙bw AM˙bV uPvR}o˙(}ær˙bw Av D ]o}(v U}oU Adults æuPR}o˙(}˙bw Or I}(v U}oU Children æruP llPvrR}o˙(}˙bw Av P}]}v]}]v A9U}]oU Adults Ao˙}o]bb]o˙ooob]}vbb}o Children Ao˙}o]bb]o˙ooob]}vbb}o CXP}bHNoP] yy Au]]˙o]v U}oU Adults æræuP]o˙oob}o}v Children N}]v](}R]b}v]}v v Chatep rP yy *Disorsof der theSkin Or C u]v U}oU Adults æræuPR}o˙oob}o}v~u˘]uuvuPR}o˙Z Children r˙bV æruPR}o˙ Then Ivb}vuPR}o˙](vbb˙ u}vRr˙bV Then Ivbbo}ò˙}æuP llPR}o˙ Or yy PPo]v U}oU Adults wæuPR}o˙oob}o}v Children N}}uuv Refeal r Criteria R(}uo]}b b]o]bX XæuP llPR}o˙ v*Chickenox p *v 90. Chicken pox CR]lv }˘ v bR]vPob b ˙ R bu ]b ~V]oo } Hb }bZ ZX Huvb R }vo˙ b} }( ]v(}v (} R]lv }˘vbR]vPobXPb}vr}rb}vvbu]bb]}v}b˙]}v `]Rb]oG](}uvb`]R]R}v]}vXCR]lv}˘u˙ ]}voo˙ vbu]' ˙ ]}v b (}u b]}˙ }vb b XTR]b]bl}(]v(}v}˙bL}vX CR]lv }˘ ]b R]PRo˙ }vP]}b ]o ]oovbb boo˙ }]vP ]v ]u]bX I ]b Pvoo˙ v]PvU bo(ro]u]vP ]bb ]v ]uuv}r }uv R]ov vb } u} b ]v }obvb v ob v ob} ]v ]uuv}bb vb XPX vb }v }]b b X C}uo]}vb ]vo ]o r]v(}v b }( bl]v ob]}vbU vu}v]Uvov}b˙bb u]v}ouv~oo˘] vRo]bZU R}u}˙}v] U v }R }uo]}vb bR b Po}uo}vR]bUR]bUvRbX E˘}b} R ]b ]vP R}v b `lb }(Pvv˙v bo ]v }vPv]o ]oo ˙v}u b R]b ˙ bl]v ]vP b U v}uo]b }( o]ubU ]vU ˙b v o}` ]R `]PRX V]oo ]v(}vv(o(}v]v(v](Ru}Ro}b]oo(}uæ ˙b(}}˙bLo]˙X SR]vPob bvb `]R bl]v ob]}vb ]v u}uo ]b]}v v ]v ]uuv}}u}u]b ]v]]obU v ˙ ˘vb]X I u˙ }uo] ˙ ]v b]bvP (} `lb } ˙b L R ]v(}v v U Standard Trtme ae ntGuidelinesUwthEditionUw ~}bRvoP]ZX sueCa yy V]oo rZ}b~}Hb}bZ Z]b v*Chickenox p *v Symptoms Chicken pox yy F yy Malaise yy Av}˘] yy Headache yy IR˙bl]vbR Shingles yy P]v(obR yy F Signs Chickenpox yy Vb]obRvoo˙}u]vPb yy RbR]v]+vPb b ~obUb]obUobb ]}vbZ yy A.b}v(Uo b }vlv}b }( b }˙U u}}vv}vvl yy Pb]bb(}ær˙bw yy Pbv }( b ]v ob]}vb bPPbb }v˙ ]o ]v( }v Shingles yy Vb]obR yy Ao}vPu}u yy Rash eventually crusts Invtiga se tions yy Uboo˙v}v~]Pv}b]b]bu]vo˙o]v]oZ yy P}o˙ubCR]vR}v~PCRZ }ooo(}ub]oG]U bU bo]U}b]vo G] } }R b]uvb ~]( ]Pv}b]b ]v }Z Trtme ae nt Tuv}ib yy T}o]R]vvb]R]vP}]v yy T}v}}v˙ b ]v(}v yy T}vR˙}v in children Non-pharmacological treatment yy }] A R]vP b yy RPoR]vP`]Rb}v` yy }] A ]vv}voo˙l]vPb]ob Pharmacological treatment AXT}o]]vv( st L]vTuv v r Chatep rP yy B. yy yy yy æræuPvrR}o˙(}ræ˙b ræuPvrR}o˙(}ræ˙b vruPvrR}o˙(}ræ˙b To soothe the skin and relieve pruritus Cou]vo}}v luU}]oUo˙o]oo˙}Rbl]v Av ]]v C Adults uP]o˙ Children r˙bV uP]o˙ vr˙bV æuPR}o˙ rv˙bV XæuPR}o˙ Or P}uR]v R˙}Ro}]U}oU~bvPZ Adults æuP]o˙}R}o˙]o˙ Or CRo}Rv]u]v uoU}oU Adult uP]o˙}R}o˙]o˙ Children vr˙bV uPvrR}o˙]o˙~u˘XuP]o˙Z rv˙bV uPvrR}o˙~u˘vuP]o˙Z r˙bV uPR}o˙ }oU v*Chickenox p *v yy ]v E RvPPC Pu}o U}oU Adults æuPrPvrR}o˙(}ræ˙b Children vr˙bV ræ˙bV u}vRbr˙V *Disorsof der theSkin CXAv]oR˙]v]uuv}}uv]v]]ob(}P}b exposure prophylaxis yy AciclovirU}oU Adults uPrvR}o˙(}æ˙b Children uP llPvR}o˙~u˘uPvR}o˙Z X D Av]oR˙]vIuuv}r}u}u]bvb~XPXHIV Av yy AciclovirU}oU Adults uPR}o˙~æub]o˙Z(}˙bw }vo˙bLb ]vP}(ob]}vb Children r˙bV uP R}o˙ ~æ ub ]o˙Z ]o˙ (} w v ) r Standard Trtme ae ntGuidelinesUwthEditionUw ˙b~}vv(}u}˙bLvP b }(ob]}vb vr˙bV ~}vv(}u}˙bLvP b }(ob]}vb rv˙bV ~}vv(}u}˙bLvP b }(ob]}vbZ u}vRr˙bV ~}vv(}u}˙bLvP b }(ob]}vb uP R}o˙ ~æ ub ]o˙Z (} w ˙b uP R}o˙ ~æ ub ]o˙Z (} æ ˙b uP R}o˙ ~æ ub ]o˙Z (} æ ˙b v*Chickenox p *v EXS]u}b]obl]v]v(}v]v]v]]obv}ooP]} penicillins ]v E RvPPC yy Foo}˘]oo]v U}oU Adults æræuPvR}o˙(}ær˙bw Children r˙bV æræuPvR}o˙ær˙bw r˙bV æræuPvR}o˙ær˙bw AM˙bV vXæræuPvR}o˙ær˙bw Or yy Au}˘]]oo]vA=Coov]A] U}oU Adults væuPR}o˙(}ær˙bw Children r˙bV væuPR}o˙(}æ˙b vr˙bV æwuPR}o˙(}æ˙b ræ˙bV uPR}o˙(}æ˙b FXS]u}b]obl]v]v(}v]v]v]]obooP]} penicillin yy A]R}u˙]v U}oU Adult æuP]o˙(}˙b Children uP llP}˙`]PR]o˙(}˙b N}}uuv(}R]ovobbRvvu}vRbb}(]bl of pyloric stenosis Refeal r Criteria R(`Rv b}uo]}vb b ]vX Aob}(vb `R} ]bl}(o}]vP]bbu]vbRXPXvb}v}] b R˙U }R ]uuv}}u}u]bb v R v`}v Rv]v(}vX N}vrS].Sl]vIv(}vb `R}b u}R Rb v Chatep rP *Disorsof der theSkin 91. LPCR}v]Uob væ v*Lager ChronicUlcs*er v Av o } b} ]b R ]v R }vv]˙ }( R bl]v v R vo˙]vP bX LP ob v b o} }( u}]]˙ v o } b]}b }uo]}vbX P]b}b]vP v vo˙]vP ]bb vb } ]vbPX C}uo]}vb ]vo (}u]˙U vl˙o}b]b }( i}]vbU }b}u˙o]bU ooo]b v uo]Pvv vb(}u}v }( obX SP]o uvu˙vX sueCa yy Iv(}vbv]v(b}vbXPXBo]obU˙`bobUo}b obUP]v`}uob yy N}vrb]. ob XPX b ~]bZU uU v}bU ]Ub]loooobU]bRu] yy Mo]PvvobXPXbu}boo]v}uUuov}uUK}b][b }u b Symptoms yy P]v yy L}bb}(bvb}vb]}(o yy D]bRPU`R]Ru˙}+vb] yy S]b.Puv yy D]b]o]˙ Signs yy So}]vPPb~v}vrb].obZ yy Uvu]vPb~o]vo}bobZ yy PvR}Pb~˙`bobZ yy R]bPb~uo]PvvobZ yy L}bb}(bvb}v]v+~]bUo}b˙U˙`b}˙R]o]b b obZ yy (}u]˙ D }(+ yy W}v]bRP~ov}}+vb]Z yy GvPv}(+~]bU]Robo]bbZ yy Dlv]vP }( + ~]Ro bo ]bbU v}b ]vb8]v˙Z yy P]vlPvo}vb`]R}bo}PR~RoR˙`}vZ Invtiga se tions yy FBU C SR E yy S]lo]vPb yy FbvPo}}Po}b yy W}v`b (}ovbvb]]˙UZ]RoN]obv]v]vP b yy VDRL lRPRtest yy Xr˙}(vo˙]vP}v yy B]}b˙}(o Standard Trtme ae ntGuidelinesUwthEditionUw Trtme ae nt Tuv}ib yy T} bo}PR R o v }u} RoR˙ Pvo}v b (}u}v yy T}}u}Ro]vP yy T}]v(˙vuvPv˙vo˙]vPb yy T}v}uo]}vb Non-pharmacological treatment yy CRvPb]vP]o˙ yy Ubb}vb]vP(}`}vbRR}(b]bRP yy Dbo}PR`}vbRRRvbo}PR yy Eoo}ò]u}vb]hvP yy v]}v A Pharmacological treatment ]v E RvPPC v*Lager ChronicUlcs*er v AXF}v}vrvb`}vovb]vP yy N}uobo]v b}o}v~D}v}bE}o Z BXF}vb`}vovb]vP ]v E RvPPC yy CRo}R˘]]v b}o}v A9U}]oU Or yy ]u] C æA9U}]oU Or yy P}]}v]}]v b}o}vA9U}]oU CXS˙bu]v]}uv(}}v˙ b ]o]v(}vb S]. vu]}]o uv ]b P] ˙ o v bvb]]˙ bobX Eu]]v]}uvu˙ ]v]`R]o`]vPo vbvb]]˙bobb}v}b o]lo˙}Pv]bubX Note 11-3 }] A }]ov]}bbR]b]vb8]v]v(}R]+vbb Refeal r Criteria R( vb `]R ob (]o]vP } bR}` b]Pvb }( Ro]vP `]R }uvUvvb`R}`}o]P˙ b ]R(}bl]v PL]vPU `}v ˘]b]}v } o]u u}v } P]o b b]o]bX Aoo ob b } uo]Pvv bR}o ob} ( } P]o b b]o]bX v Chatep rP *Disorsof der theSkin 92. Pruritus v*Pruritus*v P]b } ]R]vP ]b v vobv bvb}v }v R bl]v R }}lbRb]}}R b RXIR]vPv]bb }u(} v (b}vX Iv b b ] v o } ]b boU v˘]˙ and depressionXC}vbvR]vP b }}]vo](vuPRbl]v v ]b +vbb ui} } ]X Tuv }( pruritus ub b R vo˙]vP }v]}vX D]Pv}b]b R(} vb}u(}+uvX sueCa Localised pruritus~}v.v}]v}(R}˙Z yy S}R}]ub yy P]b vulvae yy Av}Pv]o]b yy Tinea]v(}vb yy G]}vou yy L]Rvb]uo˘R}v]b P]bl]v]b}b~}]u˙bl]v]bbZ yy }] A u yy D˙bl]v yy AooP]}vub yy U] yy Scabies yy P]P} yy Miliaria~RbRZ yy P]o}b]b yy Ivb]b yy DubR(}u]b yy L]Rvovb yy Boo}buR]P}] Generalised pruritus (usually due to a systemic disease) yy Hu}o}P]o XPX ]}v .]v˙ vu]U }o˙˙Ru] Uo˙uR}ubUolu]b yy L] ]bb XPX ]vR } ˘R R}obb]bU ]u˙ ]o]˙]R}b]bURb yy Chronic kidney disease yy Thyroid disease yy PPvv˙ yy D]buoo]b yy ]v}ub C yy DP}v yy OvR}]b]b yy Pb˙R}Pv] Symptoms yy IR]vP vw Standard Trtme ae ntGuidelinesUwthEditionUw yy v*Pruritus*v SR]vP Signs yy E˘}]}v yy L]Rv].}v yy Scars yy Fb}(vo˙]vP}v]}vb Invtiga se tions yy FBU C .ou}uuv yy BUEUv]v C yy LFTS yy FBS yy TR˙}](v}vb yy Sl]vbv]vbl]v]vPb b yy Stool RE Trtme ae nt Tuv}ib yy T}o]˙u}ub b yy T}]v(˙vvo˙]vP]b} Non-pharmacological treatment yy }] A }u]v]u]˘}b}v˙]v.obPvbXPX b}bUPvbUPbUo}Rb}(]U(}}bX yy G}}b}voR˙P]v yy C}vboo]vP~(}˙R}Pv] b ]b Pharmacological treatment AXS˙u}uuv ]v E RvPPC yy H˙}}b}v yy yy B. yy Av ]]v C U}oU Adults uP]o˙(}˙bw Children wr˙bV rv˙bV AM˙bV Or CRo}Rv]u]v Children AM˙bV Z A9U}]oUo˙R}o˙(}˙b uP]o˙(}˙bw æuP]o˙(}˙bw (˙ b v}o]b b R U}oU uPR}o˙(}æ˙b For treatment of Scabies ]v E RvPPA PuR]v o}}vA9U}]oU v Chatep rP Adult Ao˙}`R}o}˙v`bR}+LrR}b RL˙bw Children Ao˙}`R}o}˙v`bR}+LrR}b RL˙bw AMu}vRbV *Disorsof der theSkin v}}uuv N}r }] A }v`]RRu}RX R(v}Ro]v]oRu]b(}}vboo]vP}vR}( b uR]v o}}v]vR]ovv(}]vP b u}RbX yy ]v E RvPPC Bv˙ov} æA9o}}vU}]oU Adults Ao˙}R`R}o}˙LRv]PR~˘R(v RZ(}v]PRbv`bR}+Rv˘u}v]vP Children~AN˙bZ~æA9rRo(vPR b ]o}vZ Ao˙}R`R}o}˙LRv]PR~˘R(v RZ(}v]PRbv`bR}+Rv˘u}v]vP v*Pruritus*v Note 11-5 Too}vb]vbuuvvb]uov}bo˙X C}vbo R o]v]o Ru]b (}}]]o}v v }vboo]vP }v R b}(v˙ov}]vR]ovX yy O MalathionXæA9U}]oU Adults Ao˙ } `R}o }˙X L }v (} R}b v `bR }+X R o]}vL˙bw Children Ao˙ } `R}o }˙X L }v (} R}b v `bR }+X R o]}vL˙bw AMvu}vRbV v}}uuv Note 11-6 Co}R]vP v o]vv ub RvPv `bR ]o˙ `]R }vP b ]b]v (vvbR}oòo]v]}v}˙rovX S˘ovR}bR}o}vbbR}oob}X C. yy r For treatment of Candidiasis Co}]u}o A9U}]oU Adults Ao˙}+R}o˙(}˙b Children Ao˙}+R}o˙(}˙b vı Standard yy D. yy yy Trtme ae ntGuidelinesUwthEditionUw Or M]}v}o A9U}]o Adults Ao˙}+R}o˙(}˙b Children Ao˙}+R}o˙(}˙b For treatment of Miliaria~P]lo˙HUHRbRZ Cou]vo}}v U}]oU Adults Ao˙R}o˙(}˙bw Children Ao˙R}o˙(}˙bw Or Z]v }˘] uU}]oU Adults Ao˙R}o˙(}˙bw Children Ao˙R}o˙(}˙bw v*Pruritus*v EXF}uv}(}] A uE yy A}bu U}]oU Adults and children Ao˙b}Lvb}bb]o Or yy Aqueous soapU}]oU Adults and children Ubb}(}R]vPR}o˙(}o˙]vPu Or yy Salicylic Acid}]vuvU}]oU Adults and children Apply as needed FXF}uv}(}] A uE }vub ) yy T}]o}]b b u˙ b ]v ]}v } R }(}}] A E u Av yy H˙}}b}v uUA9}]oU Adults and children Ao˙rub]o˙ GXF}uv}(U] yy ]]v C U}oU Adults uP]o˙(}˙bw Children wr˙bV rv˙bV `]RGrb~bb}v r uP]o˙(}˙bw æuP]o˙(}˙bw w Chatep rP yy AM˙bV Or C Ro}Rv]u]v Children AM˙bV ~Sb}v}vRU] *Disorsof der theSkin v}}uuv U}oU uPR}o˙(}æ˙b [Z HXF}uv}(C}vDub yy H˙}}b}v A9U}]oU Adults and children Ao˙R}o˙(}˙b IXF}IvbB]b~XPXFobUBPbZ Note 11-7 S}b}(]v(b}vbR}ub b URUo}R]vP}]vPbR}o}v u]v˙R}}PR`bR]vPU]}v]vP}(u]P}vX yy uP]o˙(}˙bw æuP]o˙(}˙bw XæuP]o˙(}˙bw U}oU uPR}o˙(}æ˙b JXF}uv}(P]o}b]b (lice) yy MalathionXæA9U}]oU Adults Ao˙ } `R}o }˙X L }v (} R}b v `bR }+X R o]}vL˙bw Children Ao˙ } `R}o }˙X L }v (} R}b v `bR }+X R o]}vL˙bw AMvu}vRbV v}}uuv Refeal r Criteria R(}u}o}P]bb}}vb}bb]o](]Pv}b]b]bvoX 93. U] U] }`Ro]bvb]vU]R˙òo]vP b }(Rbl]v}v˙ b }Rob}(R]bu]vXR E ]b}}(`Rou˙ob(ù]vb }ob R}b v u˙ RvP bRX WRob u˙ }vU } (}u w v*Urticaria*v yy ]]v C U}oU Adults uP]o˙(}˙bw Children wr˙bV rv˙bV AM˙bV Or CRo}Rv]u]v Children AM˙bV r Standard Trtme ae ntGuidelinesUwthEditionUw v*Urticaria*v ]vPbU uro]l 'v } P]v RbX TR b( `Rob u˙ }uv] ˙ òo]vP b }( u}b uuv bR b R ˙o]bU o]bU Rvb v }R b }( R }˙X TR òo]vP b ]b oovP]}uX U] ]b obb]. b ] ]( R }v]}v obb obb Rvb]˘~vZ`lbvR}v]]](]obbu}Rvb]˘~vZ`lbX Cb }( ]b v b]o˙ ]v. b P]vb R}b (} R}v]]X sueCa yy M]]vb XPX v]]oo]vbU Ro}b}]vbU b]]v U NSAIDSU }˘}]bU v]uoU b u}R]v U]}}vbu]UCE]vR]]}b A yy F}}b XPX .bRU vbU PPbU R}}oU bRoo.bRU }lU b]bU u]olU RbU(}}˙bU]b yy Iv(}vbXPXb]bURb~]oZ yy L˘XPXPo}bUu]o]uv yy M]o }v]}vb XPX ob ˙Ru}bbU o˙uR}uU }o˙˙Ru] yy Povb yy I]}R] yy Ev]}vuvovR˙b]o(}b yy Pb]b P`Rob }vR}(bl]v˘]v r ]vPv˙(}u}(XP b Xb}ob}((L}o}vPv]vP b yy S}oU }o v R]P `Rob `Rv˘}b } Rbv]}vuvb yy APv]]P˘}b}òb}]R˙`Rob yy CR}o]vP] ]P ]vvb ] `Rob are seen in rer b}vb}`vP b U˘]bUu}}vbUvR}(}}b yy Du}PR]buPo]v`Rob v}bo}(R]vP b or pressure Symptoms yy IR]vP yy WRob Signs yy WRob yy Du}PR]bu yy AvP]}u Invtiga se tions yy Uboo˙v}v yy Foo o}} }v ~u˙ bR}` }b]v}R]o] o } ooP˙ } b] ]v(b}v } o}` `R] o}} }v (}u ˙bb u] ob ˙Ru}bbZ yy Stool RE yy TR˙}] v}]b v (v}v ~]v R}v] ] ]( }]uuv }]P]v]b}vb]o]lo˙Z w Chatep rP *Disorsof der theSkin yy Sl]v]}b˙~](`Rob }o}vPU}]v(˙bo]bZ Trtme ae nt TuvOib yy T}}]]uu]o]( yy T}v}uo]}vbbRbvR˙o˘]b yy T}]v(˙}bb]ovo˙]vPbvb]X Non-Pharmacological Treatment yy }] A }v `]R } (R b }( R b ooPv } Pv b Pharmacological Treatment UbR}l}bR˙˘]}v ıX RE˙Ru vBoo}bR}v TRb ]uuv}o}P] }vb R] ˙ v]vP `]R } `]R} o]b]vP }( R bl]v vl} u}bX TR }uu}v ˙b ˙Ru uo(}u U SvbrJ}Rvb}v ˙v}u b w v }˘] ]uo v*Rectiv a ythe eEr maandBullousRection a *v AXC}v}o}(`Rob and itching ]v E RvPPC yy ]]v C U}oU Adults uP]o˙(}˙bw Children wr˙bV uP]o˙(}˙bw rv˙bV æuP]o˙(}˙bw AM˙bV XæuP]o˙(}˙bw Or yy CRo}Rvu]v U}oU Adults uPrvR}o˙ Children vr˙bV uPrvR}o˙ rv˙bV uPrvR}o˙ r˙bV uPR}o˙ Or yy P}uR]v U}oU Adults æræuPrR}o˙ Children r˙bV XæræuPrR}o˙}æuPv]PR ær˙bV vXærXæuPR}o˙}ræuPv]PR ræ˙bV vXæuPR}o˙}æræuPv]PR AM˙bV v}}uuv Refeal r Criteria R(b}(R}v]]}u}o}P]bX Standard Trtme ae ntGuidelinesUwthEditionUw v*Rectiv a ythe eEr maandBullousRection a *v v}o˙b]b~TENZ XW]RooRb}v]}vbUR}o}uv˙]vP ˘vb] v}v }( bl]v `]R }vbv G] v o}o˙ o}bb v]bl}(}v˙ b ]o]v(}vXAooR}v]}vbbR}o }vb]buPv]b]]vP]vvb]X E˙Ruuo(}ubvbb]R˙UPro]lUv}vrbo˙ob]}vb }(RoubUb}obU(}ubvoPbX SvbrJ}Rvb}v ˙v}u b ]b R] ˙ ˙Ru v o]b (}u}vU `R]R ]}voo˙ ]v}ob R u}b uuvb ~}vivUu}RUPv]obXZX T}˘]]uov}o˙b]b~TENZ ]bPvo]ob ˙}(bl]v }vU }Lv } v ooP] }v } PbX A b]u]o }v }b]vR]ovuR˙o}}o b ob bl]v˙v}u b U`R]R]b caused by Staphylococcus aureusX sueCa yy V]o]v(}vbXPXRbb]uo˘]b U}]b yy M˙}obuvu}v] ]v(}v yy bA P }v XPX } boR}vu]bU v]]oo]vU NSAIDSU v}vobvbX yy Mo]Pvv˙ Symptoms yy F yy Bo]bb yy IR˙bR yy Sore throat yy Gvouo]b yy D]bRP]vP]v(o˙b yy ˙u}u Ab Signs yy F yy Fo]oo yy Gv]ovl}}oo}vb yy Dv}(bl]v Invtiga se tions yy FBC yy BUEv]v yy HIV screen yy Bo}}v`}vob~](]v]Z Trtme ae nt Tuv}ib yy T}u]v]vR˙}v yy T}u]v]vv]}v yy T}}o}o˙]uov w U˙}uPo}]b Chatep rP *Disorsof der theSkin yy T}u]v]vv}uo}˙u yy T}v}v˙ b ]v(}v yy T}]v(˙vo]u]vvo˙]vPb yy T}v(R˘}b}RPv b }P Non-pharmacological treatment yy W]Rò}(]v.oPv b }P yy M]vvv}(]vv}}(G] yy }o A G]b yy Pv }v }( o bl]v `]R }vu]v o]vv b]vP vb]vPo yy o˙ E }RRou}o}P]o}vbo}v yy N]}b] Pharmacological treatment B. yy UIVU For Pain and Fever ]v E RvPPA Pu}o U}oU Adults æuPrPvrR}o˙ Children vr˙bV ræ˙bV u}vRbr˙V v*Rectiv a ythe eEr maandBullousRection a *v AXF}R˙}v yy N}uobo]v æræuPvrR}o˙ ræuPvrR}o˙ vruPvrR}o˙ CXF}C}v}o}(RIuuvP}bb]vvb`R}vòo}` b ]v E RvPPC yy Pv]b}o}v U}oU~}vb}(}v]}vZ Adults XæruP llP]o˙v}+}wr˙b Children XæuP llP]o˙v}+}wr˙b X D F}C}v}o}(RIuuvP}bb]vvb`R}vv} swallow yy H˙}}b}v UIVU Adults uPvR}o˙voo}òo}` b Then yy Pv]b}o}v U}oUb} Children uP llPvR}o˙voo}òo}` b Then yy Pv]b}o}v U}oUb} wæ Standard Trtme ae ntGuidelinesUwthEditionUw EXT}S}v˙]o B Sl]vIv(}v}M˙}obu Pneumonia ]v E RvPPB yy A]R}u˙]v U}oU Adults æuP]o˙(}æ˙b Children uP llP}v]o˙(}æ˙b AMvu}vRbV O yy E˙R}u˙]v U}oU Adults æuPvR}o˙(}˙bw Children vr˙bV ræ˙bV AM˙V v}}uuv æuPvR}o˙(}˙bw æuPvR}o˙(}˙bw vXæuPvR}o˙(}˙bw v*AcneVulgaris*v FXF}v}v}(bl]v]v(}vb ]v E RvPPC yy CRo}R˘]]v b}o}v A9U}]oU Or yy ]u] C æA9U}]oU Or yy P}]}v]}]v b}o}vA9U}]oU Note 11-8 D}v}b]obo(]]vb]]b bo(P (}bl]vX G. yy For oral ulcers P}]}v]}]v A9u}R`bRUR}o˙ Or yy CRo}R˘]]v XA9u}R`bRUR}o˙ Refeal r Criteria R(oovb}}]b]o]bX 95. AvVoP]b Av oP]b ~]uob or spotsZ ]b }uu}v R}v] ]vGuu}˙ b ]b} ]v}o]vP R R] (}oo]o v b}b Pov `R]R l]v bvb u]vo˙ ]v }obvX A ]˙ }( b}b u}bo˙ }v R ( v }R b }( R }˙X S v u˙ ] o}v } ˘o v vo˙]vP R}u}vo ]b}X TR]b }v]}v u˙ ]v b}u ˙R}o}P]o b ]bvbX TR R}] }( uv vb }v PU ]˙ b U v `RR R v ]b }u]vvo˙ ]vGuu}˙ } wv Chatep rP *Disorsof der theSkin w v*AcneVulgaris*v }u}voX sueCa yy Ivbbu}v b yy Av}uolv]b}v}(RR](}oo]ob~R]˙Z yy Ivbbvb]]˙}(Rb}bPovb}uoR}u}vb yy Propionibacterium acnes yy P}o}vPb}(˙bb u]v}]o}]b b XPXAv}o]}]b b bRbv}oUv}}o}o b vvv}o}v yy Ub}(}ubUb]oo˙}bR}v]vov}o]vU}ouU Po}]obU˙oU b o˙oo}R}ov}o]] yy C}vPvbPu}˘˙}Pb}v]vi}vU]uov} ]v]v}Pb}vUv}o}vb yy PPvv˙ yy P}o˙˙b}]v˙v}u b yy Adrenal disorders Symptoms yy P]uob ~}v R ( v }b]}voo˙ }v R vlU Rb v bR}obZ yy Greasy skin yy F]o]b.Puv Signs yy C}u}vb~olRbv`R]RbZ yy Pob yy Cysts yy Scars yy Nodules yy Pbob yy H]bbu~bPPb˘bbv}PvbZ Invtiga se tions yy Uboo˙v}v yy Su }bb }v ~]v (uob `]R }uv˙]vP R]bbu v ]]o]b]vP(bZ yy Po]ob}v~]v(uob}˘o}o˙˙b}]b](R]bbu bvZ Trtme ae nt Tuv}ib yy T}]u}}buv yy T}v}uo]}vboo˙]vP b yy T}vb yy T}]v(˙v}]v˙}b }v]vP(}b Non-pharmacological treatment yy C}vboo]vP}(vb Standard Trtme ae ntGuidelinesUwthEditionUw Pharmacological treatment AXF}u]o}u}v ]v E RvPPA yy Bv}˙o }˘] ˙bvRu}buuvbZ yy yy Av C o]vu˙]v UA9o}}v}PoU}]oUo˙]o˙ Or Tv}]v XA9PoU}]oUo˙v}~}]]vPRbvU˙bUv}b ]obUu}RUu}buuvv}lvbl]vZ C}vrX T}]ov}]b~Tv}]v yy B. v*AcneVulgaris*v yy yy yy æA9 o}}vU }]oU o˙ ]o˙ ~}]]vP u}RU r }v]v] Z ]vPvv˙ Or Adapalene XA9 u } PoU }]oU o˙ R]vo˙ }v ]o˙ ~ v]PR(}boZ For moderate to severe acne (or where topical therapy is ]v+}v}}oZ ]v E RvPPB T}]ouv(}u}~AZ Av D }˘˙˙o]v U}oU Adults uP]o˙(}`lb v ru}vRb v ~v]vP}vb}vb} uvZ Children N}}uuv Or TetracyclineU}oU Adults æræuPR}o˙(}`lb v ru}vRb v ~v]vP}vb}vb }uvZ CRvP u]}v } ˙R}u˙]v L u}vRb ]( b}vb ]b poor Children AN˙bV bu}bb(}ob} AM˙bV v}}uuv Or E˙R}u˙]v U}oU Adult æuPR}o˙(}v`lbrvu}vRb Children AN˙bV æuPR}o˙(}v`lbrvu}vRb r˙bV æ uP R}o˙ Or æ uP }v ]o˙ (} w r Chatep rP *Disorsof der theSkin v`lbrvu}vRb Refeal r Criteria R( vb v} b}v]vP } uv } u}o}P]bX Sb vo˙]vP v}]v }v]}vb bR}o ( } v v}]v}o}P]bX 96. Eczema wı U v*Eczema*v uE }ub ]bv}R}v]]vGuu}˙}v]v R bl]v }Lv } v ˘vo ~˘}Pv}bZ } ]vvo ~v}Pv}bZ (}X E˘}Pv}b u ~}v uZ ]vob ]u˙ ]]v ub v ooP] }v ub X Ev}Pv}b u ]vob }] u U b}R}] u U ]b}] u U }b u ]}bu vv}Pv}bRvvb}obubX C}vub u˙ v ]]v ~}vv}v vvZ } ooP] ~o˙ R˙bvb]]˙Z }v } b]. ˘vovb bR b uobU U Ru]ob X Iv }vb } R v}Pv}b ˙bU R bl]v }v ]b }v.v } R b ]o˙ ]v }v `]R R}+v]vPvb }ooPvX }] A u ]b }uu}v R}v] bo(ro]u]vP ] bl]v ]b} u]vo˙ }( R]oR}} b}uub b]bb ]v} o o](X TR bR boo˙ b `]R]v R .b ˙ }( o](U u}bo˙ `v Pb v u}vRbX Iv }o R]ov R bR R]boo˙ ]v}ob R G˘o bX A (u]o]o lP}v }( }˙ ~bRuU R˙ (U }b]v}R]o]U ooP] R]v]b v b]u]o bl]v }ouZ ]b }Lv vb X TR}v]}v]bR]b˙obbvu]bb]}vbX S}R}] u bvb b o˙ b U Gl]vPU ˙ v v bR }( R ob U ˙}`bU vb}o]o (}obU ]}oU ]}]o v ]]o bl]vbX S}uub ] bvb b R˙}]Puv uobX I u˙ b}] `]R Pityrosporum ovale ]v(}vX E˘vb] (}ub b}]`]R]uuv}bb]bUoo˙HIV ]buoo]bX sueCa yy Gv yy I]vb~XPX]bUolo]bUPvbU}ou}bZ yy AooPvb~XPXv]loUU]bUR}ubUR]˙bU}]o u]uvbUovbUv]ov]bRU}bubXZ yy FvPo]v(}vb~XPX Pityrosporum ovaleUu}R˙}b]bZ yy Vv}bb]b~XPX]}b]vbUR(]oUo˙uR}uZ Symptoms yy IR˙bl]v yy D˙bl]v yy W]vPUvbR yy Robbvu]bb]}vb'v lAIDS and Standard Trtme ae ntGuidelinesUwthEditionUw v*Eczema*v Signs yy D˙bl]v yy Scaly skin yy E˙Ru yy E˘}]}vb yy L]Rv].}v yy P}b]vGuu}˙R˙]Puv}v}R˙}]Puv}v yy Pob yy Vb]ob yy F]bb]vP Invtiga se tions yy PRvP b (}}vub yy Sl]v]vP b (}(vPoouvb yy HIV vb ~b}R}]u ]vobZ yy FbvPo}}bP~b}R}]u Trtme ae nt Tuv}ib yy T}o]}}v}o˙u}ub b yy T}]v(˙v}]v˙}b ]}b]vP(}b Non-pharmacological treatment yy C}vboo]vP}(vb yy }]v A }(]v.o]]vP(}b Pharmacological treatment ]v E RvPPC AXF}}] A uE yy Eæu U}]oU Adults Ao˙R}o˙ Children Ao˙R}o˙ Or yy A}bu U}]oU Adults Ao˙R}o˙ Children Ao˙R}o˙ Or yy SR' U}]oU Adults Ao˙R}o˙ Children Ao˙R}o˙ Or yy Salicylic Acid}]vuvA9U}]oU ]vobZ Chatep rP *Disorsof der theSkin Adults Ao˙R}o˙ Children Ao˙R}o˙ yy yy yy yy B. yy yy ~}RPoZU}]oU Av H˙}}b}v ul}]vuvrXæA9U}]oU Adults Ao˙rR}o˙ Children~A9uZ u}vRbr˙bVo˙R]vo˙}R}o˙]v}(bR Or M}ub}v o}}vl}]vuvXA9 Adults Apply thinly once daily Children Apply thinly once daily Or uRb B }v ul}]vuvXærXA9U}]oU Adults Ao˙R]vo˙rR}b Children~XæA9Z r˙bV o˙R]vo˙}R}b And C Ro}Rvu]v U}oU Adults uPrvR}o˙}uP}vv]PR(}˙bw Children vr˙bV uPrvR}o˙}uP}vv]PR(}˙bw rv˙bV uPrvR}o˙}uP}vv]PR(}˙bw r˙bV uPR}o˙}uP}vv]PR(}˙bw Seborrhoiec Eczema ]v E RvPPC M]}v}o UA9obR˙}}b}v Adults Ao˙R}o˙oobRb}ob Children Ao˙R}o˙oobRb}ob Or Co}]u}o UA9obR˙}}b}v A9uU}]oU A9uU}]oU v*Eczema*v yy Av O]oub} Adults Ao˙rR}o˙ Children Ao˙rR}o˙ Standard yy yy v*Eczema*v yy Trtme ae ntGuidelinesUwthEditionUw Adults Ao˙R}o˙oobRb}ob Children Ao˙R}o˙oobRb}ob Or K}}v}obRu}} U}]oU Adults Ao˙ `] `lo˙ (} `lb `]R ob ˙b `v R o]}v Children r˙b~bRu}}ZVAo˙`]`lo˙(}`lb`]Rob ˙b`vRo]}v AM˙bV(˙ b v8˙v}o]b b O Sov]uboR] bRu}} Adults Ao˙`R}o}˙ub`l(}`lb]v]oo˙ Then Ov˙r`lb}}v}o˙u}ub b X Aoo}`}u]v}vRob (}ru]vbRv]vbR}}PRo˙ Children ær˙bV bubo}b AMæ˙bV v}}uuv Or I}v}o U}oU Adults uP]o˙(}`lb Children AN˙bV uP]o˙(}`lb u}vRr˙bV ræuPllP]o˙(}`lb C}vrX Ub}(]}v}o]bb}]`]R}voo˙o](rRRv]vPo]r}˘]]˙X M}v]}o](v}v`R]o}vo}vPruR˙X CXF}C}vDub yy uRb B }v ul}]vuvU}]oU Adults~XærXA9Z Ao˙R]vo˙rR}o˙(}˙bw Children~XæA9Z r˙bVo˙R]vo˙rR}o˙(}˙bw Or yy M}ub}v o}}vl}]vuvXA9 Adults Ao˙R]vo˙}v]o˙(}˙bw Children Ao˙R]vo˙}v]o˙(}˙bw Chatep rP *Disorsof der theSkin D. yy For facial contact Eczema H˙}}b}v uUA9}]oU Adults and children Ao˙R}o˙ Refeal r Criteria R( vb v} b}v]vP } uv v R}b v]vP (R]vbP}vbbRR b vP b }u}o}P]bX 97. Intertrigo v*Intetrr igo*v Iv]P} ]b R u b } b] bR ]v }˙ (}ob } }b]vP bl]v b(b bR b ˘]ooU P}]vU buuu˙ P]}vbU vR v }u]vo }v }( (U .vP } } ` bX A+ bl]v]bvvv}u(}oXIv]P}]boo˙}uu}v]v R}b`R}}`]PRvvb`]R]buoo]bX B}˙ (}ob ~G˘bZ }v } ]vGuu}˙ bRb b }( oo˙R]PRbl]vuvu}]b(}u]vbvb]oò}bbX S`vP R ]b v} ˙b } } v (]}v (}u u}uv }( ivbl]vUbob]vRb}bl]vX sueCa yy Candida albicans~u}v]o] Z yy Tinea]v(}v yy uE ~XPXb}R}]U}]U}vZ yy Pb}]b]b ~G˘oZ yy E˙Rbu Symptoms yy IR˙Uo˙ b bR yy D˙bl]v yy W]vPUvbR yy D]bRP]vPob]}vb Signs yy D˙Uo˙ b bl]v yy E˙Ru yy E˘}]}vb yy Pob yy Vb]ob yy u˙ C oo] b obb RuP]vb}(+ yy Pb]bv}`vRb yy WooruRb yy Pob Invtiga se tions yy PRvP b (}}vub yy Sl]v]vP b (}(vPoouvb Standard yy yy Trtme ae ntGuidelinesUwthEditionUw FbvPo}}Po}b S`(}ovbvb]]˙ Trtme ae nt Tuv}ib yy T}o]˙u}ub b vl}b}]]b}u(} yy T}]v(˙vv˙]b}b]vP(}b Non-pharmacological treatment yy Wo}}b}'}vo}R]vPv}v(}}`(}}v}((}ob yy W]PRo}bb yy }] A ]]vP(}b](v˙ Pharmacological treatment AXF}v] intertrigoUb}R}]u ]v E RvPPC yy M]}v}o A9obA9R˙}}b}v Adults Ao˙R}o˙(}˙b Children Ao˙R}o˙(}˙bw v*Intetrr igo*v yy yy yy yy yy Then M]}v}o A9uU}]oU Adults Ao˙rR}o˙oobRb}ob Children Ao˙rR}o˙oobRb}ob Or Co}]u}o A9uU}]o Adults Ao˙rR}o˙oobRb}ob Children Ao˙rR}o˙oobRb}ob Or M]}v}o UA9}Ù}]oU Adults Ao˙rR}o˙oobRb}ob Children Ao˙rR}o˙oobRb}ob Or Co}]u}o UA9}Ù}]oU Adults Ao˙rR}o˙oobRb}ob Children Ao˙rR}o˙oobRb}ob ]v E RvPPB I}v}o U}oU }v]v(}v uU}]oU Chatep rP Adults uP]o˙(}˙bw Children AN˙bV u}vRr˙bV *Disorsof der theSkin uP]o˙(}˙bw ræuPllP]o˙(}˙bw C}vrX Ub}(]}v}o]bb}]`]R}voo˙o](rRRv]vPo]r}˘]]˙X M}v]}o](v}v`R]o}vo}vPruR˙X B. yy yy yy yy CXF}C}vub U}] A u or Flexural psoriasis yy H˙}}b}v uUA9}]oU Adults~rXæA9ul}]vuvZ Ao˙rub]o˙ Children~A9uZ AN˙bV o˙R]vo˙rR}o˙]v}(bR(} æ v*Intetrr igo*v yy For Erythrasma Fb]]A] UA9uU}]oU Adults Ao˙vrR}o˙}+b Children Ao˙vrR}o˙}+b Or Co]R}u˙]v U}oU Adults PX b Children æræuPX b Or E˙R}u˙]v U}oU Adults æuPR}o˙(}æ˙b Children r˙bV æræuPR}o˙(}æ˙b r˙bV æuP}(˙b R}o˙(}æ˙b Or M]}v}o A9uU}]oU Adults Ao˙rR}o˙oobRb}ob Children Ao˙rR}o˙oobRb}ob Or WR]]o[b}]vuv U}]oU Adults Ao˙R}o˙oobRb}ob Children Ao˙R}o˙oobRb}ob Standard Trtme ae ntGuidelinesUwthEditionUw ˙bw Or yy M}ub}v o}}vl}]vuvXA9 Adults Ao˙R]vo˙}v]o˙(}˙bw Children Ao˙R]vo˙}v]o˙(}˙bw Or yy uRb B }v ul}]vuvU}]oU Adults~XærXA9Z Ao˙R]vo˙rR}o˙(}˙bw Children~XæA9Z r˙bV o˙R]vo˙rR}o˙(}˙bw Refeal r Criteria R(vbv}b}v]vP}uv}u}o}P]bX v*Intetrr igo*v v Chapter EndocrineandMetaolic b Disorsder 98. Diabetes Mellitus D]b uoo]b is characterised by persistently elevated blood Po}boobXI(oLv}]u}o˙(}o}vP]}bR]b `]oobo]v`]bo}}bouPv}uo]}vbovP } R ˙bU l]v˙bU RU ]v v vbX TR ]b v ]vb ]bl }( o}` o]u u}vbU }} (o]˙ v Pvv˙ }}ub `]R ]u}Po}b}v}oX AoR}PR R]ov v }obvb }Lv bv `]R ˙u}ub b U uv˙ ob `]R ]b ˙u}u b X I ]b R(} vbb˙ } ˘o ]b ]v oo b}vbU b]oo˙ obU 'v]vP RoR(]o]b(}}vu]o˘u]v}vbU.b}rv]Ù vrvo U o v uPv˙ u]bb]}vb } vP}]vP P]o b }bX TR v}vrRu}o}P]o v Ru}o}P]o ]vv}vb ]v ]buvPuvboo˙o](ro}vPX Iv]]ob (}v } R v}b } ]oo˙ obu Po}b oob ]v R r]b } ]bvPbU b R}`v ]v R o o}Ù `]oo v(Rbuv}}v.uR]Pv}b]bX FbvPobu Po}b rR}bv]o obuPo}b HA AMæXvuu}olL AMwXuu}olL AMæXwA9 N}uo AMæXvuu}olL wXWXuu}olL æXwWvXA9 IGT~Pr]bZ æXwrvXıuu}olL AMwXuu}olL æXwWvXA9 IFG~Pr]bZ ANwXuu}olL ANXuu}olL ANvXæA9 D]b HAWGo˙Hu}Po}]v IGTWIu]Go}bT}ov IFGWIu]FbvPGo˙u] w c Status Standard yy yy yy yy sueCa yy yy yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw F}(}ub}(]bv}v]vP T˙]b T˙]b Gb}vo]b ~Sb}v}vRD]b]vPPvv˙ [Z S}v˙ ]b ~o } u]}v bU v}]v } v]bX b Z }]uuv A ]b}~T˙]bZ I]}R]~T˙]bZ Gv (}b b]vP (]v R }v }}v b }( ]vbo]v ~T˙]bZ Ev]}vuvo (}b XPX ˘bb] o}] ]vl v ol }( R˙b]o]˙~T˙]bZ PPvv˙~Gb}vo]b Z Secondary diabetes: yy M]}vXPX}}b}]b}b yy Pv]bb}v}u˙ yy Ev}]v]b}bXPXCbR]vP [b˙v}u b v*DiabetesMellitus*v Symptoms yy Uboo˙v}v]vuv˙ob yy P}o˙]vv}] yy P}o˙]b] yy Uv˘o]v`]PRo}bb yy Bo]b]}v yy Recurrent boils yy Recurrent pruritus vulvae yy oE ˙b(v}v yy S˙u}ub o } R}v] }uo]}vb ~XPX R]vb v vob[ bvb}v } vuvbb ]v R Rvb } (U (}} PvPv ]b]}vXZ yy Do]˙}(oP]b~ANlPZ Signs yy Uboo˙v}v]vu}bvb yy Ll}(bvb}v]vR(}Rvb yy F}}PvPv yy Po}u yy Iu]]bo]˙ yy Cataract yy RvoRvPb}v(v}b}˙ Invtiga se tions Nò˙]Pv}bv yy FbvP}v}uo}}Po}b yy OoPo}b}ov~]( b ]}}v.u]Pv}b]bZ yy Bo}}Uo}o˙bvv]v U}uPo˙X U }} Chatep rP *EndocrineandMetaolic b Disorsder yy FbvPo}}o]]}.o~obZ yy Go˙Ru}Po}]v~HAZ yy FBC yy GCE ~obZ yy U]vo˙b]b yy U]vl}vb~`]RR]PR]v]oPo}boobZ D]vP}v(}oo}`b yy Bo}}Po}b yy R} bob }( Po bo(ru}v]}]vP }( (bvP v v }uR}u b ˙Rvb]vPPo}bu yy P]}](bvP}v}ub]vPo]v]]`b yy Go˙Ru}Po}]v~HAZ~ob`]˙Z yy Bo}}o]]b~vvoo˙Uu}(vo˙](oobv}uo} }vo]]o}`]vPu]}vZ yy Bo}}Uo}o˙bvv]v~vvoo˙Uu}(vo˙ ](oobv}uoZ yy U]vu]}ou]v~vvoo˙Z ı v*DiabetesMellitus*v Trtme ae nt Tuv}ib yy T}o]˙u}ub b yy T}vR˙Po˙u]}uo]}vb~]XXl}]}b]bv RR˙}bu}oZ b yy T}vuvroR˙}Po˙u] yy T}R]vu]v]v}]Po˙u]Pb yy FbvP o}} Po}b `v rw uu}olL ~obb ]vvb] Po˙ u]Pb]voo˙vbZ yy rR} }bruo o}} Po}b `v ærı uu}olL ~obb ]v vb]Po˙u]Pb]voo˙vbZ yy Go˙Ru}Po}]vwA9}obb~obb]vvb]Po˙u] Pb]voo˙vbZ yy T}vb`]PR}v]v}`]PRv}b]v]]ob yy T}vR}v]}uo]}vb}(]b˙u]v]v]vP yy TRPo˙u]Pbv}} yy Bo}}obb bRvluuHP yy LDLrR}ob}oobbRvXæuu}olL r r r r Standard Trtme ae ntGuidelinesUwthEditionUw Non-pharmacological treatment B}˘rP) TRo](b˙ou}].}v D]P yy C}uo˘}R˙b~XPXlvl˙U˙uUov]vX(Z yy }] A .v bPb b ]v b}L ]vlbU } ]vP bP}PbX A. ]o `vb b v R][ b}L ]vlbU `R]R } v} }v]v Po}bU u˙ R}`b yy ˙A [b]ubPvoo˙}vb]b}(V yy C}R˙b ~vA9ZU }]v ~æA9Z v ( ~A9Z u}bo˙ }( ovr}]P]v vo}`]vv]uo( yy yy yy yy v*DiabetesMellitus*v So~b}]uRo}]ZAMæP l˙ F]bvPobAHP l˙ S}oo.~XPXb(}v]v}bUvbUobUvbXZ A }o o}] }vv ~}}vbZ }( (}} v v ]vb ]v R u}v}(.XPXPobU(]bvob yy O`]vP } R b]o vb }( R]ov (} ] R `]oo vb }uo P}`RU R] ] ub u]v ˙ ]]v ]v }vbo}v `]R a paediatrician Alcohol: yy Ivl }( o}R}o ]b }R]] (} ]v]]ob obb Rv ˙b }( PX WR]oo}`}vbu}v]bu]bb]o]vovbUu}}R˙ ]vl]vP}(o}R}o]vbbR}oo}]]vlvu˙`}bv} `]PRv}b]˙XIu˙ob}]vbR]bl}(R˙}Po˙u] E˘]bP yy RPoUb]uo˘]bXPXu]vb]blòl]vPob˙b`l ]vuovvb yy Aoo]}v˘]bubP]}vb]}v}Rv[bPvR bv}(}uo]}vbv}Ru]o}v]}vb r r Pharmacological treatment AXT˙]bvbvT˙vb}v]vbo]v monotherapy Note 12-1 Ivbo]v }b ]uvb ˙ (}u v} v ]b }( P v }˙`]PRX TR }o ]o˙ ]vbo]v ]uv (} u}b ob v ro R]ov ]b } XvrX v]bllPU `R]R bR}o P]v ]v ]] }bbX H}Ù ] ]b v } P]v `]R o}` }bb v ]o R]b `]R u } v R˙}Po˙u]X Ivbo]v]uvb]vb]vP]v(}vbU˙U]}b}(bU] vo}P]o b uUPvv˙X TR bo} (} ]vbo]v ]vi}vb (} }v ]buv ]b b v}bU u]v]b u]vb (} uo (} Polb}oo ]vbo]vU u]˘]vbo]vU}NPH]vbo]vv]uu]o˙(}Ruo(}]vP vo}P]vbo]vb~XPXbUo]b}}]vP Z }R(}oo}`]vPP]uvbP yy T`] ]o˙ ru]˘ ]vbo]v ~b}oo A= ]vu] vP ]vbo]vZ (} l(bvb~(Z O ı r r Chatep rP *EndocrineandMetaolic b Disorsder yy T`]]o˙]vi}vb}(S}ooPLUSNPHu]vb(}l(bv S}oo PLUS NPH u]vb (}X b TR S}oo v NPH ]vbo]vb ubP]v]v˙]vPb b X yy yy yy ]v E RvPPA Ivbo]vPu]˘USCU ~A9b}oo]vbo]vvwA9NPH]vbo]vZU A0}(}o]o˙]vbo]v]uvu]vb(}l(b Av A+}(}o]o˙]vbo]v]uvu]vb(}v]vPuo ~bZ Or S}oo]vbo]vUSCU A+ }( }o ]o˙ ]vbo]v ]uv ]v ]] }bb u]vb before breakfast and supper vA Ivbo]vNPHUSCU A0 }( }o ]o˙ ]vbo]v ]uv ~A0 }( `R]R `}o P]v u]vb(}l(bvA+u]vb(}bZ v*DiabetesMellitus*v BXT˙]bvb}v}ou]}vbV]v]ouvPuv (Monotherapy) st L]vTuv ]v E RvPPA yy M}u]v U}oU Adults æuPrP]o˙ Then Ivb˙u}vRb}u˘]uu}(PR}o˙](vbb˙ Children Refer to specialist CXT˙]bvb}v}ou]}vbVvbv} R]]vPPo˙u]Pb`]RM}u]v approximately 3 months (Dual Therapy) yy M}u]v U}oU Adults PR}o˙ Children Refer to specialist yy Av Go]vou] U}oU Adults XæruP]o˙ ~I(]Uv}u}RvæuP}(Go]vou] P]v]vRv]vPu˘]uu}o}bæuP]o˙Z Children N}}uuv u}v}R˙L }o]}voo˙ ı Standard yy yy yy Trtme ae ntGuidelinesUwthEditionUw Or Go]o] U}oU Adults rvuPR}o˙ Children N}}uuv Or Go]u]] U}oU Adults rvuP]o˙~bb]vPo}b]vRu}v]vPZ Children N}}uuv Or T}ou] U}oU Adults æruPrR}o˙ Children N}}uuv v*DiabetesMellitus*v Note 12-2 T}ou] elderly ]b(]v ]v]]ob `]R ]u]vo (v}v v ]v R X D T˙]bvb}v}ou]}vbVvbv} R]]vPPo˙u]Pb`]R}u]v}v}(M}u]v SoR}v˙oXPXGo]vou]XL}˘]uo˙u}vRb (Triple Therapy) st L]vTuv ]v E RvPPA yy M}u]v v Go]vou] ~} ovZU }oU b ]v b}v C above yy yy yy Av S˘Po]v U}oU Adults XæræuP]o˙ Children N}}uuv Or S]Po]v U}oU Adults æruP]o˙ Children N}}uuv Or V]oPo]v U}oU Adults æræuPrR}o˙ ı and Chatep rP *EndocrineandMetaolic b Disorsder Children N}}uuv yy Or P]}Po]}v U}oU Adults æræuP]o˙ Children N}}uuv EXT˙]bvb}v}ou]}vbVv}R]]vP glycaemic targets with Triple Therapy yy Triple Therapy Av yy Ivbo]vNPH USCU Adults rv]b(}u Children Refer to specialist v*DiabeticKetoacidosis*v Note 12-3 R( } ]}o}P]b } R˙b]]v b]o]b (} ]vbo]v v }o u]}v }u]v}vR˙]v˙]b Refeal r Criteria Aoo ]v]]ob `]R ]b ub ( } ]]v (} ]˙ ]X Aoo R]ov `]R ]b ub bv ˙ b]o]b ~]]]v}v}]v}o}P]bZXAoovb]v`R}uPo˙u]Pb vv}R]bòobR}b`]R]b}uo]}vbub (}R}]b]o]bX Aoo ˙ ]b ]Pv}b]b v ˙ ]b æ ˙b L ]Pv}b]bbR}o(}v˙b]o]b(}v]vP b (}D] Rv}R˙X 99. D]K}]}b]b D]l}]}b]b ~DKA ]bZ }v]}vb}]`]RR]PRo}} Po}b ~boo˙ AN uu}olLZU `R]R v}vRobbU ]b v]oo } R }˙ b b b} }( vP˙X F ]b R(} }lv }`v b v ov b} }( vP˙U ob]vP }˘] Ru]ob oo l}vb b ˙r}X A]}voo˙U R ]b b R˙}v ]uov ]v DKAU b]oo˙ o}` }bb]uX I ]b }uu}v b }( Ru}vP]bvb]vGRvXI}Lv}b]v˙]b vbu˙ob}}]v˙]bX Iv}vbU R H˙}bu}o N}vrK}~HONK b Z ]v ]b }b]u]o˙]vT˙vbUv]bb]u]o]v]bo]v]obv}v }]l}]}b]b]vuv˙bXAui}]+vUR}Ù]b ı and electrolyte Standard Trtme ae ntGuidelinesUwthEditionUw Rbv}(b]Pv].vu}v}(l}vb]vR]v~boo˙ } A=Z v R bv }( bR˙}vX TR uvPuv }( R]b }v]}v]bb]u]o}R}(DKAX sueCa yy S.]v˙}(]vbo]v yy Iv}v }( vrR˙Po˙u] R˙ ~boo˙ (} .vv]o b}vb}(}ovuvZ yy Sbb }( ]vv ]oovbb ~XPX ]v(}vU u˙}]o ]v(}vU strokeUP˙ b U}uo]Pvv˙XZ Symptoms yy P}o˙] yy P}o˙]b] yy NauseaU}u]vP yy A}u]vo]v yy Ao}v]vbvb}]u}}oob yy S˙u}ub}(]v(}v}}Rvo˙]vP}v]}v v*DiabeticKetoacidosis*v Signs yy DR˙}v ~˙bl]vUbl]vP}}bvlv˙bZ yy Dv(bR]vP yy L}ò}}b yy Fbv`lob yy RF]˙ [R~buoo}(}vZ yy C}v(b]}vU}b }v}vb]}bvbb yy ]v E }(]v(}vUvP˙ b U}l b Invtiga se tions yy 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o]˙ vR}b}} u] uvb r Check ader quate urine }~AN uolR}Z Por uu}oKCo]v æuoS}] r uRo}] XıA9 RvRIV infusion over at least one hour S}ool Po]vbo]v subcutaneously ˙Rbo]]vP ob [ RP}b b]uIv(b]}v L R}b]( necessary ~b˘uo }(Rbo]]vPob [ in the table o}`Z Check blood P}bb]u oo`] D ]o˙ W]RR}oKCo if blood level }(}bb]u ANvuu}olL RPo MvPuv AQ Monitor blood Po}b`]] r o˙~rl(b vrbZ SR}b L]v] r ]vP]vbo]v vS}]u Chloride Iv(b]}v Bo}}Po}b u]v]v `v vruu}olL PvvPv}uoo˙ ~}uuv]Z U]vl}vb vP} trace ıæ CRvP(}u Rbo]]vPob [ }`]]o˙ subcutaneous ]vu] r rvP }u]˘ insulin v*DiabeticKetoacidosis*v TRLU u]v]b S}oolPo ]vbo]vUIV Iv(b]}v Xv]bllP hourly O ærv]bIM R}o˙vo o}}Po}b AMuu}olL o]} v˘R}b P}bb]u CRo}]~KCoZ Iv(b]}v P}bb]u Ro}]U}oU if required r Standard TorP) Trtme ae ntGuidelinesUwthEditionUw RP]u(}uvP]vPD]K}]}b]b]vCR]ov CHILDREN Bo}}Go}b U]v K}v Test Results Iv]vP MvPuv AQ Monitor blood Po}bR}o˙ Bo}}Po}b ANuu}olL O U]vl}vb ANA= Monitor urine l}vb`] daily Ivv}bFo]b Type of Fo] R}(IVFo] Iv(b]}v S}]u Chloride XıA9 R} b æuollP vR} æuollP H} wXæuollP RR}v vo˙ b U ibG] }u ]uvb S}oolRP oIvbo]v r S}oolP r o]vbo]vUIV} IMUXæv]l lPb TRLU u]v]b S}oolPo ]vbo]vUIVIv( b]}v}IM Xv]bllP R}o˙vo Bo}}Po}b AMuu}olL SR}b L]v]vP insulin and Sor ]uCRo}] Iv(b]}v r v*DiabeticKetoacidosis*v M]v]v]vP MvPuv AQ Monitor blood Po}b˙ Hours Bo}}Po}b AMuu}olL Monitor urine l}vb`] daily S}]u Chloride in XA9 Glucose SIv(b]}v }u ]uvb This ub]b necessary to prevent subsequent R˙}Po˙ r u] Bo}}Po}b u]v]v `v vruu}olL PvvPv}uoo˙ ~}uuv]Z U]vl}vb vP} trace B}˘rP) C}b}v]vPD}b}(RPoIvbo]v}u]v]b Subcutaneously uu}olL ADULTS ~b˘uo }(Rbo]]vPob [ in the table o}`Z Check blood P}bb]u oo`] D ]o˙ W]RR}oKCo if blood level }(}bb]u ANvuu}olL CRvP(}u Rbo]]vPob [ }`]]o˙ subcutaneous ]vu]r vP} u]˘ insulin CHILDREN ıv AKCoX rXuu}ol lP~u˘X uu}oZ]vIV G]bXRv infusion over at least one hour RP}b b]uIv(b]}v L R}b]( necessary Sample Sliding Scale Chart Bo}}Go}bRbo ~(}oo}`]vPrR}o˙vP b Z Check ader quate urine }~AN uolR}Z S}ool Po]vbo]v subcutaneously ˙Rbo]]vP ob [ 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ae ntGuidelinesUwthEditionUw 101.Treatment-Induced Hypoglycaemia v*Trtme ae ntrInducedHypoglycaemia*v H˙}Po˙u] (b } o}} Po}b oo o}` Xv uu}olLX I ]b u} }uu}v ]v oo˙ ]b v R}b `]R l]v˙ (v}v ]u]uv b òo b R}b }v o}vPrvP }o vrR˙Po˙u] u]}vb } ]vbo]vX S R˙}Po˙u] ~o}} Po}b AM X uu}olLZ u˙ bo ]v o}v }( }vb]}bvbbU .bU bo(r]vi˙ v ]}bPb}(]b]o]vuPX F}oo}`]vP(o b uv}(R˙}Po˙u]U]bbub u]v v ubbU ]vo]vP v }v v ]b]}v }( vrR˙Po˙u]P}bbUbR}olv}v]bvX sueCa yy O}b }( v˙ vrR˙Po˙u] u]}v ]XX ]vbo]v } }o Pv yy AvR˙Po˙u] u]}v b ]v vo ]u]uv v R elderly yy Ou]'}]vu}v}((}} yy Uvb}uR˙b]o}r]˙ yy E˘bb]o}R}o]vl Symptoms yy D]]vbb yy Bo]b]}v yy Headaches yy Po]}v yy S`vP yy SRl]vP}(RRvbv}˙ yy Uv}vb]}bvbb yy Convulsions yy I]]o]˙vv}uoR]}b]oo˙]vR]ov Signs yy S`vP yy Tu}b yy Tachycardiav}v]vPob yy Confusion yy Uv}vb]}bvbb yy Convulsions Invtiga se tions yy Rv}uo}}Po}b~Pvo˙}vb]vPPo}buZ yy Bo}}vo}o˙b yy L](v}vb Trtme ae nt Tuv}ib yy T}]o˙}b o}}Po}boob}v}uo ı Chatep rP *EndocrineandMetaolic b Disorsder yy T}u]v]vRoo}(o}}Po}b`]R]vRv}uovPvo RvvP]vvPv}uoo˙ yy T}]v(˙vbRb Non-pharmacological treatment yy M]oR˙}Po˙u] yy r b}}vb }( Pvo bP } b }( bP } A* }'o }( b}L ]vl ~bPr}v]v]vPU v} R] [ ]vlbZ } ]v] ]ob`R}}vb]}bX yy A Pobb }( u]ol } (] ]vl v ob}}v(o }( R}v˙ (o b ovb yy TR}ubbR}o(}oo}`]uu]o˙˙uo or snack yy M}R˙}Po˙u] yy Su(} b u]oR˙}Po˙u]ULu]vbXI( v}]u}uv]b}bU(} b R˙}Po˙u] b Pharmacological treatment yy nd L]vTuv ]v E RvPPA GoP}v UIVUIM}v}b b U Adults uPX b Children r˙b~}˙`]PRANælPZV r˙b~}˙`]PRAMælPZV u}vRr˙bV NeonateV v*Trtme ae ntrInducedHypoglycaemia*v AXSR˙}Po˙u] st L]vTuv ]v E RvPPA yy ˘}b D UIVU Adults æA9b}o}v æræuo}ru]vbR}PRoP]v Then ærA9b}o}v æuoR}o˙voRv]bo}v}uoo˙ Children A9b}o}v uollP}˙`]PR}ru]vbR}PRoP]v Then æA9b}o}v }]vP A } }o ]o˙ G]]uv vo o}} Po}b oob v}uo]b uPX b æu]}PubX b æu]}PubX b u]}PullPX b ıı r Standard Trtme ae ntGuidelinesUwthEditionUw Refeal r Criteria I( R v }b v} b}v } R } uv }uuv}vbU(}b]o]bX 102.Dyslipidaemia v*Dyslipidaemia*v TR ]b uo ]v o]vl]vP R]PR o}} R}ob}o oob } ]}b C o D]bb ~CVDZ vbU ]vo]vP u˙}]o ]v(}vU }lb b Uv]Robo]bbXOvR}RRvUR]bob} ]v (} b]Pv].v }v ]v u}]]˙ v u}o]˙ (}u CVDb ˙]vPo}}R}ob}ooob]vR}b ]bl~]u˙v}vZ vR}b`R}Rb+CVDv~b}v˙v}vZX TR}uu}vo˙o}} b o]]ub}oR}ob}oU HDL R}ob}oU LDL R}ob}o v ]Po˙]bX H}Ù R ]u˙ P (} ]vv}v ]b R LDLrR}ob}o ooX Ab uv u˙ (} o}vP ]}b } o](o}vPU ]}] u}v]}]vP }( o] v ubo v˙ub ~vbu]vbb v v l]vbZ v o}} Po}b ]bo}(}boou]}vrob]+bX sueCa yy H]PR]˙]vl}((bb ~v]uo(Z yy Ll}(R˙b]o]˙ yy M}o] ˙v}u b ~ }u]v}v }( ob }( R (}oo}`]vPV }b]˙UR˙vb]}vU˙]bU˙bo]]u]UP} yy Hereditary factors yy E˘bb]o}R}o]vl yy H˙}R˙}]]bu yy NR}˙v}u b Symptoms yy Uboo˙v}v yy A}u]vo]v(}uvbo}R˙]Po˙]u] Signs yy Uboo˙v}v yy Ob]}voo˙ yy WR]bR]vP}vR}v~}vobZ yy Yoo}`]bRbl]v}vb}vR˙b~˘vRobuZ yy WR]bRo}}buo~o]u]o}}Z Invtiga se tions yy FbvPo}}o]]}.o yy TR˙}](v}v~]( b o]]oob˙R]PRZ yy Pobu }]v ~]( o]] oob ˙ R]PRU } ˘o vR} ˙v}u b Z yy U]v}]v~](o]]oob˙R]PRU}˘ovR}˙v}u b Z XZ Chatep rP *EndocrineandMetaolic b Disorsder AXL}`CVD]blr]u˙v}v st L]vTuv ]v E RvPPA yy S]ubv U}oU Adults ruPv]PR B. yy yy yy Moderate CVD risk - Diabetes and CVD risk equivalents ]v E RvPPA }bA v U}oU Adults ruP]o˙ Or R}bvb U}oU Adults æruP]o˙ Or S]ubv U}oU Adults ruPv]PR r r v*Dyslipidaemia*v Tuv}ib yy T} R ]bl }( o]v]o R}bo} ]}bo vb and related deaths in: yy HoR˙]v]]ob]bl~]u˙v}vZ yy Iv]]ob `R}Rb+CVDv~b}v˙v }vZ yy T}RLDLrCoo}R(}oo}`]vPPbP yy Aob æ A9 LDLrC }v (} ]u˙v}v ~]v R Pvo}o}v]XX]v]]obAH˙b}(P`]Rvv LDLrCAHXıuu}olLZ yy rı A9 LDLrC}v (} ]u˙v}v ~]v ]v]]ob } wæ ˙b }( P `]R ]b `]R v v LDLrC XrXıuu}olLZ yy LDLrC AM X uu}olL (} }v˙ b v}v ~]v ob `R} R ]}bo˙ b+ R 'lU }l b } ]Ro bo]bbZ Non-pharmacological treatment yy D]˙ ubb r o}` o}]U o}` b ( ~v]uo (ZU R]PR }o˙vb(~ov (Z ] ]b}uuv v R b]b]}v}(]]v yy W]PR}v]vvb`R}}`]PR}}b yy R}v]vo}R}o}vbu}vU`RR]b]b˘bb] yy RPoR˙b]o]˙}˘]b]o}}R]v]]ov Pharmacological treatment Standard Trtme ae ntGuidelinesUwthEditionUw CXH]PRCVD]blWS}v˙v}v yy }bA v U}oU Adults ruP]o˙ Or yy R}bvb U}oU Adults ruP]o˙ Refeal r Criteria R( oo vb `R} u]v }b] R P ob b] 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b Disorsder Thyroid ultrasound scan TR˙}]}v}]b~](vbb˙Z R]}]b}}v b }(R˙}]~](vbb˙Z F]vvob]}v˙}o}P˙~](vbb˙Z Xr˙}(Rvl]vo]vPR}]]vo]`(}oPP}]b X (See v*Hypothyroidism*v Trtme ae nt Tuv}ib yy T}bv}oo}(R˙}]R}u}v}}v yy T}˙u}ub b b}]`]RR˙}}˘]}b]b yy T}}v}b˙u}ub b yy T}]v(˙R˙}]v}obubvuvP}]o˙ Non-pharmacological treatment yy S}oR˙}]}u˙`R]v] Pharmacological treatment yy }] A uv }( R˙}R˙}]]bu } R˙R˙}]]bu b}vb}vRH˙}R˙}]]bu [vRH˙R˙}]]bu [Z Refeal r Criteria R(vb}R˙b]]v}P]o b b]o]b`R}uo]}vb ~XPX R˙}R˙}]]bu U R˙R˙}]]bu U R]vP ]8o˙ XZ } uo]Pvv˙ b} ]( (oo o]v]o buvv ]vbP}vb v}}bb]oX Hypothyroidism H˙}R˙}]]bu ]b }v]}v b}] `]R }v ]v R˙}] R}u}v}}vXTR˙}]R}u}v]b](}v}uou}o]bu vP}`RXIb.]v˙Rbui}}vbvb}v(}oo}uv b òo b ]vooo v R˙b]o o}uv ]v ]v(vb v R]ov ~b}(v]bu ZX Iv obU ] u˙ R b }( ob }oub ]vo]vP R ]bbUuvbo]Po]˙v]v(o]˙UuvoRoR}v]}vbv uvXI}]vouv]bv}Ruv(}R˙}R˙}]]bu Sv]vP (} R˙}R˙}]]bu ]v oo v` }vbU v ˙ æ ˙b ]v ob L P æ ˙bU b]oo˙ (uobU ˙ ub]vP TSH ~R˙}] uovP b R}u}vZ oob ]v o}} `R R]b ]b }bb]oU bR}o v}PX sueCa yy Av}˙roR˙}]Pov}v b yy S}oR˙}]}u˙ yy P]]˙P˙ b }ob]}vb yy C}vPv]o yy S]}]v.]v˙ yy DP]v~XPX]}]}]vR˙Uu]}}v X XZ Standard Trtme ae ntGuidelinesUwthEditionUw v*Hypothyroidism*v Symptoms yy Gvo`lvbbvvbb yy Iv}ov}}ov]}vuvb yy C}vb}v yy W]PRP]v yy Hair loss yy D˙bl]v yy Hoarse voice yy Mu}˙o}bb yy Goitreu˙bv yy Av}uouvbo]}bvbr(o]˙~]vo(uobZ yy P}}P}`RUo}uvv}}bR}}o(}uv]vR]ov Signs Neonate yy P}o}vPv}voiv] yy E˘bb]bo yy F]vP}oub Children yy v]b C u ~uvo bv}uo]˙U bR} U b oP }vPU ˙ bl]vU b R]U }v }uvU u]o]o Rv]U v}uo (]bZ obA yy So}òb~boo˙AMvu]vZ yy D˙}bbl]v yy P+˙( yy Poo} yy Hoarse voice yy So}`G˘b yy Duv yy Goitreu˙bv Invtiga se tions yy TR˙}](v}vbr(TU(TUTSH yy FbvPo}}o]]b~(}oR}ob}oooZ Trtme ae nt Tuv}ib yy T}}o}}oo}(R˙}]R}u}vb yy T}u]v]vo](o}vPv}uooob}(R˙}]R}u}vb Non-pharmacological treatment yy SP]o]vv}v(}]]˙ob]}vb`Rvbb˙ Pharmacological treatment AXIv]}v}(TuvvM]vvv Note 12-5 Suv `]R o}` }b }( o}R˙}˘]vU b]oo˙ ]v R oo˙ v Chatep rP *EndocrineandMetaolic b Disorsder R]ov b òo b ]v]]ob `]R R ]bb ~XPX æræ u]}PuZU v ib }b b }]˙ vr `lb vo TSH oob `]R]v v}uo (vvPXTuv]b}Lvo](ro}vPX ]v E RvPPA L}R˙}˘]v U}oU Adults æru]}Pu]o˙ Children AN˙bV æu]}Pu]o˙~u˘Xu]}PubZ r˙bV æu]}Pu]o˙~u˘Xu]}PubZ AM˙bV ærwæu]}Pub]o˙ Refeal r Criteria R( ]Pv}b } b }( oo PbU b]oo˙ R]ov `]R ]vooo ]u]uvU v ]v]]ob `]R ]]˙ ]bb } b]o]bX yy 105.Hyperthyroidism æ v*Hypthyr er oidism*v E˘bb R˙}] R}u}v ]v R o}} bob ]v R˙R˙}]]bu ~R˙}}˘]}b]b ZX I( oL vU b]Pv].v `]PR o}bbU ˙ v] }uo]}vbU u˙ }X A]}v }( ˘ ]}]v } R ] ~XPX b ]v ]}bo]bZ v}R}uuvuvvu˙U]v(U`}bv R}v]}vX sueCa yy G[b]bb yy T}˘]uorv}oP}] Symptoms yy W]PRo}bb]]vb yy E˘bb]`vP b yy Heat intolerance yy Tu}b}(RRvb yy Nervousness and irritability yy Mvbo]Po]˙vbr(o]˙ Signs yy S]vPP}}]vP˙b yy Tu}b}(RRvb yy M}]boub yy R]ob~`R]Ru˙]PoZ yy W] ob b ~H]PR ˙bb }o] BP `]R o}` ]b}o] BP XPX wlæuuHPZ yy Heart failure yy Goitre~}Lvbvv}o`˙bZ yy Su}}Rv]+b]vG[b]bb Standard Trtme ae ntGuidelinesUwthEditionUw yy IPo]v}˘]uorv}oP}] Invtiga se tions yy TR˙}](v}vbr(TU(TUTSH yy Thyroid ultrasound scan Trtme ae nt Tuv}ib yy T}R˙}]R}u}voob]vRo}}}v}uo yy T}˙u}ub b b}]`]RR˙}}˘]}b]b yy T}v}}uo]}vbXPXR(]oU}RRou}R˙ Non-pharmacological treatment yy S}oR˙}]}u˙ Pharmacological treatment v*Hypthyr er oidism*v AXIv]}v}(TuvvM]vvv st L]vTuv ]v E RvPPA yy C]u}o U}oU Adults ruP]o˙ Children r ˙bV Iv]o }b æ uP ]o˙ ~ib }]vP } R˙}] R}u}vooZ AM˙bV v}}uuv Note 12-6 bD }b }( ]u}o `Rv R˙}] R}u}v oob `]R]v R v}uovPvib}bbvo˙}]vP}`}ru}vRo˙R˙}] (v}vb yy nd L]vTuv ]v E RvPPA P}˙oR]}]o U}oU Adults uPR}o˙ Children r˙bV æruPR}o˙ ær˙bV æuPR}o˙ ræ˙bV æuPR}o˙ u}vRr˙V ]v]oo˙æruP llPR}o˙U Then XæræuP llPR}o˙b}vR˙}]R}u}voob AMu}vRV XæræuP llPR}o˙ Note 12-7 P}˙oR]}]o ]b ( ]v Pvv˙ v ]v R}b `R} } v} }o C ]u}o X bD R }b `Rv R˙}] R}u}v oob `]R]v R v Chatep rP *EndocrineandMetaolic b Disorsder v}uovPvib}bbvo˙}]vP}`}ru}vRo˙R˙}] (v}vbX BXAivuv~}˙u}ub b }(R˙}}˘]}b]b yy P}v}o}o U}oU Adults r uP R}o˙ ~ib }b oo R˙}] (v}v v}uo]bb r }]]vRub b Z Children AN˙V uP llP~u˘XuPZR}o˙ NeonatesV uP llPR}o˙ Refeal r Criteria R( oo b v} b}v]vP } }vv}vo uv } b]o]bb ]v }v˙ b } ˙ R}b]o (} (R ]vbP}vb vuvPuvX ) 106.AvoIvb8]v˙ Z v*AdrenalInsufficiency*v vo A ]vb8]v˙ ]bb `Rv R vo Pov ]b}˙ b ˙ ]bbU } }R]b (}oo}`]vP ]]˙ (]o } R}v] }}b}] b } bX Iv Rb b]}vbU R u}v }( }b}o } (}u RvoPov]b]vb8]v}uR}˙ [bvb]vP]}b }( R˙b]o v ˙R}o}P]o b b } b ]oovbbX TR }v]}v ]b b}] `]R b G] v o}o˙ ]uov v bob ]v ]o}˙}oobX sueCa yy Sv}v b }(}o}vP}}b}]b}bX yy Sb~ b XPX]v(}vUub UP˙ b Uvvo}bZ ]v v `]R v]Pv}b vo ]vb8]v˙ } vb }v }o}vP}}b}]uvX yy P]]˙(]o yy }A r]uuv]bb}(RvoPov~A]b}v[b]bb yy S ]v(}vb +vP R vo Pov ~XPX uv]vP}}bU o}b]bUHIV Z yy C}vPv]ovoR˙ob]]vR]ov Symptoms yy Nausea yy V}u]vP yy Wlvbb yy Collapse yy A}u]vo]v yy D]R} Signs yy DR˙}v yy L}`}v}oo}}b w Standard yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw Dlv]vP }( }o u}bU PubU bl]vU oub v b}ob ]v b}u individuals ]v E }( }}b}] b XPX bl]v oR]vPU CbR]vP}] appearance Au]P}bPv]o]UbR}vb (]o}R]]vR]ov V]ob}(}vb]}bvbb v*AdrenalInsufficiency*v Invtiga se tions yy FBC~u˙bR}`vu]v}b]v}R]o]Z yy Bo}}vo}o˙b~u˙bR}`R]PR}bb]uZ yy Bo}}Po}b~u˙o}`Z yy Pobu}b}o~o}`Z yy Bo}}.ou(}uo]b]bU](]v] yy U]vvo}}obU](]v] Trtme ae nt Tuv}ib yy T}}RG]vo}o˙]uov yy T}}R˙}Po˙u] yy T}o}}b}]b yy T}]v(˙bvv˙]]vP(} Non-pharmacological treatment yy None Pharmacological treatment AXuv A yy yy L]vTuv ]v E RvPPB Ivv}bG]ouv Adults XıA9S}]uCRo}] ]væA9Go}b~D˘}b So]vZUIVU o]rvR}o˙Uvo}v]}v]bob Children XæA9S}]uCRo}] ]væA9Go}bUIVU}]vP}}oG] ]uv vA H˙}}b}v UIVU Adults uPX b (}oo}`˙uPvR}o˙vo}v]}v]bob Children vr˙bV uPvR}o˙ ræ˙bV æuPvR}o˙ AM˙V æuPvR}o˙ st Note 12-8 TR IV R˙}}b}v R˙ u˙ ] (} ob ˙bX D} v} bR } RvP} u]vvv R˙X WRv R v[b }v]}v ]bob ~]XX r Chatep rP v}uoBPU}v b }(}u]vP *EndocrineandMetaolic b Disorsder XZP}}v}u]vvvR˙X BXAivuv]vb T ]v(}v ~XPX uo]U vu}v]U UTI }v]}vU](bv}U b `]R}]u]}vX Z } br]v]vP CXM]vvvr(}vbv}]}bo˙}v}}b]}b st L]vTuv ]v E RvPPA yy Pv]b}o}v U}oUo](ro}vP Adults æuPu}v]vPvXæuPv]vPR˙ Children wu]}PubllPR}o˙ L]vTuv ]v E RvPPA H˙}}b}v U}oUo](ro}vP Adults ruPu}v]vPværuPv]vPR˙ Children u]}PubllPR}o˙ nd yy v*AdrenalInsufficiency*v X D M]vvvrF}vb}vo}vPu}}b}]R˙ `R}P}]v}v}}o]b]b~XPXRu b UvR} syndrome) Adults and Children yy RbR]}b }bb }( }o }}b}]b P]v (} R }v ]}vX r EXM]vvvrF}vb`R}}}b b }]b Adults Rb}o}}b}]bU}o}]o}}b}]b`]R }o}}b}]b yy Pv]b}o}v U}oUruP]o˙ Goo˙ }+ R }b }ob u}vRb ~XPX ]vP ˙ XæuPu}vRZvvoo˙]b}vvX C}vrX yy L}vPru}}b}]R˙]bb]o]bb]b]}vXHoR }vbbR}o]v(}uvb}(R(}oo}`]vPV yy Pvb}v}}b}]b bR}o}} R}b]o](R˙}u]oo v bR}o oo R] }}U vbU vb } Ru]b R R˙ }v}}b}]b yy Pvb SHOULD NOT }b uv ]( R˙ }u ]ooU R v ]v( }v}vP}]vPvo}XRR}o]vP}(RP o}bb}(}}b}]b]bv yy R}R˙}}b}v UIV(}vu]v}P]o b }b]vo]vP labour and delivery yy TR }b }( }}b}]b ub Poo˙ ]( uv Rb ı r r Standard Trtme ae ntGuidelinesUwthEditionUw v(}o}vPRv`lbv]b}}b yy D]b}PRb}(}o}}]o}}b}]b Refeal r Criteria Aoo vb b } R vo ]vb8]v˙ bR}o (U L b]}vU } P]}vo } R]vP R}b]o (} buvvo}vPruuvPuvX 107.Cushing’s Syndrome v*Cushing[sSyndome r *v TR]b}v]}vbob(}uR]PRoob}(}b}o]vRo}}v]b b}] `]R ]}b RvPb ]v R }˙ ]vo]vP R o}uv }( }b]˙U R˙vb]}vU ]b v }b}}}b]bX TR }o}vP b } b ~b]oo˙ ˙ `}uv (} }bu b}vbZ }( }o } }]o }}b}]b bR bv]b}o}vU˘uRb}v }b}vU}}vb}v]v]vPv˙}(RbPbU]bob}bX sueCa yy P]]˙u} yy vo A u} yy P}o}vP v ˘bb] ]vl ~(} Ru b U vR} ˙v}u b XZ}b}(}}b}]b Symptoms yy W]PRP]v yy E˘bb}˙R]vv~]uob Z yy ˙bE ]b]vP}(bl]v yy SRulb~]bR}o]bRZ yy Mvbo]Po]˙vbr(o]˙ yy Wlvbb}(RR]PRubob yy L]PRv]vP}(Rbl]v Signs yy R}v}Ru}}v[( yy P}u]vvo]o b (b yy Truncal obesity yy E˘bb(]ov}˙R] yy Acne yy S]~]bR}o]bRR b ulbZ yy Thin skin yy ˙bE ]b]vPvo]vP]v}Rbl]vLvv yy Hypertension yy Iv]o]˙}]b(}uRhvP b }b]}v Invtiga se tions yy Pobu }b}o ~}uu}vo˙ o ]v ]]˙ v vo u}bUo}`]v}}b}]b}bZ U R˙}}b}v or Chatep rP yy yy yy yy *EndocrineandMetaolic b Disorsder Bo}}o}o˙b~u˙bR}ò}`}bb]uZ Bo}}Po}b~}uu}vo˙oZ A}u]voob}vv b ~u˙bR}`vvou}Z CTv b ~u˙bR}`]v}(]]˙}vou}Z Note 12-9 D}v}`]R`}}b}]bbvo˙]vvb`]RCbR]vP [b˙v}u b } }}b}] b } }o}vP bX IvbU R }b ub }+bo}ò˙}ob `lbvu}vRb}vvo]vb( .]v˙~ Sb}v}vRAvoIvb8]v˙ r r [ZX Refeal r Criteria R(oo}b vv}]v}o}P]b}b]o]bR˙b]]v ]v P]}vo } R]vP R}b]o (} R }] ]vbP}vb v uvPuvX 108.Overweight and Obesity O`]PR v }b]˙ b}] `]R }v]}vb R b u ]oorRoR v RU bR b ˙ ]bU R]PR o}} b ~R˙vb]}vZU R ]bb v }l b bR b P} U }b bo v}U Poob}vbU RvU R]bU bl]v]v(}vbbòo]}b b vbRvo]vl}˘bb}˙ `]PRX TR˙ ob} ]vb R ]bl }( o}]vP ]v R}u}b]b v ou}v˙ u}o]bu b òo b o o}} R}ob}oU `R]R ]vbbR]bl(}R'lbv}lb b X W]PR}v}Lv}bU}Rob}}v}oURbb}] }v]}vbX Ob]}voo˙ ] `]PR P]v u˙ b}] `]R v vo˙]vP v}]v }v]}v bR b R˙}R˙}]]bu v CbR]vP [b ˙v}u b X X OR }v]}vb v*Ovweight r andObsity e *v Trtme ae nt Tuv}ib yy T}v}uo]bobuoo}(}b}o yy T}}o}o˙]uov yy T}}obuPo}b yy To correct blood pressure yy T}v}uo]}vb}(˘bbobu}b}o Non-pharmacological treatment yy P]]˙}voP˙ b `Ru}b]v RbPovb Rv]Pv}b Pharmacological treatment Tuv ]b vv }v R b v ]b b]o] ]vbP}vbX MvP R˙vb]}v v ]b o}vP vb o]vb ~S}]b}vbZv(v(}.v]uvX Standard sueCa yy yy yy Trtme ae ntGuidelinesUwthEditionUw E˘bb]vl}(o}]b Ll}(PoR˙b]o]˙ S}v˙bXPXR˙}R˙}]]buUCbR]vP [b˙v}u b Symptoms yy Uboo˙v}v Signs yy B}˙MbbIv˘~BMIZ]vb yy XærXılP lurIo`]PR yy æXrıXılP lurO`]PR yy XrXılP lurOb yy ANæXlP lurSo˙}b yy M]r}u]vo ~`]bZ P]RU lv }PRo˙ R oo }( R u]o]bU]vb Ao(uobP v*Ovweight r andObsity e *v AMu}]vRb Io}u]voP]R ru}ræ]vRb O`]PR ANu}æ]vRb Ob AouobP AMıu}w]vRb Io}u]voP]R ıru}wr]vRb O`]PR ANu}]vRb Ob Invtiga se tions yy Bo}}Po}b yy Bo}}o]]}.o yy Bo}}]] yy ECG Trtme ae nt Tuv}ib yy T} vb o}bb }( A9 }( R ]v]o }˙ `]PRU `]R]v v u}vRbU }(v}u}RvrlPu}vR yy T}']vR]oBMIvl}}u]voP]R yy T}]v b R`]PR}vR] Non-pharmacological treatment yy W]PR}v]U(o˙vRb]b]}v}(]]v yy RPo R˙b]o ]˙ }u]b]vP u]vb ]bl òl]vPU } ]ov]˙U(}u]v]uu}(˙b`l](Rv} Chatep rP *EndocrineandMetaolic b Disorsder }v]v]}vb yy }] A uvPuv}(b}]}ru}]]b}b Pharmacological treatment yy }A vr}b]˙ uvb ]oo bR}o }vo˙ P]vvb]o]bP]v Refeal r Criteria Iv]]ob`]Rvb u}]}b]˙u˙](o} R˙b]]vb]o]bv}b]}voo˙u˙v˙R}o}P]o b }vboo]vPX Iv]]ob`R}P]v`]PR]o˙}bR}]}u˙Rv vo˙]vP R}u}vo ]b} v `]oo ] (o } R˙b]]v } v}]v}o}P]bX v*Ovweight r andObsity e *v Chapter Obtes tricCarend Obtes tricDisorsder 109.AvvoC Antenatal care(b}R}uRvb]P]v}Pvv `}uv } vb R bR P}b R}PR Pvv˙U o} v R ]u (o˙ b `]RRo]˙}(RoR˙˙X TR}uuv}R} vvo ]b lv}`v b F}b Antenatal CareX I Rb R (}oo}`]vP ]v]obP uRb]b o]˙ }( R Rv v˙ }( ~(} }uRvb] vvo ]b]b }uuv (} `}uv `]R v}uo Pvv˙ZV ]v]]o] R ub R `}uv[b }`v u]o v ˙R}b b }]o vbV v ]bb }v ]vb }( ]bl P}]}v b }v R b]uo ]v]oRooPvv`}uv]bl}(}uo]}vbX PPvv `}uv bR}o (oo˙ b }}l]vP v oo bv ]b]b } ]v(˙ }oub R o]lo˙ } Rvb + }v R Pvv˙X PPvv]b `]R ]bl }v]}vb ~}v } u} ]bl(}bbR}o Z bvu}(vo˙vob}(}R}b]o vl}}b]]v(}uvPuvX Av}R ]u}v }u}vv }( vvo ]b R RoR }vv}vboo]vPR]bP]v}o]vbXTRb}u}RoR˙ R]}vo](b˙o]vPRPvv˙vob}voR`}uv } }Pv] vP b]Pvb ]v Pvv˙ v o˙ (} uPv]bv(b o]˙XF]v]vPbR]b]bR}oo˙ }uvX AvvoV]b]bSRo(}N}uoHoR˙W}uv W}uv `R} RoR˙ }}l]vP v `R} u]v RoR˙ bv]b]bv}v}Rv˙]v.}vo]bl}v]}vb u˙R(}}uRvb]]b]bb(}oo}`bP TorP) R}uuvbRo(}AvvoV]b]b(}N}uo Healthy Woman V]b] R}uuvbRo B}}l]vP]b] Ab}}vb`}uvbR]bPvvV~(o˙ (}`lbZ Chatep rP V]b] *Obtes tricCarendObtes tricDisorsder R}uuvbRo scheduled visit vWA `lb nd scheduled visit Ivb]˘Ru}vR~}W`lbZ rd scheduled visit Iv]PRRu}vR~W`lbZ th scheduled visit Ivv]vRu}vR~}v`lbZ D]vPRob]b]UR`}uvbR}obl}v ](bR}bv}P]]R`]R]v`lbLR˘ date of birth st M} (v ]b]b } (}oo}` bRob ]uouv } uRo]v[b]v]]ovbX Iv GRvU uv˙ o]vb }u (} R] .b ]b] ]vP R] }v b ]ub}( Pvv˙X Iv R]b bU R ]b] bRo ub u}]. } vb R R o]v ]b oo R bvo }u}vvb }( (}R]o]RX v*AntenatalCare*v Abuv}(Ru}RR}}l]vP]b] yy Tl ]o R]b}˙ ~bv RoRU b u]o v P]o b R]b}˙U}bb ]R]b}˙U(u]o˙vb}]oR]b}˙Z yy C}v.uRobuvbo]}vo]b b RPb}voP yy E˘u]v(}uR}}voo}˙˙bb ub]vo]vPRl(} vu]U o}} U b obU Pvo RoR b v uvP appropriately yy C}v }b] ˘u]v}v } }v.u Pvv˙U ub ]vb]~SFHZvb(}oòo]vP~FHRZX yy Rb(}l}vv]vP b v}vo b }}}o~So]b }(]vbP}vbZ Abuv}(Ru}R(}oo}`r]b]bP yy Abl}u}R [bRoRb]vob]b]vbl}RoR concerns yy Ev]}(}o]˙~Pb}vAN`lbZ yy Tb]v(}ou]vvbP yy E˘u]v u}R (} `]PR P]vU vu]U v (} }uo]}vb bRroub b ]vuvP}]o˙ yy CRlo}}~R b o]u]}(v}uo]buuHP(}R ˙bb }o]vb ıuuHP(}R]b}o]ZX b yy Ob]˘u]v}vP yy MbU]vb]Pub˙uR˙b b ]}r(voR]PR]vv ub`vvv`lbPb}vX yy CRl R o]U bv}v v }b]}v }( R ˙ v R bv}(RbvvP~]ubZXCRlR(}o Rb}vbXN}uo]brbu]v v æ r Standard Trtme ae ntGuidelinesUwthEditionUw v*AntenatalCare*v Invtiga se tions yy Fooo}}}v~}}l]vPU vv`lb}u}(vo˙]( ]v]Z yy FbvP o}} Po}b ub }v }v oo Pvv `}uv ~ }}l]vPUv`lbZSv}o}` yy Hu}Po}]voo~}}l]vPUvv`lb}u}(vo˙ ](]v]Z yy Bo}}.ou(}uo]b]b yy S]lo]vP~](vbb˙Ho}R}b]bZ yy GvPD ]˙ yy U]vvo˙b]bR]b]~}]v]UPo}b]Z yy S}}ovo˙b]b}}l]vP yy Bo}}P}vv}˙vb yy VDRL lTPHA lRPRtest yy HBbAPb yy HIV v}˙vP b ~}vboo]vP](}vP b Z yy Uob}vv b yy o˙ E ob}v v b (} (}o P u}v b v } ˘o }]Pvv˙ yy F}ov}uo˙vv]vP b r`lb]bv.]o yy Lv]vP b `lb v ~ov}b]}vU(}oòo]vP XZ B}˘rP) Screening tests for diabetes in pregnancy FbvPo}}Po}bubb }v}vooPvv`}uv}}l]vPv ob}r`lb Tb(}]vPo}bRvvo]b] yy U]vPo}b}(A=lA=}v }b]}vb}A=lA=}v}v}b]}v`vb (oo}oPo}b}ov~OGTT b Z TR}b(}v}Rv}uovP]v b o]vPvv˙L r`lb TR}b `]R ]u] Po}b }ov } (vlo˙ ] b R}o R uv Trtme ae nt Tuv}ib yy T} vb P}} RoR R}PR} Pvv˙U o}lo]˙ v R]u yy T} v o˙ v˙ ˘]bvP } }vo RoR }oub yy T}vvu]vuo] yy To ensure delivery of a healthy baby Non-pharmacological treatment yy Ev}Pb}(]vb]vb yy C}vboo]vPv}v}vR(}oo}`]vP}]bP yy Healthy balanced diet yy }] A bu}l]vPvo}R}o]vl v Chatep rP *Obtes tricCarendObtes tricDisorsder yy yy yy yy yy yy yy yy AXAvu] yy yy yy yy B. yy v}v L]vTuv ]v E RvPPA F}bboR ~]}vR˙}bZU}oUuP~væuPouv o]}vZ]o˙ Or F}b(u U}oUuP~væuPouvo]}vZ]o˙ Or I}v~IIIR˙}˘] Z P}o˙uo}b}uo˘ U}oUuPouvo]}v daily r and unr r v*AntenatalCare*v }] A v}vrb]u]}vbvRb PPvv˙]b}u(}bvuvPuv Malariav}v Fu]o˙ovv]vP (]vP bB vv`}v Iuuv]b}v DvPb]Pvbv˙u}ub b ]vPvv˙ E˘]bP M]o } u} ˘]bU (o˙ v}vr`]PR ]vPU ob ub `l ]b } v}PX }] A ˘]b ]v R b]v }b]}v LR .b]ubX D]b}v v ˘]b `Rv R vP b]Pvb bR b v˙ }( R (}oo}`]vPP o}}˙ P]vo ]bRPU b]bv RRb v }]bo]bvbU(]vvb}b ]]vbbURb]v ˘o]v}u]vo]v yy E˘]b]b}v]v]]vP yy PPvv˙r]vR˙vb]}v yy Pu}(uuvb yy Pu o} ]v `}uv `]R ]v}uv ]˘ b }vlR]]ubo]vP yy Uv˘o]vIv]vP}`R}v yy o} D ]Rvbb v}uo]}v]vbb ov `]RR`}uv Pharmacological treatment st Av F}o]A] U}oUæuP}v]o˙ WR }u]v}v rvo P (}uo}vb }( I}vU (}o v }R u]}v]vb (U vb R R ]}v }vv ubRu]v]uu]uv}b}(væuP l˙N Malaria}R˙o˘]b ~Sb}v}vRMo] ]vPPvv˙[Z SoRuR}˘}orP˙]uRu]v ~SPU Z }oU æ }bbU }v u}vR vP b (}u `l v } b ]lv]vP ~}R˙ouvbR}ov}˘`lvZX w r Standard C. yy Trtme ae ntGuidelinesUwthEditionUw Tetanus prophylaxis TetanolUIMUXæuoP b }b (}u R `l Pb}vV v }b ~}vZ u}vR L ]v]o }bU ]( v Rb v} ]}bo˙ R vrvb Iuuv] }v b }bA }(vb}˘}]]v}vbbR}oP]v}oo`}uv }]vP}R(}oo}`]vPbRoP yy yy yy yy TTrG] R b }b ~Xæ uoU SC } IMZ v˙ }v `]R Pvv`}uv]vo]vPRvvo b ]b] TTrG]Rv}bob`lbLTT TTrG] R }b ob v u}vRb L TT } ]vP bvPvv˙ TTTTærOv}b]vR}(bvPvv]b}ul }o}(.}bbXN}(R}b`]oo b vbb˙]vbv Pvv]bX B}˘rP) High-risk pregnancies v*AntenatalCare*v H]PRr]blPvv]b]voP yy Bo]vP v˙u]vRPvv˙(}o} yy Y}vP~AM˙bZv}o~ANæ˙bZu}Rb]vR].bPvv˙ yy Pbv}(u]o}v]}vbbRbP yy yy yy yy yy yy yy yy Svu] S]loroo]bb Hypertension D]buoo]b Heart disease Ru Ab UR}v]}PRbRbou}v˙o}b]bv TR˙}}˘]}b]b HIV }b]]˙ yy W}uv`]Ru}RvæR]ov~RPvuo}bu}RZ yy PbR]b}˙}(o]vPLo]˙}]vov yy Av}uo bv}v v }b]}v }( R ˙ ]v R `}u u vbbo]}Rbv}v yy MooPvv]b yy P}o}vPPvv˙~`RvRPvv˙obbo}vPRv`lbZ yy C}vo]b~o]b}}buoo(}R˙}o](o˙ b P]vuZX TR]b u˙ }]}b `Rv R u}R ]b bR} ~AM æ uZ } Rbbuoo(~bR}b]AMA*UKZ yy B]P ˙ u `Rv R ˙uR˙b b ]}r(vo R]PR ]b u} Rv ır uu}`RvRub (}o`]PR]blP}R]PR yy Pb R]b}˙ }( oo]Rb b } ]b `R} ] `]R]v R .b `l }( o](U b]oo˙](R˙]}(Rbu}ou yy PbPvv˙R]b}˙}(u]b]Pb}vRbuPb}voP r Chatep rP *Obtes tricCarendObtes tricDisorsder yy bD ]v P}`R }( R ˙ ~(}o P}`R ]}v b Z r ]v b] buooRvRPb}voPX yy U]vb]uR]PPRvRPb}voP`]R}v(}bbv yy P]}b]vbuvoo]˙~u˘}v}(}bo]˙Z yy P]}b}}v}vR`}ubRvbC b}vUu˙}u}u˙ }`RvRb]b]L(}}v]vPDC yy Puo} ~o}(}}uo w `lbZ yy RhesusNPu}Rb`]RRRb}bb ]Rbvbvl}`]R}R v}]b yy W}uv`R}]bl(}bvb]}vubP]vAvrDIuuv}Po} o]v~æIU`l Z v`]R]vwR}b}(o]˙ r Refeal r Criteria H]PRr]bl Pvv]b ~S v} }Z bR}o ( } R}b]o}}b]]v(}uvPuvvo]˙X v*AntenatalCare*v ı TIMING OF VISIT Av˙u (}v `lb Pb}v vrA `lb W `lb VISIT BOOKING VISIT FIRST VISIT ND VISIT • Give TT • E˘o uoo Pvv˙ • CRl(}P r nancy induced hypertension • Check foetal P}`R • E˘o vu] • Pvb r uv • Pov(}ANC • o} D ]R vuPv˙ plan • Give health }v • Check foetal P}`Rv uvo òo]vP • Start prevenr ]vv r }vb GOALS AvvoP}}}o C CR • Ask for }oub • Ask date }(.b foetal u} r uvb • Ask if any P]vo o]vP ~˙U }vZ • STI • Social: bu}l]vPU o}R}ol Pb • Social supports • MbBP • MbSFH • A}u]vo˘uP o}uoo Pvv˙ • Check foetal heartbeat • Gvo˘uX ]vo]vPBP • Voo˘uX ~bou b ]( ]v]Z • SFH~b˙uR˙b]}r (voR]PRZ • A}u]vo˘uX • V]o}b r }vb M}} ]v E }( u • • • • • Medical SP]o Ob] LMP C }v.u period of Pb}v • Contrar EXAMINATION HISTORY TAKING • I(BPANlıU check urine for protein • Check Hb • Syphilis test ~RPR Z • VCT • Check urine (}}]vU Po}b • Check Hb • u]v D o}}P} • Check for sickr o]vPUGvPD LABORATORY INVESTIGATIONS v*AntenatalCare*v TorP) • }oub bA • U]RvuPv˙ plan • R]`vPb]Pvb]v Pvv˙ • I(HIVr }b]U}vbo}v PMTCT • C}vbo}vITNb • A]b}v}uu}v]b}u (}b}(Pvv˙ r • Educate on ANC visits • Address any observed or }ov}oub • Iv}oRbv]vANC • o} D ]RvuPv˙ plan • TRvPb]Pvb]vP Pvv˙ • D]bbSTI lHIV lAIDS • P}]VCTXI(HIVr }b]U bl}}ul`lb }P]vARV(}PMTCT • D]bPvv˙ b ]b}u(}bU ˘o b o}vb • C}vbo}vv]}vv bo(r • C}vbo}vITNb • A]b}v}uu}v]b}u r (}b}(Pvv˙ HEALTHPROMOTION • • • • • • • G]TT R.oo]}vl(}o]] IPTlSP}b Mv}o I(HIV r}b]UPMTCT Tv˙}oub C}vbo`}uv • G]TT • G]]}vl(}o]] • HIV }vboo]vPUvP b v }brb}vboo]vP • I(HIV r}b]UP]v PMTCT`lb Pb}v • Tv˙}oub • C}vbo`}uv • SIPT`]RSPLv `lbPb}v CTIONS A Standard Trtme ae ntGuidelinesUwthEditionUw TIMING OF VISIT AL `lb ANv`lb RD VISIT TH VISIT • Check foetal P}`R • CRl(}PIH • Check for oub] • E˘o Ro}ro] ]b}}}vU v}uo bv}vl lie • U]R vuPv˙ plan • Check foetal P}`R • E˘o vu] • CRl(}PIH • U]R vuPv˙ plan GOALS • Ask for }oub • Ask if there is P]vo o]vP • Ask for }oub • Ask if any P]vo o]vP HISTORY TAKING MbBP Check for pallor MbSFH A}u]vo˘u Check foetal heartbeat • MbBP • MbSFH • Count foetal heart rate • A}u]vo˘u • Check lie • Check presenr }v • • • • • EXAMINATION HEALTHPROMOTION • }oub bA • TRvPb]Pvb]vPvv ˙lo} • D]bbo} • U]RvuPv˙ plan • D]bb(u]o˙ovv]vP • I(HIVr }b]U}vbo}v PMTCT • C}vbo}vITNb • TR}}bu • TR}(Rv`r}v o˙ E ˘ob]]vP b U RuoU}U vPb]Pvb • o˙ E ˘ob]]vP b U RuoU}U vPb]Pvb • }oub bA • D]bbo} • U]RvuPv˙ plan • TRPMTCT]vo}U]RU }bu • C}vbo}vITNb • Rr]bbFPvHIV v}v • TR}}bu • TR}(Rv`r}v vPb]Pvb]vv`r}vUo˙ v˘ob]]vP b U RuoU} LABORATORY INVESTIGATIONS • I(BPANlıU check urine for protein • Check Hb • I(BPANlıU check urine for protein • Check Hb v*AntenatalCare*v VISIT : : r R.oo]}vl(}o]] Tv˙}oub I(HIV r}b]UPMTCT Do}}v(}FPlHIV v}v • C}vbo`}uv • • • • R.oo]}vl(}o]] IPTlSP}b Tv˙}oub I(HIV r}b]UPMTCT Ubo}}v(} FPlHIV • C}vbo`}uv • • • • • CTIONS A Chatep rP *Obtes tricCarendObtes tricDisorsder Standard Trtme ae ntGuidelinesUwthEditionUw 110.Hyperemesis Gravidarum v*HypermesisGrvid a arum*v TR]b (b } ˘bb] }u]vP boo˙ ]vP R o˙ }( Pvv˙U v ]b boo˙ }uu}vX I ]b ]Pv}b]b }( ˘ob]}v v R(} ]u}v } o } }R b }( }u]vP bR b uo]U ]v˙ ]v(}vU Pb]bU o ]bbU Rb v R˙}Po˙u]X SP]o }v]}vb bR b v]]bU }ò }b}vU R}o˙bb v `]b }]v ˙bU bR}o ob} ˘oX H˙ub]b P]u u˙ b}] `]R uoo Pvv˙}u}oPvv˙X sueCa yy PPvv˙ Symptoms yy E˘bb]}u]vP ~b}uub`]R]v]o]˙}lv˙R]vP}`v R}PR}R˙Z yy Iv]o]˙}}]vl~}(}(}u]vP Z yy W]PRo}bb Signs yy TRvo}}lbvòo yy DR˙}v ~˙bl]vU˙}vPUbvlv˙b]v˘ubZ yy TRob]b]vR˙]v˘ub yy TRBPu˙o}` yy Dv(bR]vP]v˘ub Invtiga se tions yy FBC yy Bo}}.ou(}uo]b]b yy U]vo˙b]bvo yy Bo}}vo}o˙b yy A}u]v}o]ob}v Trtme ae nt Tuv}ib yy T}}b R}u]vP yy T}R˙Rv yy To treat shock if present yy T}b}]}v]}vbXPXUTI Uuo]X Non-pharmacological treatment yy M]ov b RuvR}u`]R(vbuoouob yy D˙(}}bbRb]b]bu˙˙Ro(o yy D]vlG]b]vb]b}buoo}oubU](o} Chatep rP *Obtes tricCarendObtes tricDisorsder Pharmacological treatment AXM]ob yy st L]vTuv ]v E RvPPA M}o}u] L]vTuv ]v E RvPPA P}uR]v Or P}uR]v U}oUuPrR}o˙ nd yy yy B. yy yy R}oU}oUæuPrR}o˙ R˙}Ro}]U}oUæuPrR}o˙ Severe Cases N}uobo]v UIVU~ov`]RæA9˘}b D Or R]vPb o U IVU ~ov `]R æA9 ˘}b D uvbZ }u]uvbZ }u] r yy yy st L]vTuv ]v E RvPPA M}o}u] UIM}IVUæruPR}o˙ I(}˙`]PRAMlP v UP]æuPR}o˙XD}v}˘æu]} PullP]v˙ nd L]vTuv ]v E RvPPA Ovvb}v r U}oUIMUIVUruPR}o˙bv L]vTuv ]v E RvPPA yy P}uR]v R˙}Ro}]UIM}IVUæuPrR}o˙ ~u˘X]o˙}bUuPZ Refeal r Criteria R( b b `]R R˙}v vl} bR}l v u}o] ]bvb } R}b]o (} ]vv}b G] ouv v vuR˙X 111.Hypertension in Pregnancy Hypertension ]v Pvv˙ denotes a systolic blood pressure of uuHP } R]PR vl} ]b}o] b }( ı uuHP } R]PR }v }b]}vb ob æ u]vb b]vP v }]rb] + b]oo˙ ]v }b vbX I ]b b `Rv ˙bb }o] o}} b ]b v uuHP } R]PR v ]b}o] o}} b ]b uuHP } R]PRXTR]b]vob`}uv`R}bR˙vb]}v`b]Pv}b]}} v*Hypteer nsioninPrgna e ncy*v Av Standard Trtme ae ntGuidelinesUwthEditionUw v*Hypteer nsioninPrgna e ncy*v Pvv˙bòob]vPPvv˙X Kv}`v R˙vb]b }v CEA ]vR]]}bU ARBb v oRro}lb bR}o`]R b }u]}vb}vb](b ]vPPvv˙X sueCa yy PPvv˙r]vR˙vb]}v~v}}]v]Z yy Proub]~R˙vb]}v`]R}]v]Z yy oub E ] ~R˙vb]}v`]R}]v]v.bZ yy CR}v]R˙vb]}v~˘]bvP(}Pvv˙Z yy CR}v] R˙vb]}v `]R r]u}b b roub] } oub] ~Sb}vb}vRH˙vb]}v [URProub][vREoub] Symptoms ~Sb}v}vRH˙vb]}v [Z Signs ~Sb}v}vRH˙vb]}v [Z Invtiga se tions yy FBC yy Co}hvP}.o yy SuU]A] yy BUEvv]v C yy U]vo˙b]bvo yy L](v}vb yy Rv}uo}}Po}b yy D]o˙buv}(]v}]vb~](v}vu]bb]}vZ yy Rob}vvb b (}o}b(}oP}`Ru}v]}]vP Trtme ae nt Tuv}ib yy To control blood pressure yy T} } v˙}uo]}vb Ru˙ ]b b]oo˙ b ]u}broub] yy T}v(}o}uo]}vb yy To deliver a healthy baby Non-pharmacological treatment ~Sb}v}vRAvvoC [v}vRH˙vb]}v PRu}o}P]ouv AX yy [Z [Z H˙vb]}v in Pregnancy not associated with pre-eclampsia or eclampsia st L]vTuv ]v E RvPPA MethyldopaU}oUæræuPrR}o˙~u˘XP]o˙Z nd L]vTuv ]v E RvPPA Chatep rP yy *Obtes tricCarendObtes tricDisorsder Nifedipine]v b obU}oUruPR}o˙ B. Hypertension in Pregnancy associated with pre-eclampsia and eclampsia ~Sb}vb}vRH˙vb]}v [URProub][vREoub] [Z Refeal r Criteria R( oo b }( r]u}b b roub] } }R }b] }uo]}v }uo˙ } R}b]o } }b]]v L ]v]}v }( uvX 112.Pre-eclampsia Severe cases æ v*Prree clampsia*v Proub] ]b ]bb ].oo˙ b}] `]R Pvv˙X I boo˙ }b ]v R }v b Ro( }( Pvv˙ v ] ]b R] ˙ R˙vb]}vv}]v]XTRbv}(o}u}˘bb] `]PRP]vu˙ob}(}(roub]X Bo}} b u}v]}]vP ˙ R}b }PR `]R ]o˙ `]PR]vP}(Rvbvo]vRuvPuv}(roub] o}vPb]R}uuv]vbP}vbX WR]o o}} b }v ]b bvoU o}`]vP R o}} b o}` lıuuHP u˙ b (}o ]bb v bR}o }]X sueCa TRb]bvlv}`vR]bb]bu}}uu}vo˙b}] `]RR(}oo}`]vPP yy P]u]P] yy MvoP~`}uvAM}ANæ˙bZ yy MooPvv]b yy H˙](}uu}o yy M]o ]b}b XPX }o˙˙b }]bU R}v] R˙vb]}vU ]buoo]bUl]v˙]b}b yy F]bPvv˙`]Rv`v yy P]}bR]b}˙}(roub] yy Fu]o˙R]b}˙}(roub] Symptoms yy Pvb`]Rroub]}Lv˙u}u b yy S`}oov( Signs Mild cases S˙b}o]o}}`v b væıuuHPD]b}o]o}} `v b ıvıuuHPP}]v]}(A=}A= yy Po}u Standard yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw S˙b}o]o}}vuuHP b }R]PR D]b}o]o}}uuHP b }R]PR P}]v]}(A=}A= Po}Pvo]b}u v*SeverPrrEe clampsiaandImminentcla E mpsia*v Invtiga se tions yy FBC yy SuU]A] yy BUEvv]v C yy U]vo˙b]bvo yy L](v}vb yy Rv}uo}}Po}b yy D]o˙buv}(]v}]vb yy Uob}vv b (}o}b(}oP}`Ru}v]}]vP Trtme ae nt Tuv}ib yy T}oo}}U b v}obbRvlıuuHP yy T}}o}vPRPvv˙buRb}bb]o}oo}`R(}b} P}`vu(}o]˙ yy To prevent foetal distress yy T}v}v˙}uo]}vbRu˙]b yy T}voub] Non-pharmacological treatment yy Au](}]( b }bb]o yy Ev}Pvb}o]}vR]b]b}}]b]vR˙}vb]}v Pharmacological treatment AXM]oroub] TR]b v} v (} Puv }( R R˙vb]}v vobb R BP ]bb } æ uuHP ˙bb }o] } uuHP ]b}o] } R v }ub˙u}u b }(]uu]vvoub]~bo}`ZX yy yy yy ]v E RvPPB MR˙o}U}oUæræuPrR}o˙~u˘XP l˙Z Or N](]]vU}oUruPR}o˙ Or N](]]vbo}òbU}oUrvuP]o˙ 113.Severe Pre-Eclampsia and Imminent Eclampsia TR]b ]b v }b] uPv˙ v ub Pvo˙X Tuv]bRbubR}(oub]~bo}`ZX TRbb uvP b ]vR}b]ovRb]b]}v}(v}b]]vX WR]o o}} b }v ]b bvoU o}`]vP R o}} v Chatep rP *Obtes tricCarendObtes tricDisorsder w v*SeverPrrEe clampsiaandImminentcla E mpsia*v b o}` lıuuHP u˙ b (}o ]bb v bR}o }]XBPu}v]}]vPub]}˙æru]vbvoR BP]bvRv]bob XTRLu}v]}]vPv}v ˙rR}o˙XD]o˙`]PR]vP}(Rv]bbvoX Symptoms yy F}voRRb yy V}u]vP yy V]bo ]bvb bR b }o ]b]}v ~]o}]ZU o ]b]}vU GbRb}(o]PR yy E]Pb]]v yy b]v D ]v}}v~}o]P]Z Signs yy Elevated blood pressure yy L]vvbb yy U]v}}v}(AMuolR}}AMuolR}b yy Ivbv}vG˘b yy Pbv}(vloo}vb~}b]}voo˙Z Invtiga se tions yy FBC yy Bo}}o}hvP}.o~b]o}hvPuU}R}u]vuUINRU APTTZ yy Su]] yy BUEvv]v C yy U]vo˙b]bvo yy L](v}vb yy Rv}uo}}Po}b yy D]o˙buv}(]v}]vb yy Uob}vv b (}o}b(}oP}`Ru}v]}]vP Trtme ae nt Tuv}ib yy T}Ro}}U b v}o}`RvlıuuHP yy T} v R u}R (}u b+]vP (}u }uo]}vb }( R hypertension such as a stroke yy T}v.bloub] yy T}]o]b b Rvvo]R](oub]]b]uu]vv Non-pharmacological treatment yy o˙ E o]˙}(u}R](oub]]b]uu]vv yy I( R v ]b v} ˙u}u b v R Pvv˙ ]b obb Rv `lb oo}` Pvv˙ } }vv ]( R (}o }v]}v `}o oo}` yy I( R Pvv˙ ]b `lb } u} }vb] o]˙ L ]o]b b }v Standard Trtme ae ntGuidelinesUwthEditionUw Pharmacological treatment ]v E RvPPC AXBPuvPuv]vroub b ]v]uu]vvoub] yy H˙o]vUIVUæruPbo}ò˙}ru]vb Or yy N](]]vUbo]vPoUuPX b Or yy Lo}oUIVUuPX b }obu]v R ru]v ]vob ]( R BP u]vb AN vl uu HP b (}oo}`bP uPV uPV uP }obb } uo }b }( uP yy yy WRvRBPAMvluuHP}uuvv]v(b]}v}(uP R}X D}oR]v(b]}vru]v]vobvo(}˙ b b}vb}}b}(vuPR}]b']vX Then N](]]vU}oUruP]o˙ Or MR˙o}U}oUæræuPrR}o˙ v*Eclampsia*v BXMvPuv}v}v}(b]b]vroub b ] and imminent eclampsia yy MPvb]uboRUIVUuo}(RA9b}o}v~PZ Av yy MPvb]u boRU IMU uo }( R æA9 b}o}vU ~æ PZ ]v} R '}l~}o}(PZ Refeal r Criteria R( oo b }( b roub] v ]uu]vv oub] }uo˙}R}b]o}}b]]vL]v]}v}(uvX WRv R S}b]]v_ }vb]b R R (}b ]b ]uuU R v bR}o vb( } R}b]o o }( o}}l]vP L R ]uu˙X X Eclampsia oub E ] }b b }uo]}v }( `}bv]vP roub]X TR o}} b ]b R]PR `]R b}] }]v] v }vob]}v } ou .U `R]R ]b b]u]o } v ]o . `]R }v] v o}v] Rbb (}oo}` ˙ }u X TR .b }Lv v }( bR} }v~vrı}vb b ZX sueCa yy Ab(}roub] r Chatep rP *Obtes tricCarendObtes tricDisorsder ı v*Eclampsia*v Symptoms yy F]b yy Uv}vb]}bvbb Signs yy Convulsions yy C}u yy Elevated blood pressure yy P}]v] Invtiga se tions yy FBC yy Bo}}.ou(}uo]b]b yy U]vo˙b]bvo yy Bo}}vo}o˙b yy Uob}v˘u]v}v}(R}b ˘ouooPvv˙ vl}u}oPvv˙ Trtme ae nt Tuv}ib yy T}}Rv(}u]vi˙ yy T}v(R.b yy T}o}`Ro}}b yy T} u}v]} (} }Pv (]ob ~XPX voZ b òo b }b] }uo]}vbXPXovo}vv(}o]bb yy T}vuvou}o]˙ yy T}o]R˙`RvRu}R]bob Non-pharmacological treatment yy L˙v]vR}˙}b]}v yy Pvv(}u(oo]vP yy }] A ]vP b v } v o]u (b v i}]v ]bo}}vb yy D}v}v˙R]vP]vv[bu}R}v}vP]vP yy M]v]v R ]`˙ ˙ ]R R}o]vP R R]v } ]( }bb]oU ]vbvPuRv]o]`˙}R}o}`vR}vP yy I( }bu v v u]vb v}vb]}b (} o}vP ]}U }vb]v]vPRu˙R}}vb}b(}uo}]vP yy A.]ob]}vu˙](}oo}`]vPPvovbRb] ALR.b yy O]vIVb yy R]b C Rv yy I( v} (R .b v Lv ]b]o] b U o]R (}b ˙ R u}b }] uR} } vb (˙ b }( }R u}R v baby yy M}}(o]˙`]oov}vRv[bo]v]o}v]}vUR status of the foetus and her preference Standard Trtme ae ntGuidelinesUwthEditionUw Pharmacological treatment ]v E RvPPA AXFo]ouv yy S}]uCRo}] O yy R]vP [b o R}bZ B. yy yy XıA9UIVU U IVU ~M˘]uu L] ]v v R}b } L]b ]v Treatment of convulsions MPvb]uboR UIVUuo}(RA9b}o}v~PZ Au]v]bbo}ò˙}æ}æu]vb Then MPvb]u boR U IMU uo }( R æA9 b}o}vU ~æ PZ ]v} R '}l~}o}(PZ C. Treatment of recurrent convulsions I( .b `]R]v u]vbU } v} MPvb]u boR ~S}Ruv}}vbo}`Z X v*Eclampsia*v I(.bLu]vbUMPvb]uSoRUIVU ANwlPV uo}(RA9b}o}v~PZ AMwlPV uo}(RA9b}o}v~PZ}v D. yy Maintenance MPvb]uboR UIMUæP]vovvP'}lb˙R}boo R}bLobb]}o]˙U`R]R]bo Note 13-1 T}˘]]˙} MPvb]u SoR bvb b o}`]vP }b}( R R v R b]}v v o}bb }( R v}vG˘bX (} B P]]vP }b vbRR(}oo}`]vPubv}uoP yy Rb]}˙ANrvu]v yy U]v}uo}u}}R]}bR}b yy Pbv}(lvil}}Rv}vG˘b Ivb}(}˘]]˙}MPvb]uSoR yy G]b]bb]}v yy Au]v]buo}(A9Co]u b]uboR}˘]]˙ E. Go}vUIVUbo}ò˙]vuPv b r Treatment of convulsions not responding to Magnesium sulphate Av ]v E RvPPA yy D]u U IVU uP bo}ò˙ }r u]vb ~v}˘]vP Xæ uP ˙}vb b U Then ANvlPV æruPR}o˙ AMvlPV æuPR}o˙ Chatep rP *Obtes tricCarendObtes tricDisorsder ~D}v}˘æu]}PullP]v˙}uP]vR}bZ F. Treatment of Hypertension in Eclampsia yy H˙o]v UIVUæruPX b ~}æru]vbZ B}obbv˙ru]vbXBPbR}ov}(ooo}` lıuuHP Then yy H˙o]v UIV]v(b]}vU ruP]væuo}(S}]uCRo}] XıA9 R}(]v(b]}v}P]vbRo}}]vPb b X Note 13-2 I(RH˙o]v ]v(b]}vvbv'vU}(}vR˙}vb]}vu˙vbX H˙o]vU IVU ]b bP]v b uoo }ob }bb r u]v]vob oo R BP ]b X TR ]b}o] b R}o v} P} o}` ı uuHP b ovo(b]}vu˙]u]`]Rbov(}o]bbX Or Lo}o UIVUuPX b }obu]v Then R ru]v ]vob ]( R BP u]vb ANvluuHP b (}oo}`bP uPV uPV uP }obb } uo}b }( uP WRvRBPAMvluuHPvb ]v(b]}v}(uPR}X D}oR]v(b]}vru]v]vobvo(}˙ b b}vb}}b}(vuPR}]b']vX Refeal r Criteria Tvb( oo b }( oub] ]uu]o˙ } R}b]o } }b]]v]v(]o]˙`]R}]˙X Ab uR b }bb]o b v IV o]v }( S}]u CRo}] R]vP [bo vu]v]bRIV}b}(MPvb]uSoRbo}ò˙ R RoR (]o]˙X F}oo}` R]b `]R R IM }b v }uv˙ R v}(o(]o]˙X I( R IV }b vv} P]vU b]uo˙ P] R IM }b }( æ P ]v} R'}lvvb(X yy ~Sb}v}vRMo] 116.Avu] [Z in Pregnancy Avu] ]v Pvv˙ ]b Ru}Po}]v }vv}v }( AM P l L ~W}o HoR OPv]b}vZX I ]b b] b b ]( R H ]b AM w P lLX Avu] Rb b +b }v R RoR }( R `}uv v R }}u }( R Pvv˙X I ]b b}] `]R v ]vb }( XıA9 } v*MalariainPrgna e ncy*v 115.Malaria in Pregnancy r Standard Trtme ae ntGuidelinesUwthEditionUw u]b]PUu o]˙U (}o P}`R]}v b U (}oR v ]vb ]vo o}bbX I ]b ob} b}]`]R vr v }bru Ru}RPvv]vbuvou}o]˙X Ioo˙ v} `}uv bR}o P} ]v} o} `]R vu]X }] A ubb ]vo]vP o}} vb(b]}v u˙ ] } } R vu]b]oo˙](`}uv]bo}b}R˘o]˙X sueCa yy yy yy yy yy yy yy PR˙b]}o}P]o~}o}}}ou˘vb]}v]vPvv˙Z P}}]˙]vl}(]}vU(}ov]u]vB Hu}o˙]b}b~XPXb]looo]bbUGvPD Malaria Iv(b}vb`]RR}}l`}uU]bb UbR]b}b}ub CR}v]]v(}vbXPXTBUUTI UHIV Bo]vP }uo]}vb]vPvv˙XPXAPH v*AnaemiainPrgna e ncy*v Symptoms yy D]]vbb yy Sòo]vP}(R( yy Gvo`lvbb yy ˙bE (P]o]˙ Signs yy Mucosal pallor yy Jv] ~u˙}u˙v}bvZ yy H}rbov}uPo˙~u˙}u˙v}bvZ yy Heart failure in severe cases Invtiga se tions yy FBC yy P]Roo}}.ou}uuv yy Bo}}.ou(}uo]b]b yy S]lo]vPvHo}R}b]b yy GvPD ]˙ yy Su]}vU}o]}v]v]vP]˙U(]v yy S}}ovo˙b]b(}R}}l`}u} yy U]vo˙b]b(}bR]b}b}u}v}]o]v}Pv Trtme ae nt Tuv}ib yy T}o]˙u}ub b yy T} } Ru}Po}]v oo (} v Rb u } P}b into labour yy T}]v(˙vvo˙]vPb yy T} }Pv] v uvP R b}] }uo]}vb ]v u}R XPX](]oUv˙XPX]v]vP}`R]}v b Non-pharmacological treatment yy Ev}P ]vl }( (}}b bR b uU }o˙U .bRU l (Z Chatep rP *Obtes tricCarendObtes tricDisorsder o(˙PobUbRoo.bRU](]b`R]R ]R]v]}vU(}oU V]u]vbBvC yy }] A U }+U vU }o v vRoR˙ R]b bR b vP }( o˙U`R]R]vR]]b]}vb}}v yy Ev}P ]vl }( (}o v ]u]v ]R (}}b ]vo]vP vbU }}U]b(]bUb]vRvuvP}b yy P}]v]R(}}bubob}]vo]vR] yy Evb Rb vu] vb bv u} (vo˙ ]v R vvo o]v] v R] b}vb } uv u}v]} `]R Ru}Po}]vooRlbX Pharmacological treatment yy ]v E RvPPA F}bboR Or F}bPo}v yy yy Av F}o]A] U}oUæuP]o˙ Bo}}vb(b]}v yy U}oUæuPR}o˙ U}oUuPrR}o˙XoE Lr`lb v yy A F}bu] X IVUruP](P]]vP`R}oo}} Refeal r Criteria R(vb`]Rvu]}]]v}]vb(}}vboo]vP v b}X Tuv (} bvu] ~H AM wP lLZ ]b b P]v ]v RoR(]o]b`]Ro}}vb(b]}v]o]˙X Aoo `}uv `R} } v} b}v (}]o˙ b } }o uv bR}o((}(Ro}vX TR}b `]R b}]}v]}vb o]lHIV bR}o uvP ]v R R}b]oX HIV vb }v v}]o u]}vu˙vu}].}v}(R]P}u]v}vb}˘o R}bRPPvu]XPX]}]vX Flowchatr v*AnaemiainPrgna e ncy*v Note 13-3 Ivvu] b ~HAMwP lLZUo}}vb(b]}vu˙vbb˙X Ivo}vu] b ]b˙b o}}vb(b]}v WRvR]bR(]o(o˙vb(bloob v Hu}P}]v}R]b Standard Trtme ae ntGuidelinesUwthEditionUw v*SickleCellDissein a Prgna e ncy*v F]PrP) Flowchart: management of anaemia in pregnancy 117.Sickle Cell Disease in Pregnancy PPvv˙ ]v R S]lo Coo D]bb `]R }} }b] }}ub (} }R R u}R v R ˙X D (}u(o vb ]v GRv bR}` Rb]lo oo}uo]}vb ]vP Pvv˙ob}R]PRuvov]vou}o]˙X C}uu}v Pvv˙ }uo]}vb }( R u}R `]R SCD u]b]PbU (v b}r}ob] ]bbU b vu]U v ]v˙ ]v(}vbU Rb ˙v}u b ~SCD Z v ]b b}] include U u o} v Chatep rP *Obtes tricCarendObtes tricDisorsder ou}v˙ u}o]buX Iv R (}bU }uo]}vb ]vo ]v]v P}`R]}v b Uu]˙v]v]v(}oRX C ˙ uo]b]o]v˙ u }vb]bvP }( R Ob]]vU PR˙b]]v b]o]bU Hu}o}P]bU Co]v]o PRu]bU AvbRbU NbvM]`](vbbP}}RoR}}ub(}RbvbX sueCa yy yy yy Pre-pregnancy Care P}]Pv}vboo]vP Ab]bv}ovPvv˙]vb}(}uuRoR }v E }vo]blvRoR}oub}(SCD v*SickleCellDissein a Prgna e ncy*v ~Sb}v}vRS]loCooD]bb [Z Symptoms yy RvJv] yy B}vvi}]v]v~v]b}bZ yy Do˙˙ yy Sr(o]˙ yy Avu]}uo]}vb~b˙(P]o]˙Uo]}vbZ Signs ~Sb}v}vRS]loCooD]bb [Z Invtiga se tions yy S]lo]vPvb Hu}Po}]vo}R}b]b yy Fooo}}}v]vo]vPo}˙}v yy RDT }o}}.ou(}uo]b]b yy M]bu]v(}Covbvb]]˙}}l]vPv`Rv indicated yy Rvo(v}v~B b UNUv]v C Uo}o˙bZ yy L](v}vb yy Su]}vUTIBC vF]v ~](}bb]oZ yy Aoo}Rvvov]vP b b Trtme ae nt Tuv}ib yy T}]v(˙vb`]R}v]}vo˙]vPPvv˙(}o}b u}v]}]vP yy T}}vu] yy T}vlv}`v]bb]PPb yy T} v uvP }uo˙ oo b}] }uo]}vb v crises yy To deliver client safely as soon as baby is viable Non-pharmacological treatment ]vPPvv˙ æ Standard yy yy yy yy yy yy yy v*SickleCellDissein a Prgna e ncy*v yy yy yy yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw Care during Pregnancy }}l]vP A Ab v (oo˙ (} ]bl }( (v ]bbU v ]}b }b]}uo]}vb E˘u]v (} v]}vo bU vu]U iv]U v R}bov}uPoo˙ P(}uob}v}Pvv˙v˘o(}ov}uo]˙ vP}`R}v P(}u R } o]b ]vbP}vb } vb (} v }uo]}vb MvP]v.}oub}}l]vP~XPX]v˙]v(}vU uo]X}]o˙ Z v}uo˙ F}oo}`]b]b I(o}`]blUbRo(}oo}`]b]bu}vRo˙vov]ubURv `lo˙voR`lvRL`lo˙ I(R]PRr]blUbRo]b]b`lo˙voR]]ubURv`lo˙ vou A ]` ]b]bU v] } uvo òor]vPU ˙u}ub b }( ]bbU]v(}vv(}o]˙XE˘u]v(}oo}Uiv]U( v}]v]XCRl(}(}oP}`Rv}u}Pb}vo P Labour and delivery Sbvb ]v}(o}vo]˙v]PP]b]bXR]blb}(]b]b ]b ]vb ]( R˙}v U (U ]v(}vU R˙}Ru] o} ]vP o}X C ]vP o}lo]˙ ]b P vvP Rb]PPb Aoo `}uv `]R S]lo oo D]bb ub o] ]v R}b]oU v R u}b ˘]v u]`]( v }b]]v bR}o ]v}o ]v their care Ivv}uo]Pvv]bUb}vv}bP]voo]˙ub ]uvo`lb~uZXIv}vubvlv}vo˙]( R`}uvRbv}o]LR]buX F}RR]PR]bl`}uv`]Rv}uo]}vbo]b}}v as baby is viable u]b A b]}v]vo}V yy L}bR}ou}v]}o}bo˙`]R}PR yy CRl(}Ru}Po}]voo yy G}v}bbruRv]}(o}}}vv˙ b yy M]v]vP}}R˙}v`]RIVG]b yy P}] ]v o]( ~S b}v }v RAvoPb] ]v L bour [Z yy P}]}R˙ov]}b~Sb}v}vRAv]}} R˙o˘]b ]vo}v]u [o}`Z VP]voo]˙bR}oR]uvobR b }b]b}vb (}vb b}v v r r Chatep rP yy yy yy yy yy yy yy yy yy yy P}o}vP}v b P b o}bR}o}]˙}+]vPb]b o]˙~uZ A MvPuv }( TR] SP }( L} ~AMTSLZ ]b }uuv}vPPH Postpartum care Aoo S]lo Coo D]bb vb ub R}b]o] v u}v]} o}bo˙(}obwR}b}bu CRl (} oo}U o b]bU Rb ˙v}u b }ob]]bbv]v˙]v(}v C}vv `]R }R˙o v]}b (} ob w R}b }bu C}vbo `}uv v R] b} b}vb } }] ]bb ]PPb bRbU]vUol}(boU(PX Ev}Po˙uo}v~b]oo˙L}o]˙Z R]` o]v w ˙b }bu v RL `lo˙ vo v `lb R(v}R˙b]]v(}}vv]vP C}vbo}v(u]o˙ovv]vPv}+}v}v U b}r v*SickleCellDissein a Prgna e ncy*v yy yy *Obtes tricCarendObtes tricDisorsder Baby The baby should be screened for sickle cell disease Co}bo˙u}v]}R]b`]Rb}]}uo]}vbXPXIUGRU u]˙X Sickling crises in pregnancy Au] oo b]lo oo vb `]R b]lo]vP vl} }b] }uo]}vb]vPPvv˙}R}b]o yy }] A NSAIDb XPXD]o}(v ]vR]ub yy O]}bo]lR]]vvu}R]v (}]vuvPuvbR}o `]R b ]vPo}}b]}vb]}v +b}v ˙~Sb}v}vAvoPb]]vL} Z yy Iv(˙ v vo˙]vP ]PPb XP UTI U uo]U R˙}v X~S}]b}vbZ yy Bo}}vb(b]}v ]b}uuv](Ru}Po}o]voo]bobbRv wP lo v `lb vl} ]vP ]bb ~S b}v }v RS]lo Coo D]bb [Z yy I(]vb}r}ob]]bu]v]v b R˙}v`]RIVG]b~˙boo}]bZ r o]b ]v R}bU v }] voPb] ~S b}v }v RS]lo CooD]bb [Z yy A Rb ˙v}u b ~ACSZr (}o u}v]}]vP ]b bvo ]vP R]b]b]b~Sb}v}vRACRbS˙v}u[Z Pharmacological treatment yy AXAvvouvb ~Sb}v}vPRu}o}P]ouvbvRAvvoC w [Z Standard yy Av Mo]u]v Trtme ae ntGuidelinesUwthEditionUw U}oU}v]o˙ BXAv]}}R˙o˘]b in labour and puerperium yy L]˘}v C UIVlIMUP]o˙(}wR}b Or yy Au}˘]]oo]vA=Coov]A] UIVUXPX b Then yy Au}˘]]oo]vA=Coov]A] U}oUvæuPR}o˙(}wR}b Refeal r Criteria Aoo vb `]R b]lo oo ]bb `]R }b] }uo]}vb bR}o(}b]o]b(}}vv]vPX 118.Diabetes Mellitus in Pregnancy v*DiabetesMellitusinPrgna e ncy*v D]b Moo]b ]v Pvv˙ ]vob ]v]]ob lv}`v } ] ]} } Pvv˙ v R}b `R} o} ]u] Po}b }ov ]vP Pvv˙X Gb}vo ]b (b } ]u] Po}b}ov}(v˙PRo}b}]b.b}Pv]]vP R v Pvv˙U ]b }( `RR ] b}ob L o]˙ } v}X D]b ]b b}] `]R }} RoR }}ub (} u}R v R ˙ ]( v} }o˙ uvPX Mv˙ vb `]R Pb}vo ]b ˙u}u b ul]vP v]vP b (} oo Pvv `}uv uv}˙} ]v(˙ R}b ]blX A (bvP o}} Po}bbub }v }v oo Pvv `}uv }}l]vP v ob} r `lb ~S b}v}vRAvvoC [ZX TR uvPuv }( ]b uoo]b ]v Pvv˙ v R ]u ]v}obo}bu}v]}]vP}(R`}uv˙uo]b]o]v˙ }R}u]b]vPu}(}b]]vbUu]`]bUvbbU]]vbU R˙b]]vbUvbRbbv]]]vbX L} ~]v } b}vv}bZ v vCb b}v b b]b]vR}b]ovb]o]bX Avr] uv ]uvb uoo˙ L o]˙ RvU }b o]˙ uv }bb ub ]o} } R ]v]]ov[bvbX TR v`}v ˙ }( ] u}R vb b]o v ]b b uvP ˙ ]]]vl v}v}o}P]bX H˙}Po˙u] ]v R ˙ ]v R .b (` R}b }( ]R ]b ui} }ouX I v v ˙ ]v]vP o˙ ~`]R]v R}Z ]vP b X TR˙ u˙ ob} ] uvPuv (} b]}˙ ]bb ˙v}u b U o}o˙ ]uovb~XPXR˙ou] UR˙}lou]UR˙}uPvbu]Zv R˙]o]]vu] X Aoo]u}Rbub}vboo}v(u]o˙ovv]vPX Chatep rP sueCa yy yy yy *Obtes tricCarendObtes tricDisorsder Pr˘]bvPT˙]buoo]b Pr˘]bvPT˙]buoo]b Gb}vo]b uoo]b Symptoms yy Uboo˙˙u}u b yy P]}bR]b}˙}(oP]b~ANlPZ yy P]}b}}}b]R]b}˙~(}oRbUu]b]PbXZ yy OR(b}(]b~Sb}v}vRD]bMoo]b [Z S]Pvb F}b oPRv Pb}vo P~b b ˙ b]o˙uR˙b b ]}r (voR]PR}˙ob}vv b Z yy F}bbuooRvPb}voP~IUGRZ yy Pbv}(}o˙R˙uv]}b yy OR b]Pvb }( ] }uo]}vb ~S b}v }v RD]b Mellitus[Z Invtiga se tions yy All basic Antenatal CareIvbP}vb yy Uob}vv b yy F}ov}uo˙v b vr`lb yy S]ovb b (}P}`Rbuv]vR]]ub yy U]vovbvb]]˙~u}vRo˙Z yy H]PRP]vo`b (}v]]b]b yy Bo}}Uo}o˙bvv]v yy Bo}} Po}b }.o ~FbvP o}} Po}b v rR} }br v]o o}} Po}b u}vRo˙ ]v R oV u} (vo˙ ˙ bo(r u}v]}]vPZ yy Go˙Ru}Po}]v~HA˙CZ vr`lb yy Trtme ae nt Tuv}ib yy T} R] v}uo o}} Po}b v Po˙ Ru}Po}]v oob R}PR}Pvv˙Uo}Uo]˙v]u yy T}vuvov(}o}uo]}vb yy T}vv}vou}]]˙vu}o]˙ yy T} v uvP }R b}] }uo]}vb XPX r oub] ı v*DiabetesMellitusinPrgna e ncy*v N}r TR]bv}o(}]vPo}bu}v b ]vRuvPuv}(]b]v Pvv˙˘(}v]vP b X So(ru}v]}]vP}(o}}bPbR}o v}P(}R}b`R}v+} Po}buX Standard Trtme ae ntGuidelinesUwthEditionUw v*DiabetesMellitusinPrgna e ncy*v Non-pharmacological treatment yy Gvoub~]˙ b u}].}vU˘]bUv}vboo]vP v }vU o}} Po}b u}v]}]vP ub ]bb `]R ]]vU}b]]v}u]`](Uo˙ b Z yy FvANC]b]b] yy Do]˙ yy ˙`lbPb}vP]vòo}v}oovb`]Rv}}u o]}vb yy ˙ `lb Pb}vV ]v Ivbo]v vb v R}b `]R}uo]}vb yy vCb b}vV(}vb`]R]R}(R(}oo}`]vPV yy roub b ]U]}bvb b}vU yy vuvoPUuobv}v}(}o yy u}b}u] yy I(ouo]˙]bvbb˙UuR(}oovPb `]R}}b}]bvb]o]b yy P]u yy Co}b o}} Po}b u}v]}]vP ]v R .b R}b L livery Pharmacological treatment B}˘rP) r Notes on glycaemic control of diabetes in pregnancy (} B ovvPvv˙ Ou]bPo˙u]}v}o]vlv}`v]b(}Pvv˙X D]vPPvv˙ I( ] o}v vv} }v}o R o}} Po}b oo }vb] R˙}Po˙u] PvbPu}u]vUPo]vou]v]vbo]v yy D] vb }v }o u]}v `R} }u Pvv v u]v ]v }v R] }o u]}v ]( bP}v}o ]b (}˙ b ~(bvP Po }boob`vrvuu}olLvrR}}bv]oPo}b`v rwuu}olLVPo˙HHAobbRvvXæA9Z Iv]}vb(}}ov]PvbbP yy Gb}voD]b`R}(]o}R](}˙ b }v}o`]R]v ˘]bo}v~FBSANvXuuu}oloZ yy P}}}uo]v}]vbo]vXPX}}u]v]b}vbl]oob yy P}}Po˙u]bo(u}v]}]vP yy Ivbo]vR˙}bb.vv]ov}]bv}]o˙]oo b}o A Iv]}vb(}Ivbo]vb yy S]Pv].v]ou}]]˙˘]bXP b XvR}R˙Uv]v}R˙U neuropathy yy Pb]bvo˙R]PRHu}Po}]vA yy Pb]bvl}v] yy S]Pv].v }b] u}]]b XPX (}o u}b}u]U }o˙R˙u]v]}bU IUGR yy D]vPvvo}}b}]R˙`]R˘]}}v}(Po˙ u]}v}o yy P}}Po˙u]}v}o`]R}ov]Pvb yy r ]v E RvPPB M}u]vU}oUæuPrR}o˙X~u˘X}bP˙Z AvlO r r r Chatep rP yy *Obtes tricCarendObtes tricDisorsder Go]vou]U}oUXæræuPrR}o˙XIvb}b˙æuP]( vbb˙vou˘X}b}(æuP l˙ Note 13-5 M}u]v v P]v b u}v}R˙ } ]v }u]v}v `]R ]vbo]v vl or Sulphonylurea TR}( b boR}v˙ob~XPXPo]vou]]v Z Pvv˙bR}oPvoo˙ }]}( b R]bl}(v}voR˙}Po˙u]XH}ÙPo]vou] nd vb]vR v]ub]v`}uv`]RPb}vo]bX AvlO Ivbo]v ]v E RvPPA ~Sb}v}vIvbo]vTR˙]vRD]bMoo]b[Z yy S `]R buoo }bb ~XPX }o ]o˙ }b }( vr v]bZ }( NPH ]vbo]v } u]˘ ]vbo]v ~`R]R Rb A9 }( Po v wA9 }( NPH]vbo]vZUv}b b o˙X yy G]}˘]uo˙`}rR]b}(R}o]o˙}b(}l(b v}vrR](}]vvX yy Aib R ]vbo]v }bb (} l(b vl} ]vv ˙ ob } u]vbv]b}]vP}bob}(o}}Po}bbX yy M}v]} ]vbo]v R˙ `]R r `lo˙ FBS ~v rR} }br v]oo}}Po}b`R}bb]oZ } `lbRv`lo˙ ooo]˙X yy K (bvP Po}b oob `v rv uu}olL v rR} }bv]oPo}b`vrwuu}olLX yy TR]b ]b }Lv R]o }v v }rv b]bX H}Ù b}u vb `}o v } u]'} R}b]o (} bR} ]}b } vbP}}Po˙u]}v}oX yy Ivbo]v ]uvb ]vP o} bR}o P]v }]vP } bo]]vPo b ~Sb}v}vRD]l}]}b]b[vSo]]vPo b Z yy Ivbo]v ]uvb ]vP vb b}v v }R } }b ~b]vP bo]]vP o b } Go}brP}bb]urIvbo]v ]v(b]}v}GKIZbR}o]bb`]RRvbRb Refeal r Criteria R(} R}b]o (} b]o]bX F} R}vv]v }(vb bR`vb]o]bvu]o}8u˙}]X yy ]C ]bb b}] `]R R]PR uvo v (}o u}o]˙ v u}]]˙X TR˙ u˙ bv (} R Pvv˙ } o} ]vP R Pvv˙ } ]u ~XPX ]u ]}u˙}R˙ZX PPvv˙ ob ]}vo v }v R R v ulbr˘]bvP]]bb`}bX v*CardiacDissein a Prgna e ncy*v 119.Cardiac Disease in Pregnancy Standard Trtme ae ntGuidelinesUwthEditionUw v*CardiacDissein a Prgna e ncy*v S}u }( R b]Pvb }( Pvv˙ u˙ u]u] ] ]bbX (o C buv}(oovbub vlv}u]v](R˙R ]]bb}v}X MvPuv ]b uor]b]o]v˙ u ]vo]vP R }b]]vU v}v}o}P]bU vbRb v R˙b]]v b]o]b } ]}o}P]bX Pvb `]R lv}`v ] ]bb ub ov R] Pvv]b (oo˙]v(oo}vbo}v`]RR]]}o}P]bv}b]]vXTR˙ ub }}l o˙ b }}v b R˙ }u Pvv (} vvo ]v R}b]oX Aoo vb v]vP Ru}o}P]o uv ub uvP ˙R˙b]]vb]o]b}]}o}P]bv}b]]vX sueCa yy RRuR]bbXPXu]o]v}uvvv}b b ]b yy Hypertension yy ]}u˙}R˙ C yy Avu] yy C}vPv]oR]bb yy TR˙}}˘]}b]b Symptoms yy ˙u}u Ab yy Po]}vb yy ˙bE (P]o]˙ yy Chest pain yy D˙bv}r}R}v}U}˘˙buov}vo˙bv} yy C}PR yy LPòo]vP b Signs yy ]C uub yy OR b]Pvb }(] ]bb v]vP }v R ˙ }( ob]}v ~S b}v}vRD]b}b}(R]}bo˙bb u[Z yy Pbv}(R(]o~Sb}v}vRH(]o[Z Invtiga se tions yy FBC yy Bo}}vo}o˙b yy TR˙}](v}vU b ](]v] yy Eo}]}Pu yy R}]}Pu E yy CRbXr˙~`]R}}v}((}bZ yy Aoo}Rvvo]vbP}vb Trtme ae nt Tuv}ib yy T}u]v]vP}}](v}vR}PR}RPvv˙Uo}U Chatep rP *Obtes tricCarendObtes tricDisorsder o]˙v]u yy T}vuvov(}o}uo]}vb yy T}vuvoR Non-pharmacological treatment ~S}]]]bbZ Pharmacological treatment ~S}]]]bbZ Refeal r Criteria Aoo vb `]R ] ]bb ub ( } b]o]b R˙b]]v}]}o}P]bvv}b]]vX 120.Jv]]vPPvv˙ v*JaundiceinPrgna e ncy*v Jv] }]vP ]v Pvv˙ u˙ ˙u}u b } b]Pv }( ]bb bvbR}ov}vbuX sueCa Obstetric yy S roub]loub]lHELLP S˙v}u ~Hu}o˙b]bU EoL]v˙ubUL}`Poob˙v}u b Z yy SR˙ub]bP]u yy CR}obiv]}(Pvv˙ yy F'˙ A L]}(Pvv˙ Non-obstetric yy V]oRb yy Hu}o˙P uo]U b]lo oo ]bbU GvPD (U u] b U PbvRou]}vb yy SP]oPR}o˙bbUR}oo]R]b]bU}biv] Symptoms yy Yoo}`]bR]b}o}}v}(˙b yy D˙oo}`}l]v yy Gvo]]R]vP yy OR˙u}ub b ovP}R~b XPXPvouo]bU]]vbbU (XZ Signs yy Yoo}`]b}o}}v}(u}buuvbvbl]v yy Do]]uv}u~](Zb yy L]voPuv~I(b}]`]Ro]]bbZ yy ORb]PvbovP}R~ b XPX(Uoo}}Zb Invtiga se tions yy FBU C o}}.ou(}uo]b]bURDT yy S]lo]vPb yy GvPDb Standard yy yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw Bo}}P}v}bbuR]vP Bo}}Uo}o˙bUvv]v L](v}vb HbBb(vPv A}u]vo ob}v v b `]R uRb]b }v R R}r]o]˙ ˙bb uvvb v*PostrPatur mHaemorrhage*v Trtme ae nt Tuv}ib yy T}]v(˙vb yy T}vouvov(}o}uo]}vb Non-pharmacological treatment yy Dvb}vRvo˙]vPb~S}]b}vbZ Pharmacological treatment yy Dvb}vRvo˙]vPb~S}]b}vbZ Refeal r Criteria Sb }( iv] v R}b b}] `]R }u]vo ]v ub((}b]o]bX 121.Post-Partum Haemorrhage P}bru Ru}RP u˙ ]u˙ } }v˙ b X P]u˙ }buRu}RP(b}o]vP}(u}Rvæuo(}uR Pv]o `]R]vR.b`v˙r(}R}b}(o]˙}v˙u}v }( o}} o}bb Rbo ]v Ru}˙vu] }u}u]b }( R vX I boo˙}b]vP}]uu]o˙LRR]P b }(o}X S}v˙}bruRu}RP]b.v˘bb b]P]vo o]vP}]vP(}u`v˙r(}R}b}b]˘`lbLo]˙X TR o]vP u˙ } `]R R ov ]v } L ]b ˘ob]}v (}u R bX P}bu Ru}RP }ub o]( Rv]vP ]( R u}R ]b o˙ vu]X Bo}} o}bb }( u} Rv æuou˙o}bR}lX sueCa yy U]v}v˙~wrıA9}(bZ yy Rv}v}(oo}}(ovob`]R]vR]v]˙ yy Iv(}v`]R]vR]v]˙~v}ru˙}u]bZ yy Gv]ou yy Co}hvP]b}b Symptoms yy E˘bb]}}o}vPP]voo]vPLo]˙ yy L}`}u]vo]vb Signs yy o]vP A (}uRPv]o Chatep rP yy yy yy yy yy yy yy yy *Obtes tricCarendObtes tricDisorsder C}vivooo} Rapid pulse Bo}}u˙ b o}`}v}uo ]}}v D }(uvooob}(}vb]}bvbb Fo˙}}o˙}vb O]}bb]v]Rvovl}]vu O]}b]vov Suprapubic tenderness }D ]v}v˙~wrıA9}(bZU`]Rv}ovov}v yy MbbP(vb}(}b uo b }v}v yy Ev}P `}uv } u˙ o } b Ro R } u˙Rovu}v]}]v} yy B]uvo }ubb]}v }( R b v oo}}v u}v ]( b(]ob}}v`]RubbP Due to retained placenta yy 'u A u}o}(Rov˙}v}oo}}vb}}v b }v}v ]b (oX I( v} (o b `] R v˘ }v}v and repeat the procedure yy I( R ov vv} ˘oo ]v R]b (bR]}vU uvo u}o under anaesthesia is indicated yy I(RovRbvo]v]b]v}uoU˘o}}vR bvuvou}ovvbRb]]b]v] yy I(R(]o]b(}uvou}o}(ovvvbRb] v}]uu]o˙]oo(}R}b]o Bleeding with uterus well contracted and placenta completely delivered yy E˘u]v R v ]v R o]R}}u˙ }b]}v `]R voPb] vl} vbRb]U P}} o]PRvP } ]v(˙ v b ]voUP]vov]ob yy I(R~b˘vb Z ]v}R]v}˙U+b]vPvv} æ v*PostrPatur mHaemorrhage*v Invtiga se tions yy FBU C b]lo]vPb yy Bb]o}hvPb yy Bo}}P}]vPv}bbruR]vP yy Uob}v v b ~]( v ]b ob } Rl (} ]v ov bZ Trtme ae nt Tuv}ib yy T}]v(˙Rbv}b o]vPb]lo˙b}bb]o yy To correct hypotension yy T}}bovPvu] Non-pharmacological treatment Standard yy Trtme ae ntGuidelinesUwthEditionUw (}uv]`]oo]v}oo}}u˙ F}bU]}R˙b}u˙]b] Bleeding associated with coagulopathy yy Bb]o}hvPrb æuo}(o}}o]vuo}v}'}u PobbR}oo}]vvu]vb Pharmacological treatment AXI(Rb]b}}o˙}v~A}v˙Z st L]vTuv ]v E RvPPA yy O˘˙}]vUIMUv]bX b Then yy O˘˙}]vU IVU]v(b]}vU rv]b ]v æuo˘}b D bo]v } XıA9 }N}uobo]v v*PostrPatur mHaemorrhage*v Note 13-6 D}bv}}˘v]b I( ]vv}b }˘˙}]v ]b v]ooU } ]( R o]vP }b v} b}v } }˘˙}]vUR(}oo}`]vP}v b o]vPb}uuvX yy yy yy yy yy nd L]vTuv ]v E RvPPB M]b}}b}oU bo]vPoU v u]}Pu ~(} PPH }R˙o˘]b `]R]v u]v}(o]˙Z M]b}}b}oU bo]vPoU u]}Pu b ]( v ]b }vb]}b ~(}PPHuvZ Or L]vTuv ]v E RvPPB P}u]v E UIVUæu]}PuX b Or ]v E RvPPB O˘˙}]vrP}u]vU IMU ~O˘˙}]v v]b v P}u]v E æ u]}PuX Zb Or ]v E RvPPB O˘˙}]vru]b}}b}oU~O˘˙}]vUIVUv]bvM]b}}b}oUoU vu]}PubX Zb Note 13-7 H]PRb}(+b b ~vbU}u]vPUvR]PRo}}Z}b ]v`}uv`]RP}u]vX TR˙ bR}o v} P]v } `}uv `]R R˙vb]}v ]v Pvv˙ } R ]bbX v Chatep rP B. yy C. yy *Obtes tricCarendObtes tricDisorsder Protracted bleeding uncontrolled by Oxytocin and other U}}v]b}](o]vP]bo˙}u ]v E RvPPB Tv˘u]A]Ubo}ÌV~v}}˘uPu]vZU PX b Then PR}o˙~M˘]uuP]vR}bZ Hypovolaemia S}]uCRo}]XıA9}R]vPboUIVUvo}}vb(b]}vb clinically indicated ~Sb}v}vRSR}l[Z yy And D]uUbo}ÌVUæruPR}o˙]b ~NOTu}RvXæ uPu]vZ Note 13-8 D} v} u]˘ R]]v v ]u ]v R bu ˙]vP b X M}v]} b]}˙ }(vo}bo˙XS}Pb](b]}˙]bobbRvu]vX yy yy Or Ku]vUIMUæruP llPX b Or Ku]vUIVUXæruP llPX b Note 13-9 Ku]vubb}vo˙˙]vM]oO8lvbRb P}]v]}b}R˙o˘]bLuvou}o}(ov}˘o}}v }(b}]}(]RvobX E. Secondary Postpartum Haemorrhage yy O˘˙}]vUIV]v(b]}vUv]b]vL}(N}uoSo]v Or yy P}u]v E U}oUæu]}PuR}o˙(}˙b FXAv]}}R˙o˘]b yy Au}˘˙]oo]vU}oUæuPR}o˙(}˙bw Av yy M}v]}oU}oUuPR}o˙(}˙bw w r v*PostrPatur mHaemorrhage*v X D AvbRb](}uvou}o}(ov yy M}R]vUIVUXæræuPX b b]~](v}vbRb]b]o oZ Or yy PR]]vUIVbo}ò˙}IMUuP llPrv R}o˙]b ~u˘X uP}bZ Standard Trtme ae ntGuidelinesUwthEditionUw Refeal r Criteria R( vb `R} } v} b}v } R uvb } } b]o]bX Aob} ( }uo˙ } R}b]o `]R R v o}} vb(b]}v (]o]b (} ˘u]v}v v vbRb] vl} o}}u˙](Rbv}]uu]o˙]ooX v*PostrPatur mHaemorrhage*v F]PræP)Flowchart: Post partum haemorrhage Chatep rP *Obtes tricCarendObtes tricDisorsder 122.Post-Partum Pyrexia P}bru˙˘](b}}˙u}(£C}u}}v }u}}b]}vb]vPR.b˙b}(R]u˘o]vP R.b˙XR]blF}b]vo}o}vPo}U}o}vPu }( uuvbU]v ovo bU ]vbuvo o]]b v]Rvo]vi]bX sueCa yy yy yy yy yy yy Malaria U]v]v(}v~v}ru˙}u]bZ P]voIv(}vb~XPX]v(]b]}}u˙Z }oub bB ~vP}PuvUubbUb(}u}vZ U]v˙]v(}v Rb]}˙]v(}v v*PostrPatur mPyrxia e *v Symptoms yy F yy OR˙u}ub b ob }b Signs yy F yy ORb]Pvbob }b Invtiga se tions yy FBC yy RDT yy Bo}}.ou(}uo]b]b yy Bo}}(}ovbvb]]˙ yy U]v(}ovbvb]]˙ yy H]PRP]vo`b yy FbvP}Rv}uBo}}Go}b yy Po] v b } ˘o ]v }b }( }v}v } o] abscess Trtme ae nt Tuv}ib yy T}]v(˙vRvo˙]vPb Non-pharmacological treatment yy E˘u]v}v v vbRb] `]R }bb]o ]v 'P (} ]v}b}(}v}v yy Ev}P (v u˙]vP }( b ]( b ]b } vP}Puv yy Iv]b]}vv]vP(}vb ]vob ı Standard Trtme ae ntGuidelinesUwthEditionUw Pharmacological treatment AX}oub bB rvP}Puv ]v E RvPPB yy Pu}oU}oUPvrR}o˙]b BX}oub bB rubblbb ]v E RvPPA yy Foo}˘]oo]vU}oUæuPvR}o˙(}ær˙bw CXEv}ru˙}u]bv]vo]v(}vb ]v E RvPPB yy Au}˘]]oo]vA=Coov]A]UIVUvuPrXPR}o˙(}wR}b Av yy M}v]}oUIVUæuPR}o˙(}wR}b yy yy Then A u}˘]]oo]v A=Coov]A]U}oUvæuPrPR}o˙(}˙bw vA M}v]}oU}oUuPR}o˙(}˙bw v*PostrPatur mPyrxia e *v Refeal r Criteria R(oob}(b]b}R}b]o(}uvPuvX æ Chatep rP *Obtes tricCarendObtes tricDisorsder Flowchatr v*PostrPatur mPyrxia e *v F]PrvP) Flowchart: Management of Postpartum pyrexia æ Standard Trtme ae ntGuidelinesUwthEditionUw 123.AvoPb]]vL} TR ]v RbR}o u˙ o}` ]vP o} }v }v }( (U v˘]˙vv]v˙X]v A o](]vPo}bob]vobb v˘]˙vP}}}PbbX Iv R .b P b }( o} ]v o]( u˙ ] (} ]v(o ]v }v}vbU `Rb ]v R }v b P b }( o}U voPb] ]b ](}]vbuvoo]˙v`Rvv]b]}}u˙]bP]vX Pharmacological treatment AX yy yy yy v*AnalgesiainLaoub r*v yy D]vPR.bP b }(o}rvo ]v E RvPPC M}R]vUIVUXæræuPR}o˙]b vA M}o}u]UIVUæruPR}o˙]b (}}u]vP Or PR]]v R˙}Ro}]U IMU ær uP X b b] rR}bo~M˘]uuuP]vR}bZ vA P}uR]vUIVlIMUæuPb]~M˘]uuæuPvR}o˙Z ]b }RRvb}(}u]vPv}}vR voPb]+}(PR]]v B}˘rwP) yy G]v IMU R u˘]uu voPb] + }( PR]]v ]b }]v L æ u]vbvob(} b rR}bXI]bR(}v} b }P]]`Rvo] ˙]bv]`]R]vR}b]XX}vrwu]o}v yy I( R ˙ ]b }v `]R]v v R}b }( PR]]v u]v]b}v ] u˙ R b]}˙ b]}v ]]vP v} vP}v]bb R b No}˘}v IMU u]}PullPX b ~I(v}b}vbUP]bv}b}(u]} PuLru]vbZXC}vvb]}v`]R}˘˙Pv] (ubl }R}PRvv}Ro vbo(]vGvP~AuZPvoR b]}v]bbX yy H}Ù PR]]v bR}o v} `]RRo (}u vb `R} v vo Pb] `Rv R ]˘ ]b o˙ vrw u ]o ]v `R]R b ærwæ uP IM PR]]v`]RXæræuPXP}uR]vu˙P]v]vv}bo˙X BX yy D]vPR.bP b }(o}W]vRo}vo N]}b}˘]vO˘˙Pvu]˘UæPæ Note 13-10 T}b]vRo.bP b `Rvo]˙]b˘`]R]vR}X æ r r r r Chatep rP *Obtes tricCarendObtes tricDisorsder CX D]vPR.bP b }(o}r]o Note 13-11 TR]b}]b]b }˙vvbRbX D. yy yy During the second stage of labour L}oAvbRb(}]b]}}u˙vvoo}lvbRb]} (]o]]vbuvoo]˙X L]}]v R˙}Ro}] ~X˙o}]vlL]Pv}]vZ A9U `]R } `]R} vo]vU ]v.o ]v R ]vu (} v ]b]}}u˙X I( v} P]v (} o]˙ ] v P]v (} R ] }( R ]b] }}u˙ r yy yy Or M}o}u]UIVUæruPR}o˙]b vA D]u Ubo}ÌVUæruP~}(XæuPu]vZ Note 13-12 M}v]} b]}˙ o}bo˙X S} D]u lu]vZX D}v}u]˘R`}Pb]vRbu˙]vP b X yy yy yy yy v*AnalgesiainLaoub r*v EXAvbRb](}bR}}b]}bXPXuvou}o}( ovU]}(oPP]vov]ob yy PR]]vUIM}IVU uP llPbo}ò˙~u˘X uPZ](v}vbRb is available Av yy P}uR]vR˙}Ro}]UIMUæuPX b ~](}u]vP}bZ if respiratory rate is less than nd L]vTuv Ku]v UIMUæruP llPX b Or Ku]v UIVbo}ò˙UruP llP Or Ku]v U IV ]v(b]}vU ~F} o}vP }bZ uP uo }( l u]v]v˘}bæA9}v}uobo]v~u]vvv}bræu] }PulPu]vib}]vP}b}vbX Av D ]u Ubo}ÌVUæruPUu]v]b}ru]vb~}˘ ]uo˙XæuPu]v}Z vHoo]v}vb FXPu]}v(}Ku]v yy AtropineUIMUvu]}PuX b Av yy O˘˙Pv U˙(ublUvrLlu]v u]v]b}v æ r r r Standard Trtme ae ntGuidelinesUwthEditionUw Note 13-13 Ku]v ]b}v]v]]vvb`]RR]PRo}}~H˙vb b ]}v vR]bbX X Z Preterm Labour in Premature Delivery v*PretermLaoub rinPrematureDlivyer *v Puo} (b}o}}]vPL `lb (} w }uo `lb bovP ]v u o]˙X TR u v`}v ]b ]bl }( R b oo ]b }˙ ˙bb ub bR b ovPbU ]vU ]Pb v ]uuv ˙bb ub v} (oo˙ o}X TR ]b ]vb ]o]˙ b } ]v(}v v ]u] o}hvP uRv]bubX TR ˙ ]b ob} ]bl }( ]R ]vi]b bR b o Ru}RP b R (P]o v]o }vb } v} }] b8]v }}v (} R ]vX S}u ]bl (}b (} u o} ]vo ˙}vP P }( u}RbU}}b}]}r}v}u]obbvbu}l]vPX sueCa yy Mvo]v(}vbXPX˙o}vR]b yy Iv}uv]˘ yy Pu}(uuvb yy MooPvv]b yy }A ov yy D]buoo]b yy Proub]loub] Symptoms yy RPov]v(o]v}v}vb}}u]vo]vb yy TRu˙bR}` Signs yy Suoou]˙ yy PooPo]v}v}vb yy P}Pbb]+uvv]o}v}(R]˘ yy Ruuvb Invtiga se tions yy FBC yy FbvP}Rv}uBo}}Go}b yy Uob}vv b ~(}R}bv}]vo]b b Ro}Z(} yy Gb}voP yy F}oo] yy Pbv}v yy Auv]}G]}ou yy Povob] yy u}v Eb }(R(}o`]PR Uuo] æ Chatep rP *Obtes tricCarendObtes tricDisorsder Trtme ae nt Tuv}ib yy T}}b ]v}v}vb](o}]bv}(oo˙o]b b R yy T}oo}`(}oP}`Rvu}v]v}]((b]o yy T}}u}(}oovPu]˙~Pb}vbr`lbZ yy T}oo}ò}}}Pbb](]]bo˙òoo]b b R yy T}v˙vo˙]vPb~XPXuo]U˙o}vR]b Non-pharmacological treatment yy }] A ˘o b ]v}b yy }] A v}b b R˙b]o]˙ yy b B yy C]o oP b (} b ]Pv}b b } ]o ]v}uv Pharmacological treatment Z N}r Monitor blood pressure yy MPvb]uboR Then P]v(b]}vR} AL Iv(b]}v]bb}vb}vb BX F}oovPM}v`]RAvvo}}b}]bGb}vb `vr`lb ]v E RvPPA uRb B }v U}oUXvrwuP˙R}b~}bbZ Or yy UIVUP v ]vv}bo}]v]o}u]vb ææ æA9V r r v*PretermLaoub rinPrematureDlivyer *v AXT}}o˙b]b ]v E RvPPB yy Sou}o UIV]v(b]}vUXæuP]væuo}(˘}b D S]v(b]}vu]}Pubu]v~]XXuou]vvZ ]vbPoo˙}]vP}b}vbu]v]vobv o }v}vb ]u]bRU Rv ]vb bo}ò˙ vo }v}vb b~M˘]uuæu]}Pubu]vZV M]v]v (} }v R} L}v}v Rb}b U Rv P oo˙˙æA9˙vR}bV~M˘]uu}vR}bXZ Or ]v E RvPPA yy NifedipineU}oUuP]v]oo˙U Then uPLıu]vb I( }v}vb b]b R˙ v }vv `]R uP ˙ r R}b (} rw R}b b }o˙ v ~u˘X v uP ˙Z Standard yy ˘uRb D }v Trtme ae ntGuidelinesUwthEditionUw UvuPR}o˙(}~}bbZ Note 13-15 Tuv ]b u}b + ]( o]˙ }b ob R}b L R .b }b}(Ru]]vRbvP]vvobbRv˙bw LRob}b}( Ru]]vX C}vrX VOID A ˘uRb D }v lBRuRb}v DvPb }( }] b b ]vo ]o]˙ b } ]v(}vU G] v}v v ou}v˙}uvuvo}bu}oobX b`Rv]v(}v]bbvX v*PrematureRutup reoftheMembaner s*v Refeal r Criteria Tuv]bb}v]v R}b]o`RR(]o]bvb} R}(Ruv}v Ro]v]vv}o˙(}R]uuv}vXI]b'} vb(R(}b]vr}}R(ovX XTR(}U(Ru}R]( 125.PuR}(RMuvb TR]b]bR}(Ruuvb(}R}vb}(o}XTR `} ˙b u ~(} w }uo `lbZ v u ~L w `lbUAHR}(}}vb}(o}ZX sueCa yy yy yy C]oIv}uv Gv]o]v(}v Tu Symptoms yy GbR}olP}(}]}bG](}uRP]v Signs yy Sou˘u]v}voboG](}uR]o}b}}}o }(G]]vR}b]}P]vo(}v]˘ yy Suoo]vb](}RPb}voP yy I(}uo]˙]v(}v~R}]}uv]}v]bZ yy F yy PovP]vo]bRP yy F}oR˙]}˙] yy Maternal tachycardia yy U]vvvbb Invtiga se tions yy FBC yy S]obou˘u]v}v]vo]vP`b (}o yy Uob}v v b ~]( ]ooZ (} R Pb}vo PU (}o o] v æv Chatep rP yy *Obtes tricCarendObtes tricDisorsder bv}vU uv]} G] }ou ~v}uo } ZU v R ovob]XuEb R(}o`]PRX U]vo˙b]bvo Trtme ae nt Tuv}ib yy T}vvl}]v(}v yy T}vo}](uv˙]b˙]uu yy T}]u}(}ob]oR}PR]u}(}oovPu]˙ Non-pharmacological treatment yy b B Pharmacological treatment AX yy L]vTuv ]v E RvPPC Au}˘]]oo]v + Clavulanic AcidU}oUvæuPrPR}o˙(}˙bw yy nd BX yy yy Iv(}vPv}vWvb`]Rv]]oo]vooP˙ E˙R}u˙]v U}oUæuPvR}o˙(}˙bw vA M}v]}o U}oUuPR}o˙(}˙bw CXF}oovPu}vW(}]br`lb ]v E RvPPA yy uRb B }v U}oUXvrwuP˙R}b~}bbZ Or yy ˘uRb D }v U}oUvuPR}o˙(}~}bbZ Note 13-16 Tuv ]b u}b + ]( o]˙ }b ob R}b L R .b }b}(Ru]]vRbvP]vvobbRv˙bw LRob}b}( Ru]]vXTR˙ob}v.Ruv`}v ]vv]oRu}RPvRX ˙o}`]vPR]bl}( Refeal r Criteria I( br]b] oo ( vb } R}b]o } b]o]b (} (RuvPuv](b]Pvb}(uvo]v(}vUPvv˙]bobRv b w`lbv}uo}}bX æw v*PrematureRutup reoftheMembaner s*v yy Iv(}vPv}v st L]vTuv ]v E RvPPB Au}˘]]oo]v~Au}˘˙]oo]vZ U}oUæuPR}o˙(}˙bw vA M}v]}o U}oUuPR}o˙(}˙bw Chapter Gynaologic ce alDisorsder 126.Dysmenorrhoea D˙buv}R (b } ˙o]o o}` }u]vo ]v b}] `]Ruvb}vXTR]v]bR}PR}bo(}u]v}v}vbX Iu˙]u˙`RvR]bv}]v.ob}}v˙ b `Rv b}]`]Rvvo˙]vPbX sueCa yy yy yy yy OLvv}vo˙]vPb~]u˙Z U]v.}]b CR}v]o]]v(}vbXPXCRou˙]o]v(}vb Ev}u]}b]b Symptoms yy L}`}u]vo ]v R]bu]vP }}o]l˙ ]v v u˙ be dull and constant yy P]vu˙]}Ro}`l}oPb yy NauseaU }u]vP U RRb v ]]vbb u˙ b}uub b}]`]RR]v Signs yy N}˙]oR˙b]ob]Pvb Invtiga se tions yy FBC yy S]lo]vP yy Po]ob}vv b }o}o]ob]}vbbRb.}]b Trtme ae nt Tuv}ib yy To relieve pain yy T}vo˙]vPb Non-pharmacological treatment yy b B yy Wubo]}Ro}`}uv æ Chatep rP *Gynaologic ce alDisorsder Pharmacological treatment AXM]oCb yy st L]vTuv ]v E RvPPA Pu}o U}oUPvrR}o˙ B. yy Severe cases I}(v U}oUruPR}o˙ Or yy M(vu]A] U}oUæuPR}o˙ Refeal r Criteria R( } P˙v}o}P]b ]( ]v ]v(b `]R v}uo ]˙ b]oo˙](uv]b]v+}vvo˙]vPb]b]v.X 127.A}}v THRETEA NEDABORTION Symptoms yy Sv˙}u}]vobP]vo b o]vP yy M]oo]]b}u(} Signs yy TR]vb]]b}uo`]RRPb}voP æı v*Aorb tion*v A}}v (b } R ˘ob]}v }( R (}b v }R }b }( }v}v (} R R `l }( Pvv˙X I u˙ } b}vv}bo˙ ~RvU ]v]oU ]v}uoU }uo } u]bbZ } ]v ~RU ]u]voZX B}R b}vv}b v ]v }}v u˙ }u }uo] ˙ ]v(}v ~bb]bZ vl} }(b o]vPX AL }] uv v ]bRP (}u R}b]oU ] ]b }uuv R vb } l } R}b]o ]( R ]b o}` }u]vo ]vU (U P]vo o]vP v uo}}}b ]bRPX A (}oo}`]`bR}oob}}v]v`}`lbX sueCa yy S}vv}bA}}vb yy Iv(}vbXPXuo]UUTI U]oP]v}b]b yy F}ov}uo]b yy Iv}uv]˘ yy CR}v] ]oovbb XPX ]bU R˙}] ]b}bU b]lo oo ]b X b yy Tu yy Uvb(A}}vb yy Iv(v}(RPvv˙`]Ru]}vb~}oUv o}}RbZ}]vbuv}v X r r Standard Trtme ae ntGuidelinesUwthEditionUw yy TR]bv}]o+uv}]o}v Invtiga se tions yy FBCvb]lo]vP yy Uob}vv b ~}}v.u]o(}b]v}`]Ro}b]˘Z yy OR]vbP}vb(}}vovo˙]vPbXPXuo] Trtme ae nt Tuv}ib yy T}u]v]v]oPvv˙}u](}bb]o Non-pharmacological treatment yy R}u bB }R}b]o yy T}]v b (}u˘o b ]v}b yy T}}l](o]vP}]v]vbb Pharmacological treatment yy N}b].uv] yy Tv˙vo˙]vP]oovbbXPXuo] v*Aorb tion*v INEVITABLEABORTION Symptoms yy L}`}u]vo]v yy H˙P]voo]vP yy N}(}b}}b}(}v}vP]v b yy P]vobbo}bb}(o]}P]vu Signs yy TR]˘]b]o`]RRuuvboP]vP yy TRu˙o}bb}(o]} yy TR]vb]]b}uo`]RRPb}voP yy TR u˙ b]Pvb }( bR}l oo}U }oob ]Ro bobU ]b]vPob`]R]vP}ouU(oo]vPBPv}oouu˙bl]v Invtiga se tions yy FBCvb]lo]vP yy Bo}}P}]vPv}bbuR]vP yy Uob}vv b ~bR}`bR(}b}o]Z yy C]˘u˙]o`]RuuvboP]vPR}PR] yy Iv ]vbvb b}] `]R o}bb }( o]} R u˙ }o]P}R˙u]v]}b yy Uob}v]bvbb˙}vo˙](R]Pv}b]b]b]v} Trtme ae nt Tuv}ib yy T}b]vvl}vbR}l yy To relieve pain yy T}oo}`Rv}}~bb]b]v}v}vb](`lZ yy T}R]v}b}(}v}v(}uRb v Chatep rP *Gynaologic ce alDisorsder yy T}u]vb}(}}v](v yy T}v]v(}v`]Rv]}}R˙o˘]b yy To prevent risk of Rhesus]v}u]o]˙]v(Pvv]b Non-pharmacological treatment yy }v E }(R]bb }v˙]R}(R(}oo}`]vPRv]b LR˘ob]}v}(R(}b}(}R˘ob]}v}(R(}b ](]]bobbRvr`lbb] yy MvoVuAb]}v~MVAZ`]R}`]R}]o block anaesthesia Or yy U]v 'P v ]o o}l } Pvo vb Rb]~Gb}vb`lb}obb yy U]v }v v vbRb] b]oo˙ `Rv R ]vb]]boPRv`lbb] Pharmacological treatment r AXI(v]b]vbR}l}o]vP]bb yy IVG]bvo}}vb(b]}vbvbb˙ B. yy yy yy C. yy yy Or PR]]v UIMUwæruPX b Then æruPvrR}o˙](] vA P}uR]v U IVlIMU æ uP b ] ~u˘X æ uP v R}o˙Z b ] } R Rvb }( }u]vP v } }v R voPb]+}(PR]]v Evacuate uterus I(]vb]ANr`lb ]v E RvPPA O˘˙}]v UIVUrv]bo]}(N}uobo]v Or U]vb]AM`lb ]v E RvPPC MisoprostolU}olSLUvu]}PuX b X D T}PvIv(}v yy Au}˘]]oo]v U}oUæuPR}o˙(}ær˙bw Av yy M}v]}o U}oUuPR}o˙(}ær˙bw v v*Aorb tion*v yy To relieve severe pain ]v E RvPPC MorphineUIVUXæræuPR}o˙]b Av M}o}u] UIVUæruPR}o˙]b (}}u]vP Standard EX yy T}vRRbb ]v E RvPPA Av D RR Iuuv Go}o]v `]R]vwR}b}(}}v Trtme ae ntGuidelinesUwthEditionUw Ib}uuv]}v]vRRbbvP`}uv U IMU u]}Pu ~Uæ Uv]bZU X b v*Aorb tion*v INCOMPLETEABORTION Symptoms yy PbbP }( oP o}} o}b vl} R (}b v b}u }b P]vu yy So}`}u]vo]v Signs yy I( o]vP ]b P b Poo} vl} SR}l ~}oob ]Ro bobU(bobU(oo]vPBPv}oouu˙bl]vZ yy U]vb]]bbuooRvRb yy C]˘]b]o`]RR(}bo˙} yy WR}o ov } b R}( u˙ bv `]R]v R ]v cavity Invtiga se tions yy FBCvb]lo]vP yy Bo}}P}]vPv}bbuR]vP yy Uob}v v b ~} b ]( } ˘]bb ]v R ]Pv}b]b b]oo˙]vo˙Pvv]bZ Trtme ae nt Tuv}ib yy T}b]v yy T}R]v}b}(}v}v(}uRb yy T}v]v(}v`]Rv]}}R˙o˘]b yy T}u]vb}(}}vU](v yy To prevent risk of Rhesus]v}u]o]˙]v(Pvv]b Non-pharmacological treatment yy D]P]o 'P ]vP P]vo ˘u]v}v } u} b uR }( R]vb}bb]o yy SP]o }v }( ]v }b }( }v}v XPX uvo ub]}v~MVAZ`]R}`]R}vbRb] yy P}b}}vv}v b (}u˘o b ]v}b(}ob`lb yy P}b }}v }vboo]vP v ˙R}o}P]o b b} ~]vo]vP Fu]o˙Povv]vPZ Pharmacological treatment AX yy I(]vbR}lvl}o]vP b IVG]bvo}}vb(b]}vbvbb˙ BX A}}v `]R]vb]AM`lb ]v E RvPPA P}u]v E UIMlIVUæu]}PuX b yy v Chatep rP yy yy CX yy yy X D yy yy yy yy Or M]b}}b}oU}oUvu]}PuX b Or M]b}}b}oUbo]vPoUu]}PuX b A}}v `]R]vb]AN`lbvAG`lb ]v E RvPPA MisoprostolU}oUvu]}PubX b Or MisoprostolUbo]vPoUu]}PubX b A}}v `]R]vb]AN`lb ]v E RvPPB O˘˙}]v UIVU v]b]v} L}(S}]uCRo}] r}bv u]v Or MisoprostolU}oUvu]}PubX b Or MisoprostolUbo]vPoUu]}PubX b XıA9v]v(b T}v]v(}v Au}˘]]oo]v U}oUæuPR}o˙(}ær˙bw vA M}v]}o U}oUuPR}o˙(}ær˙bw v*Aorb tion*v EX yy *Gynaologic ce alDisorsder FX T}v]v(}vW]vvb`]Rv]oo]vooP˙ yy E˙R}u˙]v U}oUæuPR}o˙(}ær˙bw Av yy M}v]}o U}oUuPR}o˙(}ær˙bw GXT}vRRbb ]v E RvPPA ~Sb}vvRIv]oA}}v Ib}uuv]}v [}Z OMPLE C TEABORTION Symptoms yy }v Cb }}v }(P]vo o]vP (}oo}`]vP R˙ o]vP `]RbP}(o}bvl}R(}bvovX yy Rb}o}v}uv}(]v Signs yy TRb]bbuooRvRPb}voP yy TR]˘]bo}bv.u yy No pelvic tenderness Invtiga se tions yy FBC yy Bo}}P}]vPv}bbuR]vP yy Uob}vv b P}}v.uu˙]v]˙ v Standard Trtme ae ntGuidelinesUwthEditionUw Trtme ae nt Tuv}ib yy T}}v.u}}v]b}uo yy T}b(}vuvPvu]](bv yy T}b(}vuvPo]]v(}v](bv yy To prevent risk of Rhesus]v}u]o]˙]v(Pvv]b Non-pharmacological treatment yy C}vboo]vPv˙R}o}P]o b b}~]vo]vP(u]o˙Povv]vPZ Pharmacological treatment yy Tvu]](bv~Sb}v}vRAvu] yy P}] v]}b ]( v ~S b}v }v uv }( RIv}uoA}}v [Z yy P}]AvIuuv D Po}o]v](Iv]~Sb}vvRIv ]oA}}v [}Z v*Aorb tion*v SEPTICABORTION TR]b ]b o]( Rv]vP }uo]}v }( }}vX M}b }Lv R ]b R]b}˙ }( ]u]vo ]v(v `]R R Pvv˙X I u˙ o } }uo]}vb bR b bR}lU ]v uPU ]}v]bU Ru}RPU ]bbu]v ]vbo }Po}v ~DIC (]oUob]}˙]b˙v}u b Uvb}PbPvPv sueCa yy Iv(]v}b}(}v}v Symptoms yy So}`}u]vo]v yy F yy V}u]vP yy Headache yy O+vb]Uo}}˙P]vo]bRP Signs yy F ~uu˙v}uoZ yy Tachycardia yy I(]vbR}lPo}ò}}b yy P]}v]bu yy Bol˙vb yy C]˘u˙}v}o}b yy R]v}+vb]}b}(}v}v Invtiga se tions yy FBCvb]lo]vPb yy Co}hvPvb yy Bo}}P}]vPv}bbuR]vP yy Bo}}ovbvb]]˙ yy U]vovbvb]]˙ v ]vPPvv˙ [Z r ZU vo X Chatep rP yy yy yy yy *Gynaologic ce alDisorsder Ev}r]o`b (}ovbvb]]˙ Bo}}vo}o˙b CRb v }u]vo Xr˙ ~} ˘o (}]Pv }˙U Pb v R ]RPubPPbvP]v(}}vZ A}u]v}ro] ob}v}PR˙ ~(} ]vr}u]vo v o] bUbv}(}b]vbUG]bvPb]vRo]bZ N}r Covbvb]]˙bob`]oo](Rv]}R˙X IVv]}R˙bR}o}vvvoRv]b(]o(}ob R}bXOoR˙bR}o}vv(}obvb ˙bXI(Gvu] cin]b}}vvP]uPIM}IVR}o˙(}obæ˙bX C. v*Aorb tion*v Trtme ae nt Tuv}ib yy T}b]v yy T}]v(}v yy To evacuate uterus yy T}}]}br}}v}vboo]vP Non-pharmacological treatment yy R E ]v}b}(}v}v~(o}v}( Rbub}vb]bl}(]v(}}v]bR]PRZ yy Gvo ]P]o 'P (}oo}` ˙ R ]vbuvo 'P v Pvo vbRb] `]R]v v R}b }( ]v]}v }( v]} therapy yy E˘u]v } }v.u ]( b ]b (}v u]v ]( P˙ b is required yy Pb˙R}o}P]ob}v(u]o˙ovv]vP}vboo]vP Pharmacological treatment AX Rbb]}v(}bR}l ]v E RvPPA yy IVG]bvo}}vb(b]}vbvbb˙ BXTuv}(Sb]b yy Au}˘]]oo]v + Clavulanic AcidUIVUXPR}o˙(}rwR}b Av yy Gvu]]v UIVUuPR}o˙(}æ˙b Av yy M}v]}o UIVUæuPR}o˙(}rwR}b r Evacuate uterus N}r T} } (}b ]( oo b ]v } vl} ]( P]o b }v }( }b ]b v} ]uu]o˙}bb]oX væ Standard yy yy D. yy yy yy yy yy v*Aorb tion*v yy Trtme ae ntGuidelinesUwthEditionUw O˘˙}]v UIV]v(b]}v ~Sb}v}vRIv]oA}}v [Z Or MisoprostolUbo]vPo}o}P]voUvu]}PuX b ~Sb}v}vRIv}uoA}}v [}Z Severe Pain management ]v E RvPPC MorphineUIVUXæræuPR}o˙]b vA M}o}u] UIVUæruPR}o˙]b (}}u]vP Or PR]]v UIMUæruPrvR}o˙~M˘]uuuP]vR}bZ vA P}uR]v U IVlIMU æ uP r R}o˙ b ] ~u˘X æ uP v R}o˙Z } R Rvb }( }u]vP v } }v R voPb]+}(PR]]v EXTvb P}R˙o˘]b TetanolUIMUXæuoX b vA HuvIuuvTvb GlobulinUIMUæræv]bX b MISSEDABORTION TR]b(b}(}oR]vr}(}`lbPb}vX Symptoms yy TR]bbo}(R˙u}ub b }(Pvv˙ yy TRu˙vo}}˙P]vo]bRP yy bv A uvo}v }( (}o u}uvb ~]( ]lv]vP Rb o˙}Z Signs yy Ub]bbuooRvPb}voPlb yy F}oR}vbv}R]R`]RRP]vbR}b b } }`]R(}oD}o]bRbS}v]] Invtiga se tions yy FBCvb]lo]vPb yy Bo}}P}]vPv}bbuR]vP yy Bo}}.ou(}uo]b]b](vbb˙ yy Bo}}o}hvP}.o(}RoPPvv]b yy PPvv˙b yy Uob}vv b yy FbvPo}}bP v Chatep rP *Gynaologic ce alDisorsder Trtme ae nt Tuv}ib yy T}ulv.(}]v}v yy T}vb(b ]v}v yy To establish cause of foetal death if possible Non-pharmacological treatment yy }v E }( R b ˙ b}v 'P ~uvo } `]R uR]vZVAM`lbPb}v yy SP]o }v }( b ~DEZ L ]o ]v]vP `]R u]}vV}v b ]ub Pharmacological treatment AXR]v]vP}(]˘}(]o]P]o b }v ]v E RvPPA yy MisoprostolU }o } P]voU u]}Pub X b ob R}b ]}}P]o b }v BX o}`Z uv v RIv A}}v [ O ]v E RvPPB O˘˙}]v ]u˙b(}]v}v`R}R]o]v ]vPuR}b~XPXF}o˙bRoo}}vbX Z N}r O˘˙}]v bR}ov}}vvo˙ b }PR`]RM]b}}b}o b]bPRv `lbXA }vR}u]voub P]v`v b }( R `} PbX I( }R ub b R]b ub }v `]R ˘u }vb]bl(}]v]bPX INDUCED~SAFEZABORTION TR]b (b } R o]u]v}v }( Pvv˙X Tu]v}v }( Pvv˙ ]b b (} v }v (} b}vb u]bb]o ˙ o` ]RR}PRP]o b }}˙Ru}o}P]ouvbXUv Rv}]b]}vb(}GRvUv]v}}vu˙]} oPoo˙}vo˙vR(}oo}`]vP}v]}vbP]vb}(U.ouv} ]vbV R} R R˙b]o v uvo RoR }( R u}RVbv }((}ov}uo]˙vuvo}v}(Ru}RX PvbP]vRu}o}P]o}}v(}}}v`]oov} u}v]}o}bo˙(}}uovbb}(R}}v}bbXTR˙bR}o ]v(}u } } l ]uu]o˙ ]v b }( }(b } R˙ P]voo]vPU(}}+vb]P]vo]bRPX Invtiga se tions yy FBC yy Bo}}P}vRRbb factor vw r for uterine v*Aorb tion*v yy Eu˙]vPb`]RM]}v]vM]bbA}}v ~S b}v }v M]b}}b}o Standard yy Trtme ae ntGuidelinesUwthEditionUw S]o IvbP}vb (} u]}roPo ]v]}vb XPX ~DNAU HIV X b Z Trtme ae nt Tuv}ib yy T}vbRoPo]uvb(}u]v}vu yy T}vb(b }}v yy T}}](u]o˙ovv]vP}vboo]vPvb]bbv yy To prevent risk of Rhesus]v}u]o]˙]v(Pvv]b Non-pharmacological treatment yy MvoVuAb]}v~r`lPb}vZ yy D]o}vv'P~r`lPb}vZ yy C]o]v]vP(}oo}`˙D]o}vv}v E ~DEZ yy ~AN`lbPb}vZ Pharmacological treatment v*Aorb tion*v AXM]}vA}}v ]v E RvPPA yy Mifepristone Then yy Misoprostol ~SToo}`(}}bPP]ub(}R]}bPb}voPbXZ TorP) Pb}voPb Dosage regimes for Mifepristone and Misoprostol for various Gestational Pb Mifepristone and Misoprostol ~E]vRvPAZ MisoprostolOvo˙ ~E]vRvPAZ r`lb MifepristoneuPX b PLUS (}oo}`rR}bo˙ MisoprostolUu]}Pub~}oU P]voo˙(}oo}` Zb ](v˙ }bb}(u]}Pub P]voo˙}bo]vPoo˙˙r R}o˙~u˘X}bbZ Misoprostol}vo˙P u]}PuX b P]voo˙ (}oo}`˙}bb}( u]}PuP]voo˙} bo]vPoo˙](v˙ rR}o˙~u˘X}bbZ ır`lb M](]b}vuP}oo˙UPLUSv rR}boP Misoprostolu]}Pu P]voo˙X b U F}oo}`˙}bb }(u]}Pu˙r R}b](v~u˘X}bbZ Misoprostolu]}PuP]voo˙U (}oo}``]R}]}vo}bb }(M]b}}b}ou]}Pu bo]vPoo˙}P]voo˙rR} ]vob~u˘X}bbZ v Chatep rP *Gynaologic ce alDisorsder Gestational Pb Mifepristone and Misoprostol ~E]vRvPAZ MisoprostolOvo˙ ~E]vRvPAZ r`lb M](]b}vuP}oo˙UPLUS vrR}bo Misoprostolu]}Pu P]voo˙(}oo}`˙ u]}PuP]voo˙~} bo]vPoo˙](R]b b]Pv].vo]vPrZ v R}o˙]vobX Misoprostolu]}Pu P]voo˙UF}oo}`˙}b }(M]b}}b}ou]}Pu˙ rR}o˙P]voo˙~}bo]vPoo˙ ](R]bb]Pv].vo]vP(}u o]P]vou]b}}b}ou]v]b }vZvo˘ob]}vX ~u˘Xæ}bbZ r `lb r M](]b}vuP}oo˙UPLUS vrR}bo Misoprostolru]}Pu P]voo˙}}oo˙˙R}b R}b]vPvo˘ob]}v~u˘Xæ }bbXb}bD }(u]b}}b}o `]R]vb]vPPb}voPX Misoprostolr u]}PuP]voo˙}}oo˙ ˙R}b R}b]vPvo˘ob]}v ~u˘Xæ}bbX }bbD }(u]b}}b}o `]R]vb]vPPb}vo PX ]vb`]R b Pb}voPXL}`}b Refeal r Criteria F}oo˙b}(}}vU(o˙(}b]o]b](R]bb b } (}v } (}} ]( }uo]}vb XPX ]v(}v } }(bo]vPX b TorP) C}uo]}vb M]b}}b}oUbbvD}bP]vMvPuv}(PPvv˙ Iv]}v D}bP Notes Iv}}v ~r`lbZ Misoprostolu]}Pu P]voo˙}}oo˙} bo]vPoo˙rR}o˙ ~u˘X}bb Ioo˙brR}bL M](]b}vU}oUuPX Iv}}v ~ır`lbZ Misoprostolu]}Pu P]voo˙(}oo}`˙ M]b}}b}ou]}Pu P]voo˙}bo]vPoo˙ ˙R}bR}o˙~u˘X }bb Ioo˙brR}bL M](]b}vU}oUuP vı r v*Aorb tion*v N}r yy U]vbvb]]˙}M]b}}b}o b}(u]b}}b}oR(}b(}}oPb}vb yy M]}vA}}vb]v}v b ]ubbR}o}vo˙}v˙}}b R}b]vPvo˘ob]}v ~u˘Xæ}bbZ Standard Trtme ae ntGuidelinesUwthEditionUw M]bb}}v ~r`lbZ Misoprostolu]}Pu P]voo˙](v }b]v}wR}b OR Misoprostolvu]}Pu bo]vPoo˙(}oo}`˙`} ]}vo}bb](v R}o˙ G]}bbvo}`}l (}r˙b~vobbR˙ o]vP}]v(}vZ Iv}uo}}v ~r`lbZ vu]}Pu}oo˙b L}`}l(}˙b~vobb R˙o]vP}]v(}vZX Iv}}v ~r`lbZ u]}PuP]voo˙r R}o˙~u˘Xæ}bbZ Ioo˙bR}bL M](]b}vU}oUuPX Ao}`M]b}}b}o dose of AMu]}Puu˙b `]R}v]v`}uv`]R caesarean scar only under specialist supervision v*Aorb tion*v Iv]v(}o R~AM`lbZ rw`lbPM]b}}b}o u]}PuvR}o˙ r`lbPM]b}}b}o u]}PuvR}o˙ Misoprostol should be used `]R}v]v`}uv`]R caesarean scar and only under specialist supervision Iv]v(}o R~AN`lbZ r`lbPM]b}}b}o æræu]}PuR}o˙ D}v}u]v]b}`}uv `]R]}bvb b}v or other uterine scar Iv}v}(o} ~o](bAN `lbZ æu]}PuP]voo˙ R}o˙O æu]}Pu}oo˙R}o˙ O u]}Pu}ob}o}v R}o˙ D}v}b](]}b vb b}vX PPHuv vu]}Pu}oo˙} bo]vPoo˙X b Ub}v b o]vP]( }˘˙}]v]bv}]oo}]b ]v+X Cervical ]v]vP]}} ]vbuv}v u]}PuP]voo˙ hours before procedure Ub(}]vb}v}(]v]v ]UP]o b u]v}v }(Pvv˙U]o}vv 'PUR˙b}b}˙ AA b b]vPo}blv]uu]o˙UPPH AA}buRu}RP Note: Misoprostol]bb}]`]Rv]vb]vbR]]vPU]R}UvuR]PR Rv£CX w r Chatep rP *Gynaologic ce alDisorsder 128.Av}uoVP]voBo]vP w v*AbnormalVaginalBleeding*v TR]b (b } o]vP `R]R ]b (}u R v}uo uvbo 'v~]vub}(Ru}vU}v}]voZXAv}uouvbo 'vb v o]vP }uu}v ]v ˙}vP }obvb v `}uv `]R]vRPb}(æræ˙bXN}u˙ b (}v}v]vbP}v]v RbPP}b]b ]bu}bo˙}]uu]˙}P]vP}(R}]b v]b]]˙}v}obX Bo]vP u˙u]o}vb o](Rv]vPX Iv }R PP}bU Rb uoo v u˙ b}] `]RR]v.o]b}bXP}buv}boo]vP]bb]}} `Rv `}uv `R} Rb }b R]vP uvb}v (} vr } u} u}vRbP]vb}oP]vXOb]}voo˙o]vP(}uRu vRu˙}v(b`]RPv]oo]vPX Tuv]b]Rb(}vX sueCa Pre-pubertal girls yy URou}bo}ob yy C}]oo}vb}v.ouv yy Tu Y}vPA}obvb yy D˙b(v}vo]vo]vP yy C}uo]}vb}(Pvv˙ yy C}]oo}vb}v.ouv yy A]vouob]}vb}(ovP]v W}uv}(CR]oB]vPAP yy C}uo]}vb }( Pvv˙U ]vo]vP }] Pvv˙U }}v vR}]}]v}u yy C}]oo}vb yy Ub }( R}u}vo uR}b }( }v}v } ]v]v }v]~IUCD Z yy Cervical cancer yy F]}]b yy D˙b(v}voo]vP Peri-menopausal Women yy D˙b(v}vo]vo]vP yy Aoo}Rbo]b(}`}uv}(R]o]vPPob}o˙ Post-menopausal Women yy Po]vbbRb]ovUv}u]ovUP]vo} ovv}]vu}b yy W]Rò(}u}b}PvR˙ yy }R] A P]v]b yy Ev}u]b yy Coital tears yy URovo Standard Trtme ae ntGuidelinesUwthEditionUw v*AbnormalVaginalBleeding*v Symptoms yy VP]voo]vP`R]R]b(}uv}uouvbo'v yy M˙b}]o}`}u]vo]v}˙buv}R} yy S˙u}ub}(vu]~]]vbbUo]}vbU˙b (PXZ Signs yy S]Pvb}(vu]~](R˙o]vPZ yy ORb]Pvbo}b Invtiga se tions yy FBC yy S]lo]vPb yy Bo}}o}hvPvb XPXP}R}u]vu yy Po]ob}vv b ~}o}o]ob]}vbZ yy U]vo˙b]b yy D]Pv}b D]o}v v 'P C ~DD CZ (} `}uv }( R]o ]vPPv}buv}bo`}uv Trtme ae nt Tuv}ib yy T}b]v`Rvbb˙ yy T}.vRb}(o]vP yy T}v}b Ro]vP Non-pharmacological treatment yy VP]vo}]orb]vP]vR yy Iv]o}]v}uo}}vr]v}v yy SP˙~u˙}u}u˙UR˙b}u˙U}}R}}u˙XZ yy R]}vR˙(}vb Pharmacological treatment AX yy yy B. yy UINR D˙b(v}vo]vo]vPWu]oo]vP st L]vTuv ]v E RvPPB Norethisterone acetateU }oU æ uP R}o˙ (} r ˙b ~} }b o]vPZ Then æuPR}o˙~˙bı}v}(˙o}vo]vPZ nd L]vTuv ]v E RvPPB M(vu]A] U}oUæuPR}o˙}v˙b}æ}(˙o ~Eb]oo˙](b}]`]R˙buv}R}Z Life threatening bleeding st L]vTuv ]v E RvPPA IVG]bvo}}vb(b]}v]b w Chatep rP yy Av ]v E RvPPA Tv˘u]A] L]vTuv ]v E RvPPB M(vu] A] ˙oZ *Gynaologic ce alDisorsder U}o}IVUPvrR}o˙(}r˙bw nd yy C. yy yy yy For recurrent or protracted abnormal bleeding st L]vTuv ]v E RvPA L}`}b}o}v]oo]o˙(}rv˙ob}o}vP R]v˙ob E ]}oA=o}v}Pbo Or Ethinylestradiol + norethisterone nd L]vTuv ]v E RvPPC C}viP}b}Pv U}oUXærXæuP]o˙(}r˙b Av ]v E RvPPA NorethisteroneU}oUæruPR}o˙(}˙b~˙bæræZ Or ]v E RvPPB yy M}˘˙}Pb}v U }oU ær uP ]o˙ (} ær ˙b ~˙bı}v}(˙oZ Refeal r Criteria R( oo `}uv `]R R˙ uvbo o]vP vl} v}uo P]vo o]vP v} b}v]vP } R˙ } P˙v}o}P]b (} }uRvb]buvvuvPuvX 129.Av}uoVP]voD]bRP WR]o P]vo ]bRP ]b v}o o]v]o ( }( S˘oo˙ Tvbu]'Iv(}v~STI Z Uv}oo(}ub}(P]vo]bRPv}uo } ]v]}( v STIX VP]vo ]bRP u˙ b}] `]R v}uo R˙b]}o}P]oRvPbbRR b uvbo˙o}Pvv˙XIvb ]bRPu˙ ob} } `]R Rbv } b }( (}]Pvvbb bRbRIvU]vC}v]D ~IUCD (o C R]b}˙ l]vP bR}o o `RR P]vo ]bRP ]b v}uo v ]( ] ]b b}] `]R b }( Ru]o vbb XPX }]o bo(ru]}vU }R]vP `]R b] vbb } ]v } STI X CRvPb ]v R R]bb }( `}uv[b P]vo ]bRP ]R ]v }o}U }}U u}v v bv }( ]}vo w ZX v*AbnormalVaginalDischager *v yy U bo}` IV ]vi}vU æ uP R}o˙ ~˙b } æ }( Standard Trtme ae ntGuidelinesUwthEditionUw v*AbnormalVaginalDischager *v ˙u}ub b v b]Pvb bR b b}vbb v ]R]vbb ]v] v (} u]o'v}vX Av}uoP]vo ]bRP } STIb u˙bo ]v b]}b o] ]vGuu}v `]R bo bR b }] Pvv˙ v ]v(o]˙X (o C ]blbuv]bR(}]~bv}o}`Z}(`}uv bvvP`]RP]vo]bRP]v}}]v(˙R}bb]ob v }] }] uv P]uvb b }v R u}b o]lo˙ }o}P˙ }( R P]vo ]bRPX F}b R ub ob} }vb] `Rv bovP uv (} vb ]vo Pvv˙ b v v]b}u(}X A]}voo˙U R ˙v}u] b }R ub b } b R vU]v(˙]bl(}bvRo]lo˙b}(]v(}vX sueCa yy STIro yy Neisseria gonorrhoea yy Chlamydia trachomatis yy Trichomonas vaginalis~Pv}˙oo}Ùbuoo˙Uo˙}(}R˙ ]bRPb}]`]R]R]vPZ yy Hbb]uo˘]b ~(}oo}`]vP˘vb].b]b}}(]v( }vZ yy N}vSTI ro yy Candidiasis ~`R]U ou˙ } R]l ]bRP b}] `]R ]R]vPZ yy ]o B P]v}b]b ~P˙ } `R]U .bR˙ buoo]vP ]bRPU b ]oo˙L˘o b ]v}bZ yy Gardnerella vaginalis yy F}]Pv}]b yy Ho}vb Symptoms yy Av}uo P]vo ]bRP r RvP ]v }o}U }}U }vb]bv˙ }u}v yy Voo]R]vP yy Vooòo]vP b yy P]v}v]v}v yy L}`}u]vo}l]v Signs yy Av}uoP]vo]bRP yy Vooòo]vP b yy Voo˙Ru yy L}`}u]vovvbb yy C]o˘]}vvvbb yy C]ou}b}}b]}vb~}vbou˘u]v}vZ Invtiga se tions yy H]PRP]vo`b (}u]}b}˙Uovbvb]]˙~](]ooZ w r r Chatep rP *Gynaologic ce alDisorsder Trtme ae nt Tuv}ib yy T}]v(˙vv}vrSTI P]v]b yy T}bSTI ]blvSTIro]v(}vb}]o˙ yy T}v}uo]}vbvbo yy T}}Rvbb]uov}bo˙buRb}bb]o Non-pharmacological treatment yy P}u}P}}]rvovPv]oR˙P]v yy Ev}Pb}(o}}b}'}vv` yy D˙v`}]vRbv yy Kv`˙ yy }] A }R]vP`]RRo}Ru]o}vb yy }] A b}(u]b}b Pharmacological treatment B}˘rP) R]blbuv AX yy yy yy BX yy v*AbnormalVaginalDischager *v Pubb]vR]blbuv(}]]bP ]XPv[bv]b˙u}u b ~]XXvRbRo]bRPZ ]]XPv]bobbRv˙b}o ]]]XPv]bb]vPo ]XPvRbu}Rv}v˘o b v XPvRbRv`˘o b v]vRobu}vRb TR]blbuv]bb]} }b]vuv(}]]b]b}u uv]( TRvb`}~]Z]b˙b} TRvb`}v˙}(]ub~]]Zr~Z]b˙bX I(`}uvRbP]vo]bRP`]Rv}}b]]bl(}U(}P]v]b o}vX I( bR Rb P]vo ]bRPU v }b]]bl (}U (} }RP]v]b v]]bX r Tuv(}VP]v]b due to trichomoniasis and bacterial vaginosis ]v E RvPPB M}v]}o U }oU uP R}o˙ (} æ ˙b ~}v]v] ]vPR]ub b }(Pvv˙Z Or M}v]}o U}oUPX b ~}v]v]]vPR]ub b }(Pvv˙Z Or Sv]}o U }oU PX b ~}v]v]]vP R b ]ub }(Pvv˙Z Tuv(}VP]v]b due to trichomoniasis and bacterial vaginosis for pregnant women in the 1st trimester Co]vu˙]v uU A9U P]voU Ov o]} (oo u (} ˙bw wæ r Standard CX yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw Tuv(}VP]v]b due to Candidiasis Fo}v}o U}oU Uv}uo]PæuPX b b]vPo}b C}uo]PæuPwR}o˙(}}bb RvP æ uP ]o˙ (} } ˙b (}oo}`˙ æ uP }v `lo˙(}vu}vRb Or Co}]u}o U P]vo obU uP ]vb ]v} P]v v]PR (}˙b Or M]}v}o P]vo obU uP ]vb ]v}P]v v]PR (} ˙b Av C o}]u}o uU P]voU A9 } A9U Ao˙ `] ]o˙ (} } w ˙b~(}oo]]}vZ v*AbnormalVaginalDischager *v X D Tuv(}C]]b due to gonorrhoea st L]vTuv ]v E RvPPB yy .˘]u C U}oUuPX b Av yy A]R}u˙]v U}oUPX b L]vTuv ]v E RvPPB L]˘}v C UIMUæuPX b Av A]R}u˙]v U}oUPX b nd yy yy EXTuv(}C]]b due to Chlamydia st L]vTuv ]v E RvPPA yy D}˘˙˙o]v U}oUuPR}o˙(}˙bw ~}]]vPvvv vb]vPu}RbZ Or yy E˙R}u˙]v U}oUæuPvR}o˙(}˙bw Or yy A]R}u˙]v U}oUPX b ~}uuv]vPvv˙Z Refeal r Criteria R( oo b }( v P]vo ]bRP vl} uv (]ob } RoR (]o]˙ `R bou ˘u]v}v v ] } v u]}]}o}P]o ov vu]}]o bvb]]˙bv }v}vRP]vo]bRPX wv Chatep rP *Gynaologic ce alDisorsder Flowchatr v*AbnormalVaginalDischager *v F]PrP) Fo}`RPAv}uoVP]voD]bRP~W]R}SouZ w Standard Trtme ae ntGuidelinesUwthEditionUw Flowchatr v*AbnormalVaginalDischager *v F]PrP) Fo}`RPVP]voD]bRP`]RSouAvB]uvo E˘u]v}v w Chatep rP *Gynaologic ce alDisorsder 130.AL}À}u]voP]v wı Z (}b v*AcuteLowerAbdominalPain*v A o}` }u]vo ]v ]v `}uv u˙ Rob bX TRb ]vo Po] IvGuu}˙ D]bb ~PID Z U }] Pvv˙ v b }}vX TR o' `} P]o b uPv]bU `R]R ] ˘u Pv˙ ]v R] uvPuv ~S b}vb }v RE}]PPvv˙[vRA}}vb[ZX PID ]b b ˙ }Pv]bub `R]R u˙ S˘oo˙ Tvbu]' Iv(}v ~STI Z ro } }R ] R bv (}u R o}` Pv]ov}]vGuu}v}(RbU(oo}]vbv }R]v b Ro]bXH}ÙL˘o]vP}]Pvv˙U STIro}Pv]bubRu}bo]lo˙}( b o}`}u]vo]v]v ˘oo˙ b `}uv`R}Rbv}vo˙o]˙U}Rbv} }b vR]b}˙}(]v]vbuv}vX TR bv }( ]v]v }v ]b ~IUCD Ro}uv}(PID oo˙]vRu}vR(}oo}`]vP]vb}vX sueCa yy }] E Pvv˙ yy Av]]b yy O]v}b]}v yy STIro yy N}vSTI ro~XP]v˙]v(}vZ yy S}}v yy P}bub]b yy F}]Pv}˙]vo]vPIUCD Symptoms yy F yy L}`}u]vo]v yy P]v`]R˘o b ]v}b~˙bv]Z yy O+vb]P]vo]bRP yy D˙b]}Ro]b}u(} Signs yy Av}uoP]vo]bRP yy Tvvbb }v u}]vP R ]˘ ~]o ˘]}vZ }v ]uvo P]vo˘u]v}v yy L}`}u]vovvbb yy Av˘ovvbb yy Av˘oubb Invtiga se tions yy Po]ob}v yy PPvv˙~]( b ˘oo˙ b vuv}R}bvZ yy H]PRP]vo`b ovbvb]]˙ Standard Trtme ae ntGuidelinesUwthEditionUw Trtme ae nt Tuv}ib yy T}]v(˙vuvP}voo](Rv]vPbXPX}] yy T}v˙vo˙]vP]o]v(}v yy T}o]]vv]vGuu}v Non-pharmacological treatment yy SP˙`R]v] yy Ru}IUDU](bvU˙bL]v]}v}(PR˙ Pharmacological treatment v*AcuteLowerAbdominalPain*v AXF}Po]]vGuu}˙D]bb st L]vTuv ]v E RvPPB yy C]}G}˘]v U}oUæuPR}o˙(}˙b Av yy D}˘˙˙o]v U}oUuPR}o˙(}˙b Av yy M}v]}o U}oUuPR}o˙(}˙b (mild cases) B}˘rP) C}vb]R}b]o]}v}(o]vR(}oo}`]vPbP yy WRP]o b uPv]bXPX}]Uv]]bvv}˘oX yy TR v ]b Pvv ~PID ]b v}uu}v ]v Pvv˙U b]oo˙ L R.b]ubZX yy TRv}bv}b}vo]v]oo˙}}ovu]}]oR˙X yy TRv]bvo}(}oo}`}}ov}v}oP]uvX yy TRvRb]oovb b bUb}]`]Rvbv}u]vP X( yy TRvRb}r}]vbX yy HIV ]v(}v yy Y}Rl}obvb~oo˙](}uo]v]bv]bbZ U}R]PR BXF}Po]]vGuu}˙D]bb (severe cases) yy L]˘}v C UIMUæuP]o˙(}˙b Av yy D}˘˙˙o]v U}oUuPR}o˙(}˙b Av yy M}v]}o UIVUæuPR}o˙(}˙b yy yy Then D }˘˙˙o]v vA M}v]}o U}oUuPR}o˙(}˙b U}oUuPR}o˙(}˙b N}ræ TRb}(]}G}˘]vv}˘˙˙o]v]b}v]v]]vPvvvo vP`}uvX r Chatep rP *Gynaologic ce alDisorsder C. yy Pain relief D]o}(v UoU }oU IMU ær uP } R}o˙ ~u˘X uP `]]o˙Z Or yy M(vu]A] U}oUæuPR}o˙ Refeal r Criteria R(}P˙v}o}P]b}PvoP}v b ](R]bv}]u}uv }](o]b]bX b Flowchatr v*AcuteLowerAbdominalPain*v F]PræP)Fo}`RPL}` A A}u]voP]v Standard Trtme ae ntGuidelinesUwthEditionUw 131.FuoIv(o]˙ P]u˙]v(o]˙ ]bb]}}`Rv}oRbvR] Pvv˙ b] ob }v ˙ }( v]v v v} ˘o b ]v}bX S}v˙ ]v(o]˙ ]uo]b R R Rb v ]}b Pvv˙X I ]b }Lv vbb˙ } o }R vb b]uov}bo˙ v } o]] ˘o b U uvbo v }b] R]b}˙U b R]b}˙ }( Po] IvGuu}˙ D]bb ~PID Tvbu]'Iv(}vb~STIbZU}v}vvb }Rb]Pv].vb u]oR]b}˙X sueCa v*FemaleInfetility* r v Female factors yy Oo}v(]o yy P}o˙˙b}]v˙v}u b ~PCOSZ yy H˙}ovu] yy Po](}b yy C}vPv]ouo(}u}vb}(X b yy Tubal disease yy Po]Rb]}vb yy U]v.}]b yy Ev}u]}b]b yy Cervical factors Male factors yy Oo]P}bu] yy }}b A u] yy Pv]ovob v}uo]b yy oE ˙b(v}v Symptoms yy Iv]o]˙ } R] Pvv˙ b] Po v} ˘b obrub`lo˙ yy Auv}R} ~(uobZ yy Iu}v ~uobZ Signs Female yy bv A }(}v˙ b ˘o b R]bb yy V]]o]b}v RvPb ~R]bbuU o]}}uPo˙U v]vP }( }] XZ yy Galactorrhoea yy A}u]voub}b ]v}}]vvoPuv yy Av}uoP]vo]bRP]v]}(]v(}v Male yy Av}uov]o]bRP]v]}(]v(}v yy bv A }(}v˙ b ˘o b R]bb yy Tbov}uo]bXPX]}}obUbuoo}bvb Z v S˘oo˙ Chatep rP *Gynaologic ce alDisorsder A. yy B. F]o}(}o}v st L]vTuv ]v E RvPPA Co}u](v ] U }oU æ uP ]o˙ (} æ˙bUvP b `v R vvæR˙}(Ruvbo˙oX H˙}ovu] st L]vTuv ]v E RvPPA yy }u}]v B U}oUXæuPv}(}˙bw ~`]RRv]vPuo }uZXIvb`lo˙}u˘X}(XæuPR}o˙ Refeal r Criteria o˙ E (o}(oovb`]R]v(o]˙}b]o]b]b(U oo˙ `}uv `]R ]vU }]v } o ]bb ]]vP P˙ b } `R} ] }o}v ]v}v v} b}vb] } o}u](v ]XAob}(uovb(}]`˙}o}P]bX v*FemaleInfetility* r v Invtiga se tions yy FBU C S]lo]vP yy H]PRP]vo`b yy Bo}}Po}b yy H˙b}rSo]vP}Pu~b}vvG}}b}]P]vZX yy Suvvo˙b]b yy Su}Pb}voo]vu]rooRb~˙r}(uvbo ˙o}Z Rl(}}o}v yy TR˙}](v}vb yy FR R}u}vo ]bb XPX Su LHU FSHU Su Tb}b}vU P}ov}}v˙b]o]b Trtme ae nt Tuv}ib yy T}Rvo˙]vPb}(R]v(o]˙](}bb]o yy T}R]Pvv˙`]R]vRbR}b}bb]ou Non-pharmacological treatment yy C}vboo]vP yy U]vUTovTboP˙ b `Rv yy Ab]b R}}v TRv}o}P]b XPX A.]o ]vbu]v}vU Ivr ]}r(o]}v`]Ru˙}vb(`R]v] Pharmacological treatment Standard Trtme ae ntGuidelinesUwthEditionUw 132.Menopause v*Menopuse*a v Menopause (b } R }]v ]v u `Rv uvv }v b }( uvb}v }b } o}bb }( }]v (v}vX TR }v b }( uvbb ]b ˙ ]ruv}bo Rb ]vP `R]R R u˙ uvbo ]Po]˙X TR P }vb ]b boo˙ `v æ v ææ ˙bX A `}uv ]b }vb]} uv}bo ]( R Rb v} v uvb}v (} ]} }( ob u}vRb ]v R bv }( Pvv˙X Mv}b u˙ b}] `]R R˙b]oU u}}voU v ˙R}o}P]o b Ro }( ˙]vP ]vvb]˙ ]v b}u `}uvX S]˘˙ v }( uv}bo `}uv R}` R u]o ˙u}ub b } ˙u}u b X TR ]bl }( }b}}}b]b v ]}bo ]bb ]vbLRuv}bX sueCa yy Avoo](v}RP]vP}(R]v]]o yy SP]ou}o}(R}]b~]oo}}R}}u˙Z yy Po]]]}v yy Pu}]v(]o yy P]]˙uP(}u]u˙}bruRu}RP~SRRv[b ˙v}u b Z yy C˙}}˘]~vvZR˙ Symptoms yy H}GbRb~R}v]vP]vR(UvlvRb`]Rbov `vP b Z yy TRGbRbu˙b}]`]R yy Po]}vb yy F]vvbb yy D]]vbb yy FP yy Wlvbb yy Eu}}vov˙R}o}P]o b }oub]voP yy M}}RvPb yy b]}v D yy Av˘]˙ yy Nervousness yy I]]o]˙ yy L}bb}(o]]} yy VP]vo˙vbbv˙bv] yy S˙u}ub}}R]RvPb]vRPv]oP yy Ivb(v˙}(u]]}vv˙b]X yy Sbb ]v}vvv ~]v˙ ]v}vvv `]R }PR]vP } ]v]vP b Z Signs yy Uboo˙v}v Chatep rP *Gynaologic ce alDisorsder Invtiga se tions yy SuLHUFSHUOb]}o yy R}v]vbP}vbXPXFBU C o}}Po}bUo]]}.o yy U]v}o}}Pvv˙b~}˘oPvv˙Z Trtme ae nt Tuv}ib yy T} }v}o }Rb}u ˙u}ub b XPX b R} GbRbU }R] P]v]bvv˙bb yy T}v]}bou}]]˙ yy T} v }b}}}b]b b]oo˙ ]v ]v]]ob `]R u uv}b Non-pharmacological treatment yy C}vboo]vPvvb yy Ev}Po](b˙obURoR˙]U˘]bvPoR˙b]o Rlb(}}uu}vu]o}oub Pharmacological treatment ) for women with intact BXH}u}vRouvTR˙~HRT hysterectomy ]v E RvPPA yy C}viP}b}Pvb ) for women with previous C. yy v*Menopuse*a v AXH}u}vRouvTR˙~HRT uterus st L]vTuv ]v E RvPPA yy C}u]v}viP}b}Pvbv}Pb}PvU ~ ob R }v]v]vP }viP}b}Pvbrvæ u]}Pub ]vo]vPob}v]v]vPv}Pboræu]}PubZ Ovo]o˙ Or yy C}viP}b}Pv vv}PbooU}oU ~væu]}Puvæu]}PuZ o]o˙}v˙bwr}(Rr˙uv˙oV }oU U}oUvæu]}Pu]o˙ For relief of vaginal symptoms only ]v E RvPPA Ob}Pvu UP]voUo˙}]oo˙}v]o˙ N}rv W}uv`]R]vbR}ovP]v}b}Pvbo}vX vC ]v bPPbb R R}u}v ouv R˙ ]v R uv} b}bv}v}}v˙R]bb}}lb b X HRT ]vbb R ]bl }( v}b R}u}ru}o] Rv}uvU b v v v}u]ovL}o}vPb v bR}o R(} P]v (} RbR}b}bb]ou`Rv]v] r æ Standard Trtme ae ntGuidelinesUwthEditionUw Refeal r Criteria R( b `]R }b}}}b]b } b vu]hvP ˙u}ub b } Rb]o]bX 133.Carcinoma of the Cervix v*Ccinoma ar ofthevix Cer *v ]v}u C }( R ]˘ ]b R }uu}vb 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v*AnaemiainChronicKidneyDisse*a v AX yy BXCKD yy yy yy yy CKD Stages 1-2 L]vTuv ]v E RvPPA F}bboR U}oUæuPR}o˙(}`lb st SPbr I}vouvPTPHbR}orP lL F}bboR U}oUæuPR}o˙ Or F}bPo}v U}oUuPrR}o˙XoE Lr`lb v Or I}v}bb UIVU}vbob]o]b Or F]b}]uPo}v}uo˘ U}vbob]o]b Av E }]v USCU}vbob]o]b Or yy MR}˘˙ }o˙R˙ov Po˙}o }]v SCU}vbob]o]b Or yy D}]vo( USCU}vbob]o]b Refeal r Criteria R( oo ~ob v R]ovZ vb `]R CKD b]o]b}vR}o}P]bX yy ~P˙o(}u }( E}ZU v vu] } Chatep rP *Disorsof der theKidneyandGenitourinayr System 139.U]v˙TIv(}v N}r UTI˙u}ub b vv}vrb].]v˙}vPR]ovX Signs yy F yy L}]vvvbb yy Suprapubic tenderness yy F}obuoo]vP]v Invtiga se tions yy FBC yy M]rbub]uv}(]v(}u]}b}˙Uovbvb]]˙ ~ro]vLuvZ yy A}u]voob}vv b ]vR]ov](]v] (bladder v*Urinayr Trcta Infection*v U]v˙]v(}v ~UTI ]bZ Rbv}(u]}r}Pv]bub]vR ]v } b }( R v}uoo˙]o b Pv]}]v˙X Iv(}v u˙ o}o]}Roo}v}Rl]v˙b}U]vuvR}bX A v}uo] UTI }b ]v `}uv `]R v}uo Pv]}]v˙ v boo˙ uv](bb b ˙bb ]v(}v } o}` ]v(}vZX C}uo] UTI }b ]v ]v]]ob `]R ob } (v}vo v}uo]b }( R Pv]}]v˙ U 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llPR}o˙~u˘XæuPZ(}ær˙bw BXTuv}(C}uo]UTI ~]vo]vPRroU}vb b U }bvoPuvU}o}P]v}uo]bvPvv˙Z st L]vTuv ]v E RvPPC yy C]}G}˘]v UIVU Adults uPrR}o˙(}˙bw ~}u]v]b}vu]vbZ Or yy Gvu]]v UIVU~](l]v˙(v}v]bv}uoZ Adults ruPR}o˙(}˙bw Children r˙bV uP llPR}o˙(}˙bw u}vRr˙bV XæuP llPR}o˙(}˙bw Or yy L]˘}v C UIVU Adults rP]o˙(}˙bw Chatep rP yy *Disorsof der theKidneyandGenitourinayr System Children AooPbæuP llPR}o˙~u˘XwæuP llP]o˙Z Or Au}˘]]oo]vA=Coov]A] UIVU Children u}vRr˙bV ruP llPR}o˙~u˘XæuP(} Z ærw days Neonates~}b}o]v]v(}v b Z wr˙bV uP llPR}o˙(}ær˙bw AM˙bw V uP llPR}o˙(}ær˙bw Av Gvu]]v UIVU~bo}`]vv}b]vi}v}obu]vbZ Children r˙bV uP llPR}o˙ u}vRr˙bV XæuP llPR}o˙ Or yy (}˘]u C UIVU Children u}vRr˙bV uP llP R}o˙ u˘X wæ uPU ~]vb }ræuP llPu˘XXæPvrR}o˙]v]v(}vb b Z Neonates~}oR}b]v]v(}vb b UIV}}vo˙Z r˙bV æuP llPvR}o˙ wr˙bV æuP llPR}o˙ AM˙bw V æuP llPR}o˙ Refeal r Criteria R( vb `R} ˙ ]ooU `]R v UTI Ru]v}vPv]ov}uo]b}R}]b]o]bX yy M]]vbvRK]v˙ M]]vb v o } vo uP ]v vu }( ]+v `˙b v ˘uob P]v o}`X Iv R `}vP ]ubvb o](rb]vP 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areas of tubular atrophy v]vbo.}b]b PrvoAKI To}]vbo vR]b TR}u} u]}vP]}R˙ Muv}}o]( Po}uo}vR]b D}bU}v D Tubular cell l˙}uPo˙U Pv}vv necrosis W]vbovR]bU AKI UFv}v]˙v}u b æ v*MedicinesandtheKidney*v Cyclosporinl T}o]ub r Standard Trtme ae ntGuidelinesUwthEditionUw M]}v R]blF} PR}R˙b]}o}P˙ Pv}v L]R]u Renal ]u]uv D R˙}v H˙}vu] D]b especially R]] Iu]uv}(}oovP }vvvP ability W]b]vb]]b CR}v]o}]vb ovR}R˙ TRvP ~XvrXuu}olLZ PvR˙}v }] A o}`rb}]u diet }] A R]] r AKI WK]v˙ A Ivi˙ CEWA AvP]}vb]v}vvPv˙u HETEWH˙}˘˙]b}bv}]] PGWP}bPov]v X C˙bA b v*AcuteCystitis*v A ˙bb ]b v ]vGuu}v }( R oX W}uv + ub u} Rv uv } R bR}vbb }( R] R }u} R }( uvX A9ræA9 }( oo `}uv `]oo o} ˙bb R]o](uX TRbv]vP(or]vorRo}]bR]u˙u}}( ]v(}vX Ob]}voo˙ ˘oo˙ b vbu]' }Pv]bub ]v}oX R]bl (}b]voRoR]}vv]bX sueCa yy E. coli~}A9Z yy Staphylococcus saprophyticus yy Kob]oo yy Proteus mirabilis yy Gonococcus yy Enterococci Symptoms yy L}`P( yy Fv˙ yy Nocturia yy UPv˙ yy D˙b] yy Hu] yy Co}˙v(}obuoo]vP]v yy L}`lv]b ]v Signs yy L}`P( yy Suprapubic tenderness yy Hu] Invtiga se tions yy U]vo˙b]b v in Chatep rP *Disorsof der theKidneyandGenitourinayr System yy yy yy yy M]rbu]v(}ovbvb]]˙ FBC FBS IuP]vP }( ]v˙ ]v v } b]bv b } ˘o v}u]ov}uo]bUo}`]v˙}b}vX yy UR}˙b}b}˙]vbob Tuv}ib yy T}]]v(}v yy T}vvv}uo]}vb yy To relieve pain Non-pharmacological treatment yy L]o}oG]b}v}PP}}]v˙} yy Pr}]ov}br}]ou˙]vP}(Ro yy Pb}voR˙P]vv}ov]vPL(}vb]oo˙]v (uob Pharmacological treatment yy yy nd L]vTuv ]v E RvPPA C]}G}˘]v U}oU Adults æuPR}o˙(}ær˙bw Children r˙bV u}vRr˙bV bZ Neonates wXæuP llPR}o˙ Or (}˘]u C U}oU Adults æuPR}o˙(}ær˙bw Children r˙bV R}o˙]vo}`]v˙]v(}vbZ r˙bV ~bv}((vGvl]vZ v*AcuteCystitis*v AXv}uo] A ˙bb st L]vTuv ]v E RvPPA yy NitrofurantoinU}oU Adults uPvR}o˙(}ær˙bw Children r˙bV u}vRbr˙bV æuPvR}o˙(}˙bw wæu]}PubllPvR}o˙(}˙bw ærwæuPR}o˙ wXæ uP llP R}o˙ ~}b }o ]v b r æuP R}o˙~}b}æuP æ uP llP R}o˙ ~u˘X æ uP R} w r Standard o˙Z u}vRbr˙bV o˙Z yy Trtme ae ntGuidelinesUwthEditionUw uP llP R}o˙ ~u˘X æ uP R} Av ]v E RvPPC M]bP}bb]u] U}oU uoR}o˙](]v]b]]~H}(}v o}`ZXT}o ]vv˙b]X N}r M}v]} }bb]u oob v }] ]v R˙lou]X D} v} P] `]R ]} G}˘]vX yy Or Pu}o r U}oUæuPrPvrR}o˙`Rv] v*BenignProstaticHyperplasia*v BXF}˙u}u b ˙bb vUTI yy (}˘]u C U}oU Adults æuPR}o˙(}ær˙bw Av ]v E RvPPC yy M]bP}bb]u] U}oU uoR}o˙](]v]b]]~H}(}v o}`ZXT}o ]vv˙b]X in pregnancy N}r M}v]} }bb]u oob v }] ]v R˙lou]X D} v} P] `]R ]} G}˘]vX Refeal r Criteria R( oo bU `R]R ] ˙b}b}˙ v oo b }( b]bv Ru]Uv˙bb }]ob]bv}Rb]o]bX X r Bv]PvP}bH˙ob] Bv]Pv P}b H˙ob] ~BPH Z (b } v}vrv}b voPuv }( R }b Pov `R]R bob ]v }b}v }( ]v G}` (}u R oX BPH ]b R }uu}vb b }( uo ]v˙ ˙u}ub b ]v GRvX TR P P `R]R o}` ]v˙ ˙u}ub b ~LUTS Z o}BPH}b]b}æ˙bXMvu˙bl uv(}LUTS]RR b ˙u}ub b }Rb}u}R˙ (o R ] u˙ o } ]v˙v}v } } }( (R ] u˙ v]v]}v}(}bvX I ]b ]u}v } o]b b R `R R v `vb (}u R }vbo}vX Iv b}u vbU }v b R R o]lo]R}} }( ]v˙v}vv}bv]bo}ÙR˙u˙v}`]bRuv r Chatep rP *Disorsof der theKidneyandGenitourinayr System ı Z v*BenignProstaticHyperplasia*v (}R˙u}ub b X vo˙ C ]oo u]]vb v ]R o˘ }b bu}}R ubob } b }v ]v R }b b] v R(} b R ˙u}ub b }( BPH X A }u]v}v }( ]oo u]}vbU b]oo˙ ]v vb `]R }bb]u}Rv uoU} 'b}vbb Rvu}v}R˙X BPH u˙ o } }uo]}vb bR b v ]v˙ ]v(}vU ]v v}v `]R ]v(o ]bvb]}v }( R oU R}v] ]v v}v `]R ]vobb P}bb ]bvb]}v }( R oU Ru]Uvvo(]oX sueCa yy Ivb ]v vu }( }b oob } uo}v b ˙ testosterone Symptoms yy L}Ù]v˙TS˙u}ub ~]}bo˙(}}bb bu yy Hb]v˙ro˙]v]v]vP]v}v yy P}}}`l]v˙ub yy S]v]vP yy Tu]vo]o]vP yy Svb}v}(]v}uoou˙]vP yy U]v˙]v}vvv~}G}`Z}`hvP yy FvbP}(]vb]oo˙v]PR~N}]Z yy UPv˙vP]v}vvv Signs yy EvoP}bPov}vo˘u]v}v yy Tvooo~]v˙v}vZ yy N}vrvooo~R}v]v}vZ yy Uu]b]Pvb~XPX}`b]vbbU}v(b]}vXZ yy Pool]v˙b]vR˙}vR}b]b Invtiga se tions yy Suv]v yy P}bb].vPv~PSA Z r}˘o}bv yy U]v(}ovbvb]]˙ yy A}u]vo v o] ob}v W } ˘o R˙}vR}b]b ]( buv]v]bo Trtme ae nt Tuv}ib yy T}˘o}bvvvbb }]vPo˙ yy T}o]˙u}ub b vvo}uv}(}uo]}vb yy T}]v(˙vv˙b}]}uo]}vb Non-pharmacological treatment yy P}Puu }( u}v]}]vP v `R(o `]vP R}PR Po Rlrb(}u]o˙u}ub b Standard yy Trtme ae ntGuidelinesUwthEditionUw URo R]}v (} v}v }( ]v } ]b ˙b}b}u˙](RoR]}v(]ob yy S] vo v v b]}vl]vP }( ]v } oo˙}ubbRovo]]vU`Rv]b ˙b}b}u˙]bo˙X Pharmacological treatment AX yy yy yy Pvb`]R}Rb}u˙u}ub b v}bb]obbRv uo~buoo}bZ st L]vTuv ]v E RvPPA T}b]v U }oU r uP v]PRU ~b `]R uP v]PRV }o }b`lo˙]vobZu˘XuPX Or Tubo}b]v U}oUu]}Pu}v]o˙ Or Ao(}b]v U}oUuP]o˙ v*Bctea rialProstatitis*v BXPvb`]R}Rb}u˙u}ub b v}bb]u}Rv uo~]P}bZ ]v E RvPPA yy F]vb] UæuP]o˙ Av T}b]v U }oU r uP v]PRU ~b `]R uP v]PRV }o }b`lo˙]vobZu˘XuPX Or yy Tubo}b]v U}oUu]}Pu]o˙ Or yy Ao(}b]v U}oUuP]o˙ Refeal r Criteria R( vb `R} }v[ b}v } Ru}o}P]o uvU } R }uo]}vb ~]v v}vU Ru]U vo (]o v v]v˙]v(}v}Z U}o}P]b}SP]ob]o]bX yy X ]o B P}bb P}bb ]b ]vGuu}v }( R }b PovU `R]R u˙ ]o } ]oX ]o B }bb ]b u} }uu}v Rv ]o }bbX I u˙ vb b v }v]}v `R]R u˙ ]R ˘oo˙ b vbu]' } bo (}u Ro G˘ }( ]v( ]v ]v} R }b bX OR }vo b}b u˙ ] (}u b u}o}}buX I( ]vo˙ R]b u˙ }Pbb } R}v] }bbX I ]b u}}uu}v]vuvo}ò}`æ˙bX Chatep rP sueCa yy yy *Disorsof der theKidneyandGenitourinayr System GurvP ]o ]v(}vb XPX (}u E. coliU Pb}u}vbU Streptococcus faecalisU P}bU Kob]ooU S v Ev}]X S˘oo˙vbu]']v(}vbXPX(}uG}v}}bvCRou˙]X Symptoms A Signs A yy S`}oov v v }b }v D]P]o Ro E˘u]v}v ~DREZX ~A}]}bubbPbR]b}oo}u] b ZX yy TRu(obSR} _(}uR]vGuu}vX Chronic yy F]v]vPb }v DRE u˙ v}uo } v }b }b]}voo˙ (} o}vPbv]vP ]bb ] u˙ (o ˙ .u } R b ]v }b vX Invtiga se tions yy U]vo˙b]bvo yy FBU C SR E yy PSA yy Bo}}o yy E˘bb }b }vb b (} o v bvb]]˙ R}PR DREXV}]b]uv(}vL}bubbP}u v*Bctea rialProstatitis*v yy F yy CR]oobvuo]b yy L}`lv`]b]v yy M˙oP]vRoP] yy Rol]vo]v yy U]v˙Pv˙v(v˙ yy Nocturia yy D˙b] yy D]8o˙]v]v}vlv}v}(]v yy Hu] yy Hu}bu]vo}bb}(o]]} Chronic yy Ivb]}b}vb yy Rob]vPUTI yy Pb]bv}(]]vbu]voG]b]v]}uv yy L}`lv`]b]v yy U]v˙Pv˙v(v˙ yy Nocturia yy D]8o˙]v]v}v yy Hu] yy Hu}bu] Standard ~]vR}v]}bb}vo˙ZX Trtme ae ntGuidelinesUwthEditionUw Trtme ae nt Tuv}ib yy To relieve pain and fever yy T}}v}o]v(}v yy T}o]o}`]v˙}b}v yy T}vR}v]}bb Non-pharmacological treatment yy b B yy H˙}v yy H}b]o]b}vu˙]]v}b b `RvR}v]}v ]b}uo]˙]v˙v}vvb]Pv].vRu]X yy S] ˙b}b}u˙ (} ]v˙ v}vX ~URo R]}vbR}o}]XZ Pharmacological treatment AX v*Bctea rialProstatitis*v yy yy yy yy BX yy yy yy yy M]o}M}]v(}vb st L]vTuv ]v E RvPPB C]}G}˘]vU}oUæuPR}o˙(}rv`lb vA D}˘˙˙o]vU}oUuPR}o˙(}rv`lb nd L]vTuv L}G}˘]vU}oUæuP]o˙(}rv`lb Av D}˘˙˙o]vU}oUuPR}o˙(}rv`lb S]v(}vb C]}G}˘]vU IVU uP r R}o˙ ~} u]v]b } v u]vbZ Or L}G}˘]vUIVUæuPR}o˙ Or L]˘}v C UIVUrPD]o˙ Av Gvu]]vUIVUuPH}o˙ N}r Iv]oR˙`]Rvov]}b]b]v]]vbXF}oo}` bR}o(}obu}vRb CX yy yy F}]u}uv}(]v˙G}` Tubo}b]vUu]}Pub]o˙~v]PRZ Or Ao(}b]vUuP]o˙ Or Chatep rP *Disorsof der theKidneyandGenitourinayr System yy T}b]vUræuP]o˙~v]PRZ X D Aivuv]vbv}vb ]v E RvPPC S}]uRo}]XıA9UIVU]b ]v˙bb u]]v(}vbX vA I}(vU}oUuPR}o˙`Rv] Or D]o}(vU}oUwæuPR}o˙`Rv] yy yy yy Av yy Lo}bU}oUræuoR}o˙vib}b}]vPo˙ Refeal r Criteria R(oo}( b ]v(}vb b }R}v]}b(} b b]o]b X X Scrotal Masses TRbòo]vPb b (}v]vR}u b X Painless Swellings yy Tbou} yy IvP]v}b}oRv] yy Hydrocoele yy H˙}}o}(bu} yy Su}}ol]]˙uo˙bb yy V]}}o yy E]]˙uou}b yy CR}v]]]˙u}r}R]b Painful Swellings yy Tbo}b]}v yy ]]˙u]b A ~STI}v}vrSTIoZ yy ]]˙u} A r}R]b yy SvPo]vP]v}b}oRv] yy Tbo u} ~boo˙ ]vobb ˘ ]o˙ P}`]vP ˙ } u}v}b]bZ yy V]}}ob}b]}voo˙}uv]˙]vl]b}u(} Symptoms yy Sòo]vPvl}]v}(}u b }]b}vvb yy Sv}vbXPX}b]}v}(b yy Go}vbXPXbu}}oUR˙}}ob yy Go}vb}u]vPbvo˙]v(oXPX}bRv] yy FUu˙bv]v]v(}vbXPX]]˙u]b A v ]]˙u}r}R]b v*Scota r lMas*e v sueCa Standard Trtme ae ntGuidelinesUwthEditionUw v*TheEmptyScotu r m*v Signs yy Tv } v}vrv òo]vP b ]b } R }u b ~˘ Rv]`R]Ru˙˘v]v}R]vP]voZ yy Fu˙bv]v]v(}vb yy Tvb]oou]v}v (} ˙b òo]vPb b XPX R˙}}ob v bu}ob yy Hòo]vP b XPXTu} Invtiga se tions yy Uob}vv b `]R}`]R}}o}}o yy L}}˙ ]vbP}vb ]o} }`b b v b]. uv Trtme ae nt Tuv}ib yy T}ulv]Pv}b]b}vb}]uv yy To relieve pain yy T}v}uo]}vb yy T}˘]uPv˙]vv}vPTboT}b]}v Non-pharmacological treatment yy SP˙Po}uPv˙ yy EuPv˙P˙ b `]R]vR}b v ]b](}ob }b]}v} boPRb Pharmacological treatment AX yy yy F}˘oo˙ b vbu]']v(}v ]v E RvPPB C]}G}˘]vU}oUæuPb]vPo}b vA D}˘˙˙o]vU}oUuPR}o˙(}˙b Or L]˘}v C UIMUæuPb]vPo}b Av yy D}˘˙˙o]vU}oUuPR}o˙(}˙b Refeal r Criteria R( oo uPv˙ b v R}b b } u}b } }o}P]b}P]o b b]o]bX yy æX The Empty Scrotum TR]b(b}Rbv}(b~bZ]vR}u b lRu]b}uX Tvv}(]oo b XSv˙r.v}((oou]v(vb `]R vbv b v ıA9 }( u ]v(vb `}o R b}vv}bbv}((}u b R]vr}u]vob]˙RP}( }v˙XPb]bvvbv}(R]bb b}]`]Rv]vb Chatep rP *Disorsof der theKidneyandGenitourinayr System ]bl}(uo]Pvv˙U(o]˙ b U}R˙}(Rvb }b]}vXAooRoR `}lb`R}v}vb b vR]ovbR}o}}v˘u]v}v}( R}u b v}b vobv}vbv}uo]}vbX sueCa yy yy yy yy yy yy yy yy yy yy Uvbvb Uvlv}`vl]]}R]Vu}b}vPv]o b Pu]R Gvoo˙]vR]]bb Ab}] `]R v}uo]b o]l Pv Boo˙ ˙v}u b v hypospadias }] E b Rob Severe atrophy OR]}u˙ APvb]b}(Rb~o˙Z æ v*TheEmptyScotu r m*v Symptoms yy Absence of one or both testes yy IvR]ovUvb}RRoR`}lu˙v}R]b]R Signs yy bv A b]v}Rb]vv]PR}b]}vb Invtiga se tions yy Uob}vv b }(}uvUo]bv]vP]vovo Trtme ae nt Tuv}ib yy T}b}vo(}v yy T}]u}(o]˙ yy To repair hernia yy To decrease risk of torsion yy T}}]b}]ov˙R}o}P]o b }uo]}vb Non-pharmacological treatment yy SP]o ]vv}v (} `} ˙b }( PX ~Aoo }] b bR}o}bR˙`]oov}bvZ Pharmacological treatment None Refeal r Criteria R( vb P } }v ˙ `]R v} ]v }( ob bv}}o}P]b}P]o b b]o]bX Standard vX Trtme ae ntGuidelinesUwthEditionUw Priapism v*Priapism*v TR]b (b } b}vv}bU }o}vPU b]bvU boo˙ ]v(o }vU `R]R ]b v`v v v} b}] `]R ˘o b b] v v} o] ˙ }]bX P]]bu ]b obb]. ]v} R ˙b vuo˙P L}`rG}` } ]bRu] ~}uu}vbZU H]PRrG}` ~v}vr]bRu]Z v S']vP P]]buX I ]b }uu}vo˙ bv b }o}vP}v }( N}vo Pv]oTubv~NPTZ}o˙u}v]vP}vXTR]b]b òorlv}`v }uo]}v}(b]looo]bbX Pvb boo˙ bR˙ v ov } }u } R R}b]o } Pub b }vX L bv}v ]b R(} }uu}v v Ro u]]v o]}vb v b]]o u]b u˙ R v ] } o] ˙u}ub b ]} } ]vP bv ]v R}b]oX o˙ E bo `]R]v r R}b u˙ R R]PR ]u}v }uo]}v }( æA9X AoR}PR R }v ]b boo˙ ]v obU ] u˙ ]}]oo˙ } ]v }oR]ovX sueCa yy I]}R]}vlv}`v]vvA9}(b yy DPbXPXu]ivvRo}v}}vb yy ORbP yy Llu] yy S]looo]bbvRobbu] yy Pv]ou yy S]vo}]vi˙ yy Po]]v(}vb yy Po]u} yy I}Pv]XPXIvv}bo}bPov]vE(}]u}vU b]ov.o]U˙R}}]b b XPXRo}}u]v Symptoms yy P]v(ob]bv}v Signs yy U E vv]b yy Co]v]ob]Pvb}(b]looo]bb Invtiga se tions yy FBU C o}}.ou}uuv yy S]lo]vPbrHo}R}b]b yy U]vo˙b]b Trtme ae nt Tuv}ib yy To relieve pain yy T}vbo˙o](}(v]o}vPb}v yy T}v}uo]}vb v Chatep rP *Disorsof der theKidneyandGenitourinayr System Non-pharmacological treatment ]v E RvPPA yy M]v]vR˙}v yy W]v[bP} yy C}}I]P}v yy SP˙PSRvb Pharmacological treatment AX yy yy B. Specialist management yy Ivv}bo]vi}vb~b(o]]Z Refeal r Criteria Pvb v} b}v]vP } }vb uvPuv bR}o }uo˙(}}o}P]b}P]o b b]o]bX wX P}b]}URoVob TRbob}(}ob}(}vPv]o b }bvPuuvb `]R]v R ouv }( R RX I +b `v ]v æU W U uobXI]bR}uu}vb}( b }vPv]oo}o}b}vX TR˙ }b]v˙ }o}` (}u R o u]˙b Ro R]b}vX bB R }b}v b ]vr}U }v˙ b RvPb]vRov]v˙v]RX S}uvbu˙}v`]Rvo b ]u]uv}R]bu˙ o} b}}v L ]R ]( }Pv]}v ]b o˙X M}b vb bv b v}vb } ]v(vbX Ob]}voo˙bv}v ]b o]v R]oR}}X Aoo w v*PosteriorUrethralValvs*e v yy C}vbuvPuv ]v E RvPPC S}]uCRo}]XıA9UIVU Adults LvR}o˙vo]o}oG]b Children æuovR}o˙vo]o}oG]b vA PR]]vUIMU Adults uPR}o˙](] Children uP llP~u˘XæuPZR}o˙](] vA D]uUIVU Adult uP X b ~P]v bo}ò˙ } r u]vbU }˘]uo˙ Xæ uP ˙}vb b ZRv( Children XuP llPX b ~P]vbo}ò˙}ru]vbZRv( Standard Trtme ae ntGuidelinesUwthEditionUw uo v`}v ]b bR}o o}bo˙ `R } vb P}} ub }(]vXPvo]Pv}b]b]b}bb]ob]vPob}vX sueCa yy v*PosteriorUrethralValvs*e v C}vPv]oob}(}ob`]R]vRouv}(R}b]}R Symptoms yy P}}]v˙ub yy C˙]vP`R]o}]]vP yy S]v]vP}}]`]R]o]vP}(]v yy Ivu]'vub yy F]o}R] yy F yy P}}(]vP yy A}u]vo]bvb]}v Signs yy V}]]vP˙b(v}v yy Pooovl]v˙b yy Respiratory distress yy S]Pvb}(b]bXPXF yy }u] A lu] yy P}}R˙b]oP}`RlP}`R}v Invtiga se tions yy FBC yy Bo}}Uo}o˙bvv]v yy U]vo˙b]b yy U]vo yy A}u]voob}v yy M]vP˙b}rR}Pu Trtme ae nt Tuv}ib yy To prevent and treat renal failure yy T}u}}bvPob Non-pharmacological treatment yy P}u o }ubb]}v v }vv}b]vP}} R(}uluP b XTR]b]b(o˙}v˙ b]}b}u˙]vu}b]v(vbXIvòo]vPRbbR}o}] ]vu}b}b }uo]}vbvR(}uu] b yy SP]ou}o}}v b }(Ro Pharmacological treatment ]v E RvPPA yy Tuv}(]v˙]v(}vb~S}]b}vZ Refeal r Criteria R( ]uu]o˙ L ]Pv}b]b (} b]o]b o}v v Chatep rP *Disorsof der theKidneyandGenitourinayr System uvX X U]v˙TCoo] TRb ˙boro]l }ibU `R]R (}u ]v ]}b b }( R ]v˙ X TR˙ }vb]b u]vo˙ }( u]vo bob ]XX ˙bor(}u]vP ]}vbX S}u }( R }uu}v }v b r˙b ]vo o]u }˘oU o]u R}bRU uPvb]u uu}v]u R}bR v ] ]X S}u ]bl (}b ]v o}]vP }vb b ]vo ˙boo]U OvU ]U }}vU o]u ~R˙}vZU (u]o˙ R]b}˙ v u]}vbX Mi}]˙}(}vb b obbRvæuu]v]u`]oob}vv}bo˙X sueCa H˙ou] H˙]u] H˙}˘o] U]v˙b]bv}b}v U]v˙]v(}vP]b ~]v(}v}vb Zb F}]Pv}˙]vo]vP]v˙Rvu]o b I]}R]R˙o]] D R˙}v Iuu}]o]b}vb]oo˙]vRoo˙ Iv}v}b}(u}o]buXPXC˙bv] v*Urinayr Trcta Calculi*v yy yy yy yy yy yy yy yy yy yy Symptomsandsigns LOCTION A OF CALCULI SYMPTOMS SIGNS K]v˙lU • L}]vP]v • U]}o]Pbv P}v]]vP}˘˙buo]vU `R]RP]vb]vRo}]vU then radiates around the Gvl}`bRo v}u b lbb]vR uovo]uuib ]vR(uoXM˙ b}]`]RvbU }u]vPv`vP b • Hu] • S]Pvbu˙(` tenderness in the loin and }uv`}o(o ]vP]v(o'l • S}uubRu˙ b}]}u]vo distension and fever if there ]brb ]v(}v • AR˙}vR}l]v˙ u˙oo ı Standard Trtme ae ntGuidelinesUwthEditionUw LOCTION A OF CALCULI SYMPTOMS SIGNS BolUR • • • • • • Suprapubic tenderness • Pooo~(}u v}v}oP}v b Z • HRoou ~]u}v b Z • Hu] Suprapubic pain Fv˙ UPv˙ Hu] SvP˙Pvv}v}ooo v}Lv]v(ob]} b]vU`R]Rbob]v o]'o]v~u˙o}}r ]v b Z}v}]v]vP voided • Rv}v}(]v v*Urinayr Trcta Calculi*v Invtiga se tions yy U]vo˙b]b yy U]vo yy Bo}}Uo}o˙bvv]v yy Su]]Uo]uUR}bRUuPvb]u yy Po]vXr˙}(}uv yy Uob}vv b }(}uv yy Ivv}b}Pu yy R}P}˙o}Pu yy CT scan yy Stone analysis Trtme ae nt Tuv}ib yy T}}v}o]v]vP'l yy T}]bP}(Roob}vb}uou}o}(oob yy T}u}oP}vb b yy T}vv](Rb]blv}`v yy T}b}]]v(}vb Non-pharmacological treatment yy Ev}P }o G] ]vl ~r L ]o˙ ]v v oZ v }] R˙}v yy }] A o}ò]u]~]v}Pb]vb}˘o˘}vZ yy D]rR˙ yy MvP]v˙v}v}o}Ro}vb b ˙ RoR]b}v}]b ˙b}b}u˙o˙ b Pharmacological treatment ]v E RvPPB yy PR]]vUIMUuPR}o˙]b Or yy D]o}(vUIMUwæuPR}o˙ Or yy D]o}(vUoUuPR}o˙ Chatep rP yy yy *Disorsof der theKidneyandGenitourinayr System Av H˙}b]v˙o}u]UIVUuPR}o˙ Or M]vU}oUæuPR}o˙u˙(o b C}vrX }] A u}R]v]b u˙(R b ]buv`}bv]vP}(˙u b }ub yy r G] v]}b ]( ]v˙ ]v(}v ]b bvX ~S b}v }v RU]v˙TIv(}v[Z Refeal r Criteria R(}}o}P]b}P]o b b]o]b(}.v]uvL ]v]ouvPuvX ıX URoS] v*UrethralStricture*v TR]b (b } v}`]vP } }uo }b}v }( R Ro ouv } .}b]b ~b]vPZX I ]b R }v b }uu}vb b }( v}v}(]v]vGRvvRu}b}uu}v]v˙}vPuobboo˙ bovP (}u ]}b ]vo˙ STIX TR }uu}vb b] ]b R v]} R ]XX o v v]o R ]v uobX I u˙ }uo] ˙ ]Ro bU b.]o ˘b}v }( ]v v R}v}b .boU v}v }( ]v v }brvo vo (]oX sueCa yy G}v}}o}v}vrP}v}}oR]b yy E˘vo u XPX } 8 ]vi]bU (oobU ob } ]b ]vi˙vo](b yy I}Pv]PURo]vbuv}vXPXR]b}vUv}b}˙ yy P}b}XPX}b}u˙ yy C}vPv]o]bb ~Z Symptoms yy L}Ù]v˙TS˙u}ub~LUTSZXPX}}]v˙ub Ubo] }bo˙ub Uo]}(ub ]u}˙]v]vP b U (v˙ v ˙b]U }br}] ]o]vPU ]v}uo u˙]vP }( bladder yy U]v˙~}G}`Z]v}vvv yy U]v˙v}v~}R}v]Z Signs yy TRu˙v}v]vv}uo]b yy Poo]v}v}(R yy P]Rob yy E˘b}v}(]v]v}}u b vb.]ob yy UR}v}b.bobl`]vPrv}u b yy yy yy yy Standard Trtme ae ntGuidelinesUwthEditionUw Bou˙oo](R]bv}v K]v˙u˙oo]vR˙}vR}bb L}o]]v}vu˙(oo}vPRR F]o}(R]b}vrR]bR]PRvbRb]]}v}(]b v*Vactomy se ~MaleSterilistion a Z*v Invtiga se tions yy U]vo˙b]b yy U]vovbvb]]˙ yy Bo}}Uo}o˙bvv]v yy Uob}v Sv }( l]v˙bU oU }b}] b]o ]v v b}vP]}.}b]b yy R}PR}Pu yy AvP R}PulM]vP C˙b}r}Pu ~MCUGZ provided a suprapubic catheter is in place yy U}G}ù˙ yy UR}˙b}b}˙ Trtme ae nt Tuv}ib yy T}o]˙u}ub b vv}uo]}v yy T}vo˙]vPb Non-pharmacological treatment yy T˙ R]b}v r Pvo 'u ]b u } b Ro RU`R]R`]ooRoURb]}(]b ]vvb`R} bv`]Rv}v}(]vXC}v.u}v}(b]}(}b}v]b oo b v˙R}PR˙}R}b}˙X yy I(R]}v(]obvv]b]vv}v yy S]˙b}b}u˙}]b vovvb]}v ~˙R]b}]((]o]b(}]b ˙b}b}u˙ol]vPZX Ab] b uR ]v b }bb]o } }ubb R o v relieve pain before referral yy .v] D uv]bP]o b X Iv u}bb(o} b]o]b v`]oovbb˙ Pharmacological treatment yy N}v˘(}U]v˙TIv(}v~S}]b}vZ Refeal r Criteria R( } b]o]b (} (R ]vbP}vb ]} } .v] uvX 150.Vb}u˙~MoS]o]b}vZ Vb}u˙ ]b uvv uo }v uR}U `R]R ]b b U bR} v (b P]o ]uo b }X I ]b ] } ˙ ]v P}vb b boo˙ v o}o vbRb] L (o }vboo]vP v ]v(}u}vbvX Chatep rP *Disorsof der theKidneyandGenitourinayr System Vb}u˙ ]b R u}b + uo (u]o˙ ovv]vP uR}X Iv}o]vP uob ]v ]bb }( } RoR v (u]o˙ ovv]vP Rb ob v.b`]R}b]]u}vb}]˙X Vb}u˙ bR}o v}P (} }] o]vbX I ]b obb ]vb]v b]uo Rv (uo]o]b b }vX Rbo }(}u˙ b ]b ]8o P˙ b b]vP o}blu]}b} `]R b }( vrA9 ]( }v]vobbRv˙bL}u˙ b X B}˘rP) M]b}v}vb yy Vb}u˙]bo]P}v}(R(vb b vNOTCASTRATION yy Vb}u˙}bv}+}v yy Vb}u˙ }b v}+io}v v }PbuX TR`}o v}uo io}vRbuv}bv}}v]vbu}} yy Vb}u˙}bv}`}l]uu]o˙XAlruR}}(}v}v ]bvbb˙(}}io}vbUu}vRbLR}}vo ˘u]v}v}(buvbR}`bv}bu yy AL}u˙ b uob`]oooo b ]Rb}(}v}ub}v˘b oo˙vbu]']v(}vb]vo]vPHIVrAIDS r v*AcuteEpididymororchitis*v B}˘rP) +vb E b}(]}buo}vuR}bP ]v E RvPPB yy Vb}u˙rııXæA9 yy Mo}v}urvA9 yy W]RòuR}rA9 P}]uvb yy ]o D }vboo]vP ~]oo˙ }R vb ub bvZ v ]v(}u consent yy C}vboo]vPbR}ouv}v]b]]o]˙}(}U}bb]ovo] }vv]bl}(R}v]}o b ]v}b}X yy Medical history yy PR˙b]o˘u]v}v yy L}}˙]vbP}vbXPXHUb]lo]vPU]vo˙b]b yy H]b}R}o}P˙ }v.u}v }( R u} bPuv }( b (vb u˙ vbb˙(}u]}oPob}vbX Refeal r Criteria Co]vb bR}o (} Fu]o˙ Povv]vP Uv] } U}o}P]b(} R}X 151.AE]]˙u}r}R]b TR]b]bv]vGuu}v}(R]]˙u]bvboo˙ }]o]v(}vXIu˙(}oo}`bv]vP]v(}v(}uRR ~]vo]vPSTIbZU]vbuv}vlR]}vUvo}`]v˙ r Standard Trtme ae ntGuidelinesUwthEditionUw v*AcuteEpididymororchitis*v }b}vvPv]}r]v˙P˙ b XI]blv}`v}uo]}v}( uubX P}}o˙ uvP ]]˙u}r}R]b u˙ }uo] ˙u] b U(}u}v b UR}v]]]˙u}r}R]bU}v˙ b R˙}}oU]v(o]˙vF}v] [bPvPvX (} B uvP]vP b ]˙u}}R]b ul b ob }b]}vRbv}vob]o˙˘oX sueCa yy Mub]b~}R]bZ yy Escherichia coli yy CRou˙] yy Gonococcus yy Staphylococcus yy Streptococcus yy Pb}u}vb yy Mycobacterium tuberculosis Symptoms yy F yy S}olbo]v yy S}oòo]vP b yy URo]bRP yy D˙b] yy Malaise Signs yy F yy Tvv`}oov b Ru]b}u yy IvGu]]˙u]bvb yy Secondary hydrocoele yy P}b] PRv[b b]Pv ~o]L]vP }( }u b }`b ] ˙uR˙b b ]b ]v Rouo]b]vZ Invtiga se tions yy U]vo˙b]b yy U]v o v bvb]]˙ r .b R }( ]v ( } u]bu]v yy FBCvSR E yy Bo}}ovbvb]]˙ yy S}oob}vlMRI Trtme ae nt Tuv}ib yy T}o]˙u}ub b yy T}]R]v(}v yy To prevent recurrence yy T}v}uo]}vbXPXbv]o]˙ b Non-pharmacological treatment yy b B yy yy yy Chatep rP *Disorsof der theKidneyandGenitourinayr System yy yy yy v*Tetic s ularTorsion~TorsionofSpermaticorC dZ*v Scrotal support SP]o]vP}(b }] A v} ˘b vo uv Rb v }uo (oo˙ b v(}oo}`}vbo]vPX yy Tv˘o b }vb Pharmacological treatment st L]vTuv yy C]}G}˘]vU}oU Adult æuPR}o˙(}˙b Children æræuP llPR}o˙(}˙b Av yy D}˘˙˙o]vU }oU uP R}o˙ (} `lb ]v b }(˘oo˙ b vbu]']v(}vb Or A ]R}u˙]v U}oU Adult æuP]o˙(}˙b Children uP llP]o˙(}˙b nd L]vuv N}G}˘]vU}oUuPR}o˙(}˙b Av D}˘˙˙o]v}A]R}u˙]v~b}]v L]vTuvZX st Or L}G}˘]vUæuP]o˙(}˙b vA D}˘˙˙o]v}A]R}u˙]v~b}]v L]vTuvZ st Av D ]o}(v b}]uU}oUæuPR}o˙ Or yy I}(vU}oUuPR}o˙ Refeal r Criteria R( oo b }( b]bv ( v }uo]}vb } R P]o b b]o]b}}o}P]bX yy 152.TboT}b]}v~T}b]}v}(SuC}Z TR]b ]b }v b }( o}} bo˙ } Rb } `]bvP }( R ub }XTR]b]b u]ouPv˙Rvb}}Pv] (} R ]vo b]Pvb v ˙u}ub b (oo˙ uv](b b }u æ Standard Trtme ae ntGuidelinesUwthEditionUw v*Tetic s ularTorsion~TorsionofSpermaticorC dZ*v P˙ b bRbX Do˙]vuv}obo]vob }R˙Uv}uobu }vo]vP}]v(o]˙lb]o]˙X I v obb]. ]v} ]vP]vo }b]}vU `R]R }vb u} Rv ıæA9 v ˘rP]vo }b]}vU `R]R ]b boo˙ (}v ]v ]v(vbX A} æA9 }( }b]}v }b ]vP bo v o˙ ]v R u}v]vPX I ]b ]v}oR]ovvob}uu}v]vR]ovvæ˙bX sueCa yy Uvbvb yy Boorouo(}u}v yy H}]}voo]}(bl]vb]}v}(b yy L}vPub}R]u yy Tu yy Sbu}(ububob Symptoms yy Sv }vb }( b]v ]v }v ob } v ]v `R]Rb}obb}vv}bo˙~v}b]}vv}b]}vZ yy P]vu˙}˙]oo˙o˙]vRu}v]vP yy L}`}u]vo]v}v+b] yy Nbv}u]vP yy N}]v˙˙u}ub b yy No fever Signs yy S`}oovUvvv}uo}b]}v}(bv]]˙u]bX yy SR}v`]b}X yy Oulv]vP}(}o b òo yy R]PRbr`]bo}l`]b yy LLbr`]bvo}l`]b yy PRv[bb]Pv]bbv~o}v}(}u b ]vRou}`bR P]˙uR˙b b ]b}bv}o]]vZ TorP) D]bvP]bR]vP`vT}b]}vvE]]˙u}r}R]b Pu Torsion E]]˙u}r}R]b AP AMæ˙b ANæ˙blb˘oo˙ Ovb}(]v Svlo˙u}v]vP Gradual History of coitus Uboo˙bv Uboo˙bv F Absent Pbv U]v˙˙u}ub b Absent Pbv URo]bRP Absent Pbv]vSTIb P}b]}v}(b CRvP UvRvP v Chatep rP *Disorsof der theKidneyandGenitourinayr System Pu Torsion E]]˙u}r}R]b Sòo]vP Tbb E]]˙u]bvb PRv[bb]Pv bvA lvP Pbvl}b] Bo}}bo˙P}o test Reduced N}uo}]vb Tuv SP]o N}vP]o b 153.Fournier’s Gangrene I]bv(ou]vv}o˙u]}]ov}b]vP(b]b}PvPv +vP R }u b v b}uub ˘v]vP } R ]vuU v]b vo}`}uvXI]bob}oo]]}R]PvPv}(R}u b X TR˙vP]b b ]v(}vb}(v}]v}]]}o `]R}o]]bbob]vR˘vb]PvPvXTR]bl(}b w v*Fournier[sGangrene*v Invtiga se tions yy U]vo˙b]b yy FBC yy D}oR}b b } yy C}o}D}oUob}vSv yy ııuTrRvb]voo}vv b ~ırA9Z Trtme ae nt Tuv}ib yy T}RP]o b ]vv}v`]R]vvR}b}(}vb yy T}P]oo˙ b ˘o}oo}ob yy T}vob o}bb Non-pharmacological treatment yy EuPv˙P˙ b ]bRvb uv yy I( P˙ b ]b o˙ Rv uvo }b]}v bR}o ] } (oo˙}vo}bb}(bX yy Mvo }b]}v }rv o}o vbRb] ~b o}`Z v v]vP b R (}} }( v`]bP R]PR b vo}l`]bU LLbro}l`]b yy EuPv˙P˙ b bR}o(}oo}`R]b}b}}vb}bb]o Pharmacological treatment ]v E RvPPC yy L]Pv}]vA9U]v}Rbu}}v}Rb]br(}}o}l vbRb]ruo Refeal r Criteria R(b}}v}bb b]o~](P]o b ]vv}v]bv}]oo}Z P}v b }}o}P]bX`B ob }b]}vRb}vou]}roPo ]uo]}vbX Standard Trtme ae ntGuidelinesUwthEditionUw ]vo ]b uoo]bU HIVlIuuv}bb]}vU ]vo bl ]v(}v }( }u b v }vvbU uU ˘b}v }( ]vU ]Ro b v Ro ]b loo]X TR }uo]}vb }( F}v] [bPvPv]vou] b U˘b}v}(]vU˘}b }(bv.bo(}u}vX sueCa yy yy yy yy yy yy Staphylococcus spp Microaerophilic Streptococcus E. coli Fb]] Clostridium welchii }]b B v*Fournier[sGangrene*v Symptoms yy A}vb}(]v(ov]}}o b òo]vP b ]v]}bo˙RoR˙ b yy F yy P]v]v+}u b yy Gvouo]b Signs yy F yy P}b}v yy R]o˙}Pbb]vPPvPv yy F}}} yy SRu}v`vR[bvRoR˙b yy ]bC }vo}v}(+b yy Tbb]bboo˙b yy U]v˙˘b}v yy Pbv}(]bl}]b}b]vP(}b Invtiga se tions yy W}vovbvb]]˙ yy Suovbvb]]˙ yy U]vo˙b]b yy FBCvSR E yy G}]vPv}bbruR]vP yy FbvPo}}Po}b yy HIVv]vP b yy Po]vXr˙}(o]b`]oooPb]v+b Trtme ae nt Tuv}ib yy T}b]v yy T}R]v(}v yy T}uvP}v}u]v]bl(}b yy T}boPRb Chatep rP *Disorsof der theKidneyandGenitourinayr System yy T}vl}uo]}vb Non-pharmacological treatment yy SP]o]vv}v yy R]o]uv yy R}vbP˙ b P yy Tbb]]vR]PRu}]o˙}vb]}v yy Sl]vPL]vPv}vb}v}(}u b ~b}}ob˙Z yy M˙}v}bGb yy N]}vbouv yy W}v yy MvPuv}(]buoo]b](bv yy MvPuv}(HIVlAIDS](bv Pharmacological treatment ]v E RvPPC IVG]bURu}vb(b]}vvR˙]}˘˙Pv ]Ab (}vbo]v]ob BX yy Av]}b Gvu]]vUIVUuPR}o˙ vA Au]]oo]vUIVUæuPvR}o˙ vA M}v]}oUIVUæuPR}o˙ yy yy yy yy v*BladerCancer*v AX Or A u}˘]]oo]v A=Coov]A]UIVUPR}o˙ vA M}v]}oUIVUæuPR}o˙ Or (}˘]u C UIVUwæuPR}o˙ Av yy M}v]}oUIVUæuPR}o˙ Refeal r Criteria R(oo`]R b bR}lLb]}vvooR}b`R} ]}vbP˙ b }}o}P]b}P]o b b]o]bX yy æX Bladder Cancer Bo v ]b R }v b }uu}vb }o}P]o v L }bvX I ]b R }uu}vb }( oo R vbU `R]R + R ]v˙ o]v]vP ~}Ro]uZX Mob u} + Rv (uob ]v } }( } PX I ]b u} }uu}v ]v R `R] }u } R ol ]v } }( PX M}Rv A9 }( o]vb `]R o v } æ ˙bX TR }uu}vb R}o}P]o ˙b ı Standard Trtme ae ntGuidelinesUwthEditionUw v*BladerCancer*v vb]}vooo]v}uTCC~ıA9ZUSu}boo]v}u~A9Zv v}]v}uv]v}u]vrb]~A9ZX sueCa yy CR}v] Iv(}vb }( R o o]l ~B]oR]ZvR}v]]o]v(}vb yy Su}l]vP }( ]P'bP v boo˙ o}b r ˙b L bu}l]vP v lbb ˙l l ]b R]PR ]bl }( v o}uvXPbb]bu}l]vPu˙ob}˙R]bl}(v yy O}vo ]blbV v]}vuvo ˘}b } vrb]vP Ru]ob b ]v ]vb]b XPX ˙U˘oUU oU ]vvP X yy Gvv(u]o]o(}b Symptoms yy M˙˙u}u b ]vo˙]bb~æA9Z yy Hu] ~boo˙ ]vobbZX P]v(o }vo˙ ]v v ]bb v ]v(}vlUTI yy I]˙u}ub b P(v˙UPv˙U˙b] yy Fovl]v~R˙}vR}b]bZ yy Po]]v(}uv]vb]}v yy Ou}(o}ò]ub(}uv]bb Signs yy Poo} yy WbvP yy Poooubb yy Pool]v˙(}u]}b}vvR˙}vR}b]b yy L˙uR}u}(o}ò]ulo]ub yy S}v˙UTI]vA9}(b Invtiga se tions yy FBCvSR E yy U]vvo˙b]bvo yy U]v˙}o}P˙ yy UUv]vUo}o˙b yy Uob}vv b PA}u]v}o] yy CTSvlMRI(}P]vP b ~B˙b]o]bZ yy S]oIvbP}vbPA}u]v}o]IVU yy UR}˙b}b}˙v]}b]b~B˙b]o]bZ yy E˘u]v}v v vbRb] ~B]uvo o}v }( o R}PRDREvPo]˘u]v}vbZX Trtme ae nt Tuv}ib yy SP]o(}o˙]bb yy Pv}v}(vU}Pbb]}vvubb yy MvPuv}(}uo]}vb Schistosoma haematobium Chatep rP *Disorsof der theKidneyandGenitourinayr System yy A]}vo uv `]R v Pb v ]}R˙ `R vbb˙~N}ivvivR˙Z Non-pharmacological treatment yy C˙b}u˙PPo}]o`]R}`]R}oouvX yy Radiotherapy Pharmacological treatment ]v E RvPPC AX yy o˙ E SP GBC } TR]} o ]vboo}v (} b.]o u}b L TvbrURoRb}v}(BoTu}~TURBTZ BX yy 155.Carcinoma of Prostate N]v˙r. v }( Rb u}b v}]v}ubX TR ui}]˙ }( uv + P `v væ v æ ˙bX TR ]v]v]vb`]R b PXI]b}uuvR˙uoU˙b v }U bR}o R vvo v]vP b ˙ P}b S]. AvPv ~PSAZ b v D]P]o Ro E˘u]v}v ~DREZ b]v o˙ }v ]b b}] `]R ' }Pv}b]bX TR v. } }R`]b }( v]vP b bR}o]bb`]RvbX Pvb`]R(u]o˙R]b}˙}(}bvvbR}o}vb] vvov]vP b (}u ˙b v }`]R PSA v DREX I ]b `}R v}vP R v} ˙ R }b }v DRE ]b uo]PvvX L]l`]b v}uor(o]vP}b}bv}˘ouo]Pvv˙X}bA ]}b˙ ]bR(}vbb˙}o]b b R]Pv}b]bX sueCa yy yy yy yy yy AP]vP Fv}vob Fu]o˙R]b}˙}(}bvUvb U}]vv R~u}}uu}v]volbZ H]PR]˙(]vl Symptoms yy ˙u}u Ab P }b v u˙ bv `]R} ˙u}ub b ]vRo˙P b yy L}Ù]v˙TS˙u}ub~LUTSZvIPSS v*Ccinoma ar ofProstate*v vA D]bb CRu}RPvb}uuv(}vP b ]vo MR}˘UV]vobvUA]u˙]vvC]bovX Refeal r Criteria R( oo b }( o v (} b]o]b o}v v uvX Aoo b }( R}v] ˙bb R}o (} b]o]b} ˘oovX yy yy yy yy yy yy yy yy yy Standard Trtme ae ntGuidelinesUwthEditionUw Rv}v}(]v Hu] Gvo]o]˙v}˘]U`]PRo}bbUo]bobbvbb B}v]v~}uu}vo˙]vR`]b}o]ubZ Po˙b]b]vRo}ò]ub}]v]o]˙}òl PR}o}P]oF Iu}v Hu}bu] Tvbub v*Ccinoma ar ofProstate*v Signs OvDREo]v]ob]Pvb]voV yy H}bPov`]Rv]Pob(vPb yy Oo]u]vbob yy ARvou}b vA }ub]bbP yy Avu] yy Uu] yy WbvP yy B}vvvbb yy PoP] yy PR}o}P]o( Invtiga se tions yy FBC yy Bo}}Uo}o˙bvv]v yy P}bS].AvPv~PSAZ yy L](v}vb yy A}u]vovo]ob}v yy TvboUob}v~TRUSZ}(R}bU](]oo yy Transrectal needle biopsy of the prostate yy TRUSrP]}.vPrP] Trtme ae nt Tuv}ib yy T}o]˙u}ub b yy T}}v}o}uo]}vb yy To achieve cure for early disease yy T}vo}o}Pbb]}vvubb Non-pharmacological treatment yy URoR]b}v}o]]v˙v}v`Rv yy R]o }b}u˙ } ]}R˙U v b]o]b U (} early disease yy SP]o}v b ~]oo}R]}u˙Z(}v]bb Pharmacological treatment ]v E RvPPA yy PRu}o}P]o uv }( ]v}u }( R }bU `R]R Chatep rP yy AX yy yy *Disorsof der theKidneyandGenitourinayr System ]v}obR}u}vouv]o}vU`R]R]vR]]bP}`R}(Ru} ˙]]vP]}(v}PvbU]b]b }vb]o]bX TR}uu}vPbb]vv}bvR˙P Avv}Pvb B]ou]U}oUæuP]o˙~(}b]o]bZ Or Fou]U}oUæuPR}o˙~(}b]o]bZ B.Oestrogen yy So}b}oU }oU ræ uP ]o˙ ~A}] ]v o]vb `]R ]}bo ]bbZU~(}b]o]bZ CX yy yy LHRHAvo}Pb G}bo]vUSCU(o˙]vR}u]voòo~(}b]o]bZ Or L}o]UIMU~(}b]o]bZ 156.EoD˙b(v}v I uvb R b]bv ]v]o]˙ }( uv } R] v }vU `R]R ]b ]v ub }( Rvbb v }v (} (}˙ b ˘o b ]v}bXS}o}vPbuvvR]Rv}PR}v } u] P]vo v}vU `]R o}vP v}PR Sb˙]vP }` _ } (}u R ˘o b oo io}v ]b ']vU R ]b iP } }vXTRvu}(S}vb_b]}v]b]ovX TR }v]}v u˙ obb]. b }Pv]U˙R}Pv] b } u]˘]v ub }( }o}P˙V ]u˙ ~v v o } ']v vl} u]v]v v }v (} (}˙ b ˘o b ]v}bZ } }v˙ b U `R ]u}v }b ]v uv `R} R ]}bo˙ R (}˙ b ˘o b (}uvX sueCa Psychogenic yy Av˘]˙ yy b]}v D yy Stress yy M]o}vG] Organic yy Vbo}Pv]P]o]vb8]v˙l}ob]}vVv}b]v}uv yy N}Pv]P]Rov}R˙Vb]vo}ob]}vb yy TuP v}u˙V o] ( ~`]R Ro ZV v*Ectile re Dysfunction*v Av yy B]R}bR}vbvFvv˙oRb~(}b]o]bZ Refeal r Criteria R(oo}b b]o]bv(}o}vvuvPuvX Standard yy yy yy yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw ]vou Ev}]vP ]b uoo]bU R˙}P}v]buV R˙}ovu]V ]]˙UvovR˙}]]b}b DPbPXPXvR˙vb]bUvbbvb P}br}P C˙b}u˙U R]o P}b}u˙V A}u]v}]vob}v IvGuu}vVR]bV}bb MRv]oP}vPv]ov]ov}uo]bVP˙}v]b]bb EvvoPRlvolo](]oVou}v˙]vb8]v˙ P}br]]bu v*Ectile re Dysfunction*v Symptoms yy Iv]o]˙}R]}v yy Iv]o]˙}]v b }v yy R˘o b b] Signs yy Fbo}vo˙]vPb yy H˙}P}vo (b XPX P˙v}ubU ol }( uo ˘o b R]bb yy Pv]oobv~P˙}v]b]bbZ Invtiga se tions yy FBCvb]lo]vPb yy L]]}.o yy U]vo˙b]b yy FbvPo}}Po}b yy Su}ov yy SuLHUFSHv}bb }v Trtme ae nt Tuv}ib yy T}u]v(}b b v}]o˙ yy T}}b ˘o b }v˙ N}r oE ˙b(v}v u˙ R .b`v]vP b]Pv }( vo˙]vP]}bo ]bbo]lM˙}]oIv(}v Non-pharmacological treatment yy Pvb bR}o }] ˘bb] o}R}o }vbu}vU ]P' bu}l]vPU}voPbv˘bb]`]PRP]v yy Pb˙R}b˘o}vbo]vP Pharmacological treatment B}˘rP) yy TuvbR}o ] vo˙]vPb XPX RvP} ]b}vv u]}vU ]( (}v } R bU ]v }vbo}v `]R R v[b physician r Chatep rP *Disorsof der theKidneyandGenitourinayr System yy DPb(}o˙b(v}vXPXb]ov.oUo.o}v.o~PDEæ]v R]]}bvZ b].bb o]vuvL(o]}bo o}vX TR˙ }v]v] ]v ]bRu] R ]bb v R}b on nitrates yy yy yy r S]ov.o]Uæ}uPu]vb}R}(}}]b Or To.oUuPrvu]vb(}}]b Or Vv.oU}uPrvu]vb(}}]b N}ræ TRbu]}vb]˘o b uo}v b (}}uobob yy P}bPov]vEub}vo˙bvb]o]bX Refeal r Criteria R(o} b]o]bv]bvbb˙(}}o}vv uvPuv]vu}bbX v*MaleInfetility r *v 157.MoIv(o]˙ Iv(o]˙ ]b R (]o }( }o } R] }v}v `]R]v u}vRb }( v} }]bX A} }v R] }( b }( ]v(o]˙bo (}uR}o}P] (}b ]v uvU}v R](}u (}b ]v }Ruvv`}uvv}vR](}u(}b]v(uobXMob R(}}v(}æA9}(]v(o]˙XA}æA9}(oou]}ob ˘]v } ]8obX C}u}vvb }( ]v(o]˙ R]b}˙ ]vo u]oU P]o b U (o]˙U ˘o b U (u]o˙U u]}vU b}]o v }}voR]b}˙X sueCa F}o}bbRu]vvb ]]]v}RP yy Treatable causes yy P}voo˙ob yy Uvob TR b v ob} obb]. v R P}]bP Pr ob UTbovP}brboX TorP) Cb}(MoIv(o]˙ Treatable causes P}voo˙o causes Uvob V]}}o I]}R] C}vPv]ov}uo]b XPXvb }(}R bvR}u}b}uo v}uo]b æ Standard Trtme ae ntGuidelinesUwthEditionUw Treatable causes P}voo˙o causes Uvob Iv(}vb}(bU ]]˙u]bURU prostate Uvbv Tbb B]ooob }R˙ Eio}˙˙b(v}v G}v}}˘]vb~PbU ]}vZ oE ˙b(v}v Bo}lP}((vb b H˙}ovu] H˙}P}v}}] R˙}P}v]bu v*MaleInfetility r *v Symptoms yy Pvb boo˙ }uo]v }( R] `]b[ ]v]o]˙ } P] Ru R]oX SR vb ] }Lv ˙ Rvb]U (b vov}vP}]vbP}vb yy S˙u}ubbPPb}(R]b}˙}(STIUUTIUuubUPv]oUo]} ]vP]v}b}oP˙ b v]vi]b Signs yy bv A }(uo}v˙ b ˘o b R]bb yy G˙v}ub yy E˘u]v˘voPv]o]}bP yy TbbPbv}bvUb]v}vb]bv˙ yy E]]˙u]bPR]lv]vP yy Vb(vbPbvUR]lv]vP yy V]}}ob yy IvP]v}b}oP]}vP(}u b ]}bRv]}RR˙ yy Pv]bPb]UUR˙}b]bU]b]b yy URP]bRPUuov}b b ]bU]b Invtiga se tions yy FBCvb]lo]vP yy Suvvo˙b]b yy U]vo˙b]b yy FbvPo}}Po}b yy S]. ]vbP}vb ovP } ]}b b XPX }o b ultrasound yy S]o]b]vbP}vbXPXR}u}vo}.o}v˙b]o]bb yy o}v E }((uov˙P˙v}o}P]b Trtme ae nt Tuv}ib yy T}]u}(o]˙}vo yy T}R]Pvv˙`]Rv v Chatep rP *Disorsof der theKidneyandGenitourinayr System Non-pharmacological treatment yy S˘o}vboo]vP yy Su}l]vP}v b yy R}v]vo}R}o]vl yy }] A o}o~b}o˘}b Z }˘bb]RU}ovRu]ob yy }] A PR v`X Ub }( }˘ bR}b v }'}v ](b ~v} b]ollv˙o}vZ]b}uuvX~TR]bbR}vR}b }u}bu}Pvb]bZ Pharmacological treatment yy TR]b]b}] b vb]o]bX Refeal r Criteria R(oobR]b]o]vbP}vURu}o}P]o} P]o b uv}b]o]bX 158.Haematuria w v*Haematuria*v TR]b ]b R bP }( o}} ]v R ]vX I u˙ u]}b}] } u}b}]U]vu]'v}}vv}bXTR'v}(o}}]vR]v u˙]v]oUu]vo}(vll}oXBo}}]v]v]bb]}b˙u}u b v ub o`˙b (oo˙ ]vbP b]oo˙ } ˘o vX ]v C Pb v (}} }b u˙ }o} ]v bovP ]v (ob Ru] v Rb bR}o ]+v (}u Ru]U `R]R ]b ˙ u]}b}] ˘u]v}v }( R ]vX E˘uob }( bR vbb ](u]]v v R}u]v B (}} }o}]vP b ]v lbU }}l]b v b}L ]vlbX Ob]}voo˙ P]vo o]vP u˙ u]blv(}Ru]X .v] D uvvb}vRbX sueCa Glomerular yy Go}uo}vR]bboo˙bvb`]R˙bu}R]o}}oob ]vR]v}o}}oobb`]R}]v] Non-Glomerular yy URPTuUIv(}v yy BoP Iv(}vU }v b U o vU ]bU BPHU }b vP}v~˙o}R}bRu]]}v Z ˙bbUb] ]v(b}v~ S. haematobiumZ yy UPIv(}vU}v b Uu} yy K]v˙P Iv(}v ~˙o}vR]bZU }v b U v}u] v}uo]b ~P}o˙˙b K]v˙ D]bbU rV A F]boZ vo ]v } ˙ R}u}b]bU yy N}obubPRvooo]v}u~W]oubTu}Z yy Tu yy Sickle cell disease yy Bv]PvP}bH˙ob]~BPHZ Standard yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw ]v}u C }(}bUovl]v˙ U]v˙]v(}v U]v˙oo] M]oXP b Xb]looo]bbUPo}uo}vR]bv v}PovR˙ v*Haematuria*v Symptoms yy FbPPbb]v(}vXPX˙o}vR]bU˙bbv}bb yy C}o]l˙Gvl]vbPPbb]v˙}vb b yy Ab}]o}`]v˙˙u}ub b bPPbo}}b cause yy Bo}}]vR]v~}v]v]}vUu]˘`]RR]vU} Rv }(b]vP]vZ yy P]vl]b}u(} }v b]vP ]v boo˙ b}] `]R ]v(}vU oo]}u yy P]vob]vu]'v b Ru]b}]`]RvbPo and kidney cancers yy L}Ù]v˙TS˙u}ub~LUTSZ yy L}]v]v Signs yy Poo} yy A}u]voubbXPXl]v˙Uo yy L}`}]b vvb(}u b ]v˙]v(}v}oob Invtiga se tions yy FBCvb]lo]vPb~Ho}R}b]b](b]lo]vP]bb }b]Z yy Bo}}Uo}o˙vv]v yy U]vo˙b]b yy U]vovbvb]]˙ yy A}u]vovo]ob}v Trtme ae nt Tuv}ib yy T}vo˙]vPb yy T}o]vP b Non-pharmacological treatment yy H]PR G] ]vl]b ]b ]v }}vo} (}u}v ]v R urinary bladder yy I(vbvb`]Ro}v}vURvR]bv( Pharmacological treatment AXF}U]v˙SR]b}b}u]b]b ]v E RvPPA yy P]voU}oU ~Sb}v}vRU]v˙SR]b}b}u]b]b[Z Chatep rP *Disorsof der theKidneyandGenitourinayr System BXF}U]v˙TIv(}v yy G]}]v]}b~Sb}v}vRU]v˙TIv(}v[Z Refeal r Criteria R(oo}Rb òobR}b`]Rb]bvRu](} }]]vbP}vbvuvX 159.U]v˙SR]b}b}u]b]b ı v*Urinayr Schistosomiasis*v TR]b ]b `r}v ]bb b ˙ v}v }( R bl]v } u}b uuvb ˙ R o˙ Pb b }( R b }Pv]bu (Schistosoma haematobiumZU`R]R]vRo(}u'ob b ]vRo}} bob }( R ]v˙ o bovP ]v R }uu}v bv}v }( Ru]X TR]b ]bb ]b }uu}v ]v GRv `]Rob vu] b o}vP R olbU bo}`rG}`]vP ]b v ]]P}v ˙bb ubX TR }uu}vb }˙b]b+RoUbvo]}PvbXPv}v v]ob}]]vP}v`]R]v(b`X CR}v] ]v(b}v u˙ o } b vu]U ] ]b vR˙}vR}b]bbòo]v}u b }(RoX useCa yy Schistosoma haematobium Symptoms Iv]o yy IR]vPvvbb}(bl]vb]}(v}v}(b] yy FPU o}` P (U uo]bU obb]U ˘bb] `vP b U headache and backache Later yy Tu]voRu] yy P]v(o]v}v~˙b]Z yy L}`}u]vo]v~o]vZ Signs yy Poo} yy Pool]v˙(}uR˙}vR}b]b}]]b yy Poo o (}u o v } v}v }( ]v } clots or bladder neck stenosis yy DRE u˙ o .}b }bU voP bu]vo b]o } thickened bladder base Invtiga se tions yy FBC yy U]v (} o}} oobU b oobU v bR]b}b}u } ~u]r˙ ]vb]uv(o˙lvLR˙b]o˘]b]b]oZ yy M]bu]v(}o]vb}]]v˙]v(}vb yy IuP]vPP Uob}v v b V Ivv}b U}Pu ~IVUZ u˙ bR}` Standard Trtme ae ntGuidelinesUwthEditionUw o].}v}(oUbUR˙}vR}b]bvR˙}b Trtme ae nt Tuv}ib yy T}o]u]vR}Pv]b b u yy T}uvPR}uo]}vb Non-pharmacological treatment yy }] A ˘}b}]v(b`}]b](}bb]o Pharmacological treatment ]v E RvPPA yy P]voU}oU Adults and Children uP llPb]vPo}b yy v*Pesis r tentorRecurentUrethralDischager *v Tvu]](bv~Sb}v}vRAvu][Z Refeal r Criteria R( v L uv ](P Ru] vl } ˙u}ub b }( ]v˙ ]v(}v b]b } ]( }uo]}vb o]l R˙}vR}b]bU o ubbU v}v }( ]vU b `bvP v vu] b bvX 160.Pb]bv}RvURoD]bRP ~S }v b }v RSTIro b]bv } v Ro ]bRP[ZX 161.Rv}v}(U]v Rv}v }( ]v ]b ]v]o]˙ } u˙ (oo oX I ]b R }uu}vb }o}P]o uPv˙ ]v GRv v `}o`]X Ao uob u} }uu}vo˙ +X I ]b ]v R]ov v ]v (uobX TR b ]+ ]v ]+v P P}b b òo b ]v uob v (uobX A (u]o˙R]b}˙}(v}v}(]v]vBv]PvP}bH˙ob]~BPHZU }bvUvb v}]vv]bl(}bX Rv}v}(]vvobb].]v}RP Xv}v A }(U]v]b}(bv}vb`]Roov oX XCR}v]Rv}v}(U]v]b}(]vb]]}b}vbvbvb`]R oov}vrvov}G}`]v}vvvbovP]vu} uP} R oUb v l]v˙bX P}brvovo (]ou˙ }uo]R]b˙}(v}v`]RR˙}vR}bbvR˙}bX Xr}v A rR}v]v}v}(]v]b`RvR}v]v}v}( ]v]bbvo˙}uo]˙v}v}(]vX Chatep rP sueCa yy yy yy yy *Disorsof der theKidneyandGenitourinayr System Aouobr~}æ˙bZPBPHURo]bb Uovl stenosis Ao uob r ~o}` æ ˙bl˙}vP uobZP Ro ]bb U Ro ]vi]bU o vl v}b b ]bU v}Pv] olb]vo ]vi˙UR]u}b]bURoo]U}bb Mo R]ov r }b]}RoobU uov}b b ]bU R]u}b]bU Rooo]U}vPv]o]bb Ao (uob r}P] bU ]v .}]blu˙}ubU ]u }]v ˙bbU v}Pv] ~}b} v o] ]vGuu}˙ ]bbZU]v}u }( ]˘ `]R ]v.o}v ]v} R urethra Refeal r Criteria Pvb `]R R˙}vR}bb }v ob}v vb v vo (]o bR}o(}b]o]bX v*RetentionofUrine*v Symptoms yy Rv}v }( ]v ]v BPH ]] ˙ }b}vuv }( u]]}vUo}R}obv]v(}v yy Sv ]v]o]˙ } b ]v `]R ]v(o oP ]v o}` }uv (}v}v}(]v yy Go }vb }( ]v]o]˙ } b ]v `]R ]vobb oP ]v o}` }uv(}R}v]v}v}(]v yy H]b}˙ }( R]bU Ro ]vbuv}v ~XPX R]b}vZ }]vo]vi˙Uo](}P˙ b ]vRo]bb yy Ivv}voP}bS˙u}uS}~IPSSZ Signs yy Poovo]vv}v}(]v yy Poov}vrvo(}R}v]v}v}(]v yy Uu]lA}u]]vvo(]o yy F]v]v(}vbPUTIv}bb yy Pool]v˙b]vR˙}vR}b]b yy Hu]]vBPHU}bvvRo]bb Chapter SexuallyTransmitted Infections 162.S˘oo˙Tvbu]'Iv(}vb]vAob S˘oo˙ Tvbu]' Iv(}vb ~STIbZ bo ]v ob o]v]o ˙v}ub b b ˙ }Pv]bub R v ] v vbu]' R}PR˘o b ]˙X TR˙ b u}]]˙ ]v ob v u˙ bo ]v o}vPru }uo]}vb bR b Ro ]b U ]v(o]˙U }] Pvv˙U vo .boU ]o vU (}o `bPU u]˙U o}` ]R `]PRU }RRou] v}v}u v }vPv]o ˙R]o]b b X TR] }v}o ]b R }vb}v ]v ]u}]vP } RoR v ]vP Huv Iuuv}.]v˙V]b~HIVZ]v(}vbX C}uRvb] uvPuv }( STI ]b ]u}v v }u]bb }u v + b }v v uvX H}Ù }`]vP } Rol}(o}}˙]uvvuv}`]v]u˙(]o]b `R u}b vb .b bvU v ]Pv}b]b ]b }Lv v} }bb]oX Aob} `]R u}b STIbU }v vv} boo˙ oo `R]R }Pv]bu ]b b]vP R ]v(}v (}u R R]b}˙ v R˙b]o ˘u]v}v o}vX Moo]v(}vbob}}U`]RRv]vP}XF]o} }v ]v(}vo˙ u˙ bo ]v R o}uv }( b]}b }uo]}vbX I]bR(}u}o]vuvP]vPSTIb}uv b }v Rb˙v}u]]Pv}b]b[U`R]R]v.booSTIbR}oob ˙u}u b }b]Pvv}]uv(}R}(Rub]uov}bo˙X TR}uu}vo]v]o˙v}ub b b}]`]RSTIb]voRo ]bRP ]v uobU b]bvlv Ro ]bRPU P]vo ]bRPU o}` }u]vo ]vU Pv]o oU }o b òo]vPb b U ]vP]vo o˙uRv}R˙ ~}bZU v}ro ˙v}ub b ~v}ro ]bRPUobvb]obZUvPv]o`bXS]bv]o}b]b ]bu˙ob}vbu]'˙˘o b }vX Iv o]vP `]R vb `]R STIU ]˙ v }v.vo]˙U b]oo˙`]RRR]b}˙l]vPv˘u]v}vUu}vX }v E v }vboo]vP }( STI vb v }vv uvPuv}(R]vb}]]}vo}}v]b} R]bl}(STI]vR}uuv]˙X v Chatep rvP *SexuallyTransmittedInfections ~S b}v }v RS˘oo˙ Tvbu]' D]bb ]v CR]ov[ (} STIb ]vR]ovZ 163.STIroURoD]bRP]vMob Ca s e u yy Neisseria gonorrhoea~G}v}}oR]bZ yy Chlamydia trachomatis~N}vrP}v}}oR]bZ vX Mycoplasma genitalum Note 16-1 Gvou]ol]vP}(RRu˙oR]bRP](]]bv}]v]oo˙]b]oX Iv v]u]b uobU Rl R R ]bRP ]b }u]vP (}u R Ro }v]vPvv}(}uRPovbv]bX Inve ti s gations yy URo`b ovbvb]]˙~](]ooZ Tre a tment Treatment }i es yy T}P}v}R}vRou˙]R]bb]uov}bo˙ yy T}v(Rvbu]bb]}v}˘o b vbX yy T}}Rvbb]uov}bo˙buRb}bb]o yy T}vo}uv}(}uo]}vbvbo yy T}]bl}(HIV]v(}v Non-pharmacological treatment yy None Pharmacological Treatment ]v E RvPPC AXF}G}v}R} yy L]˘}v C UIMUæuPb Or yy .˘]u C U}oUuPb Or yy C]}G}˘]vU}oUæuPb Av v*STIrrelatedUrethralDischager inMales*v Sympt oms yy URo]bRP yy D˙b]}]b}u(}}v]v}v Signs yy URo]bRP Standard B. yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw For Chlamydia and Mycoplasma: D}˘˙˙o]vU}oUuPR}o˙(}˙bw Or T˙o]vU}oUæuPvR}o˙(}˙bw Or E˙R}u˙]vU}oUæuPvR}o˙(}˙bw Or A]R}u˙]vU}oUPX b 165.STIroPb]bv}RvURoD]bRP v*STIrrelatedPesis r tentorRecurentUrethralDischager *v TR]b u˙ } } P b]bvU }} uv }uo]v } r]v(}v (}oo}`]vPuv (} v STIX Iv b}u b ]bv }(Ro]bRPu˙}]v(}v`]R Trichomonas vaginalisX Ca s e u yy Neisseria gonorrhoeaeU Chlamydia trachomatis or Mycoplasma genitalum(}oo}`]vPPb]bvU}}}uo]v}r]v(}v Luv yy Trichomonas vaginalis Tre a tment Treatment }i es yy T} r(} P}v}}o } v}vrP}v}}o R]b ]( b }}]}b}}uv}uo]v}r]v(}v yy T}]v(}v`]R Trichomonas vaginalis yy T}vvbu]bb]}v}˘o b vb yy T}}Rvbb]uov}bo˙buRb}bb]o yy T}vo}uv}(}uo]}vbvbo yy T}]bl}(HIV]v(}v Non-pharmacological treatment yy None Pharmacological Treatment ]v E RvPPC AXF}G}v}R}UCRou˙]UM˙}obu Ruv(}Ro]bRP B. yy yy yy yy For Trichomonas vaginalis M}v]}oU}oUuPR}o˙(}˙bw Or M}v]}oU}oUPX b Or T]v]}oU}oUPX b Or Sv]}oU}oUPX b Chatep rvP *SexuallyTransmittedInfections Refeal r Criteria R( oo b }( uv (]o } RoR (]o]˙ `R u]}]}o}P]oovvu]}]obvb]]˙bv}v}v RRo]bRPX 166.STI-related Vaginal Discharge æ v*STIrrelatedVaginalDischager *v WR]oP]vo]bRP]bv}oo]v]o(}(vSTIUv}oo (}ub}(P]vo]bRPv}uo}]v]}(vSTIXAP]vo ]bRP u˙ b}] `]R R˙b]}o}P]o b R b uvbb } Pvv˙U } `]R R bv } b }( (}]Pv vbb v Ru]ob]vRP]vX A (o ]bl buv ~S v} o}`Z }( `}uv `]R P]vo ]bRP u˙ Ro ]v(˙ STIb v v}vrSTIb v bo}v }( }]uvP]uvb}v b Ru}bo]lo˙}o}P˙}(R P]vo ]bRPX OR }vb]}vb (} bovP uv ]vo Pvv˙bvv]b}u(}X sueCa yy Neisseria gonorrhoea yy Chlamydia trachomatis yy Trichomonas vaginalis ~Pv } ˙oo}Ù buoo˙U o˙ } (}R˙ ]bRPb}]`]R]R]vPZ yy Hbb]uo˘]b~(}oo}`]vP.b]b}}(]v(}vZ Sympt oms yy VP]vo]bRPrRvP]v}o}U}}U}vb]bv˙}u}v yy Vooòo]vP b yy P]v}v]v}v yy L}`}u]vo}l]v Signs yy VP]vo]bRP yy Vooòo]vP b yy Voo˙Ru yy L}`}u]vovvbb yy C]o˘]}vvvbb yy C]ou}b}}b]}vb~}vbou˘u]v}vZ Inve ti s gations yy H]PRP]vo`b (}u]}b}˙Uovbvb]]˙~](]ooZ Tre a tment Treatment }i es yy T}]v(˙vv}vrSTIP]v]b~b]oo˙v]]b]bU`R]R]b (vo˙]Pv}b]v`}uv]vPo(}STIbZ yy T}bSTI]blvSTIro]v(}vb}]o˙ yy T}v}uo]}vbvbo Standard Trtme ae ntGuidelinesUwthEditionUw yy T}}Rvbb]uov}bo˙buRb}bb]o Non-pharmacological treatment yy N}v(}STIro]bRP Pharmacological Treatment ]v E RvPPC v*STIrrelatedVaginalDischager *v Note 16-2 R]blAbuv Pubb]vR]blbuv(}]]bP ]XPv[bv]b˙u}u b ~]XXvRbRo]bRPZ ]]XPv]bobbRv˙b}o ]]]XPv]bb]vPo ]XPvRbu}Rv}v˘o b v XPvRbRv`˘o b v]vRobu}vRb TR ]bl buv ]b b] } }b] v uv (} ]]b ]b }uuv]( rTRvb`}~]Z]b˙b} rTRvb`}v˙}(]ub~]]Zr~Z]b˙bX I(`}uvRbP]vo]bRP`]Rv}}b]]bl(}U(}P]v]b o}vX I( bR Rb P]vo ]bRPU v }b] ]bl (}U (} }R P]v]bv]]b AXTuv(}]R}u}v]b]bv]oP]v}b]b yy M}v]}oU}oUPX b ~}v]v]]vPR]ub b }(Pvv˙Z Or yy M}v]}oU }oU uP R}o˙ (} æ ˙b ~}v]v] ]vPR]ub b }(Pvv˙Z Or yy Sv]}oU }oU PX b ~}v]v]]vP R b ]ub }(Pvv˙Z Or yy T]v]}oU}oUPX b ~}v]v]]vPR]ub b }( Pvv˙Z Or yy Co]vu˙]vu~A9ZU}]o~(]vPvv˙Z Av B. yy yy yy Treatment for candidiasis M]}v}oP]vo obU uP ]vb ]v}P]v v]PR (} ˙b O Co}]u}oU P]vo obU uP ]vb ]v} P]v v]PR (}˙b And Co}]u}ouUo˙R}o˙~(}oo]]}vZ C. yy Treatment for gonorrhoea L]˘}v C UIMUæuPX b yy yy v r Chatep rvP yy yy *SexuallyTransmittedInfections Or .˘]u C U}oUuPb Or C]}G}˘]vU }oU æ uP X b ~}] ]v Pvv v ovP u}RbZ Av D. yy 167.STIroL}À}u]voP]v]vW}uv Ca s e u yy Neisseria gonorrhoea yy Chlamydia trachomatis yy Av}]]~}LvovP}v]v(}vbZ Sympt oms yy L}`}u]vo]v yy P]v`]R˘o b ]v}b~˙bv]Z yy VP]vo]bRP yy D˙b]}Ro]b}u(} yy F Signs yy L}`}u]vovvbb yy VP]vo]bRP yy Tvvbb }v u}]vP R ]˘ ~]o ˘]}vZ }v ]uvo P]vo˘u]v}v yy Av˘ovvbb yy Av˘oubb Inve ti s gations yy H]PRP]vo`b ovbvb]]˙ w v*STIrrelatedLowerAbdominalPaininWomen*v Treatment for chlamydia D}˘˙˙o]vU}oUuPR}o˙(}˙bw ~}]]vPvvv ovPu}RbZ Or yy T˙o]vU}oUæuPvR}o˙(}˙bw ~}]]vPvvv ovPu}RbZ Or yy E˙R}u˙]vU}oUæuPvR}o˙(}˙bw Or yy A]R}u˙]vU}oUPX b Refeal r Criteria R( oo b }( v P]vo ]bRP vl} uv (]ob } RoR (]o]˙ `R bou ˘u]v}v v ] } v u]}]}o}P]o ov vu]}]o bvb]]˙bv }v}vRP]vo]bRPX yy Po]ob}v Standard Trtme ae ntGuidelinesUwthEditionUw Tre a tment Treatment }i es yy T}(}P}v}R}URou˙]vv}]]o]v(}v yy T}o]]vv]vGuu}v Non-pharmacological treatment yy Ru}IUDU](bvU˙bL]v]}v}(PR˙ Pharmacological Treatment ]v E RvPPC AX yy yy yy v*STIrrelatedGenitalUlcer*v yy O t-Pvb .˘]u C U}oUuPX b Or C]}G}˘]vU}oUæuPR}o˙(}˙b Av D }˘˙˙o]v U}oUuPR}o˙(}˙b vA M}v]}oU}oUuPR}o˙(}˙b B.In-Pvb yy L]˘}v C UIMUæuP]o˙(}˙b Av yy D}˘˙˙o]vU}oUuPR}o˙(}˙bw Av yy M}v]}oU}oUuPR}o˙(}˙bw 168.STIroGv]oUo Ca s e u yy Hbb]uo˘ yy Treponema pallidum~b˙R]o]bZ yy Haemophilus ducreyi~Rv}]Z yy Calymmatobacterium granulomatis~Pvo}u]vP]voZ Sympt oms yy Gv]oo~]v(o}]vobbZ yy URo]bRP yy IvP]voòo]vP b ~o˙uRv}R˙Z Signs yy IvP]voo˙uRv}R˙ yy Hbb]uo˘ yy MooUvb]oob]}vb~Hbb]uo˘Z yy S˙R]o]ob yy OLv b]vPoU ]vobb v ]v ob]}vb `]R o b vòor.vPb yy yy yy Chatep rvP *SexuallyTransmittedInfections Ob]}voo˙ uooU ]v(oU v}vr]v } R lent base yy D]bU.uU]vobbU]vP]voo˙uRv}R˙`lL R]u˙ob]}v yy P]u˙ o boo˙ Rob `]R]v b]˘ `lbU boo˙ `]R} o]vPX b Chancroid yy P]v(o`]Rvu]vPPPb yy TR b ]b }`]R ov˘v b]o˙ ob to touch yy Soobu˙}ob}(}ub]P]v}bob]}vb yy L˙uRv}R˙ ]b boo˙ v]oo v u˙ }u G tuant Gvo}u]vP]vo yy BP]vb `]R buoo o R }Pbb ]v} v voP]vP Pvo}u}bo`]Ru yy Pb E òo.v yy Ho]vP ]b v} b}vv}b v ]b }uv] ˙ ˘vb] ]vP b X A yy yy yy yy yy yy For Herpes simplex A]o}]U}oUuPrvR}o˙(}wr˙b~æ}bb]o˙Z Or A]o}]U}oUuPR}o˙(}wr˙b F}]v]]ob`]RRbvHIV}r]v(}v A]o}]U}oUuPR}o˙(}wr˙b Or A]o}]U}oUuPR}o˙(}wr˙b Episodic therapy for recurrent episodes A]o}]U}oUuPR}o˙(}æ˙b Or A]o}]U}oUuPR}o˙(}æ˙b Or ı r v*STIrrelatedGenitalUlcer*v Inve ti s gations yy VDRL~](]ooZ yy TPHA~](]ooZ Tre a tment Treatment }i es yy T} buoo ob v b]obU b]oo˙ ]( v (} Hb b]uo˘ yy T} ]]v]o uvPuv}( oo ob Rb b]uo˘U˙R]o]b b and chancroid concurrently Non-pharmacological Treatment yy Kob]}vb˙vov Pharmacological Treatment ]v E RvPPC r Standard yy yy B. yy yy yy yy yy v*STIrrelatedScota r lSwelling*v yy C. yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw A]o}]U}oUuPR}o˙(}˙b Sbb]R˙]vHIV]v(]v]]ob A]o}]U}oUruPrR}o˙(}rv˙b For Syphilis BvR]v Pv]]oo]v GU IMU X MU ]v R '}l ~}o }b X MUX Zb Or P}]vPv]]oo]vA}bUIM~˙]vi}vZUXMU]o˙(} ˙b F}b}vbooP]}v]]oo]v D}˘˙˙o]vU}oUuPR}o˙(}˙b Or T˙o]vU}oUæuPvR}o˙(}˙b F}Pvv`}uvooP]}v]]oo]v E˙R}u˙]vU}oUæuPvR}o˙(}˙b Or A]R}u˙]vU}oUæuP]o˙(}˙b For Chancroid L]˘}v C UIMUæuPX b Or A]R}u˙]vU}oUPX b Or C]}G}˘]vU}oUæuPR}o˙(}˙b Or E˙R}u˙]vU}oUæuPvR}o˙(}˙bw 169.STI-related Scrotal Swelling Ca s e u yy Chlamydia trachomatis yy Neisseria gonorrhoea yy Treponema pallidum~˙o˙Z Sympt oms yy S}oòo]vP b yy Scrotal pain yy URo]bRP yy D˙b] yy Fv˙}(u]]}v yy F Signs yy S}oòo]vP b U}uvl}˙Ru yy Scrotal tenderness yy URo]bRP æ Chatep rvP *SexuallyTransmittedInfections yy AX yy yy yy B. yy yy yy F}G}v}R} L]˘}v C UIMUæuPX b Or .˘]u C U}oUuPX b Or C]}G}˘]vU}oUæuPX b Av For Chlamydia D}˘˙˙o]vU}oUuPR}o˙(}˙bw Or T˙o]vU}oUæuPvR}o˙(}˙bw Or A]R}u˙]vU}oUPX b Or E˙R}u˙]vU}oUæuPvR}o˙(}˙bw 170.STI-related Inguinal Bubo Ca s e u yy Chlamydia trachomatis~L˙uR}Pvo}uvuZ yy Haemophilus ducreyi~CRv}]Z Sympt oms yy P]v(o}]vobb]vP]vobòo]vP~bZ Signs yy IvP]voòo]vPb b P yy unilateral or bilateral yy v}v}vrv æ *v yy v*STIrrelatedInguinaloBub F Inve ti s gations yy URo`b (}o yy U]vovbvb]]˙ yy Uob}vv b }(R}u b Tre a tment Treatment }i es yy To provide pain relief yy T}]v(˙vSTIvv}vrSTIo}]o˙ b yy T}(}P}v}RvRou˙]b]uov}bo˙ Non-pharmacological treatment yy b B yy S}ob}vo]vGuu}vv(b] Pharmacological Treatment ]v E RvPPC Standard yy Trtme ae ntGuidelinesUwthEditionUw yy Gv yy vP b Genital ulcer v*STIrrelatedGenitalWatsr *v Inve ti s gations yy N}]vbP}vb]U]v]`}(R˙v}u] b }R yy R}uuv]vuvP]vPSTIb Tre a tment Treatment }i es yy To relieve pain yy T}o]Ròo]vP b yy T}R]v(}v}(o˙uR}Pvo}uvuvRv}] concurrently Non-pharmacological treatment yy Ab]}v }( Gv }b b]vP `] } vo R}PR iv RoR˙ bl]v ˙ }v b } R] ˙X Av ]v]b]}v v ]vP bR}o v} 'uX I( }b b]bU R v bR}o(X yy SobR]bb vl}.bou˙]P˙ b X Pharmacological treatment X A yy yy yy F}L˙uR}Pvo}uVuv~LGV RCv}]Z ]v E RvPPC D}˘˙˙o]vU}oUuPR}o˙(}˙b Or A]R}u˙]vU}oUPX b Or E˙R}u˙]vU}oUæuPvR}o˙(}˙b 171.STI-related Genital Warts Ca s e u yy Huv]oo}u]b Symptoms yy Uboo˙v}˙u}ub b yy Suoo]vobòo]vPb b ]vRv}rPv]oP]}v yy IR]vP}]b}u(}]vRPv]o yy M˙b]vbP]vo]bRP yy Avo}P]voo]vP]vP}L˘b Signs yy SuooU GU oU voU GbRr}o} òo]vPb b }v R bl]v v u}b uuvb }( R Pv]ob ~v]bU oU P]vU ]˘URU]voP]}vZ æ Chatep rvP *SexuallyTransmittedInfections Note 16-3 D}v}bTCA]vPPvv˙vo}vX D}v}bP}}R˙oo]v}TCA}v]o`bX 172.STIroAv}roRoS˙v}ub sueCa yy yy yy C. Trachomatis HbS]uo˘V]br~HSVrZ NXG}v}R} æ v*STIrrelatedAnorrctae lRelatedSyndome r s*v Inve ti s gations yy ]A b}o}v~]vPbZ Tre a tment Treatment }i es yy T}o]u]vR`b Non-pharmacological treatment yy P} v}uo bl]v `]R bo]v ~8vZ `R]o o˙]vP P}}R˙oo]v yy E˘vo Pv]o v ]vo `b bR}o `bR R}}PRo˙ r R}b L o]}v }( P}}R˙oo]v v vr R}b L o]}v}(Iu]]u}X yy C˙}R˙ `]R o]] v]}PvU b}o] }v ]}˘]U } ˙}}XRo]}vb˙r`lb yy Eo}bP˙ yy SP]ou}o Pharmacological treatment ]v E RvPPC yy P}}R˙oo]vræA9v}(v}]vU}]oUo˙]o˙}R `b}]]vPv}uobl]vbX yy P}v}uobl]v`]Rbo]v~8vZX Ruv`lo˙]vobvo}uob}o}vX Or yy T]Ro}}A]~TCAZ~rıA9ZU}]oU o˙ (oo˙ } R `b }]]vP v}uo bU (}oo}` ˙ }`]vP}(R`]Rou}`}u}v ]X Ruv`lo˙]vobvo}uob}o}vX Or yy P}}R˙oo}}˘]vU XæA9U }]oU o˙ R}o˙ R ub `l (}`lb Or yy Iu]]u}U æA9 uU }]oU o˙ R ub `l (} v `lbXSR}o`bRvrR}bLo]}vX Standard Trtme ae ntGuidelinesUwthEditionUw Treponema pallidum Symptoms yy Avo]bRP yy RoBo]vP yy P]b yy Ro]vU yy Tvbub yy C}vb}v Signs yy Anal ulcers or blisters yy AvoP}`R yy Tvvbb}vo˘u]v}v yy Avo]bRP}o]vP Trtme ae nt Tuv}ib yy To relive pain yy T}(}Rui}b]uov}bo˙ Non-pharmacological treatment yy Kob]}vb˙vov Pharmacological treatment yy v*STIrrelatedAnorrctae lRelatedSyndome r s*v AX F}v}o]bRPU(}P}v}RvRou˙] ~Sb}vb}Z B. For anorectal ulcers or vesicles F}]bb }}(b]oob]}vb(}Rbb]uo˘]b A]o}]UuPUrvR}o˙(}˙bw ~æ}b˙b Z Or A]o}]UuPUR}o˙(}˙bw E]b}]uv(}vHSVb]oob]}vb}b }v.b˙}(v}(ob]}vb A]o}]UuPUR}o˙(}æ˙b Or A]o}]UuPUR}o˙(}æ˙b Or A]o}]UuPUR}o˙(}˙b Av yy yy yy yy yy C. yy yy For Syphilis BvR]v Pv]]oo]v GU IMU X MU ]v R '}l ~}o }b X MUX Zb Or P}]vPv]]oo]vA}bUIM~˙]vi}vZUXMU]o˙(} ˙b Or æ Chatep rvP D. yy yy yy E. yy yy yy *SexuallyTransmittedInfections For persons allergic to penicillins D}˘˙˙o]vU}oUuPR}o˙(}˙b Or T˙o]vU}oUæuPvR}o˙(}˙b Or E˙R}u˙]vU}oUæuPvR}o˙(}˙b vA For Chlamydia D}˘˙˙o]vU}oUuPR}o˙(}˙bw Or T˙o]vU}oUæuPvR}o˙(}˙bw Or E˙R}u˙]vU}oUæuPvR}o˙(}˙bw vA For Chanchroid L]˘}v C UIMUæuPX b Or yy A]R}u˙]vU}oUPX b Or yy C]}G}˘]vU}oUæuPR}o˙(}˙b Or yy E˙R}u˙]vU}oUæuPvR}o˙(}˙bw Refeal r Criteria I( R ˙u}ub b } ob]}vb } v} ]u} Luv (} RoR(]o]˙`]Ru]}]}o}P˙b}(}}]uvv ˘ob]}v}(}R}b ˘o}RbX v*SexuallyTransmittedInfectionsinChildren*v F. yy 173.S˘oo˙Tvbu]'Iv(}vb]vCR]ov N}vbU ro v o R]ov ob} ]bl }( }vvP STIbX TR u}b }(vbu]bb]}v ]v Rb R]ov u}bo˙ R}PR uvo ]v(}vbU ˘o b b } ˘o}]}v v }ov˙ ˘o b ]˙ ]v }o R]ovX TR STob ]v R]b P P} ]vo v}vo }viv]b ~}RRou] v}v}uZU v }R STIro ˙v}ub b b]u]o}R]vobX S}u }( Rb STob ~XPXU P}v}RU ˙R]o]b b U v Rou˙]ZU ]( ] L R v}vo ]}U ]v] }( ˘o b }vX F} }RSTobU~XPXHPV]v(}vbvP]v]bZURb}]}v`]R˘o b }v]bv}oX wX STIroN}voC}viv]b~ORou]N}v}uZ ~Sb}v}vRN}voC}viv]b[vN}voD]b}bZ ææ Standard Trtme ae ntGuidelinesUwthEditionUw MvPuv}(b].STIvSTI˙v}ub b ]vR]ov 175.STIroURoD]bRPS˙v}u]vCR]ov v*STIrrelatedUrethralDischager Syndome r inChildren*v AXF}G}v}R ChildrenAM˙b~}R]oAMælPZ yy L]˘}v C UIMUæuPX b ChildrenAN˙b~}R]oANælPZ yy .˘]u C U}oUuPX b Or yy L]˘}v C UIMUæuPX b Av B. yy yy yy yy For Chlamydia ChildrenAM˙b E˙R}u˙]vU}oUXæuP llPvR}o˙(}˙b ChildrenAN˙b A]R}u˙]vU}oUPX b Or D}˘˙˙o]vU}oUuPR}o˙(}˙bw Or E˙R}u˙]vU}oUæuPvR}o˙(}˙bw 176.STI-related Vaginal Discharge Syndromes in Children N}vr E˘u]v}vbR}o ]}`]R} bouXIvP]vouv ]b v}}uuv (} ˙}vPP]obX Oouvu˙ u}}] X r Non-pharmacological treatment yy EvbP}}Pv]oR˙P]v yy Ev}Pb}(o}}bv` yy D˙v`]vRbv}]}v`]RR}o yy EvbP}}]rvoR˙P]v yy }] A }R]vP`]RRo}Ru]o}vb yy }] A u]b}b Pharmacological treatment A X F} VP]v] b ~ T ] R } u } v ] b ] b v B ] o P ] v } b ] b Z ChildrenAM˙b~}AMælPZ yy M}v]}oU}oUwXæuP llPR}o˙(}˙bw ChildrenAN˙b~}ANælPZ yy M}v]}oU}oUuPR}o˙(}˙bw æv Chatep rvP yy *SexuallyTransmittedInfections Or M}v]}oU}oUPX b vA Note 16-5 IvP]vo uv ]b v} }uuv (} ˙}vP P]obX Oo uv u˙u}}]X Av C. yy yy yy yy yy yy yy For ]]b C F}G}v}R ChildrenAM˙b~}AMælPZ L]˘}v C UIMUæuPX b ChildrenAN˙b~}ANælPZ .˘]u C U}oUuPX b Or L]˘}v C UIMUæuPX b Av F}CRou˙] ChildrenAM˙b E˙R}u˙]vU}oUXæuP llPvR}o˙(}˙b ChildrenAN˙b A]R}u˙]vU}oUPX b Or D}˘˙˙o]vU}oUuPR}o˙(}˙bw Or E˙R}u˙]vU}oUæuPvR}o˙(}˙bw 177.STIroL}À}u]voP]v}Po]IvGuu}˙D]bb Syndrome in Children yy yy yy yy CR]ovAM˙b~}AMælPZ L]˘}v C UIMUæuPX b Av E˙R}u˙]vU}oUXæuP llPvR}o˙(}˙b Av M}v]}oU}oUwXæuP llPR}o˙(}˙b CR]ovAN˙b L]˘}v C UIMUæuPX b Av æw v*STIrrelatedLowerAbdominalPainorPelvicInflammatoryDisseSynd a ome r inChildren*v B. For Candidiasis yy Co}]u}o A9 uU }]o ~P]voZU o˙ r R}o˙ (} w days Or yy Fo}v}oU}oUrvuP llPX b Standard yy yy Trtme ae ntGuidelinesUwthEditionUw D}˘˙˙o]vU}oUuPR}o˙(}˙b vA M}v]}oU}oUuPR}o˙(}˙b 178.STIroGv]oUoS˙v}u]vCR]ov v*STIrrelatedGenitalUlcerSyndome r inChildren*v AXF}S˙R]o]b yy Bv˙ov]]oo]vUIVU Children AN˙bV æUv]bllPrvR}o˙(}˙b AM˙bV æUv]bllPrvR}o˙(}˙b Or yy P}]vv]]oo]vUIM~ZU Children AN˙bV XMU]o˙(}˙b AM˙bV æU IUllP ]o˙ (} ˙b ~u˘X ]o˙ }b wæUv]bZ Or yy BvR]vPv]]oo]vUIMU AN˙bV XMU]v}R'}l]vP}vo]v]]b]~}o XMUZ F}b}vbooP]}v]]oo]vP yy D}˘˙˙o]vU}oUuPR}o˙(}˙b Or yy T˙o]vU}oUæuPvR}o˙(}˙b Av B. yy yy yy yy yy yy C. yy For Chancroid ChildrenAN˙b .˘]u C U}oUuPX b Or A]R}u˙]vU}oUPX b Or D}˘˙˙o]vU}oUuPR}o˙(}˙bw Or E˙R}u˙]vU}oUæuPvR}o˙(}˙bw ChildrenAM˙b~}AMælPZ L]˘}v C UIMUæuPX b Or E˙R}u˙]vU}oUXæuP llPvR}o˙(}˙bw Av For Genital Herpes Simplex A]o}]U}oU Children æ Chatep rvP yy *SexuallyTransmittedInfections AN˙bV uPrvR}o˙(}æ˙b u}vRr˙bV uPrvR}o˙(}æ˙b F}Iv(vb`]RKv}`v}SbN}voHb A]o}]UIVU ChildrenAMu}vR uP llP˙ R}b (} ˙b ~ (} ]bb o]u]} R bl]v vu}buuvbZ Or uP llP ˙ R}b (} ˙b ~(} ]bbu]v v CNS ]b bZ r 179.STIroAv}rRoRoS˙v}ub]vCR]ov v*STIrrelatedAnorRectalRelatedSyndome r sinChildren*v Anorrctae lDischager AXF}G}v}R ChildrenAN˙b~}ANælPZ yy .˘]u C U}oUuPX b Or yy L]˘}v C UIMUæuPX b ChildrenAM˙b~}AMælPZ yy L]˘}v C UIMUæuPX b Av B. yy yy yy yy For Chlamydia ChildrenAN˙b A]R}u˙]vU}oUPX b Or D}˘˙˙o]vU}oUuPR}o˙(}˙bw Or E˙R}u˙]vU}oUæuPvR}o˙(}˙w ChildrenAM˙b E˙R}u˙]vU}oUXæuP llPvR}o˙(}˙b Anorctae lulcsler sic ve les AXF}S˙R]o]b ~S b}vb } v RGv]o Uo S˙v}u ]v CR]ov[ (} uv}(S˙R]o]b[Z B. For Chancroid ~S b}vb } v RGv]o Uo S˙v}u ]v CR]ov[ (} uv}(CRv}][Z C. 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vbub(X Pv}v}(]v(}vu]vbRl˙}]vP]bX b sueCa yy HuvIuuv}.]v˙V]b Symptoms yy Pb]bv}PR yy Pb]bv}v]R} yy W]PRo}bb yy Skin rashes yy Pb]bv}v( yy Mouth ulcers Signs yy W]PRo}bb yy Chronic diarrhoea yy P}o}vP( yy Gvo]bo˙uRv}R˙ v Standard yy yy yy yy yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw O}R˙vPov]]b]b Pb]bv}PR Gvo]bub RvRb}b~obZ CR}v] }Pbb] v ]bbu]v Rb b]uo˘ ]v(}vb ~obZ F]vPv]oRvPbXPXo]b}o}}v}(Rv]ob~obZ F]o}R]}bo}`P}`R~]v(vbvR]ovZ Rv }uu}v ]v(}vb XPX }b u] vR]ovZ U R˙vP]b ~]v(vb Invtiga se tions yy C}v.u}˙HIV ~HIV b UHIVUHIVvZ yy HIV V]oo} yy }v CD yy OR b OR b OR b ] ~S To wr }vPZ~STowr}vPZ~STowr}vPvZ TowrP) Other baseline tests for HIV v*HIVInfectionandAIDS*v Hu}o}P]ob Fooo}}}v B]}Ru]ob Bo}}U Eo}o˙bvv]v C L]Fv}vb FbvPBo}}SP CR}ob}ovo]]}.o R}v˘u]v}vb U]vo˙b]b~U]vRlEZ S}}oRlE Rb]}˙˘u]v}vb TBv]vP b CRbXr˙ S}o}P]oTb S}o}P]oTbHb Souv˙b TRb(}u b v]vP}vb]Pvbv ˙u}ub b H]b}o}P˙}vbl]vvo˙uRv}]}b˙ K]v˙]}b˙ Sv]vP(}STIb PPvv˙b Pbu UHPVDNA Trtme ae nt Tuv}ib yy T} b HIV o]}v } b o}` b }bb]o v (} b o}vP b possible yy T}v b vRvR]uuv(v}v~C}}v bD Z yy T}]u}o]˙}(o]( yy T}u}]]˙vu}o]˙o}HIV yy T}}u}P}`Rvv}o}P]oo}uv]vR]ov v BS(vPv Chatep rwP *HIVInfectionsandAIDS Pharmacological treatment AXSvTuv st L]vTuv TowrP) Standard Treatment (1stL]vTuvZ(}HIVrAIDS Medicines C}v C}uuv C}v`]R Tenofovir in renal ˙b(v}v M}v]}vo(v}v]vo]vP urinalysis TenofovirA=Lu]]v ~}Eu]]]v ~FTCZ + Nevirapine~NVPZ C}v`]R Tenofovir in renal ˙b(v}v Nevirapine is contraindicated in o]˙b(v}vv NVPR˙bvb]]˙ M}v]}vo(v}v]vo]vP urinalysis S}NVP](o]vo}biv] or severe rashes and refer to ART v(}(RuvPuvX Z]}]v ~AZTZA= Lu]]v ~TCZA= Nevirapine~NVPZ Z]}]v is contraindicated in vu] b Nevirapine is contraindicated in o]˙b(v}vv NVPR˙bvb]]˙ TDF}b`RH]bAMP l L}}bANæA9(}uRbo]v o]vo]v}vAZTX S}NVP](o]vo}biv] or severe rashes and refer to ART v(}(RuvPuv Z]}]v Lu]]v (]v E Z]}]v is contraindicated in vu] b TDF}b`RH]bAMP l L}}bANæA9(}uRbo]v o]vo]v}vAZTX P(RP]uv Tenofovir~TDFZA= Lu]]v ~TCZ ~}Eu]]]v ZA= (]v E ~EFVZ AovRP]uv nd TowrP) L]vTuv 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]v(}vb `}l v ob} ob }bb]o HIV ]v(}v (}u ]v( v] oobX W}lo ]vb } ]vi˙˘}b RoR `}lb} }˙ G]b }(vbX R]bl }( ˘}b } o}} v o}} }v R}Pvb ]b bo]PRo˙ R]PR (} RoR b}vvoX TR ]bl }( ]v(}v (} HIV (}u v}b ]vi˙ ]b }˘]uo˙ rA9 v R }( u}b uuvb } v}vr ]v bl]v uR o}`X PEP ]b oo˙ + `]R]v r R}b vv}u}RvwR}bL˘}bX sueCa yy Av ˘}b }vb] b }bb]o ]bl ]b .v b Sv ˘}b (}u}bb]o˙]v(o}}Ub}}R}˙G]bR}PRP yy A v}b ]vi˙ ~XPX vo lb } `]R bR }iZ} yy Au}v}buuv}v}vr]v~RU bl]v}v Z yy TR]bl}(]v(}v}b R]PRLP yy E˘}b}oPv˙}(o}}}}}R]v(}bG ids yy E˘}b} R o}} }( v]v vv HIV ]bb v r Chatep rwP yy *HIVInfectionsandAIDS P b A v}b ]vi˙ } v ]vi˙ `]R R}oo}` }U o}}.oovoX Signs yy None Symptoms yy None Invtiga se tions yy Fooo}}}v yy L]vvo(v}vb yy HbBS(AvPv yy HIV}o}P˙ b }PCR](]oo Trtme ae nt TuvOib yy T}vo]b b Ruv}(HIV]v(}v Non-pharmacological treatment yy C}vboo]vPvTbvPP yy E˘}b RoR `}lb ub ] }vboo]vP v vP b ]uu]o˙ (}u ]v }vboo}X TR b]}v ]b } }vv R}PR}RPEP]}vRL](vbb˙XR(bo}(HIV ˙b v˙˘}b`}lbR}o}uv yy C}vboo}ubuRb](b ˘b ]vo]vP}v}ubX yy Aoo lv}`v b}rvb bRoo ob} }vboo v b væ r r v*HIVPostxpE osureProphylaxis~PEPZforxpe osedhealthcone sarep l*v B}˘wrP) Sb}v}}vovbu]bb]}v}(HIV IvRv}(}bb]o˘}b}HIVR(}oo}`]vP}vbbR}olvP yy TR`}vb]bR}oov`]Rb}v` yy F}u}buuvbUR˘}bbR}oGbR`]Rov˙}( `~XPX˙b`]R`}bo]vZ yy Ab R oo }( ]blP R ]bl }( }bb]o ]v(}v (}u R ˘}b bR}obvobb].b}vRP}]bo}`P yy V˙L}È˘}bP yy E˘}b}(}voo˙]v(}bu]o}]vbl]vZ yy L}`R]blE˘}bP yy E˘}b } buoo }ou }( o}} } }˙ G]b }vu]v `]R o}}(}u˙u}u b HIVr}b]v yy Ivi˙`]Rb}o]vo}v˙b.]o]vi˙}u}v}b˘ posure yy H]PRR]blE˘}bP yy E˘}b}oP}ou}(o}}}}voo˙]v(}bG]b yy E˘}b } o}} } }˙ G]b }vu]v `]R o}} (}u v HIV }b]v`]RR]PR]oo} yy Ivi˙ `]R R}oo}` }vol v˘vb]]vi˙ (}u }v u]vbR]vbuv yy E˘}b}o}}(}uvHIVPb]bvv Standard Trtme ae ntGuidelinesUwthEditionUw (}HIV]v(}v](R]b]bv}lv}`vX Pharmacological treatment Note 17-1 T]u]vPPI(PEP]bvbb˙U]bR}o]v]}uo˙U(o˙`]R]vr R}b}bW˘}bvv}u}RvwR}bL˘}bX ]v E RvPPA v*HIVPostxpE osureProphylaxis~PEPZforxpe osedhealthcone sarep l*v AX yy V˙L}`R]bl WbR˘}b]uu]o˙`]Rb}v` BX yy L}`R]bl Tv}(}]uP]o˙(}˙b vA Eu]]]v uP]o˙(}˙b yy yy yy CX yy yy yy yy yy yy Or Z ]}]v vA Lu]]v uPR}o˙(}˙b æuPR}o˙(}˙b H]PRR]bl TenofoviruP]o˙(}˙b vA Eu]]]v uP]o˙(}˙b vA L}]v] luP luPR}o˙(}˙b Or Z ]}]v vA Lu]]v vA L}]v] uPR}o˙(}˙b æuPR}o˙(}˙b luP luPR}o˙(}˙b Note 17-2 I(Rb}v]bHIVlHBV}r]v(RvTv}(}] bR}obX }v]v]vPP]uv Follow up D]vP R ]} }( }R˙o˘]b vu }( bo]v v (}oo}`r ]vbP}vb v } }v } u]v HIV }b rbbU v } u}v]}Roo}(P}˘]]˙X v Chatep rwP *HIVInfectionsandAIDS TowræP) R}uuvM}v]}]vP}(DPT}˘]]˙HIVS}o}P˙}( Exposed Health Care Personnel Fooo}}}v L]vvo(v}vbUHbBS(AvPv HIV}o}P˙ b }PCR](]oo T`}`lbP Fooo}}}v L]vvo(v}vb S]˘`lbP HIV}o}P˙ b TRu}vRbP HIV}o}P˙ b S]˘u}vRbP HIV}o}P˙ b v*HIVPostxpE osureProphylaxis~PEPZforxpe osedhealthcone sarep l*v o]v Bb bP Iv]]ob `R} }b r}v bR}o R b } }uRvb] vARTb]bX B}˘wrP) R}vPvD}uv}v Aoo }}vo ˘}bb R}o } ]uu]o˙ } R b]b}V ]ubvb}(R˘}bvPEPuvPuvbR}o}X ]ob D bR}o]voP yy vD u}(˘}b yy WRvR}`R˘}b}U˘}bb]}vR}˙v˙ }( bR ]X T˙ v ub u}v }( ˘}b G]U ]˙ b ~Rl˘vZ}(R˘}b yy S} }( ˘}b v `RR R b} u]o }v]v HIV } o}}X yy Co]v]ob}(b}vX yy Rov ]v(}u}v } ˘}b RoR `}l ~u]o }v] }vbU ]v}v ]vo]vP Hb U B v u]}vbU Pvv˙ } r(]vP b Z yy D}uv}vboo]vPU}b˘}buvPuvv(}oo}`b vw r Chapter InfectiousDissande Infetas tions 182.Fever F ]b}uu}v}uo]vU`R]R]bboo˙o}v]v(}v }( ]oU ]o } b] }]P]vX I u˙ oo P] } R ]Pv}b]bv]˙ b }(]v(}vbX F ]b.vbv˘]oo˙u}wXæ£C~L l]vP R Ru}u ]v o (} u]vbZX F } £C ]v R]ovvob}LvvbPv'v}vUb]oo˙](Rv ]b obb b } o]]}bX N} ˙ ( ]b } uo] } ˙R}]X ˙E (bR}o ]vbPv}]o˙XAR}}PR R]b}˙UR˙b]o˘u]v}vv}]]vbP}v`}oboo˙ oRb}(R(X Ivv}vbvRoo˙U]v(}vb b u˙v}}uv] ˙ (X Iv ]v(vb v ˙}vP R]ovU ( u˙ b}] `]R }vob]}vbU }oob } }u X ~S o o}` (} }bb]o ]+vo ]Pv}bbv}]}vZ sueCa yy V]o]v(}v yy ]o B ]v(}v yy FvPo]v(}vb yy Pb]]v(b}vb yy Hu}o}P]ouo]Pvv]bXPXo˙uR}uUolu] yy C}vvb]bb yy M]]vro Symptoms yy CR]oobU]P}b yy B}˙Rb Signs yy TuANwXæ}C yy ]v E }(R˙}v XPXbvlv˙b yy ]v E }(vo˙]vP}v]}vb~(P]o]vbo}`Z yy Tachypnoea yy Tachycardia v Chatep rP *InfectiousDissande Infetas tions TRb}(R(}]o˙~S}]b}vZ vı v*Fever*v Invtiga se tions yy FBC yy Bo}}.ou(}uo]b]b yy R]]Pv}b(} b uo] yy Cob}(]vUo}}UbuU]bRPUR}`b U`}v `b U}b]voG]v]vP}vbv}v Trtme ae nt Tuv}ib yy T}}˙u}v}uo yy T}o]˙u}ub b yy T}]v(˙vRvo˙]vP}( b R(~bP]o]vb o}`Z Non-pharmacological treatment yy K R v òo R˙ `]R G]b XPX Ù (] i]bU o]PR}]PUS]r`_}}}vu]ol yy M]v]vv]}vU}vvr(]vP b ]v]b yy T]b}vPRR]oX~W}ò`]Rolù`vo˙ } R }˙ vP b (}u R ˘u]b v Poo˙ `}l ˙} `˙ `b } R RX L .ou }( `}v R }˙ } ˙ }vRbl]vXRR}bb}LvbvZ Pharmacological treatment ]v E RvPPA yy Pu}o U}oU Adults PvrR}o˙ Children ræuP llP l}bXM˙}bvrR}o˙bvbb˙ Or yy Pu}o Uob}b]}˙U Adults PvrR}o˙ Children æræuPvrR}o˙ Or yy I}(v U}oU Adults ruPvrR}o˙ Children wr˙bV uPvrR}o˙ rw˙bV uPR}o˙ vu}vRbr˙bV æuPR}o˙ rvu}vRbV æuP llPvrR}o˙ Standard Note 18-1 DONOTP]Ab]]v `]R]u~ Trtme ae ntGuidelinesUwthEditionUw }R]ovvRP}(v˙bXC}v}o}vob]}vb Sb}v}vRS]D]b}b[Z Refeal r Criteria F b]bvP (} u} Rv ˙b ]v b] }(uv bR}o }vb]˙˘] b }(vlv}`v}]P]v~PUOvZ bR}o( (}(R]vbP}vX TorP) G]o]vb(}Ruv}(Rv`]R( C}uo]vb v*Fever*v D]Pv}b]b A}v (See appropriate b}vZ ~S}]b}vZ R]P}bU(~}b]}voo˙ ]}]ZU`vP b UPvo uo]bUi}]v]vb Malaria Tlo}}.ou}(}u ]]Pv}b(} b uo]b]bv appropriately R]P}bU(U`vP b UPvo uo]bUobvb}]u Cerebral Malaria Tlo}}.ou}(}u ]]Pv}b(} b uo]b]bv appropriately HeadacheU}u]vP U }`b]vbbU+b vlUb]b Mv]vP]b D}v}o˙uv`R]o `]vPbob}(ou puncture C}PR U}`vbuU] R]vPU]v}v R]vP Pvu}v] G]}]v]} Ivb(v˙}( ]v}vvl}]v(o u]]}vUo}]v]v U]v˙ ]v(}v D}]v˘u]v}vob ovbvb]]˙VG] }]v]} F U}vb}v} ]R}~u˙`]Ro}}ZU RRU}u]vo]vU Pvouo]b Typhoid S}]uv WuU`}oov b U]v(oU ]bRo}}l]vPo]u Cooo]b UE˙b]ob }]uP} G]}]v]} F ]vR]o`]R}PRU b}R}vub Obu] G]}]v]} w Chatep rP *InfectiousDissande Infetas tions D]Pv}b]b A}v F ]vPPvv˙`]R loin pain P˙o}vR]b Tlbuo(}]vo vvbb ]]˙vP] }]v]} P]v]v}v~boo˙o]u }vZU]v(o}}R Ob}u˙o]b Xr˙R+Vb (}}b}u˙o]b Jv] ˙(o]vP vòoUv}˘]Uo}`P F V]oRb D}o](v}vbUHb Bb(vPvV }vbo˙Ub HeadacheU}˙RUvv˙ v}bUbv]vP C}uu}v}o} ]vGv G]Pu}o L}vPv]vP b (U`]PR o}bbUR}v]]R}U o˙uRv}R˙ Acquired ]uuv}.]v˙ ˙v}u b MvP}] b Sore throat or pain on òo}`]vP b T}vb]oo]b and R˙vP]b MvP}] b (A UR]oobv uo]bV`lvbbUubo ]vUbRU]R}Uo]vP V]oRu}RP] (XPXE}o virus disease MvP}]vP}vb protocol if required v*Tuculos ber is*v C}uo]vb 183.Tuberculosis Tuberculosis~TBu˙ Z +v˙}(R}˙UR}uu}vb b] ]b R ovP ~Pou}v˙ TBZX OR b]b + ]vo R b]vU }v v i}]vbU ]vU ]v˙ U }uv v o˙uR v}b X Pou}v˙ TB vb `R} R ]r(b ]oo] ~AFBZ ]v R] bu ~]}o}P]oo˙}b]TBZu}b]v(}bvbR]bb R}PR ]}v }ob `Rv R˙ }PRU b] } bvX D]vl]vP vb] u]ol u˙ b }]v TBU `R]R uv](bb }u]vo TBX Pb}vb `]R o}` b]bv } ]v(}vU bR b HIV ]bU b]oo˙ ]bl }( o}]vP TBX SR ]v]]ob v v}}RR˙]o˙u}ub b vb]Pvb}(TBXTR˙u˙R(b bR b (U `]PR o}bb v ]R}U `R]R }o ob} '] }R}v]}vX Iv R]ov `]R b uov]}v `R} bR}` }} b}vb } ]˙uvUTBub}vb]v˘oX w lAIDS and Standard sueCa yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw Mycobacterium tuberculosis Mycobacterium bovis~}]vTBZ Mycobacterium africanumIvII M. microtiUM. kansasii and M. malmoensi~bZ v*Tuculos ber is*v Symptoms Aob yy C}PR }Lv(}`lb}u} yy Chest pain yy L}bb}(`]PR yy L}bb}( yy Bo}}]v b bu yy F yy vR]vP D v]PR`bb Children yy Aooo˙u}ub b vR(}oo}`]vP yy Mov}]bRvR}v]oo˙]ooo}}l]vP~R˘]Z yy Pb]bvo}`P(~obvPAHr`lbZ yy F]o}R] yy FPUuo]bU}} yy Bl]v vl}o}ò]u`lvbb yy I]]o]˙ yy V}u]vP v]u]}vb]}bvbb~}TBuv]vP]b Signs yy S]Pvb}(uov]}v yy CR˘] yy Poo} yy S]Pvb}(vu}v]}oo+b]}v yy L˙uRv}R˙ yy Nl+vb b bUooo}(}vb]}bvbb]vTBuv]vP]b yy S]vovvbbUP]bUoP]lb]b]vP}' [b]bb yy S]Pvb}(˘ou}v˙]bb Invtiga se tions yy Subuu]}b}˙ yy CRbXr˙ yy Mv}˘ test yy GvX~XMTBlR](Z yy L]vP}˙Ab yy Mycobacterial culture yy Fooo}}}v yy ESR yy L](v}v~(} b u}v]}]vPu]}vb]+bZ yy HIV v]vP b w Z Chatep rP *InfectiousDissande Infetas tions Trtme ae nt Tuv}ib yy To cure the disease yy T}v(Rvbu]bb]}v yy T}vRo}uv}(Pb]bv yy T}uvPPb]+b yy T}}+˙R}b b }]ob} yy T}]vbPo}b}vbXWRR]o]b+Uo`˙bRl o}vb`]R}}PR Non-pharmacological treatment yy C}vboo]vP yy Ev}P P}} v]}v ~b}u (}} bouv}v ]b }] ˙N}voTBP}PuuZ yy Ev}Pb yy Au]o˙ b ]oovb yy Ab]Pvuvb} Pharmacological treatment AXSvuv v*Tuculos ber is*v Note 18-2 F}R}bb}(TBuvPuvU}vb]R(}oo}`]vP.v]}vbP yy AobWAoob}vbPæ˙bv} yy CR]ovWAoob}vbPo}`æ˙b yy N`PvbWAoob}vb`R}RvRTBuv}Rlv TBuv(}obbRv}vu}vRX yy P]}bo˙ TPvb W Aoo vb `R} R]}bo˙ ] TB uv(}}vu}vR}u}X R( } R TB Co]v C ~TB Z (} P]v }v (}uo}vb v }b]vP by weight. L]vTuv st TB Tuv P}˙ C TBPvT˙ Adults N` Pvb IC A=III TuvRP]uv C}vv}v PRb Iv]oPRb AooN`bC ~]vo]vPZPN` bur}b] PTBV N`bu vPPTBV C}v}u]vHIV ]bV b E˘rou}v˙ TB u}vRb }(HRZE æv}bb}( HRZE w C}uuvb = u}vRb }(HRAA doses of HR Tuv]b}v daily IvHIV ]bbU uvv ˘v} u}vRb Standard Trtme ae ntGuidelinesUwthEditionUw TB Tuv P}˙ C TBPvT˙ TuvRP]uv P]}bo˙ Treated Pvb IIC P]}bo˙ bu bur}b] PTBP rRob rTuvL ]v}v rTuv(]o u}vRb}( SA=u}vRb }(HRZE AAæv}bb }(Sv doses of HRZE All cases u}vRb }(HRZE æv}bb}( HRZE TB Mv]vP]b Ob}r oTB r Children C}uuvb æu}vRb}( HRE AA}bb of HRE RbDP ]o]˙ b vP b ~DSTZ before start of uv Tuv]b}v daily = Iv]oPRb v*Tuculos ber is*v u}vRb of HR AA}bb of HR Tuv]b}v daily C}vv}v PRb C}uuvb u}vRb of HR AA}bb of HR Tuv]b}v daily N` Pvb AooN`bC ~]vo]vPZPN` bur}b] PTBV N`bu vPPTBV C}v}u]vHIV ]bV b E˘rou}v˙ TB u}vRb }(HRZE æv}bb}( HRZE P]}bo˙ Treated Pvb P]}bo˙ bu bur}b] PTBP rRob rTuvL ]v}v rTuv(]o u}vRb}( SA=u}vRb }(HRZE AAæv}bb }(Sv doses of HRZE æu}vRb}( HRE AA}bb of HRE RbDST before start of uv All cases ~HRZE ZAA æv}bb}( HRZE ~HRZAA doses of HR Tuv]b]o˙ TB Mv]vP]b Ob}r oTB Ib}v]] r ~HZUR](u]]v Note 18-3 Tuvu}vR]b˙bX Aoovbl]vPIb}v]] v]Rov}R˙X D}b}(P˙]}˘]v ~RZUP˙]vu] = ~ZZURu}o E ~EZUS}u˙]v ~HbR}o Z læuP}(P˙]}˘]v bR}o}o]vHIV vb w IvHIV ]bbU uvv ˘v} u}vRb Tuv]b}v daily ~SZ ~V]u]vBv }Z Chatep rP *InfectiousDissande Infetas tions Iv]}vb (} }] b b ]v R]oR}} TB ]vo Ev}}vR]o TB Poo+b E ]}vbUP]]o+b E ]}vvTBMv]vP]b bR}ov}˘}vu}vRX Aoo R]ov v æ ˙b v oo HIV TB v bR}o P]v }R˙o Ib}v]] `]PR(}obvu}vRbX TorP) R](u]]v r R}uuvD]o˙D}bP~M˘]uuD}bZ AoD}b]vP ~HZ ~RZ P˙]vu] Ru}o E S}u˙]v }b] R]ov `R} }vb }( }b }( uP llP }˙ Dosing for TB Medicines AvrTB DP ~A ]}vZ Ib}v]] U LP XTR}v}(}] b ~ZZ ~EZ ~SZ CR]ovD}b]vP rvuP llP~wæuPZ WæuP llP~uPZ ruP llP~wæuPZ WuP llP~vuPZ ruP llP~uPZ WuP llP~uPZ æruP llP~wæuPZ æWæuP llP~uPZ ruP llP~uPZ WuP llP~uPZ v*Tuculos ber is*v BXAivuv yy P˙]}˘]v ~V]u]vBv ZU}oU Adults æruP]o˙(}ru}vRb Children æræuP]o˙(}u}vRb Av yy Pv]b}o}v U}oU~]vb}(TBuv]vP]b Adults rv uP ]o˙U r `lb Rv }+ }v ]u}uv } r `lbv]b}vv Children ruP llP]o˙Ur`lbRv }+}v]u}uv}r `lbv]b}vv vTB]]bZ CXTuv]vS]oS]}vb Chronic kidney disease N`b~AobvR]ovZ O`]vP}R]PR]bl}(]bUP]R(}oo}`]vP yy Ivvb]Rb rHRZ(}u}vRb yy C}vv}vRb rHR(}u}vRb PPvv˙v]vP b yy G]vb uvX yy D}v}}u˙]v b ~}}}˘]}(}bZ N}r Pv}v}(Pb]bv yy T} v R o}uv }( P b]bv } R](u]]v ] ]b }u wæ r Standard Trtme ae ntGuidelinesUwthEditionUw uvRIb}v]] A=R](u]]v}u]v}vo]bb]vbXP b]]vPR](u]]vo}v]bv}}vub]b}P yy D]vPuvRv ubòo}` b oo R }o Pb(o˙ }v vu˙}uR b v]}b}v yy TR v vb } v o}b b]b]}v ˙ RoR `}l } b}vb]ob}v}uu}(R}uuv]˙`]Rb}(}uRoR + b ]vPR(oo}v}(uv Monitoring D]vPR}b}(uvUoobu}b]ou}v˙TBvbbR}o R bu bub ˘u]v L ~} u}vRb ](uvZU æ u}vRb v R v }( uvX I( bo ]b bu }b]U b (} u˙}]oovPbvb]]˙vP b X X DPb]bvo}b]b~DRrTB ) v*Drugsis re tanttuculos ber is~DRrTBZ*v DP b]bv o}b]b ~DRrTBZ ub bu ~bZb ]v b}vb `R} u]v ]}o}P]oo˙ }b] ~]R bu }b]U o}b]}GvX}b]ZL]vvb]Rb}(vb .bro]vTBuv`]R}`]R}o]v]o]u}uvXPb}vb`R} b ](u]]v b]bv }b] ]v]o ]Pv}b]b `]R Gv X ub ob} b }( DRrTBX TRb b}vb ub (R ob]vPTBovDPSb]o]˙TbvP~DSTZ}v` u}oo]Pv}bbRbL]vP}˙bAb ~LPAZX Pb}vbR]PR]bl}(Pb]bvTBvb(]o]vPP}˙ C IA=III } P}˙ C II uvU }vb }( }v.u DRrTB vb v TBlHIV}r]v(vbv}]u}]vP}vuvX Pb}vb u]u ]bl }( P b]bv ob TB vbU v L o}br}r(}oo}` v RoR `}lb vò˙ ]Pv}b `]R TBX Pvb obb]. }]vP } R 'v }( }uv Pb]bv}.oX TR P P]uv (} uv ]b bo b }v R (}oo}`]vP principles: yy H]b}˙ }( Pb b} TBvbU}.o }( Pb]bv ]vGRvvl}DST}.o}(Rv yy u]v]uu A }((}v`}u]]vbRlv}`v}+ yy Kvu˙]vlC}u˙]v v ]vio u]]vU ]b R l}v }( R(}}u]]vbvbR}ob]vR]vvb]Rb yy Av + G}}]v}o}v bR}o b } R ˘vb] b}(o]Pv}vG}}]v}o}vb yy M˙]vo.bo]vP}`R]RR]v b ]bo b X yy }bC brb]bv u˙ } `v Pb }( R bu P} v R]b]blv]v}}vb]}vX yy DPb u]v]b ]o˙ v ]b DOT R}PR} R ]viov}vv}vRbbX Tuv }( Mo DP Rb]bvrTB ~MDRrTBZ v R](u]]v Rb]bvrTB ~RRrTBZ vb ]b ]}]bX Tuv }v ]b r wv r Chatep rP *InfectiousDissande Infetas tions Note 18-5 Tuv }( Mo DP Rb]bvrTB ~MDRrTB ~RRrTBZ vb ]b ]}]bX Tuv }v ]b r u}vRb v ]b u]v˙bubuvo~]}o}P]o}vb Z ]}v~Tuv obbvru}vRbL]}o}P]o}vb]}vZXP}Pbb]}v(}u]v]o} }vv}vRb]bvv}vob(}~}vb Z u}vRb}(vP buobX nd Z v R](u]]v Rb]bvrTB r L]vTuv BXMoDPRb]bvrTB~MDRrTB TBTuv P}˙ C TBPv Type ) TuvRP]uv C}uuvb Adults and Children Iv]o PRb C}vv}v PRb MoDP Resistant Tuberculosis ~MDRrTBZ u}vRb }(rCZ ur L(˘rP}r Cb•~PASZ u}vRb rL(˘ Z rP}rCb• ~PASZ AooNò˙ D ]Pv}b MDRrTB`]R} `]R}HIV S˙u}u contacts of C }v.u MDRrTB`]R} `]R}HIV •F}˙æuP}(C˙o}b]vP]æuP}(P˙]}˘]v~V]u]v}BvZ vP]Ro N}R˙XD}b}(P˙]}˘]vbR}o}o]vHIVvbX PAS]bvov}Cb w r Tuv]b ]o˙~Tuv u}vR]b ˙bZX Modify uv }]vP} obobX v*Drugsis re tanttuculos ber is~DRrTBZ*v u}vRbv]bu]v˙bubuvo~]}o}P]oZ }vb]}v ~Tuv obb vr u}vRb L ]}o}P]o }vb]}vZX P}Pbb]}v (}u ]v]o } }vv}v Rb ]b vv }vob(}~}vb Z u}vRb}(vPbuobX C}uuv]˙rb]b}u}]vGRv}(]o]˙rb ˘]vb]}vb]]vPu]bb]}v(}uvPuv}(}uo]}vbX TR}(]v(}vv}vv}v}obR}o u]v]v ooub]vPuv}(RbvbX Tuv Rv ]b ]o ]v R uv }( DRrTB } o]u]vu}(]ooU+u]]vbXTuv]bRoovP]vP }o}vP}vUP}˘]]bvb]+bXCo]v]oubub b vrv }R v b} vb R}PR} uv vo X Pb˙R}b}]o v }v}u] b} ]b ] (}uuvb}bUv(u]o]bvo]v]oubR}PR} uvXo˙ E }v v}u uvPuv}( P b]+b vb(o b }}ubX Trtme ae nt Pharmacological treatment Standard Trtme ae ntGuidelinesUwthEditionUw CXTuvP}}}o(}ORRb]bvT˙b TorP) TuvP}}}o(}ORRb]bvT˙b Rb]bv P tern r TB Pv Type TuvRP]uv Adults and Children C}uuvb Iv]oPRb C}vv}v PRb S}u˙]v b]bv~SZ M}v}rRb]b tant r u}vRb}( HRZE u}vRb}(HR Ru}o E b]bv~EZ M}v}rRb]b tant r u}vRb}( HRZ u}vRb v }(HR M}v}rRb]b tant r ıu}vRb}(HRZE Ib}v]]b]b v~HZ r v*Drugsis re tanttuculos ber is~DRrTBZ*v S}u˙]v vIb}v]] b]bv~SrHZ Ib}v]]vR E u}ob]bv ~HrEZ P}o˙rRb]bv TB r ˘A }b}( Ib}v]]} u˘]uu}( uP]o˙(} uv}v ıu}vRb}(HRZE ˘A }b}( Ib}v]]} u˘]uu}( uP]o˙(} uv}v P}o˙rRb]bv TB ıu}vRb}(RrZrL(˘ HUEUvS~AFZ P}o˙rRb]bv TB u}vRb}( KurP}rL(˘rRrZ æu}vRb}( P}rL(˘rRrZ M}].MDR P]uvobR Ru}v}r}}o˙r resistance R](u]]vrR b]bvTB u}vRb}( HrZrCurL(˘rP}r Cb~PASZ u}vRb}( HrZrL(˘rP}rCb ~PASZ FooMDRP]uv plus H r r r E˘vuv }u}vRb]( ˘vb]ovP }v b (}u ˘r˙]uP PAS]bov}Cb Note 18-6 .v]}vb D Mono-resistant TB: TB]oo]Rb]bv}}vo˙}v(}uR.bo]vvro}b]bu] ]vbP}u˙]v b U]b}v]]U](u]]vU˙]vu]}Ru}oX P}o˙rRb]bvP TB ]oo] R b]bv } ob `} u]]vb v} } }R ]b}v]] v](u]]vX R](u]]vrRb]bv~RRrTBZP TB]oo]Rb]bv}](u]]vU`]R}`]R}b]bv}}R.b o]v vro}b]b u]]vbX TR]b u˙ u}v}U }o˙U uo } ˘vb]o˙ Pb]bvTBX w r Chatep rP *InfectiousDissande Infetas tions MorDPRb]bv~MDRrTBZP TB]oo]Rb]bv}ob}R](u]]vv]b}v]]X E˘vb]o˙ DP Rb]bv ~XDRrTBZP TB ]oo] R b]bv } }v }( R G}}]v}o}vbvob}v}(RR]vio}v b ro]vPb~l vu˙]vU}u˙]v}u]l]vZU]v]}v}MDR TorP) r TBX Dosing of Second-Line Medicines R}uuvD]o˙D}bP~M˘]uuD}bZ AoD}b]vP CR]ovD}b]vP P˙]vu]~ZZ ruP llP}v]o˙~uPZ ruP llP}v]o˙~ uPZ Kvu˙]v~KuZ æruP llP}v]o˙~uPZ æruP llP}v]o˙~ uPZ }u˙]v C ~CuZ æruP llP}v]o˙~uPZ æruP llP}v]o˙~ uPZ L}G}˘]v~L(˘Z wæruP}v]o˙~ uPZ æruP llP l˙]v]] }bb~uPZ R]}vu] E ~E}Z ærwæuP]o˙]v]] }bb~uPZ æruP llP l˙]v]] }bb~uPZ P}R]}vu] ~P}Z ærwæuP]o˙]v]] }bb~uPZ æruP llP l˙]v]] }bb~uPZ C˙o}b]v~CbZ ærwæuP]o˙]v]] }bb~uPZ ruP llP l˙]v]] }bb~uPZ Pru]v}bo]˙o] ]~PASZ P}v]o˙}]v]]}bb ~PZ ruP llP l˙]vr]] }bb~PZ Note 18-7 GRv`]oo }vP bR}uvP]u~ıru}vRbZ(}uvP uv}(DRrTBXPoblRl]vP`]RRN}voTBC}v}o}PuuX Refeal r Criteria R( oo vb } DOTS uv v (} uvPuv v u}v]}]vPvGRvN}voTo}b]bP}PuuX 185.Typhoid Fever Typhoid fever (enteric feverZ ]b b ]o ]oovbbU `R]R }b `R bv]˙ }v]}vb }} u]hvP }vu]v}v }( (}}}``]R(bXTR]`R]R˙b R(}r}o } ]v R ]vbvo òo v b R}PR R o}}bu } oo }PvbX TR˙ b ]v} R }}o b v ]v }( ]v(vbX OPv]bubu˙}vv}bv]vR}}o b }(RoR˙]bU]XX wı v*TyphoidFever*v AvrTBDP ~A]}vZ r r Standard Trtme ae ntGuidelinesUwthEditionUw v*TyphoidFever*v vb`]R}b]}}o b obU u}vRbLuv}R}b `]Ro}vPrubo]v]o]bbX I(]u}o˙˙R}]( u˙bo]v}uo]}vbbR b ]vbvo (}}v `]R ]}v]bU o}}˙ }}ob b U ˙R}b b ]b v b ]vbo Ru}o˙b]b o]vP } l]v˙ ]vi˙ ~b]oo˙]vGvPD .]v˙ZX Po] }v }v P}} b}vo R˙P]vU Rv `bR]vP v }] ]b}bo }( b}o] `b `}o }Lv v R ]bbX Sv]vP }( (}} Rvob ˙ ˙]vP } }}o b ob } ˘o ] b v (b Rvo]vP }( (}}U (]b v Pob ob} Ro(ovubbX sueCa yy Salmonella typhi and paratyphi Symptoms yy F `R]R]vbPoo˙ b }R]PR(vb]b(} b `lb ~(}bv}b}v}vuo]obZ yy C}vb}v ]vRo˙Pb b yy A}u]vo]vv]R}]vR}v b `l}(]oovbb yy Severe headache yy D˙}PR yy Pb˙R}b]b v}v(b]}vu˙} Signs yy H]PR(`]Roo˙bo}òb~}b]}voo˙ob]b(b b]oo˙`]Ru˙}]b}]vbvo(}}vZ yy A}u]vovvbb yy H}rbov}uPo˙~vZ yy Confusion yy S]Pvb}(Rb]v(}v~vu}v]bZ Invtiga se tions yy FBU C ]+voU yy RDT lo}}.ou(}uo]b]~}˘ouo]Z yy Bo}}o yy Stool culture yy U]vo Note 18-8 Notes on Diagnosis yy D]Pv}b]b}(˙R}]( ]bb}v}vP b o]v]ob]]}vl˙ yy Bo}}obU}b]]vP.b˙b}(( yy S}}oobU}b]LR˙}R}æR`l yy U]vobU}b]]vPvv`l yy TR}b]}}RW]oU b `R]R]bvo]ovo˙ (o b ]v}v.u]vP]Pv}b]b}(˙R}]( Chatep rP *InfectiousDissande Infetas tions v*TyphoidFever*v Trtme ae nt Tuv}ib yy T}]R]v(}v yy T}vuvP}uo]}vb yy T}vvbu]bb]}v}(]v(}v}}R}o Non-pharmacological treatment yy T]b}vP]vP}}˙u](] Pharmacological treatment ]v E RvPPB yy C]}G}˘]v U}oU Adults æuPR}o˙(}r˙b Children uP llPR}o˙(}r˙b Or yy C]}G}˘]v UIVU~}u]v]b}vu]vbZ Adults uPrR}o˙(}r˙b Children uP llP~u˘XuPZR}o˙(}r˙b Note 18-9 C]}G}˘]v bR}o b `]R ]v R]ovX C]}G}˘]v u˙ o˙ b v]v]bX A R .b b]Pv }( ]v } ]vGuu}vU vb ub ]b}vv uvvovuv~XPXA]R}u˙]v nd L]vTuv ]v E RvPPB yy L]˘}v C UIVU Adults rP]o˙(}wr˙b Children uP llP]o˙(}wr˙b Or yy A]R}u˙]v U}oU Adults æuP]o˙(}˙bw Children ruP llP(}˙bw Refeal r Criteria R(˙]oovbvR}b`]R}uo]}vbbR]vb b vo (}}vU ]vbo Ru}o˙b]b v ]}v]b } R }] b]o]bX HoR˙ ]b bR}o ob} ( (} b]o]b uvPuvX lCL]˘}v X Zb Standard Trtme ae ntGuidelinesUwthEditionUw 186.Malaria v*Malaria*v Malaria ]b ˙ }uu}v ]v(}v ]v GRvX I (}oo}`b R ]v}}v }( }}}v uo] b]b ]v} R o}}bu ˙ R ] }( v ]v( (uo Av}Rob u}b]}X Mo] ]b ui} b }( b]Pv].vu}]]˙ v u}o]˙ b]oo˙ u}vP ovo ]v]]obU bR b R]ov v æ ˙b }( PU Pvv `}uv ~b}uub `]R b (}o v uvo }}ubZU vb `]R b]looo]bbv]b]vPv}vrb]vGRv]vbv˘]bX Bb }v R o]v]o ]˙ b U b }( uo] P}] b ]RRv}uo][}Rb[X]Pv}b A ]b}(uo]vb }v b Rv[b˙u}ub b vRR˙b]o.v]vPb˘u]v}vX H}Ù(}.v]]Pv}b]b}uo}}˙~o}} b .ou vl}R]D]Pv}bTb Zubu}vbRuo]b]b} R] }u}vvb b]v R o]v]o bv}v }( R }v]}v v b]u]o } }R }uu}v ]bb bR b ˙R}] ( U ]v˙ ]v(}vU u] b U vu}v] v uv]vP]b in both adults and R]ovvubobU}bu] U}vb]oo]bUX]vR]ovX Iv GRvU ]Pv}b]b ]b }Pbb]o˙ ]vP bR]L (}u o]v]o } o}}˙}v.u}vbRb]b(}uvXR]D]Pv}bTb ~RDT u˙ Z }b }v.u]Pv}b]b](u]}b}˙~o}}.ou]bZ v} ]ooX Pv ubb ]v R }uuv]˙ u]vo˙ P o]u]v}v }( R ]vb } } v}v }( u}b]} ]b `R]o ]}vo Ru}}R˙o˘]b]b](}ovo]v]]obX TR o}uv }( b]bv }( uo] b]b } vruo]o u]}vb]bu'}(ui}o]RoR}vvXTR]bRv}uv}v ]b oPo˙ R bo }( R}r]Pv}b]b[ v `}vP ]Pv}b]b }( uo] ˙ RoR }vb v vb o]lU `]R ]b 'vv }r uv v b}uub o } ]v}uo uvU o]vP } }r˘}b }( R b]b } R vruo]o P ~PZX b A]}voo˙U u]b A ]v]v C}u]v}v TR˙ ~ACT Z U R Rv u}v}R˙`]Ru]b]v]v]bU]bvo˙}uuv(} R uv }( v}uo] uo] } v R o}uv }( Pb]bvX I ]b R(} vbb˙ } }]v o}}˙ }v.u}v }( ]Pv}b]b }( uo] (} vP b uvX E˘}vb } R]b ]v]o R]ov v æ ˙b v b }( b b uo] `R o}}˙ }v.u}v ]b v} ]uu]o˙ }bb]oX Iv bR ]ubvbU }uo }b }( R }] vruo]o u]}v~bZubP]vX sueCa yy Plasmodium falciparum~}uu}vbvb}vb]o(}u}b}(R Rbvu}]]˙b}]`]Ruo]]vGRvZ Chatep rP yy yy *InfectiousDissande Infetas tions Plasmodium malariae Plasmodium ovale 187.Uv}uo]Mo] v*Uncomplictea dMalaria*v Symptoms yy F yy Chills yy R]P}b yy S`vP yy Headache yy Gvo]}˙vi}]v]v yy Nauseavl}}u]vP yy L}bb}( yy A}u]vo]v~b]oo˙]vR]ovZ yy I]]o]˙v(bo}(~]v]v(vbZ Signs yy F yy Mild pallor yy M]oiv] yy Sov}uPo˙ Invtiga se tions yy M]}b}˙rR]lvR]vo}}.oub(}uo]b]b yy R]D]Pv}bTb~RDT Z yy FBC yy ORb]v] Trtme ae nt Tuv}ib yy T}}]}Pbb]}v}uo] b yy T}o]u]R}v}(R]oovbb yy T}u]v]u]Ro}uv}(Pb]bvb]b Non-pharmacological treatment yy IvR]ovU]b}vP]vP}}˙u Pharmacological treatment st L]vTuv ]v E RvPPA yy bvA A=Au}]]v U}oU~SToræ}vPUTo rv}vPUTorw}vPZ Or yy uR A A=Lu(v]v U}oU~STor}vPæZ Or yy D]R˙}u]b]v]v A= P]]v U }oU ~S To rı }v P æZ Standard Trtme ae ntGuidelinesUwthEditionUw ToræP) bvA (}ONCAILY ED DOSINGZ W]PR PA ærlP AM˙ rlP rv˙ rælP wr˙ ærwlP r yr ANwlP AN˙ A=Au}]]v }ro]b(}uo}v~RP]uv Artesunate~æuPobZNu }(TobT}BG]v r Au}]]v~æuPb obZNu}(TobT} BG]v ˙D ˙D ˙D ˙D ˙D ˙D A* A* A* A* A* A* TR}b]vuP l}˙`]PR]bPAu}]]vuP llPA=bvA }b]o˙(}R~˙bZ ULuobX v*Uncomplictea dMalaria*v TorvP) bvA (}TWICAILY ED DOSINGZ W]PR PA uP llPUlvb]vPo A=Au}]]v }ro]b(}uo}v~RP]uv Artesunate~æuPobZNu }(TobT}BG]v ˙D ˙D r ˙D Au}]]v~æuPb obZNu}(TobT} BG]v ˙D ˙D ˙D AM PM AM PM AM PM AM PM AM PM AM PM ærlP AM˙ ¼ ¼ ¼ ¼ ¼ ¼ ¼ ¼ ¼ ¼ ¼ ¼ rlP rv˙ A* A* A* A* A* A* A* A* A* A* A* A* rælP wr˙ ærlP w r˙ A* A* A* A* A* A* A* A* A* A* A* A* ANwlP AN˙ TR }b ]v uP l}˙ `]PR ]bP Au}]]v uP llP A= bvA ]]}bb]o˙(}R~˙bZ ULuobX uP llPU lv b `} TorwP) bvA vAu}]]vF]˘D}bC}u]v}v ~SvRP]uvUb]vPR]oo}b]vPvPRb b Z Artesunate~ASZA=Au}]]v~AQZ Nu}(F]˘D}bC}u]v}vTob}P]v W]PR PA ToD}b]vP SvPR AMlP ru}X ASPæuPQ A P vwXæuP ˙D ˙D ˙D Chatep rP *InfectiousDissande Infetas tions TorwP) bvA vAu}]]vF]˘D}bC}u]v}v ~SvRP]uvUb]vPR]oo}b]vPvPRb b Z ırwlP ræ˙b ASPæuPQ A P æuP rælP vr˙b ASPuP Q A PwuP ANvlP AN˙b ASPuP Q A PwuP R E F]˘D}b C}u]v}vo}v]vb }RbvA ~ASZ v Au}]]v ~AQZU R }bPb ]v]X TR} lP]vP oo˙]v]b`R]R }b]vPvPR b o]b }`R]RPP}XTR maximum daily dose of Artesunate/Amodiaquine is 200 mg/600 mP TorP) uR A vLu(v]v~D}b]vPRP]uvZ uR A T}BG]v W]PR PA ~uPZA=Lu(v]v~uPZNu}(Tob ˙D AMælP AMvu} ærælP vu}r˙ ærælP r˙ ærælP r˙ ANælP AN˙ ˙D Second }bD ~L RbZ AM ˙D PM AM N}}uuv(}vbvælP TorıP) D]R˙}u]b]v]vvP]]v~D}b]vPRP]uvZ W]PR PA D]R˙}u]b]v]v~uPZlP]]v~uPbZ Nu}(TobT}G]v B ˙D ˙D ˙D ærlP AM˙ ¼ ¼ ¼ rælP r˙ A* A* A* vrlP rv˙ rælP wr˙ AH AH AH vrælP r˙ A* A* A* ærwlP r˙ ANwlP AN˙ æ PM v*Uncomplictea dMalaria*v F]b }bD Standard Trtme ae ntGuidelinesUwthEditionUw 188.Severe Malaria v*SeverMalaria*v S } R}uo] uo][ v ]b (}u o˙ ]v ]Pv}b]b } ]v}] uv }( v}uo] uo]X I u}bo˙ }b ]v R]ov v æ ˙b }( PU Pvv `}uv v v}vr]uuv ]v]]obX TR vb b]vP u}b Rb ]v b uo] o } o ]v}ouv ~o uo]ZU b vu]U R˙}Po˙u]UR˙}v b Uvo(]ovb]}˙]}b]bX TR ]Pv}b]b }( b uo] ]b b }v o]v]o (b v }v.u `]R o}}˙ vP b X N} oo b }( b uo] R R]PR b]u] v ]v]o o}} .ou ˘u]v}v u˙ vPX WR R ]Pv}b]b ]b U b uv ub b `]R} o˙`R]o`]vP}v.u}vX Symptoms yy P}}}o]vl~XPXu]ol b ]vR]ovZ yy R}(b}u]vP yy Dl}R}or}o}[]v yy Pbb]vP}(˙o]'o]v yy D]8o˙]vR]vP yy Gvo]b`lvbbU]v]o]˙}òl}b]`]R}b]bv yy Ao }vb]}bvbb ~RvP }( R]}U }v(b]}vU o]]uU }u Z yy RPvo]}vob]}vb Signs yy H˙˙˘] ~˘]oo˙uANXæ£CZ yy E˘uoo}~bvu]VHAMæP loZ yy Mliv] yy C]o}˙}oob}bR}l~}oo]ubU`l]obZ yy Tachypnoea~R]R]vPZ yy ]}vb C }vRb˘u]v}v yy S`vP~}R˙}Po˙u]Z yy Hu}Po}]v]~l}R}or}o}[]vZ yy Oo]P] yy S}vv}b v˘o]v R˙ o]vP ~]bbu]v ]vbo}Po}vZ yy Ao }vb]}bvbb ~RvP }( R]}U }v(b]}vU o]]uU }u Z Invtiga se tions yy R]]Pv}bb yy Bo}} .ou (} uo] b]b r R]l v R]v o}} .oub ~bR}o }v`R]ooZ yy FBC yy S]lo]vPb v Chatep rP yy yy yy yy *InfectiousDissande Infetas tions Rv}uo}}Po}b BUEvv]v Bo}}P}]vPv}bbruR]vP Lu v ]v R }vob]vP } }u}b v } ˘o uv]vP]b }vRo]b Trtme ae nt Tuv}ib yy T}vb]ov}(b]u] yy T} }] Pv uv (} o]( Rv]vP }uo]}vb } }v]}vb XPX }vob]}vbU R˙}Po˙u]U R˙}v ]u]uv yy T}}]}]b} Non-pharmacological treatment yy Po vb `R} v}vb]}b } R]vP b]b ]v v }]}b]}v}vb]}v Pharmacological treatment ]v E RvPPA TorP) D}b]vPRP]uv(}Q]v]v IMIvi}v]v˙}vPCR]ov W]PR V}ou}(Q]v]v D]R˙}Ro}] Ivi}v~æuP luo]o}vZ AMælP Xuo æXrwXælP Xæuo wXvrXlP Xuo XrXælP Xæuo XvræXlP Xuo æXrwXælP XæuorRo(}RR]PR w v*SeverMalaria*v AXPr(ouv yy ArtesunateUIMU Adults and ChildrenANlP XuP llP ChildrenAMlP uP llP Or yy uR A UIMU Adults and Children XuP llP Or yy QuinineU IMU bvA U oU uP llP ~( ]v R]ov vv˙bVToZ Or yy ArtesunateUoUuP llP~(]vR]ovvv˙bV U vo Standard TorP) Trtme ae ntGuidelinesUwthEditionUw D}b]vPRP]uv(}Q]v]v IMIvi}v]v˙}vPCR]ov wXvrXlP XuorRo(}RR]PR XrXælP XæuorRo(}RR]PR XvræXlP æXuorRo(}RR]PR æXrwXælP æXæuorRo(}RR]PR wXvrXlP vXuorRo(}RR]PR TR}bP(}IMQ]v]v ]buP~XuoZlP}(}˙`]PR˙R}bX v*SeverMalaria*v Note 18-10 H}`}P]IvuboQ]v]v IvuboQ]v]v ]vY}vPCR]ovP yy W]PRRR]o yy P Q]v]v ]o}v }( æ uP luoP Ub uo ]o b ˙]vP b v vo}`æuob}(]o b `(}]vi}v}bo]v~v}˘}bZX TRv]v}Rbu˙]vP b ` uP~uoZ(}uvu}o}(Q] v]vXTR˙]vP b v}`}v]vbæuPQ]v]vuoX yy TR}bP]buP~XuoZlP}}˙`]PR˙R}bXCoo R }ou } P] b }v }˙ `]PRX ~F} ˘uob }( }˙ `]PRb v }bb ]v R]ov AM lPU bvA U oU uP llP ~( ]v R]ovvv˙bVZX yy Au]v]b˙]vubo]vi}v}RR]PRXI(R]o}ou˘ buoU]viRo(R}b]v}RR]PRX IvuboQ]v]v ]vAobP yy UbQ]v]v ]o}v}(uP luoXT}R]bUùob}(Q]v]v vuPvuob}(]o b `}bo]v~v}˘}bZ yy TR }bP ]b uP llP }˙ `]PR }( Q]v]v P]v R}o˙ ˙ IM ]vi}vU}u˘]uu}b}(vuP yy Suoo ob ~`]PR]vP obb Rv v lPZ bR}o `]PR } oo R }}bXLPob`]oob]uo˙]Ru˘]uu}b~vuPZ yy I( R ] }ou ]b u} Rv æ uoU ]] ] ]v} `} v ]vi separate sites TorP) RobvA W]PR PA Artesunate }bD ~PrR(oTuv]vCR]ovZ RP]uv ærlP AM˙ æ OvæuPb}b]}˙ ırılP rA*˙b T`}æuPb}b]}]b rılP A*ræ˙b OvuPb}b]}˙ rılP vr˙b T`}æuPv}vuP suppositories ANlP AN˙b T`}uPb}b]}]b r r Chatep rP *InfectiousDissande Infetas tions BXTuv]vR(oCv Note 18-11 Pvovuo]obv(}oo}`r}vuvX TR v }uuv}v ]b } P] vo vuo]ob ]v R uv}(uo] b (}u]v]uu}(R}b~]b}(Rv[b ]o]˙}}o}ou]}vvo Z Rv]bo}}o}ou ]}v b (}oo}`r}v uvX R}uuv (}oo}`r}v uvb ]vo CTbA vQ]v]vA=o]vu˙]vX yy r r v*SeverMalaria*v ArtesunateUIV}IMU Adults and ChildrenANlP XuP llPR}o˙ G]vuR}~]XX}vu]bb]}vZUR}bvR}b Then XuP llP]o˙vovvòo}` b ~u˘X˙bw Z Then A (oo r˙ }b }( }uuv }o u]b]v]v }u]v}v therapy (ACTZ ChildrenAMlP uP llPR}o˙ G]vuR}~]XX}vu]bb]}vZUR}bvR}b Then XuP llP]o˙vovvòo}` b ~u˘X˙bw Z Then A(oor˙}b}(}uuv}oCTA Note 18-12 bvA }vb}v(}vo]vi}v R}vb}vP Ub ˙]vP b } ` v ]vi R b}ov ~b}]u ]}v æuP luo b}o}vZ ]v} R ]o }( bv}`X SRlR ]o vo R }` ]b }uoo˙]bb}ovRb}o}v]boX F} ]vv}b ]vi}vP A ]R Po}b æ uP luo ~]XX æA9˘}b D }vZ } b}]u Ro}] ı uP luo ~]XX XıA9 N}uo bo]v }vb bv b}o}v } uP luo b}o}v }( bvX `D ] }ou v P] bo}ò˙ ˙ IV } r uolu]vA ]R Po}b æ uP luo ~]XX æA9 ˘}b D b}o}vZ } b}]u Ro}] ı uP luo ~]XX XıA9N}uobo]vb}o}v}Z R}vbbvb}o}v} uP luob}o}v}(bvX`D ]}ouvP]bo}ò˙˙IM v]}R]PRXI(R]}ou]bu}RvæuoU]]]]v}`}v ]vib]A]RPo}bæuP luo~]XXæA9˘}b D b}o}vZ} b}]uRo}]ıuP luo~]XXXıA9N}uobo]vb}o}v}Z R}vb bvb}o}v}uP luob}o}v}(bvX`D ] }ou v P] bo}ò˙ ˙ IM v]} R]PRX I( R ] }ou ]b u} RvæuoU]]]]v}`}v]vib]A]RPo}bæuP l uo ~]XX æA9 ˘}b D b}o}vZ } b}]u Ro}] ı uP luo ~]XX XıA9 N}uo ı b}o}vZ } R solur r Standard Trtme ae ntGuidelinesUwthEditionUw bo]v b}o}vZ } R }vbbv b}o}v } uP luo b}o}v }( bvX `D ] }ou v P] bo}ò˙ ˙ IM v]} R]PRXI(R]}ou]bu}RvæuoU]]]]v}`}v]vi b]bX~SToZToZToZoZX F}]vubo]vi}vP A ]R Po}b æ uP luo ~]XX æA9 ˘}b D b}o}vZ } b}]u Ro}] ı uP luo ~]XX XıA9 N}uo bo]v b}o}vZ } R}vbbvb}o }v } uP luo b}o}v }( bvX `D ] }ou v P]bo}ò˙˙IMv]}R]PRXI(R]}ou]bu}RvæuoU]] ] ]v} `} v ]vi b]A ]R Po}b æ uP luo ~]XX æA9˘D }bb}o}v}Z b}]uRo}]ıuP luo~]XXXıA9N}uobo]vb}o}v}Z R}vbbvb}o}v} uP luo b}o}v }(b vX`D ]}ouvP]bo}ò˙˙IMv]}R]PRXI(R] }ou]bu}RvæuoU]]]]v}`}v]vib]A]R Po}b æ uP luo ~]XX æA9 ˘}b D b}o}vZ } b}]u Ro}] ı uP luo ~]XX XıA9N}uobo]vb}o}v}Z R}vbbvb}o}v} uP luob}o}v}(bvX`D ]}ouvP]bo}ò˙˙IM v]}R]PRXI(R]}ou]bu}RvæuoU]]]]v}`}v ]vib]bX~SToZToZToZ v*SeverMalaria*v TorP) r r r }˘]u A vb(}]o}v Route IVIvi}v SvPR}(u]]v uP S}]u]}v æuP luob}o}v(} }vb}v~uoZ Xæ Go}bæuP luo b}o}v(}]vi}v O S}]uRo}]ı uP luo(}]vi}v ~uoZ Xæ Total diluent needed ~uoZ IMIvi}v vuP uP vuP uP Xæ æ v Xæ Artesunate }vv}v~uP l uoZ Note 18-13 Coo}v}(}b}(bvA uP needed (ml): AobP F}IV}P XuP˘}˙`]PR~lPZ IVbvA b}o}v}vv}vuP luo ı v Chatep rP *InfectiousDissande Infetas tions F}IM}P XuP˘}˙`]PR~lPZ IMbvA b}o}v}vv}vuP luo CR]ovAMlPP F}IV}P uP˘}˙`]PR~lPZ IVbvA b}o}v}vv}vuP luo F}IM}P uP˘}˙`]PR~lPZ IMbvA b}o}v}vv}vuP luo P}vbP yy Ivi]uu]o˙L}vb}vv]b](v}`]R]v b R} yy D]b](b}o}v]bv}o yy D}v}b]vIV]UG]bo}ò˙˙]IV]vi}v}ruolu]v yy yy Or QuinineUIVU~]v˘}b D saline}]væA9˘}b D æruollPZ Adults and Children uP llP~u˘X}bvuPZ]v(b}rR}bX R]v(b]}vR}o˙vovvòo}` b X Then QuinineU}oUuP llPR}o˙}}uo˙bw }(uv yy And C o]vu˙]v yy U}oUuP llPUR}o˙(}˙bw N}r Co]vu˙]v bR}ou]v]b`]R(}}v}]}bu}vb}(`X QuinineU IVU bR}o o`˙b P]v ˙ bo}` ]v(b]}vU v˙ }ob ]v v}b]vi}vbR]bu˙R˙}vb b ]}vX yy yy v*SeverMalaria*v Or uR A UIMU Adults and Children XuP llPX b Then ~R}boZ XvuP llP Then ~R}bL]v]}v}(uvZ XvuP llP}v]o˙vovvòo}` b ~}æ˙bZ Then A (oo r˙ }b }( }uuv }o u]b]v]v }u]v}v therapy (ACTZ Or QuinineUIMU Adults and Children uP llP~u˘X}bvuPZUR}o˙vovvòo}` b Then QuinineU}oUuP llPR}o˙}}uo˙bw }(uv ı r Standard Trtme ae ntGuidelinesUwthEditionUw Av yy Co]vu˙]v U}oUuP llPUR}o˙(}˙bw Refeal r Criteria Pvb]Pv}bR]vP b uo] b }`R}(]o}b}v} R}uuvvuo]ou]}vbub(X}] A uv b ]v] } ub ]v] ]} } vb(]vP R vX I( (o ]b v} }bb]o ]uu]o˙U }vv R uv P]uvbR}`v}(}uo] b vo(o]b}bb]oX 189.Malaria in Pregnancy v*MalariainPrgna e ncy*v PPvv˙ ulb `}uv u} o]lo˙ } P uo] } ] (}u uo]X Mo] ]v(}v ]b u} b ]vP Pvv˙ `R]o Pvv˙ v ]b }}ub v }u }uo] ˙ ]X TR +b }( uo] }v R Pvv u}R ]vo b (}u }( R ]oovbbU vu]U u]b]PU ru o}U v }bru Ru}RPX R]blb } R (}b ]vo (}o vu]U ru]˙U ]vr]v P}`R ]}v b U o}` ]R `]PRU oo]R b U }vPv]o uo]U v ]vb ]vo u}o]˙X Pv ubb ub uRb]b ~]XXIvb]rNbITNbvIvu]'vPvTuv ]vPvv˙IPT v]}b}v`R]o Z }v.uubb }uo˙X Tuv}ib yy T}vb}uv+buvPuv Non-pharmacological treatment yy None Pharmacological treatment AXTuv}(Uv}uo]Mo] in the First Trimester yy QuinineU }oU ~u˙ P]v b u}v}R˙ ]( Co]vu˙]v ]ooZ uP llP~u˘XvuPZR}o˙(}˙bw yy Av C o]vu˙]v is not U}oUuP llPU`]]o˙(}˙bw Note 18-15 TR P }( R}] (} v}uo]uo] (} Pvv `}uv ]v R .b ]ub ]b }o Q]v]v X CTbA v} }uuv (} b ]v R .b ] ubX H}Ù R] b bR}o v} `]RRo ]v b `R R˙ }vb]} o](rb]vPU}`R}Rvuo]ob}vb]} vb]oX ı r Chatep rP *InfectiousDissande Infetas tions BXTuv}(Uv}uo]Mo] in the Second and Third Trimesters yy bvA A= Au}]Abv A= Au}]]v }ro]b (}u o}v ~RP]uv (} TWICE AILY D DOSINGZ}TR }b ]v uP l}˙ `]PR ]bP Au}]]v uP llP A= bvA uP llPU lv b `} ]] }bb ]o˙ (} R~Z˙bULuobX To æU T ovUTowZ Or yy uA (v]v U}oU~SToZ Or yy QuinineU }oU ~S b}v Tuv }( Uv}uo] Mo] RF]bT]ubZ C. yy yy yy D. yy yy Or QuinineUIV}IMU Then Q]v]vA=o]vu˙]v}u]v}vU}oU ~Sb}v}vTuv}(RSMo][ }Z Treatment of Severe Malaria in Pregnancy (Second and Third trimesters and Puerperium) uR A UIMU Then ˙b}(}oCTA ~Sb}v}vTuv}(RSMo][ }Z EXIvu]'vPvTuv]vPPvv˙~IPT IPT }vb]bb }( P]]vP R .˘r}b }u]v}v u]}v SoR}˘]v P˙]uRu]v ~SPZ ]v uv }bb .v ]vobL]lv]vP~Pbv }vo`lbZXvC }uuv}v ]b R IPT `]R bo(}˘]vr˙]uRu]v ~IPTrSP Pvv`}uvRbRovvo]b]˘]vPR .b ]ubX WHO }uuvb bRo }( (} (}b vvo ]b]b (} v}uo Pvv˙X Iv GRvU R v}vo uo] }v}o P˙ b SP b (}R}b}(]vu]'vvuv }vo˙X T}vRo}uv}(Pb]bvUSP]bv}} b (}}R}bbRuv b }('lb}(uo]X yy SoR}˘]v ~æuPZrP˙]uRu]v ı ~æuPZU}oU r in v*MalariainPrgna e ncy*v yy Treatment of Severe Malaria]vPPvv˙~Aoo]ubbv puerperium) ]v E RvPPA ArtesunateUIV}IMU Then ACTU}oU(}˙b ~Sb}v}vTuv}(RSMo][ }Z r ) Z P]v } oo Standard Trtme ae ntGuidelinesUwthEditionUw Note 18-16 C}ru]v]bbD]o˙ObTR˙~DOTZ]vPvvo]b]b}v ob}b]}vbvu}b}vw}b]}vb v*Seona sa lMalariaChemopvention r ~SMCZ*v D}b}( IPT Antenatal visit R}uuv Pb}vo `lb HoR`}l} u]v]b IPT F]bANC]b]L ]lv]vP v M]`]bUM]o }8bUFu]o˙ R˙b]]vbUOb]]vb IPT obA }vu}vR LR.b}bX IPT obA }vu}vR LR}v b }bX IPTrw obA }vu}vR LR}bX M]`]bUM]o }8bUFu]o˙ R˙b]]vbUOb]]vb PR˙b]]vb]bvbU C}uuv]˙HoR O8bUC}uuv]˙ Health Nurses UUvU Note 18-17 PPvv `}uv `]R R (}oo}`]vP }v]}vb bRoo ˘u (}u b]vP SPP yy F]b]ub}(Pvv˙~AM`lbPb}vZ yy GvPD v˙u.]v˙ yy So]]bb}v˘o]vviv] yy Kv}`vooP˙}v˙boRPb}ooP˙}˙]uRu]v yy H]b}˙}(]}b}v}SP yy Rvuv`]RboRPbR}b r]u}˘}o~`]R]v`lbZ yy P}brbPvv˙~Pb}v˙}vv`lbZ yy ]vP bB yy b}( A uo]~b}Z O`]vP } vP}v]bu `v (}o] ] v SPU (}o] ] bouv}v bR}oo˙v}v b `lLSPu]v]b}vXF}]}vo ]v(}u}v}vIPT vuo]]vPvv˙U(}RobGRvHoR S]]v]vPuvobvP]o]vb}vRbiX 190.Sb}voMo]CRu}v}v~SMC ) TR]b ]b R ]vu]'v u]v]b}v }( (oo uv }bb b ]vP R }uuv vruo]o u]]v ]vP l uo] vbu]bb]}v b}vb } v uo] ]oovbbX A }uo uv }b ]b P]v } R]ov P `v v æı u}vRb u}vRo˙ ]vob } u˘]uu }( }bb ]vP R uo] vbu]bb]}v b}vXIvGRvUSMC Rbv]uouv]vRN}RvSvvR b]vPSoR}˘]v rP˙]uRu]vvAu}]]v~SPA=Q A Z ı Chatep rP yy yy *InfectiousDissande Infetas tions SoR}˘]v rP˙]uRu]vU}oU vA Au}]]vU}oU 191.Mv]vP]b ıæ Neisseria meningitidesU ]b ]b u]o v*Meningitis*v TR]b ]b v ]v(}v }( R }]vPb }( R ]vU v ]b u}b }uu}vo˙ b ˙ ]U ]bbU (vP] v }}}X Ov ˙U }bC ]vo Mv]vP]b (CSMZU b ˙ }uu}v ]v R N}Rv v U RP]}vb }( GRvU v boo˙ }b ]v ]u]b ]vP R Ru'v b}vX TR bv}v u˙ b}uub }v(b `]R o uo]X Mv]vP]b uPv˙X F]o } }Pv]b v o˙ uvP uv]vP]b bob]vb]}b}uo]}vbX Iv(}uP]}vo}]b]RoRR}]b]uu]o˙]v]u] uv]vP]b X sueCa yy ]o B yy Neisseria meningitides yy Streptococcus pneumoniae yy Haemophilus influenza yy Mycobacterium tuberculosis yy Staphylococcus aureus yy Escherichia coli~v}vbZ yy V]bbXPXHb]bb yy P}}}XPXT}˘}obu ]vHIV rAIDS yy FvP]XPXCryptococcus neoformans Symptoms F}AobvCR]ovANæ˙b yy F yy Neck pains yy Severe headaches yy PR}}R}] yy CRvP]vR]} yy Convulsions yy V}u]vP CR]ovAM˙ yy F yy I]]o]˙ yy Refusal to eat yy P}}bl]vP yy V}u]vP yy }`b D ]vbbv`l˙ yy yy yy Standard Trtme ae ntGuidelinesUwthEditionUw F}o}Pvo]}vob]}vbL`R]RRR]o]bbo˙ LRP˙ BoP]vP(}vvoo v*Meningitis*v Signs F}AobvCR]ovANæ˙b yy F yy Nl+vb b b yy P}b]Kv]P [bb]Pv yy Altered consciousness yy C}u CR]ovAM˙ yy Nl}v yy Pbv}bv}(vl+vb b b yy Pbv}bv}(( yy BoP]vP(}vvoo yy C}u yy Hypotonia or hypertonia yy Convulsion Invtiga se tions yy FBC yy R]]Pv}b~} b ˘oouo]Z yy Bo}}.ou(}uo]ob]b~}˘oouo]Z yy Luv~}vo˙L˘o]vP]b]vv]oZb yy Bo}}ovbvb]]˙ Trtme ae nt Tuv}ib yy T}]v(˙v]R}Pv]b b ub yy T}v}uo]}vb yy To prevent spread to contacts yy T}u]v]vP}}v]}v N}vrRu}o}P]ouv yy T]b}vP]vP yy KR]`˙o yy Nb}Pb](]vP](o]o Pharmacological treatment AX]o B Mv]vP]b st L]vTuv ]v E RvPPA yy L]˘}v C UIVlIMU Adults rP]o˙(}wr˙b Children AN˙bV rP]o˙(}wr˙b ıv Chatep rP yy yy yy *InfectiousDissande Infetas tions æruP llP(}r˙b ræuP llP}v]o˙(}˙b æuP llPR}o˙(}wr˙b æuP llPR}o˙(}wr˙b æuP llPR}o˙(}r˙b v}}uuv Or ]v E RvPPB B v˙ov]]oo]v UIVU Adults MUR}o˙(}˙b Children XMUllPvR}o˙(}˙b Av CRo}uRv]}o UIVU Adults PvR}o˙(}˙b Children æuP llPvR}o˙(}˙b TR]b u˙ bvo˙ RvP } }o R˙ `]R b]Pv].v o]v]o]u}uv Or CRo}uRv]}o UIMU~}]o˙}vZ Adults uP llPb]vPo}b Children uP llPb]vPo}b Note 18-18 N}}uuv(}R]ovo}ù}vRbUvob}(}Pvvvo vPu}RbX C. yy yy v*Meningitis*v yy AM˙bV NeonatesV vA Vv}u˙]v UIVU Adults æuP llPR}o˙(}wr˙b Children AN˙bV r˙bV u}vRr˙bV AMu}vRV r For penicillin allergy Co]vu˙]v UIVU Adults vrıuPR}o˙(}˙b Children uP llPR}o˙(}(}˙b Av CRo}uRv]}o UIVU Adults PvR}o˙(}˙b ıw Standard Children æuP llPvR}o˙(}˙b yy yy Trtme ae ntGuidelinesUwthEditionUw nd L]vTuv ]v E RvPPB (}˘]u C UIVU Adults PvR}o˙(}˙bw Children AN˙b}}˙`]PRANælPVPvR}o˙ AM˙b}}˙`]PRAMælPVæuP llPvR}o˙ Av Vv}u˙]v UIVU Adults æuP llPR}o˙(}wr˙b Children AN˙bV æuP llPR}o˙(}wr˙b r˙bV æuP llPR}o˙(}wr˙b u}vRr˙bV æuP llPR}o˙(}r˙b AMu}vRV v}}uuv v*Meningitis*v D. Prophylaxis for CSM P}R˙ouv]b}uuv (}vb ˙b ]}} ]bRPvob}(}R]o}b}vb yy C]}G}˘]v U}oU Adults æuPb]vPo}b~A}]]vPPvv˙Z Children ær˙bV æuPb]vPo}b Or yy L]˘}v C UIMU Adults æuPb]vPo}b Children AM˙bV æuPb]vPo}b Note 18-19 R}o}(}]b b P˘uRb D }v }PR b `]RR.b}b}(R }] v]} Rb v (}v } o } ui} }v ]v R]vP o}bb vR]v}RR]ovvobX yy ˘uRb D }v UIVUruPvR}o˙(}ær˙bw Refeal r Criteria R( oo vb v} b}v]vP } uv `]R]v R .b R}b(}b]o]bX ı r Chatep rP *InfectiousDissande Infetas tions TorP) Suu˙}(uv}}vb(}]o B Mv]vP]b PA PR}Pvb AMæ˙b Mv]vP}}bU Pvu}}b Hu}R]ob IvGv ANæ˙b Pvu}}b L]b] U GurvP]oo] Hospital Acquired StaphylococciU GurvP]oo]U Pvu}}b Pb}u}vb U U o]v b Eu]]o uv Aovb ~S]o]bZ L]˘}v C And Vv}u˙]v (}˘]u C M}vu Fo}}]v}o}vb L]˘}v C O Au]]oo]v And Vv}u˙]v Fo}}]v}o}v L]]u C A=lrGvu˙]v M}vu Vv}u˙]v Iv(b}v `]R `}ub ]b ˙ }uu}vX P}} R˙P]v } }v }( bl]v `]R b}]o ]v `R]R R `}u } ]b PPb o] ]b}bb ]v]]ob}]v(b}vX sueCa yy yy yy yy yy yy H}}l`}u Ascaris S}vP˙o}]b T`}u TR`}u WR]`}u Symptoms yy Gvo]bIR]vP yy P]vo]R]vP~R`}uZ yy D˙}PR~`RvRobR}PRRovPbZ yy WR~`RvRobR}PRRovPbZ yy A}u]vo]b}u(}v}]v yy ˙bE (P]o]˙ yy PbbP}(`}u~bZ]vR}}o b yy Ao}òR] yy V}u]vP }(`}ub Signs yy Poo} yy Fb}(uov]}v ıı v*WormInfetas tion~Intetina s lZ*v 192.W}uIv(b}v~IvbvoZ Standard yy yy yy Trtme ae ntGuidelinesUwthEditionUw P}}R˙b]oP}`R]vR]ov LP]bv}uv]vR]ov WR]vP v*WormInfetas tion~Intetina s lZ*v Invtiga se tions yy S}}o(}}v˘u]v}v yy FBC Trtme ae nt Tuv}ib yy T}o]u]vR`}ub yy T}R}uo]}vb}(]v(b}vXPXvu]Uuov]}v yy T}vb}bv]}v Non-pharmacological treatment yy Evb}v]}v yy P}Rv`bR]vP`]Rb}vvv]vP` Pharmacological treatment ~S o o}` }v RPRu}o}P]o uv }( W}u Iv(b}vb[Z Refeal r Criteria R( vb `]R ]vbvo }b}v (}u R˙ o} }( `}u b ]v(b}v}P]o b b]o]bX PRu}o}P]ouv}(W}uIv(b}vb W}u Tuv Note Evidence RvP H}}l`}u Mv}o U}oU Adults æuPb]vPo}b O uPR}o˙(}˙b CR]ovANu}vRb uPR}o˙(}˙b N}}uuv (}R]ovo}` u}vRbv]v Pvv`}uv B O A ov}o U}oU AobvR]ovAN u}vRb uPb]vPo}b CR]ovo}ù}vRb uPb]vPo}b N}}uuv ]vPPvv˙ B æ Chatep rP *InfectiousDissande Infetas tions PRu}o}P]ouv}(W}uIv(b}vb W}u Tuv Ascaris Mv}o AobvR]ov} u}vRbV uPR}o˙(}˙b O æuPb]vPo}b TR`}u Evidence RvP N}}uuv (}R]ovo}` u}vRbv]v Pvv`}uv A O A ov}o U}oU AobvR]ov} u}vRb uPb]vPo}b CR]ovo}ù}vRb uPb]vPo}b N}}uuv ]vPPvv˙ A Mv}o AobvR]ov} u}vRbV uPR}o˙(}˙b O æuPb]vPo}b N}}uuv (}R]ovo}` u}vRbv]v Pvv`}uv B O A ov}o U}oU AobvCR]ov} u}vRb uPb]vPo}b CR]ovo}ù}vRb uPb]vPo}b N}}uuv ]vPPvv˙ B Mv}o AobvR]ov} u}vRbV uPR}o˙(}˙b O æuPb]vPo}b N}}uuv (}R]ovo}` u}vRbv]v Pvv`}uv C U}oU U}oU U}oU v*WormInfetas tion~Intetina s lZ*v WR]`}u Note Ruv L`lb O A ov}o U}oU AobvCR]ov} u}vRb uPb]vPo}b CR]ovo}ù}vRb uPb]vPo}b N}}uuv ]vPPvv˙ Ruv L`lb æ C Standard Trtme ae ntGuidelinesUwthEditionUw PRu}o}P]ouv}(W}uIv(b}vb v*WormInfetas tion~Intetina s lZ*v W}u Tuv Note Evidence RvP S}vP˙o}]b Aov}o U}oU AobvCR]ov} u}vRb uPR}o˙(}˙b CR]ovo}ù}vRb uPR}o˙(}˙b O T]v}o ~TR]v}oZU }oU Adults XæPR}o˙(}˙b Children æuP llPR}o˙(}˙b N}}uuv ]vPPvv˙ Ruv LR`lbX Aovo˙U wr˙buv `]R}]b oX B P]vo U}oU AobvR]ovV æruP llPb]vPo}bX ~æuP llPb]vPo}b(} Hymenolepis nanaV]v ˙bZ TlvLo]PR breakfast T`}u O N]o}bu] AobvR]ov}v ˙bV Pb]vPo}b Iuv]bR P}(R}] RbRvP }(]]vP o](rRv]vP encephalopathy in u]}.o]vu] b X C U}oU CR]ovAM˙bV æuPb]vPo}b rv˙bV Pb]vPo}b CRòbR}b(} uo C æ Chapter yeE Disorsder ı 193.N}voC}viv]b ~Sb}v}vRN}voC}viv]b[vN}voD]b}bZ ıX Xerophthalmia TR]b}v]}v]b}uu}v]vR]ovXI]bb}]`]R]v ]vl}((}}bR}v]vV]u]vA XI]b}uu}vb}(o]vvbb ]vR]ovXI]b]u}v}vR]b}v]}v˙˘u]v]vPR˙b }(oob]lvuov}]bRR]ovXTR]}(R]ovbR}o]vo (}}bR}v]vV]u]v~l A Pvo(˙PobXPXvl}v}u]U ˙oo}`(]bvPobUou}]oUu]olUPPbZX Pvb v }R P]b bR}o ]b}P (}u hvP v˙]}vo}vbbRRb b U`b Ubo]U]vUX} Pb]v}R˙vobb]˙R˙b]]vX sueCa yy V]u]vA .]v˙bovP(}u yy P}]vo}]uov]}v yy Measles yy Mob}}vb Symptoms yy P}}v]PR]b]}v~]vRo˙Pb b Z Signs yy D˙}viv yy Grey sclera yy C}vivo(}o]vP~`]vlo]vPZ yy K}uo] ~o}˙}vUb}Lv˙b o}vZ Invtiga se tions yy Nil æ Standard Trtme ae ntGuidelinesUwthEditionUw v*Foreignodb yintheyee *v Trtme ae nt Tuv}ib yy T}}Pv]v}]u]v.]v˙ A yy T}v}uo]}vbXPXo]vvbb Non-pharmacological treatment yy H]PR]u]v}v]v]vP A (}}bbR}ov}P Pharmacological treatment G]V]u]vA }R]ovb}}vR b ]oovb]bb ]Pv}bvob} ]vvb`]Rubobvuov]}v ]v E RvPPA yy V]u]vA U}oU Children Iuu]o˙L]Pv}b]b rv˙bV UUv]b vru}vRbV UUv]b TRv~LR}bZ rv˙bV UUv]b vru}vRbV UUv]b TRv~L`lZ rv˙bV UUv]b vru}vRbV UUv]b Refeal r Criteria R(ooo]b b R}( b ˘}RRou]}v˙b]o]b](R }v]}v]b`]R b vvv}oP]vP}vX 195.Foreign body in the eye F}]Pv }]b ( } blb }( U b buoo ]vbb } }R v˙ }ib R P ]v} R ˙bX TR (}]Pv }˙ u˙ ]R ]v R }vivo bU }v R }v } ]vb] R ˙oo ~]v}oZX A R]b}˙ }( R o]lo˙ v }( R (}]Pv }˙ ]b ]v ]b }v v u}oX TR (}]Pv }˙ u˙ bv ˙ (o ]vb}v }( R }v}}vivobXo]PRvP A ]bv}}vo (}]Pv}]bX sueCa yy Specks of dust yy Suoo]vbb yy F}buoo]b~bRb}b`]RuoP]vbZ yy ORv˙}ib Symptoms yy Fo]vP}(b}uR]vP]vR˙`R]Ru˙]]vP yy Sv]b}u(}}]v b yy W]vP}(R˙ yy R˙~bZ æ yy yy Chatep rıP PR}}R}] ]XX]v}ov}o]PR Iv]o]˙}}vR˙ *EyeDisorsder AXF}]Pv}˙]v.}v yy Tetracaine hydrochlorideUXæA9˙}UIvboo}v}`}}b] }}o}v BXF}˙]]P}v yy N}uoSo]v CXPv}v}(]v(}v st L]vTuv ]v E RvPPC yy CRo}uRv]}o }˙Z D. yy UXıA9U ˙}]vuvUA9}]oU~ALu}o}((}]Pv Pain control Pu}o U}oU Adults æuPrPvrR}o˙]b Children vr˙bV ræ˙bV u}vRbr˙V æræuPvrR}o˙]b ræuPvrR}o˙]b vruPvrR}o˙]b ææ v*Foreignodb yintheyee *v Signs yy ]v E }((}]Pv}˙ yy C}viv]b yy T]vP}(R˙b yy PR}}R}] yy CRu}b]b yy Sr}vivoRu}RP yy IPo ]o ]v vvP ˙ ]vi˙ `]R ]v ]v}o (}]Pv}˙ yy Bo}}]vRv]}Ru~R˙RuZ Invtiga se tions yy Xr˙}(R}]~buoo] b (}]Pv}˙Z Trtme ae nt Tuv}ib yy T}u}b.]o(}]Pv}]b yy T}b}]]vi˙ yy T}v}uo]}vb Non-pharmacological treatment yy WR R (}]Pv }˙ ]b v R ˙o]U R ˙o] vu}R(}]Pv}˙X yy I( R (}]Pv }˙vv} u}Uo˙}]o v]}U R˙vREFER}v˙b]o]bo]v]X Pharmacological treatment r Standard Trtme ae ntGuidelinesUwthEditionUw Refeal r Criteria R( vb `]R }vo (}]Pv }]bU ]v}o (}]Pv }]bUb]bv]vvvbb}(R˙}R˙b]o]bX 196.R˙E v*ReyedE *v R ˙b ]R R bo }( ]vGuu}v }( }o b } o]vP ]v} R b }vivo bX TR 'v }( R vbbU v}( R ]bRPU b}]]v v ]b ]vvb]˙U ]b]}v o}bb v v }( R }v Ro(o ]v R]b]vP R ˙X R ˙ ]b }voo˙ ˙ b]}b }v]}v b]oo˙ ]v b]}vb `R Rvbb]b}vR}vX sueCa yy C}viv]b yy C}voo}lb yy v]} A ]b~]vGuu}v}(RoZ yy vPo A o}bPo}u yy E]bo]b yy So]b yy S}vivoRu}RP ToırP) CR]b]vPR A ˙E Diagnosis Predominant P'v}( Rvbb Nature of Discharge Vision Loss Corneal vA Ab}]P]v C}viv ]b Poo~]vv o]v]vP}(R ˙o]bZ W˙Uu}]U u}ov} purulent N]o˘ `Rv}v is involved CoUu˙ bR}`v epithelial ]vb b `]R G}b]v]v l}}viv ]b N]o}u]o]v r with no history of injury Corneal Uo Around the cornea W˙}u} purulent Acute anterir }U]b Around the cornea AvPo Closure Go}u r r V]o G˙}P˙]bR `R]R `Rv]o }(vPo} v]`Rv HbS]uo˘ Severe pain W˙ V]o Co}R˙ Moderately severe Around the cornea W˙ P}(}v Uv](}uo˙R˙ V˙b E]bo]b Sectorial N]o}`˙ Nil Clear Mild to severe So]b Sectorial N]o}`˙ N]o˘ `Rvb} ]`]R ]b Clear V˙b æv r Chatep rıP Diagnosis S}viv oHu }RP r r *EyeDisorsder Predominant P'v}( Rvbb Nature of Discharge Vision Loss Corneal vA Ab}]P]v Sectorial Nil Nil Clear Nil ToırP) Suu˙}(R}uu}v˙b}(C}viv]bvR] management Type of Discharge Predominant type of ocular discomfort }v D Treatment ]o B AooPb Pov N]o}u]o ]R]vP}]v r`lb Av]}˙ drops V]o AooPb W˙}M copurulent N]o}u]o ]R]vP}]v r`lb S˙u}u AooP] Children and ador lescents S]vP˙u}] IR]vP Chronic inr u]'v Mast cell ]o]]vP b PvbUb}]u R}u}Po˙ A9 TR}u AooPbUb}] `]R]˙U˙U dusty and poor v]}vuv Mucopurulent N]o}u]o ]R]vP}]v u}vR} ˙} u} Tetracycline ˙}]vuv A]R}u˙]v tablets r WHOG]vP}(TR}u Z TF r ob . (}oo]ob ]v R bo }vivX Iv]b ]bb v v (}uv ZTIr]vvb]vGuu}vXN(}Pvuv ZTSr]vP b P b XOo]v(}vUv}`]v ZTTrR}u]R]b]bXNP]o b uv æO ZC r}vo}]bXV]boo}bb(}u]}b]v(}v Invtiga se tions yy C}vivo `b (} o v bvb]]˙ ~ov } u}ov]bRPZ Trtme ae nt Tuv}ib yy T}R]v(}v]vRb}(}viv]b yy T} o] ]v v ( ]uu]o˙ } R b]o]b (} Pv uvPuv } v o]vvbb ]v R b }( }vo obU v]}]bUvPoo}bPo}uU]bo]bv bo]bX Non-pharmacological treatment yy yy yy }viv]b A W] ]bRPb `]R bU ]b ] v `bR Rvb L R `] D}v[bR}òb`]R}Rb AobvR]ovbR}o}]o}b}v`]R}RbXPX(}u æw v*ReyedE *v APvlP}v B }(Pvb Standard Trtme ae ntGuidelinesUwthEditionUw b R}}o U`}lUuv`]uu]vP b Pharmacological treatment AXF}uv}(}viv]b A st L]vTuv ]v E RvPPC yy TetracyclineUA9}]vuvUo˙v]PR(}˙bw Av yy CRo}uRv]}o UXæA9˙}bU }R}o˙(}R}b Then }vrR}o˙(}˙bw Or yy C]}G}˘]v UXA9˙}bUr}bvrR}o˙ Refeal r Criteria R( }vo obU v]} ]bU vPo o}b Po}uU ]b]b v bo]b ]uu]o˙} R˙b]o]bX Aob} (}viv]bU`R]RbR}`bv}]u}uvLR}b}( uvX v*Glaoma uc *v 197.Glaucoma Go}u ]b v } v}R˙ boo˙ v} o`˙b b}] `]R ]b ]v}o X b I ]b R }v b o]vP b }( vo o]vvbb ]v R `}oX CR}v] Go}u u˙ } b o}bb }( ]b]}v v o]vvbb `]R} ]} `v]vP ˙u}ub b v ub R(} vb (} ]v oo ob ˙}v R P }( ˙bX A Po}u ]b R}` b}] `]R ˙ R]PR ]v}o bv˙]v b v]vGuu}v}(R˙vvo } o]vvbb ]lo˙ ]( v} X WRv }vPv]oU Po}u b voPuv }( R ˙oo b}] `]R ]vb bvb]]˙ } o]PR v`]vPX PRu}o}P]o uv u˙ ˙ (}u v } v }]vP } o}o ]o]o]˙U +}]o]˙U v ]v]]o b}vb } uvX sueCa yy A o}b }( R ]vP vPo ~ } ]o o}l ]v ]u˙ vPoo}bPo}uZ yy Iv]vP}(}b(}uRv]}Ru~b] }v]vPvPob]vR}v]}vvPoPo}uZ yy N}bo uuv ]v R ]vP vPo ]v ]bRu] ˙ ]bbR}o]( b ]v}R˙ yy D]boovb]v}v˙ b vPoo}bPo}u yy Mo(}u}v}(R]vPvPo]v}vPv]oPo}u æ Chatep rıP Symptomsandsigns *EyeDisorsder ToırP) CR]bb}(R]}b˙b}(R}uu}v˙b}( Glaucoma S˙u}ub vb]Pvb CR}v]}vvPo vPo A o}b C}vPv]o Ovb Uboo˙˙bv above Elderly Iv(vbv}ob S˙u}ub N]ooooRv }Pbb]]boo}bb Sv]boo}bbU S˙]vU˙ ]vGu˙U`˙ ]bRPURR v}u]vP b }uub PR}}R}] `]vPU Iv}o pressure Uboo˙R]PRUu˙ v}uo V˙R]PR H]PR Cornea N}uo H˙ EvoPvR˙ `]Ro]vlb v*Glaoma uc *v Invtiga se tions yy Gonioscopy yy CvovoR]lvbbubuv yy V]bo.ovo˙b]b yy OD]bR}}PR˙ yy RvoNF]TR]lvbbAvo˙b]b yy E˘u]v}v}(R]ovvvbRb] Trtme ae nt Tuv}ib yy T}v}Pbb]}v}(R]bbvRo(R]}}v of vision yy T}v}uo]b]v}ob Non-pharmacological treatment yy ]vP D SP˙ yy LbSP˙ yy Go}u ]vP D ] yy V]}b}R]uovb Pharmacological treatment U Note 19-1 C}vbov}RRou}o}P]b}vRuv}(Po}uX st L]vTuv ]v E RvPPB Tuv]b`]R}vu]}v(}u}v}u}}(R(}oo}`]vP P}bP yy Lv}}bU˙}bUæu]}Puluo æı Standard Trtme ae ntGuidelinesUwthEditionUw yy yy B]u}}bU˙}bUu]}Puluo T}}bU˙}bUu]}Puluo yy yy yy AvlO T]u}o}oXæA9˙}b L}v}o}oXæA9˙}b ˘}o}o B XæA9˙}b yy AvlO B ]u}v]]v UuP luo}XæuP luo yy yy yy AvlO }ou] A U}oUæuP B]v}ou]U˙}bUuP luo D}}ou]U˙}bUuP luo AvlO yy P]o}]vrA9U˙}b Refeal r Criteria R( oo b b }( Po}u } R }RRou}o}P]b (} buvv]v]ouvX v*Ctaa ct* ar v 198.Cataract I ]b R }]˙ }( R ˙boo]v ovb }( R ˙X I ]b R o]vP b}(o]vvbb`}o`]X sueCa yy OoP yy Tu}R˙ yy IvGuu}v`]R]vR˙ yy M}o]}v]}vbbRb]buoo]b yy C}vPv]o Symptoms yy V]o ]bv }( ]b]}v ~b}uub `}b `Rv bvv˙ } ]vPZ yy Gob]oo˙v]PR]vP]]vP yy M}v}o}o]b]}v]vR+˙ yy CRvP]v(bP yy u}bR}b]PR~u˙}]bR]LZ yy u}o}vPb]PR~R˙u}]bR]LZ yy WR]b}]vR˙~R]ovZ Signs yy Lvb}]˙ yy Reduced visual acuity yy R}vbbvb]]˙ æ Chatep rıP Invtiga se tions yy FbvPo}}bP yy FBC Trtme ae nt Tuv}ib yy T}]u}]b]}v yy T}vRo}uv}(uo˙}] Non-pharmacological treatment yy Ub}(obb yy SP]ou}o}( Pharmacological treatment yy Nil Refeal r Criteria R(oo}b R˙b]o]bX *EyeDisorsder in the child 199.E˘}bK}R˙ æ v*ExposureKetop ar thy* a v E˘}bl}R˙ ]bR˙]vP}(R}vbob }(]v]o]˙ } o}b R ˙o]b } o]vl o˙X I( v} v v bo]v}voo}vv(}}vo]vP}o]vvbbX sueCa yy F]ovob˙XPXBoo[bob˙}o}b˙ yy S]vP}(R˙o]b yy C}u yy Thyroid eye disease yy Pl]vb}v[b]bb yy P}}b]b yy SvJ}Rvb}v[bS˙v}u Symptoms yy Fo]vP}(˙]vP}(R˙ yy F}]Pv}˙bvb}vb]vR˙ yy PR}}R}] yy Bo]vP}(]b]}v Signs yy LP}RRou}b ~]v]o]˙}o}bR˙bZ yy Iv}uoo]vl~R˙o]}bv}}R`R}o}v ]vPo]vlZ yy Iv(vo]vl yy S.]ov]vb b }vR}v yy LP}obv}vo]Ro]o( yy C}voo}v yy C}vo(}}v Standard Trtme ae ntGuidelinesUwthEditionUw Invtiga se tions yy Nil Trtme ae nt Tuv}ib yy T}u}]bvR}v.]oo˙ yy T}vR}uo]}vb}(˙˙b Non-pharmacological treatment yy T]vPR˙o]bo}b]vR}u}bv yy Pob}RR˙ yy }v E }( vb `]R Pl]vb}v[b } R˙}] ˙ ]bb } } o]vl(vo˙}ov]o˙RRvo˙}vG˘o]vl Pharmacological treatment L]vTuv ]v E RvPPC H˙}˘˙uR˙o ooo}b u st yy v*Strabismus*v yy U XA9 ˙ }bU r R}o˙ ]vP `l]vP nd L]vTuv ]v E RvPPC P}o˙]v˙oo}R}o UXrA9˙}bUrR}o˙]vP`l]vPu Av C Ro}uRv]}o UA9˙}]vuvUv]PR(}u Or yy TetracyclineUA9˙}]vuvUu Refeal r Criteria R( vb `R}b ˘}b l}R˙ ˙b]o]bX yy ]b v} ]u}]vP } R 200.Strabismus S]bub ]b u]bo]Pvuv boo˙ }( }v ˙ vvP b]uov}b ]`]vP }( v }i˙ }R˙bX Ovb]v R]ov v w ˙b ]v(b `]R R o}uv }( R ]bo ˙bb u }( R ]vP ˙ ]v R ]v o]vP } uo˙}] X A }vb v }o Pb }o ]b]}vX D]o}] does not occur in children because of R ]o]˙ } b R }v b ]uP } o}uv }( uo˙}]X Auo˙}]}bv}}](R]}vov(}u}v˙}R }RXTRu}(v˙bR}]}vou]bo]PvuvXEb}}] is }vPv]}vv˘}}] ]b]Pv]}vX sueCa yy C}vPv]ou]bo]Pvuv yy A]]}v yy Po˙b]b}(Rv]ovVIUIII}IV æ yy yy yy Chatep rıP F]}b]b]vv˘}oubo M˙bRv]P]b Iv}oob]}vXPXv}ob}uvuob *EyeDisorsder 201.Sickle Cell DiseaseWRv}R˙ Symptoms yy Svo}bb}(]b]}vb]oo˙]vb]loooSSC _vb æ Z Z v*SickleCellDisseWa Retinopthy a *v Symptoms yy M]bo]Pvuv}(R˙ yy Iu]iPuv}(R}]bv yy D]o}] or double vision Signs yy ]}v D }(R}voo]PRG˘]v}v˙(}uvo}b]}v yy M}uv }( R ]vP ˙ } l .˘}v `Rv R .˘]vP eye is covered yy N}uo˘}o˙u}uv~]vv}vro˙]bb ub yy L]u]}v}(˙u}uv~]vo˙}]b ]bb ub yy H˙u}] }v(}v]vR]ov yy Rvoob]}vXPXv}ob}u Invtiga se tions yy C˙o}oP](}v]vR]ov yy OR b]. b (} b XPX u˙bRv] P]b } v}ob}u Trtme ae nt Tuv}ib yy T}]v(˙v}v˙b]Pv].v(} yy T}v˙uo˙}] yy To relieve any diplopia yy T}}Ru]bo]Pvuv yy T}v˙vo˙]vP}v]}v Non-pharmacological treatment yy So}}v}(v˙(} yy Tuv }( uo˙}] ]v R ]vP ˙ ˙ R]vP R v}vr ]vP˙ yy Ub}(]bub}}buoo]}vb yy PR]vP}(R]vP˙}o]]o}]]v}ovb Pharmacological treatment yy Nil Refeal r Criteria Aoo vb ]Pv}b `]R ]bb ub ub (} R ˙ b]o]b(}(RuvPuvX Standard Trtme ae ntGuidelinesUwthEditionUw Refeal r Criteria Aoo S]lo Coo SSC _ vb ˙b v } bR}o ( } R˙b]o]b(}v]vP b (}}o](b]lo oov}R˙X R(oob]looovb`]R˙}uo]}vb}R˙b]o]bX 202.Ev}]vvu}o]]b}b`]R˙}uo]}vb v*Endocrineandmetaolic b disorswith der yee omp c lictions a *v Refeal r Criteria Pvb `]R b]bvo˙ }} o}} Po}b }v}oU }} o}} b }v}oU (v ]bro u]bb]}vbU ]bo ]u]uvU } v˙ vo RvPbU (}} ob } PvPv b]bv}]v]U } }R R}v]}uo]}vb }( ]b bR}o (}R˙b]o]bX æ U Chapter EarUNoseandThroat Disorsder 203.Stridor Stridor]bvuPv˙}v]}vXIRbR]bv}]b]vR ]vb]}˙ Rb }( R]vPX TR]b }b `Rv R ]b v }b}v }(R]`˙(}uRvb}Rv˙˘}`v}RRvu]v }vR]XTR}b}v]bboo˙]vRbPo}hX I ]b }uu}vo˙ ]o ]oovbbU v u˙ boo˙ ˙ R }uu}v }oX Mbob u˙ ob} }uo] ˙ L˙vP}R}}vR]b ~LTBZ X T`} ]u}v b }( ]} b R]ov]o}~LTBZv]Po}hbX Iv R uvPuv }( ]} b U}]b b u}b (o b `Rv P]v `]R]v v R}b }( }vb }( ˙u}ub b X C}PR ˙bb }v]v]vP }]b and atropine}v]v]X STRIDORINCHILDREN sueCa yy yy yy yy yy yy yy yy yy V]o~o˙vP}R}}vR]bZ ]o B ]v(}v ]Po}hb A IvGuu}˙}b}v IvRo}v}(R}(ubXPX]v.}lb AvP]}v}}u R}R˙vPob IvRo}v}((}]Pv}˙ C}vPv]ouo(}u}v}(Ro˙v˘XPXo˙vP}uo] Symptoms yy L}`P( yy Hoarse voice yy Bl]vP}PR yy R]vP B ]8o˙ yy Restlessness Signs yy Stridor ææ in Standard yy yy yy yy yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw L}`P( RbobRvb b ]R]o`Rv}b}v]bb Hoarse voice Bl]vP}PR L}R]vPXPXvo b Uo]o b Uvo b v ]v}bob}vb Tachypnoea Cyanosis]v}bb }v Reddened throat v*Stridor*v Invtiga se tions yy Suo yy Lob}LbXr˙}(vl yy CRbXr˙ Trtme ae nt Tuv}ib yy T} }] PP}v }( R }b}v `]R R]l } b }vb b yy T}vbo˙vuo˙o](}(}b}v Non-pharmacological treatment yy Evb]vPP}}R˙}v]vo]vPo]o}oG]b yy Evbu˘]uu(} b RR]o yy o]b Eb R R ]`˙ ˙ ]v}v } R}b}u˙ ]v b }b}v Pharmacological treatment AXF}R˙}v}(˙b]lvb`R}vv}]vl st L]vTuv ]v E RvPPC yy ˘}b D salineUIVUæA9 B. yy For restless and distressed children who require oxygen O˘˙Pv UrvL]b ~b}v}˘˙Pv}v b ooZ C. yy For steroid therapy ˘uRb D }v U}olIMlIVU Children XvuP llPX b Or Bb}v] Uvo]bU Children uPX b Or Pv]b}o}v U}oU Children ruP llPX b Or yy yy æv Chatep rP yy *EarUNoseandThroatDisorsder H˙}}b}v UIVU Children uP llPvR}o˙(}r˙b Note 20-1 S}]bu}b(o b `RvP]v`]R]vR}b v }(}vb}(˙u}ub b XAv ]}bbR}oP]v]v}v˙ b ]o]v(}vX C}PR ˙bb }v]v]vP}]bv}]v X D yy yy yy yy E. yy are contraindicated æuPvR}o˙(}˙bw æuPvR}o˙(}˙bw vXæuPvR}o˙(}˙bw XæuP llPR}o˙(}˙bw XæuP llPR}o˙(}˙bw v*Stridor*v yy Ivb]u}b]o]v(}v st L]vTuv ]v E RvPPC Co}˘]oo]v UIVU Children ær˙bV ræ˙bV AM˙V vA Gvu]]v UIVU Children r˙bV AM˙V vA M}v]}o UIVU Children wXæuP llPR}o˙(}˙bw r nd L]vTuv ]v E RvPPC (}˘]u C UIVU Children uP llPR}o˙ Av M}v]}o UIVU Children wXæuP llPR}o˙(}˙bw For severe Croup AdrenalineUPb}o}vUvo]bUuoX b Then RR}o˙](+ STRIDORINADULTS sueCa yy yy yy yy IvGuu}˙}b}v ]Po}hb A L˙vPou} V}o}o˙b]b æw Standard yy yy Trtme ae ntGuidelinesUwthEditionUw R}R˙vPob IvRo}v}((}]Pv}˙ v*Stridor*v Symptoms yy Hoarse voice yy R]vP B ]8o˙ yy Restlessness Signs yy Stridor yy L}R]vP yy Tachypnoea yy Cyanosis]v}bb }v Invtiga se tions yy Lob}LbX˙}(vl yy CRbXr˙ Trtme ae nt Tuv}ib yy T}vbo˙vuo˙o](}(}b}v Non-pharmacological treatment yy o]b Eb R R ]`˙ ˙ ]v}v } R}b}u˙ ]v b }b}v Pharmacological treatment st L]vTuv ]v E RvPPC AXF}}˘˙PvR˙ yy O˘˙Pv UrvL]b ~b}v}˘˙Pv}v b ooZ B. yy For steroid therapy H˙}}b}v UIVU Adults uPvR}o˙(}r˙b CXF}b]u}b]o]v(}v st L]vTuv ]v E RvPPC yy Au}˘]]oo]vA=Coov]A] Adults vuPR}o˙ Or XPR}o˙ Av yy M}v]}o UIVU Adults æuPR}o˙(}˙bw UIVU æ Chatep rP *EarUNoseandThroatDisorsder L]vTuv ]v E RvPPC yy (}˘]u C UIVU Adults wæuPR}o˙ Av yy M}v]}o UIVU Adults æuPR}o˙(}˙bw Refeal r Criteria R(b`]R}bb }vv}uo]}vb]vR]ov} P]]]v } ENT b]o]bX Aob}(oo b }(]} b v}˘b}]v}(}uR}b}u˙}b]o]bX nd X if there is E]Po}hb A æı v*AcuteEpiglottitis*v TR]b]bv vo](rRv]vP]v(}v]v`R]RR]Po}hb v }v]vP b b }u o˙ ]vGu v }u}b b]vP}bb }v}(R]`˙bXTR]bvbb }v v˘uo˙]}b~rvR}b}Z b]}˙(]ovRX I ]b u} }uu}v ]v R]ovX H}Ù R ]v]v Rb b]Pv].vo˙ } Rv]uuv]b}v bRo `]R R vov]vX E˘u]v}v }( R R} ]v vb `]R R]b }v]}v ub }v}vo˙]vRbv}(}}ov˙}]vX sueCa yy Haemophilus influenzae˙B yy Streptococcus pyogenes yy Streptococcus pneumoniae yy Staphylococcus aureus Symptoms yy Sv}vb}(R]PR( yy }}o]vP D }(bo] yy D˙bRP] yy R]vP B ]8o˙ Signs yy E˘uo˙]oov}˘]R]o yy F yy H]bRo(}`}˘vRvl yy R]vP B ]8o˙ yy Wl}]~v}R}bZ yy R]v˙}vbo}v yy Stridor yy yy Standard Trtme ae ntGuidelinesUwthEditionUw Cyanosis in very sick children S`}oovvv]Po}hb Invtiga se tions yy FBC yy Bo}}o yy Lob}LbXr˙}(Rvl Trtme ae nt Tuv}ib yy T}o]}b}v yy T}u] Non-pharmacological treatment yy o]b Eb Ruv}(]`˙](vbb˙˙]v}v}R}b}u˙ Pharmacological treatment v*AcuteEpiglottitis*v AXF}uv}(]o]v(}v st L]vTuv ]v E RvPPB yy (}˘]u C UIVU Adults wæuPrXæPR}o˙(}˙bw Children æuP llPR}o˙(}˙bw Av yy M}v]}o UIVU Adults æuPR}o˙(}˙bw Children wXæuP llPvR}o˙(}˙bw L]vTuv ]v E RvPPB (}˘]u C UIVU Adults rPIV}IMR}o˙(}˙bw Children æuP llPR}o˙(}˙bw Or Au}˘]]oo]vA=Coov]A] UIVU Adults XPR}o˙U Ivb}XPR}o˙(}˙bw ]v]v(}vb b Children r˙bV v }XPR}o˙U uP Ivb}XPR}o˙(}˙bw ]v]v(}vb b u}vRbr˙bV uP llPR}o˙U Ivb}uP llPR}o˙(}˙bw ]v]v(}vb b nd yy yy æ Chatep rP *EarUNoseandThroatDisorsder ˙bw ru}vRbV PuvAM˙bw V uP llPR}o˙(}˙bw uP llPR}o˙(}˙bw Note 20-2 TuvbR}o RvP}}ov]}b`Rv}]v}vv (}}o}(˙bw r Refeal r Criteria R(oo vb ]uu]o˙ } b]o]b ]( R ]b v} ˘b ]oo(}]v}v}R}b}u˙X 205.R}R˙vPobA æ v*Retrophaynge r als*ceAb v TR]b uPv˙ }v]}v (b } }oo}v }( b ]v R }R˙vPo bX o˙ E ]Pv}b]b v uv `]oo v u}o]˙X sueCa yy G}Ar haemolytic Streptococcus yy Staphylococcus aureus yy Ob}u˙o]b}(]o(}uo}b]b Symptoms yy F yy Sore throat yy D]8o˙]vòo}`]vP b yy H˙˘vb]}v}(vl yy L}vv}]b˙R]vP Signs yy F yy RvR}UoPv]vGuu}vb]ob yy L}b]}v`]R]v}bo}vb yy Stridor yy BoP]vR}b]}R˙vPoòo Invtiga se tions yy FBC yy TR}`b (}ovbv]˙vP b yy Z]RorNobv]v b }˘oo}b]b yy Lob}LbXr˙}(vl yy CRbXr˙}˘oo}b]b Trtme ae nt Tuv}ib yy T}]v(}v yy T}o]R}b}v˙]v]vPRb yy To relieve pain Standard Trtme ae ntGuidelinesUwthEditionUw Non-pharmacological treatment yy Iv]b]}vv]vP}(bvPvovbRb] Pharmacological treatment AXF}]vo]( st L]vTuv ]v E RvPPB yy Pu}o U}oU Adults æuPrPrvR}o˙ Children vr˙bV ræ˙bV u}vRbr˙V æræuPrvR}o˙ ræuPrvR}o˙ vruPrvR}o˙ v*Retrophaynge r als*ceAb v BXF}uv}(]v(}v st L]vTuv ]v E RvPPB yy (}˘]u C UIVU Adults wæuPrXæPR}o˙(}wR}b Children æuP llPR}o˙(}wR}b Av yy M}v]}o UIVU Adults æuPR}o˙(}wR}b Children wXæuP llPR}o˙(}wR}b yy yy Then (}˘]u C U}oU Adults æuPR}o˙(}˙bw Children r˙bV r˙bV days u}vRbr˙bV days Av M}v]}o U}oU Adults uPR}o˙(}˙bw Children wXæuP llPR}o˙(}˙bw æuPR}o˙(}˙bw æ uP llP ~u˘X æ uPZ R}o˙ (} w uP llP ~u˘X æ uPZ R}o˙ (} w nd L]vTuv ]v E RvPPB æ Chatep rP yy yy *EarUNoseandThroatDisorsder Foo}˘]oo]v UIVU Adults æuPvR}o˙(}wR}b Children æruP llPvR}o˙(}wR}b vA M}v]}o UIVU Adults æuPR}o˙(}wR}b Children wXæuP llPR}o˙(}wR}b Then M}v]}o U}oU Adults uPR}o˙(}˙bw Children wXæuP llPR}o˙(}˙bw Av yy Foo}˘]oo]v U}oU Adults æuPvR}o˙(}˙bw ](v]bo}òo}` b Children æuP llPvR}o˙(}˙bw ](v]bo}òo}` b Refeal r Criteria R(oo}b RENTb]o]bX yy vT}vb]oo]b TR]b ]b v ]v(}v }( R R} v }vb]obX M}b b} R}b } ]o ]v(}vb v bR}o NOT `]R v]}b b R˙ b] `]R]v } æ ˙bX H}Ù ] ]b ]u}v } ]Pv}b }}o b R˙vP]bb]v]u˙P]]b}b]vRR} ~}R˙vPo v ]}vb]oo bZ b òo b }uo]}vb R ]v}o }Pvb o]l R l]v˙b v R RX S}}o R} ]v(}vb ] uv `]R v]}b ]v } } R }uo]}vbv}}X sueCa yy V]bb yy Hu}o˙}}b b yy Haemophilus influenza yy ORPu}b]] Symptoms yy F yy D]8o˙]vòo}`]vP b yy Sore throat æ v*Phayngitis r andTonsillitis*v 206.PR˙vP]b Standard yy yy Trtme ae ntGuidelinesUwthEditionUw Runny nose C}PR v*Phayngitis r andTonsillitis*v Signs yy Reddened throat yy EvoPvv}vb]ob yy Sb]vR]PRP( yy Poo}vb]ooo˙uRPovb~b}}oR˙vP]bZ yy Rvv˙v}b~bPPbb]oZ yy C}PR ~bPPbb]oZ yy R˙b~bPPbb]oZ yy WR]bR˘Rl}(RR}bòob`R]bR}vb]oo ˘ yy Scarlet fever rash Invtiga se tions yy FBC yy Monospot test yy TR}`b (}ovbvb]]˙ Trtme ae nt Tuv}ib yy T}o]˙u}ub b yy T}}Pv]bv}}o b R}]v(}v yy To relieve pain Non-pharmacological treatment yy WuUbo˙`PPob Pharmacological treatment AXF}]vo]( st L]vTuv ]v E RvPPA yy Pu}o U}oU Adults æuPrPvrR}o˙ Children vr˙bV æræuPvrR}o˙ ræ˙bV ræuPvrR}o˙ u}vRbr˙V vruPvrR}o˙ Or yy I}(v U}oU Adults ruPR}o˙ Children wr ˙V wXær uP llP vr R}o˙ ~u˘X uP llP } v uP ˙Z r˙bw VwXæruP llPR}o˙~u˘XuP llP}æuP˙Z æ Chatep rP *EarUNoseandThroatDisorsder rv˙bV }b}o]v]v(}v b æuo}(lXæuPbvb]}vR}o˙(}˙bV u}vRr˙VXæuo}(lXæuPbvb]}v R}o˙(} ˙bV}b}o]v]v(}v b yy yy NeonateV Xæ uo }( lXæ uP bvb]}v R}o˙ (} ˙bV}b}o]v]v(}v b Or Au}˘]]oo]vA=Coov]A] UIVU Adults vuPrXPR}o˙(}˙b Children r˙bV æuP llPR}o˙(}˙b Or C˙boo]vPv]]oo]vUIVU Adults rMUvR}o˙(}˙b Children AN˙bV rMUvR}o˙(}˙b r˙bV XvrXMU~æuP llPZvR}o˙(}˙b Note 20-3 D}v}P]}r]u}˘}o(}}}o b R}]v(}vb ææ v*Phayngitis r andTonsillitis*v BXF}vPR]v(}v st L]vTuv ]v E RvPPA yy Au}˘]]oo]v U}oU Adults æuPR}o˙(}˙b Children vr˙bV æuPR}o˙(}˙b ræ˙bV æuPR}o˙(}˙b AM˙V vXæuPR}o˙(}˙b Or yy Au}˘]]oo]vA=Coov]A] U}oU Adults PuR}o˙(}˙b Children AN˙bV Ov ælæ uP vPR b oU R}o˙ (} days vr˙bV æ uo }( læw uP bvb]}v R}o˙ ~æ uo }( ælvuPbvb]}v R}o˙(}˙bV}b}o]vb ]v(}vZ Standard L]vTuv ]v E RvPPB (}˘]u C U}oU Adult æuPR}o˙(}˙b Children AN˙bV u}vRbr˙bV Or (}˘]u C UIVU Adult wæuPR}o˙(}˙b Children AN˙bV u}vRbr˙bV Trtme ae ntGuidelinesUwthEditionUw nd yy yy æuPR}o˙(}˙b uP llPR}o˙(}˙b wæuPR}o˙(}˙b æræuP llPR}o˙(}˙b v*AcuteSinusitis*v CXF}vPR]v(}v]vvbooP]}v]]oo]v yy E˙R}u˙]v U}oU Adults æuPvR}o˙(}˙b Children r˙bV æuPvR}o˙(}˙b u}vRr˙bV æuPvR}o˙(}˙b NeonatesV XæuP llPvR}o˙ Or yy A]R}u˙]v U}oU Adults æuP]o˙(}˙b Children ANvu}vRbV uP llP]o˙(}˙b Refeal r Criteria R( vb `]R v }vb]oo]bU }R˙vPo v ]}vb]oo}b vENTb]o]bX 207.AS]vb]b TR]b ]b v ]v(}v }( R rvbo b]vbbX I u˙ o } }uo]}vb `]R 'vv u}]]˙ v u}o]˙X o˙ E }Pv]}v }(R]bo]v]o}v]}v]buv}˙X S`]uu]vP ]v ]˙ `bU vo ]v(}v } vo ˘}vU (b]v}o]vPRb]vbbUvbo}b}v(}u}o˙bvooP] R]v]b ]b}b]vP(}b}o}]vPb]vb]bX sueCa yy V]o~}uu}v}oZ yy ]o B yy G}ARu}o˙S}}] æv Chatep rP yy yy yy yy yy *EarUNoseandThroatDisorsder S. pneumonia S. aureus H. influenzae M. catarrhalis A ooP˙ AXF}uv}(]o]v(}v st L]vTuv ]v E RvPPB yy Au}˘]]oo]v U}oU Adults æuPR}o˙(}˙b Children vr˙bV æuPR}o˙(}˙b ræ˙bV æuPR}o˙(}˙b AM˙V vXæuPR}o˙(}˙b Or yy Au}˘]]oo]vA=Coov]A] U}oU æw v*AcuteSinusitis*v Symptoms yy C}PR yy Nbo}vPb}v yy Pb]v b R(vR yy F}voRRb yy P}bvbo] Signs yy Yoo}`}PvR]lvbo]bRPU`R]Ru˙(}obuoo]vP yy Halitosis yy Pb]bv( yy Tvvbb } v o}` R ˙bU `Rv v vb } } `RvRbo]PRo˙ b Invtiga se tions yy FBC yy Xr˙}(vbob]vbb Trtme ae nt Tuv}ib yy T}˙u}ub b }(]vv( yy T}]]v(}v yy T}v}P]vP}(b]vbb Non-pharmacological treatment yy R˙}v A yy Su]vRo}v yy T}}R ˘}v v v]} } ~]( vo (}b }( ]v(}v ]bbvZ Pharmacological treatment Standard Trtme ae ntGuidelinesUwthEditionUw Adults PR}o˙(}˙bw Children AN˙bV OvælæuPoR}o˙(}˙b vr˙bV æuo}(læwuPbvb]}vR}o˙(}˙b rv˙bV æuo}(lXæuPbvb]}vR}o˙(}˙b u}vRr ˙V Xæ uo }( lXæ uP bvb]}v R}o˙V }b }o]v]v(}v b `lbru}vRV R}o˙V}b}o]v]v(}v b yy nd L]vTuv ]v E RvPPB (}˘]u C U}oU Adults æræuPR}o˙(}ær˙bw Children u}vRbr˙bV }v Xæ uo }( lXæ uP bvb]}v æ uP R}o˙U }o ]v b ]v( v*AcuteSinusitis*v BXF}uv}(]o]v(}v]vvb`]Rv]]oo]v allergy yy E˙R}u˙]v U}oU Adults æuPvR}o˙(}˙b Children r˙bV æuPvR}o˙(}˙b u}vRr˙bV æuPvR}o˙(}˙b NeonateV XæuP llPvR}o˙ Or yy A]R}u˙]v U}oU Adults æuP]o˙(}æ˙b Children uP llP]o˙(}æ˙b C. yy For pain relief Pu}o U}oU~}o]]v](bvZ Adults æuPrPvrR}o˙ Children vr˙bV æræuPvrR}o˙ ræ˙bV ræuPvrR}o˙ u}vRbr˙V vruPvrR}o˙ X D F}vbo}vPb}v yy Ephedrine nasal drops Adults~A9Z æ r Chatep rP *EarUNoseandThroatDisorsder r}b]v}Rv}b]o}ub]o˙`Rv] Children~XæA9Z r}b]v}Rv}b]o}ub]o˙`Rv] Or yy N}u˙]v XæA9lH˙}}b}v Adults }bR}o˙ Children }R}o˙ Refeal r Criteria R( oo bU `R]R } v} ]u} L `l }( uv } the ENT Specialist XæA9vbo}bU 208.AObM] sueCa yy yy yy yy Haemophilus influenzae Haemolytic streptococcus Streptococcus pneumoniae Staphylococcus aureus Symptoms yy F yy Sudden and persistent ear ache yy Pov]bRP(}uR yy V}u]vP yy D]R} yy C˙]vPvP]}v yy Iu]R]vP Signs yy Ru yy D]bRP]vP yy Ob]}voo˙]vGuR} yy P(}u Invtiga se tions yy FBC yy `bE (}ovbvb]]˙ æı v*AcuteOtitisMedia*v TR]b ]bv]v(}v}(Ru]oU`R]R}uuv]b`]RR R}XI]b]u}v]v(]oR]o}o}}l(}]v]XUv } }}o˙ uvP b u˙ o } }uo]}vb bR b ub}]]bU R}v]}bu] U(vbbUuv]vP]b v]vbX Pb}b}R]]v(}vb]ob]}˙ ]v(}vbX Standard Trtme ae ntGuidelinesUwthEditionUw Trtme ae nt Tuv}ib yy T}o]˙u}ub b yy T}vb}uvv]}R˙ yy T}vR}v]]˙v}R}uo]}vb Non-pharmacological treatment yy R˙}v A yy SP]o]v]vP}(b Pharmacological treatment v*AcuteOtitisMedia*v AXF}]vo]( st L]vTuv ]v E RvPPB yy Pu}o U}oU Adults æuPrPvrR}o˙ Children vr˙bV ræ˙bV u}vRbr˙V BXF}uv}(]v(}v st L]vTuv ]v E RvPPB yy Au}˘]]oo]v U}oU Adults æuPR}o˙(}˙b Children vr˙bV ræ˙bV AM˙V Or yy Au}˘]]oo]vA=Coov]A] Adults PR}o˙(}˙bw Children AN˙bV days vr˙bV ˙b rv˙bV (}˙b u}vRr˙V o˙V}b}o]v]v(}v b `lbru}vRV R}o˙V}b}o]v]v(}vb b æræuPvrR}o˙ ræuPvrR}o˙ vruPvrR}o˙ æuPR}o˙(}˙b æuPR}o˙(}˙b vXæuPR}o˙(}˙b U}oU Ov ælæ uP o R}o˙ (} æuo}(læwuPbvb]}v R}o˙(} æ uo }( lXæ uP bvb]}v R}o˙ Xæuo}(lXæuPbvb]}v R} Xæ uo }( lXæ uP bvb]}v æ r Chatep rP *EarUNoseandThroatDisorsder L]vTuv ]v E RvPPB (}˘]u C U}oU Adults æuPR}o˙(}æ˙b Children æuPR}o˙(}æ˙b nd yy 209.CR}v]ObM] TR]b ]b R}v] ]v(}v }( R u]o `]R (}}v }( R ˙uv] uuv v b ]bRP]vP (}u R (} u} Rv `lbX sueCa yy S}v˙]o]v(}vbP yy Pseudomonas aeruginosa yy Proteus vulgaris yy Pvu}}] Symptoms yy CR}v]]bRP~}}R}Z yy H]vPo}bb Signs yy P(}}v}(˙uv]uuv yy C}vR]vPo}bb yy ]bE RP æ v*ChronicOtitisMedia*v CXF}uv}(]v(}v]vvb`]Rv]]oo]vooP˙ yy E˙R}u˙]v U}oU Adults æræuPvR}o˙(}˙b Children r˙bV æuPvR}o˙(}˙b u}vRr˙bV æuPvR}o˙(}˙b NeonateV XæuP llPvR}o˙ Or yy A]R}u˙]v U}oU Adults æuP}v]o˙(}æ˙b Children uP llP}v]o˙(}æ˙b Refeal r Criteria R( v } ENT b]o]b ]( R ]b v} b}vb L ˙b }(uvX Standard Trtme ae ntGuidelinesUwthEditionUw Invtiga se tions yy `bE (}ovbvb]]˙ Trtme ae nt Tuv}ib yy To keep the ear dry yy T}v˙˘}vbv}uo]}vbXPXub}]]b Non-pharmacological treatment yy R}oo]}(ovb}vP]v}`]lv]vb(oo˙ ]v} RX L (} }v u]v Rv u} v o `]R ov`]lXD}(vo˙~obub˙Z yy I(o]vP}bU˙]vPRbR}o}b u}]o˙ yy N}R]vPbR}ooL]vR`v`]l]vP yy }] A `]uu]vP b }PhvPR]vb]}(R` yy Rrb`lo˙ b }vbRRu}R]b˙]vPR}o˙ Pharmacological treatment AXF}˘}vb ~Sb}v}vTuv(}RAObM] [Z v*Epistaxis*v BXF}}]ov]}R˙ ]v E RvPPB yy Gvu]]v }bUXA9Ur}bvrR}o˙vv]PR Or yy C]}G}˘]v ˙l}bUXA9U}vR}o˙]o˙ Refeal r Criteria R(ooR}v]oo˙]bRP]vP}b RENTS]o]bX 210.Epistaxis E]b˘]b ob} oo v}bo ]b }uu}v u]o uPv˙U `R]R]b}uuvPuv}}]u}]]˙vu}o]˙X sueCa yy yy yy yy yy yy P]l]vP }( R v}bU b]oo˙ `Rv R ]b v b]}˙ ]v(}v Tu S]v}vbovvb}R˙vPov}obub Hypertension Bo]vP disorders }R] A R]v]b Symptoms yy Nose bleed Signs yy Nose bleed æ Chatep rP yy yy *EarUNoseandThroatDisorsder S]Pvbo}vo˙]vPb S]Pvb}(bR}l~](Zb AXF}Ru}bb]b st L]vTuv yy O˘˙u}o]v Uvbo˙b Ur˙bb v}b]oR}o˙ Or yy AdrenalineU}]oU~bv}blU}v}'}v`}}oZPb}o}vb Refeal r Criteria R(vb`]Rv}]bb ˘]b}RENTb]o]bX æ v*Epistaxis*v Invtiga se tions yy FBC yy S]lo]vPb yy C}Po}vvb yy L](v}vb yy R}]ovb U](]v] Trtme ae nt Tuv}ib yy T}}b ]b˘]b yy To prevent recurrence yy To detect shock and replace blood if necessary Non-pharmacological treatment yy S] v v G˘ R } v o}} vv]vP }`v R} v]`˙ yy P]vRb}L}(v}b(}u]vb~vubRR}PR u}RZ yy Ao˙]rl}vbo]P Pharmacological treatment Chapter OralandDentalond C itions 211.Dental Caries Dvo]b]b}}Rb(]˙˙b ]u]vo]}v }( }}R R bX I }b b bo ]o }vb]}v }( .v }R˙b } ]bU `R]R ]v }o}vP }v `]R }}R b( ob}Ru]vo]b}vXTR]b}b]bb vo˙vov }Pb}b ˙b v}}Ro}bb}}uo]˙]v(}vX sueCa yy A]u]vo]b}v}(R}}Rb( Symptoms yy Uboo˙˙u}u b yy T}}RR]]˙R}U}o}`b (}}b}]vlb yy P]v u˙ ]vu]'v }U b bR v }vbv ]( R v v]vPb˘}b Signs yy AR}o}olb}u˙]b]o}vv˙b(}(}}R yy Tvvbb}vb]}v}(R+}}R Trtme ae nt Tuv}ib yy To relieve pain yy T}}bb ˙b ˘}vv.oo]vP}(]b yy T}}vP}}voR]b yy T}v}uo]}vb Non-pharmacological treatment yy RPou}R]vbL.v}R˙]vl yy BbR]vP}(R(}u Pharmacological treatment AXF}]vo]( ]v E RvPPC yy Pu}o U}oU æ Chatep rP Adults æuPrPvrR}o˙ Children vr˙bV ræ˙bV Or yy I}(v U}oU Adults ruPR}o˙ Children rw˙bV vrR}o˙Z wr˙V vrR}o˙Z Refeal r Criteria R(v}vb(}.v]uvX *OralandDentalond C itions æræuPvrR}o˙ ræuPvrR}o˙ æ uP R}o˙ ~u˘X wXær uP llP ]o˙ uP R}o˙ ~u˘X wXær uP llP ]o˙ 212. Oral Candidiasis sueCa Candida albicans~u}v]o] Z Symptoms yy WR]Rb]vRu}R yy Bv]vPbvb}v]vRu}R yy D]8o˙]vòo}`]vP b yy (bB ]bu˙(b}bl yy S}u}R Signs yy Woo .v `R] } uW}o} obb v Rb ]v R u}R Invtiga se tions yy o B u}bo]vP b (}(vPoouvb yy FBS yy Retroscreen Trtme ae nt Tuv}ib yy T}]]v(}v yy T}]v(˙vv˙vo˙]vP}v]}v ææ v*OralCandidiasis*v Oo v]]b]b ~}o RbRZ ]b v ]v(}v }( R u}R ˙ ˙bX Iu]vo˙+bR˙˙}vPUR˙}o}R}b`R}b]uuv]˙]b ]u]XI}bu}(vo˙]vHIV lAIDS vbURuov}]bRU ]bUvb}vo}vPruv]}bv}}b}]bvR}b `]R}}}oR˙P]vX Standard Trtme ae ntGuidelinesUwthEditionUw Non-pharmacological treatment yy P}}oR˙P]vv}]ovP Pharmacological treatment AXF}uv}(v}uo]}ov]]b]b st L]vTuv ]v E RvPPB yy N˙bv bvb]}vU}oU Adults Uv]bvR}o˙L(}}(}˙b Children Uv]bR}o˙ v LR((}ob˙bXMlb ]]bòo b ]vRu}RX yy v*AcuteNeotis cr ingUlctiv aer eGingivitis*v nd L]vTuv M]}v}o U}oPoU Adults and Children Xæuobu}vR}ou}b`]]o˙(}wr˙b BXF}]uuv}}u}u]bvb`]R}ov]]b]b ]v E RvPPB yy Fo}v}o U}oU Adults æruP]o˙(}wr˙b Children r˙bV æruP]o˙(}wr˙b ˙br˙bV rvuP llP}v.b˙U Then uP llP~u˘XuPZ]o˙(}˙b wr˙bV rvuP llP}v.b˙ Then uP llP˙R}b(}˙b AM˙bw V rvuP llP}v.b˙ Then uP llP˙wR}b(}˙b Refeal r Criteria R( vb v} b}v]vP } } uv } ]( R ]b R bv }( v vo˙]vP ]oovbb XPX ]b uoo]bU ]uuv}bb]}v}}]b]o]bX 213.AN}b]vPUoG]vP]]b I ]b b]. Pu ]bb +vP u]vo˙ R ]vvo ]oo v Pu uP]vX I +b boo˙ RoR˙ ˙}vP ob `]R }} }o R˙P]vX æv Chatep rP sueCa yy yy yy *OralandDentalond C itions Spirochaetes GurvP(b](}ub H}b (}b }( }} }o R˙P]vU ]P' bu}l]vP v ]uuvr suppression AXF}uv}(]v(}v st L]vTuv ]v E RvPPB yy Au}˘]]oo]v~Au}˘˙]oo]vZ Adult PX b Then æuPvR}o˙(}˙bw Children wr˙bV rw˙bV r˙bV B. yy U}oU æuPvR}o˙(}˙bw æuPvR}o˙(}˙bw vXæuPvR}o˙(}˙bw For Individuals with penicillin allergy ]v E RvPPC Co]vu˙]v U}oU æw v*AcuteNeotis cr ingUlctiv aer eGingivitis*v Symptoms yy GuuP]vb}vbb}]v}(bv}vb yy Bo]vP yy Malaise yy vbB (}oR Signs yy ro]l C ob v v}b]b u]vo˙ o]u] } Pu uP]v v ]vrvoP]vP] yy P}}}oR˙P]v yy F yy L˙uRv}voPuv Invtiga se tions yy S`(}ovbvb]]˙ Trtme ae nt Tuv}ib yy T}]]o}P}`R yy T}o]b b RP}}}oR˙P]v yy To control fever and pain Non-pharmacological treatment yy Iu} }o R˙P]v R]b XPX bR]vP ob `} ub ]o˙U (vvb}o]vb Pharmacological treatment Standard Adults æruPvrR}o˙(}˙bw Children r˙bV u}vRr˙bV Trtme ae ntGuidelinesUwthEditionUw æruPvR}o˙(}˙bw rvuP llPvR}o˙(}˙bw C. yy v*Bctea rialEndocarditisandProphylaxisinDentistry*v For pain and fever control Pu}o U}oU Adults æuPrPvR}o˙]b Children vr˙bV æræuPvR}o˙]b ræ˙bV æræuPvR}o˙]b u}vRbr˙V vXæræuPvR}o˙]b Refeal r Criteria R(oovbL]v]vPR˙}vbX X ]o B Ev}]bvP}R˙o˘]b]vDvb˙ Av]} }R˙o˘]b ]b v o]b b R ]uv ]v R uvPuv}(vb`]R]o]bb ]bl}(]o v}]b]vR}b}(vouv]o}vX P]b}b]vP ]bl (}b ]vo ]}b R]b}˙ }( ]o v}]bU R]b}˙ }( R o ]bb v R]b}˙ }( R o ouvX sueCa yy Streptococcus sanguis yy Streptococcus mitis yy Streptococcus mutans yy Streptococcus salivarius yy OR}o]oG} Trtme ae nt Tuv}ib yy T}vb]vP}(}o]]vPRvb]vu] Rb ]vP vo uv]o}v v} ]vr] (b v valvular lesions Pharmacological treatment st L]vTuv ]v E RvPPB yy Au}˘]]oo]v~Au}˘˙]oo]v ZU}oU Adults PX b ~R}b(}}Z Children æuP llPX b ~R}b(}}Z æ Chatep rP *OralandDentalond C itions Or C o]vu˙]v U}oU Adults vuPX b ~R}(}}Z Children uP llPX b ~R}(}}Z Refeal r Criteria R( } ]}o}P]b ]( ] b vv} ]v b } R]b}˙]bv}oX yy 215.A]o B S]o}v]b ]o B ]v(}vboo˙}(R}PovbXI]bu}bo˙v]ooX Sv ˘ob]o˙ ]v ]o]U oo˙U R˙vb } `R} R P}]bbr]v˘}b}u]X sueCa Staphylococcus aureus Anaerobes Streptococcus~}b]}voo˙Z v*AcutecteaB rialSialoadenitis*v yy yy yy Symptoms yy P]v(o}òo]vP b }(bv}vb yy F yy Chills Signs yy E˙Ru}bòo]vP b yy TvbvbR]v˙}o˙]vPbl]v yy Pov]bRP(}u Invtiga se tions yy FBC yy Covbvb]]˙}(]bRP Trtme ae nt Tuv}ib yy T}]v(}v yy To provide pain relief Non-pharmacological treatment yy Ev}Prb yy G] A ]vl yy D]b}vvu]}vbRvb˘}b}u] yy SP]o]vP](]v] æı Standard Trtme ae ntGuidelinesUwthEditionUw Pharmacological treatment AXF}uv}(]v(}v st L]vTuv ]v E RvPPB yy Foo}˘]oo]v U}oU Adults æuPvR}o˙(}wr˙b Children ær˙bV ræ˙bV AM˙V æuPvR}o˙(}wr˙b æuPvR}o˙(}wr˙b vXæuPvR}o˙(}wr˙b v*Luwig d [sAnginalCvic er orFacials*ceAb v BXF}uv}(]v(}v]vvb`]Rv]]oo]vooP˙ ]v E RvPPC yy Co]vu˙]v U}oU Adults æruPvrR}o˙(}˙bw Children r˙bV æruPvR}o˙(}˙bw u}vRr˙bV rvuP llPvR}o˙(}˙bw C. yy For pain relief Pu}o U}oU Adults æuPrPvR}o˙]b Children vr˙bV ræ˙bV u}vRbr˙V Refeal r Criteria R(}vbL]v]}v}(uvX 216.L`]P [bAvP]v æræuPvR}o˙]b æræuPvR}o˙]b vXæræuPvR}o˙]b lC]}rF]obA I]b]vP b ]v(}v}]P]vvPboo˙(}uu}o}}R]v} R (b]o b }( R bro]vPoU bruv]o v rR˙v˘X TR]b Rvb `Rv ]]o b }b R}PR R o]vPo }o o }( R uv]o v P]vb b } Rb vl (b]o bXTR]v(}vvRvl}`vvvRR}˘XAv}R b} }( ]v(}v ]b R }vb]oo ˙ bX TR ]v]o bv}v `]R òo]vP b }( R G}} }( R u}R v U b `]R vl ]v}ouv]buL`]P [bvP]vXAb]b}`vRvlUR u ]}r(]o b ]b bX TR]b }v]}v ]b v uPv˙ v ubbRX æ Chatep rP sueCa yy yy *OralandDentalond C itions O}v}Pv]]v(}v yy rrRu}o˙S}}] yy Staphylococci yy ]}b B Tonsillar crypt abscess AXF}uv}(]v(}v]vvbvo}òo}` b v toxaemic st L]vTuv ]v E RvPPB yy Au}˘]]oo]vA=Coov]A] UIVU Adults XPR}o˙(}wr˙b Children u}vRbr˙bV uP llP R}o˙ ~u˘X X P R}o˙ (} æ v*Luwig d [sAnginalCvic er orFacials*ceAb v Symptoms yy F]oòo]vP b `]RG}}}(Ru}Ro`]R}u yy P}]vP}vP yy }}o]vP D }(bo] yy F yy Chills Signs yy Tvbvvi`òo]vP b yy B}ro]l.uvbb}(i`òo]vP b yy S˙bb u]b yy R]bG}}}(Ru}R`]Ro]u]}v}(u}Rro}b]vPvbo] }}o]vP yy DR˙}v Invtiga se tions yy FBC yy BUElCR yy Xr˙}(i` Trtme ae nt Tuv}ib yy T}R]v(}v yy T}vR˙}v yy To control fever and pain Non-pharmacological treatment yy R˙}v A yy Iv}v](]`˙}b}vbv yy Iv]b]}vv]vP}] b yy E˘}v}(}}R](]]bRb}}(]v(}v Pharmacological treatment Standard yy yy v*Luwig d [sAnginalCvic er orFacials*ceAb v yy Trtme ae ntGuidelinesUwthEditionUw wr˙bZ A u}vRbV M uP llPR}o˙(}wr˙b vA L]˘}v C UIVU Adult P]o˙(}wr˙bU Children AooPbæuP llPR}o˙~u˘XwæuP llP]o˙Z nd L]vTuv ]v E RvPPB Co]vu˙]v UIVU Adults rvuPvR}o˙(}wr˙b Children rvuP llPvR}o˙(}wr˙b vA L]˘}v C UIVU Adult P]o˙(}wr˙b Children AooPbæuP llPR}o˙~u˘XwæuP llP]o˙Z L]vTuv ]v E RvPPC yy P}]vPv]]oo]v UIMU Adult vUrUUv]b]o˙ Children ANwlPV vUv]b]o˙ AMwlPV æUræUv]bllP]o˙ NeonatesV v}}uuv Av yy Gvu]]v UIVU Adults ruPR}o˙(}wr˙b Children r˙bV XæuP llPR}o˙(}wr˙b AM˙V XæuP llPR}o˙(}wr˙b Av yy M}v]}o UIVU Adults æuPR}o˙(}wr˙b Children wXæuP llPR}o˙(}wr˙b Refeal r Criteria R(}Rb]o]bb}}vb}bb]oX æ Chatep rP *OralandDentalond C itions 217.CR}v]P]}}voIv(}vb CR}v] ]}}vo ]v(}vb } }o}vP ]o ]v(}v }v R RU `R]R ob } }v b }( ]}}vo v }v˙ b}vP b }( R }}RX TR]b boo˙ ob } }l (}u}vUPub]}vU}}Ru}]o]˙v}o}bbX sueCa yy AXAivAvu]}]oR˙ yy Co]vu˙]v U}oU Adults ræuPvrR}o˙(}˙bw Children r˙bV u}vRr˙bV Or yy Au}˘]]oo]vA=Coov]A] Adults PR}o˙(}r˙b Children AN˙bV vr˙bV æruPvR}o˙(}˙bw rvuP llPvR}o˙(}˙bw U}oU OvælæoR}o˙ æuo}(læwbvb]}vR}o˙ æ v*ChronicPeriodontalInfections*v ]B Symptoms yy Rv]v(oR`]vP yy Mobility of teeth yy Bo]vP PuuP]v Signs yy Gub]}v yy P}l(}u}v yy L}bb}(b}vP}v˙b Invtiga se tions yy Xr˙}(]v}oRvb}vPb Trtme ae nt Tuv}ib yy T}}b }}R(v}v yy T}]v(}v yy To relieve pain Non-pharmacological management yy D]uv yy R}vbP˙ b Pharmacological treatment Standard rv˙bV u}vRr˙V bvb]}vR}o˙ AMu}vRV bvb]}vR}o˙ For pain relief Pu}o U}oU Adults æuPrPvR}o˙]b Children vr˙bV ræ˙bV u}vRbr˙V Refeal r Criteria R(oovb}Rvob]o]bX Trtme ae ntGuidelinesUwthEditionUw Xæuo}(læwbvb]}vR}o˙ XæuollP}˙`]PR}(æl XæuollP}˙`]PR}(æl B. yy æræuPvR}o˙]b æræuPvR}o˙]b vXæræuPvR}o˙]b 218.M}RUob v*MouthUlcs*er v M}R ob Pvoo˙ } ]v(}v ~]oU ]o } (vPoZU v}v]U uo]Pvv˙ro}uX TR }uu}v }vb R}bv]oobX APTHOUSULCERS Apthous ulcer ]b v o }( v}vr]o }]P]v R }b }v Ru}ob(b}(R}o]˙XS]]b]ou˙R]u }(˙Ru`]R˙oo}`]bRbUvo}u]vPP˙]bRRXTR˙ obb]. ]v} u]v}U ui} } R(}u }v o]v]o bv}vX TR u]v} ]b AM uU v R ui} r u ]v ]uX TR R(}u }ub]vuoo}b}(ruXTR}PRR]bb vlv}`vU˙bb u] }v]}vbb}]`]RR}bo]voBR[b˙v}u b V]u]v.]v˙b~]u]vBP}U(}o]]ZX H(}uob }}(}oR}bobbuo]vP}o ]oobX BR[b]bb ]bu}vb Pvo]b(}u]v}o]vPR ˙Ubl]vvPv]o]X sueCa yy Uvlv}`v Symptoms yy T]vPo]vP}vR}ou}b~}}uoRbZ yy P]v(oo yy yy SIGNS ro]l C b}Lbo`]R˙oo}`]bRrP˙G}} Tenderness æ UHIV U Chatep rP *OralandDentalond C itions Invtiga se tions yy Nil Trtme ae nt Tuv}ib yy To control pain yy To treat ulcer yy To control stress yy T}v}v˙ b ]v(}v Non-pharmacological treatment yy P}}oR˙P]v yy Ro˘}v Pharmacological treatment 219.O}v}Pv]Iv(}vb O}v}Pv] ]v(}vb ]v(}vb ]b]vP ]u]o˙ (}u R }}RXTR]b}bR b bo}(]v}o]P]v]vP}b o ] vo]˙ bR b ]}b ob]}vX TR o vP}b v}b]b vv}oob b R}}R˘}uX sueCa yy Streptococci ææ v*OdontogenicInfections*v AXT}}v}o]v st L]vTuv ]v E RvPPC yy L}o vbR PoU }oU o] `]R }'}v o}oo˙ } R ulcer base Adults Ao]v}obbRv˙ R}bbvvv}u}Rvv o]}vb]o˙ Children Ao]v}obbRv˙ R}bbvvv}u}Rvv o]}vb]o˙X Av yy I}(v U}oU Adults uPvrR}o˙bv Children vr˙bV ruPvrR}o˙bv ræ˙bV ruPvrR}o˙bv u}vRbr˙V v}}uuv Refeal r Criteria R(}vb](Ro}bv}Ro`]R]v`lbX Standard Trtme ae ntGuidelinesUwthEditionUw v*OdontogenicInfections*v Symptoms yy P]v}vR`]vP yy J`òo]vP b `]Rb]bvPv`]vP]v yy F yy Chills Signs yy Tooth tenderness to percussion yy L˙uRv}R˙ Invtiga se tions yy Xr˙}(+}}R Trtme ae nt Tuv}ib yy T}}v}o]v(}v yy To control pain yy T}u}b}}(]v(}v yy T}}b }}R]vP]˙v(v}v Non-pharmacological treatment yy R}}voR˙`]R]vPU]uvU]}u˙X yy Rb}}v}(vb (v}v Pharmacological treatment AXF}uv}(u]o]v(}v st L]vTuvP ]v E RvPPB yy Au}˘]]oo]v U}oU Adults æuPR}o˙(}˙bw Children ær˙bV ræ˙bV u}vRr˙V æuPR}o˙(}˙bw æuPR}o˙(}˙bw æuPR}o˙(}˙bw BXF}uv}(u]o]v(}vr]vvbooP]}v]]oo]vb ]v E RvPPB yy D}˘˙˙o]v U}oU Adults uPR}o˙(}˙bw Note 21-1 N} }uuv ]v Pvv˙U ovP u}Rb v ]v R]ov AM ˙b }(PX CXF}uv}(]v(}v b st L]vTuv ]v E RvPPB yy Au}˘]]oo]vA=Coov]A] U}oU æv Chatep rP yy *OralandDentalond C itions X D F}uv}(]v(}v b r]vvbooP]}v]]oo]vb ]v E RvPPB yy A]R}u˙]v U}oU Adults æuP]o˙(}æ˙b Children uP llP}˙`]PR]o˙(}æ˙b N}}uuv(}R]ovobbRvvu}vRbb}(]bl of pyloric stenosisX Or yy Co]vu˙]v U}oU Adults æruPvrR}o˙(}˙bw Children r˙bV æruPvR}o˙(}˙bw u}vRr˙bV rvuPllPvR}o˙(}˙bw E. For pain relief ]v E RvPPB yy Pu}o U}oU Adults æuPrPvR}o˙]b Children vr˙bV ræ˙bV u}vRbr˙V æræuPvR}o˙]b æræuPvR}o˙]b vXæræuPvR}o˙]b æw v*OdontogenicInfections*v Adults væuPR}o˙(}˙bw Children AN˙bV OvælæoR}o˙(}wr˙b r˙bV æ uo }( læw bvb]}v R}o˙ (} wr˙b r˙bV æ uo }( l bvb]}v R}o˙ (} wr˙b u}vRbr˙V uP llP~}(u}˘]]oo]vZR}o˙(}wr days AMu}vRbV æuP llP~}(u}˘]]oo]vZR}o˙(}wr days Or A ]R}u˙]v U}oU Adults æuP]o˙(}æ˙b Children uP llP}˙`]PR]o˙(}æ˙bX N}}uuv(}R]ovobbRvvu}vRbb}(]bl of pyloric stenosisX Standard Trtme ae ntGuidelinesUwthEditionUw Refeal r Criteria R( oo vb `]R }}v}Pv] ]v(}vb } vo b]o]b L]v]}v}(uvX 220.Oral Squamous Cell Carcinoma v*OralSqamou u sCellcinoma Car *v TR]b}v]}vbvbv}v b rRo]vPo}(u}Rv`}`lb ]v R u}RX TR u˙ Pv ]b}b]}v v]}vuvo b R v ]v.X F} v }o oU `lb }b}v (} Ro]vP ]b boo˙ X I( b } } v ]v(}vU v }]vu]}]o]bP]vX sueCa yy Uboo˙vlv}`v yy Ab}]}vbP yy T}}lovR`]vP yy Alcohol yy Su}l]vP yy HPV ]v(}vb Symptoms yy N}vrRo]vPo]vRu}R yy P]v yy J`òo]vP b v(}u]˙ Signs yy Ivr}oubbo yy WR]u}boR yy Nlubb Invtiga se tions yy Iv]b]}vo]}b˙(}R]b}R}o}P˙ Trtme ae nt Tuv}ib yy T}]u}ubbloob yy To control pain yy T}˙}.v]uv Non-Pharmacological treatment yy SP˙A=lr]}R˙ Pharmacological treatment yy CRu}R˙~A=lrP˙ b A=lr]}R˙Z Refeal r Criteria R(]uu]o˙}R}v}o}P]b(}(RuvPuvX æ Chatep rP 221.Tu}}ruv]oJ}]v ˙b(v}v *OralandDentalond C itions ˙b(v}v vub}˙ubo AXF}uboo˘}v st L]vTuv ]v E RvPPC yy D]u U}oU Adults æuPR}o˙ æı v*TemporormandibularJointysd functionandmatic s tor a ymucle s ysd function*v Tu}}ruv]o J}]v ~TMJ Z ˙b(v}v v } ub}˙ ubo˙b(v}v ]b}uo˘}(vPuvb+vP}vo˙Ri}]vU Rubob}(ub}v}}RXTRR}o}P]o}bbu˙ } i}]v R}R˙U ]b ]bb } vb]}v ]v v}vb v ub}˙ ubob(}uv}uou}uvR]}}}obo]bRu}v˙X sueCa yy BR]}o]v˘]bu yy Arthropathy yy Tu~R˙b]oZ yy Oobo]bRu}v˙ Symptoms yy Pr]o]vb}]`]R}v]vPvo}b]vPRu}R yy Co]l]vPv}]b}v}v]vPvo}b]vP yy DooUb]bv]v]vub}˙ubob Signs yy Tvvbb]vRTMJ b}]`]Ru}R}v]vP yy Co]l]vP]vTMJ }vu}R}v]vPvo}b]vP yy Tvvbb]vubob}(ub}v}v}v}v yy Oobov}uo]b Invtiga se tions yy Xr˙rTMJ ]`b yy ESR Trtme ae nt Tuv}ib yy To control pain yy T}o˘ubob}(ub}v yy T}}v˙b]v]vP]uov Non-pharmacological treatment yy Oobobo]vb yy Ovro˙b yy Rbvv}Po˘}v]vub}˙b Pharmacological treatment Standard Trtme ae ntGuidelinesUwthEditionUw Children r˙bV ær˙bV For pain relief I}(v U}oU Adults uPR}o˙]b Children vr˙bV ræ˙bV u}vRbr˙V Refeal r Criteria R(oo}b Rvb(}(RuvPuvX æuPR}o˙ XæuPR}o˙ B. yy ruPvrR}o˙]b ruPvrR}o˙]b v}}uuv 222.Trigerminal Neuralgia v*TrigerminalNealgia ur *v T]Pu]vovoP] ]b}v]}vR]b˙v]oo(]o ]vR(}oo}`bR]b]}v}(R]Pu]vovXIbvb`]R vU bv }vb bRrbR}}vP ]v ]v R ( v u˙ R ]PPr}]vX TR v u˙ bv `]R ul v˘]˙ u]u]˙R]] b ]b}X sueCa yy DPv yy IvGuu}˙ yy Pbr]v b Symptoms yy SvbRrbR}}vP]v]vR( yy Sv˘]˙ Signs yy Av˘]˙ yy H˙bRb]}(+~vb]vZ Invtiga se tions yy Xr˙}o}(}}R yy MRI}o}]vv]oR}o}P˙ Trtme ae nt Tuv}ib yy T}vb yy T}oo˙v˘]˙ yy T}uvPRv}R˙ Non-pharmacological treatment yy Rbvb v}vbo]vP ææ v u˙ Chatep rP *OralandDentalond C itions Pharmacological treatment AXF}R}v}o}(v˘]˙ st L]vTuv ]v E RvPPC yy D]u U}oU Adults æuPv]PR Children r˙bV ær˙bV B. yy For treatment of neuropathic pain st L]vTuv ]v E RvPPA Cu]v U}oU Adults æræuPR}o˙oob}o}v~u˘XvuPR}o˙Z Children r˙bV æruPR}o˙ Then Ivb}vuPR}o˙](vbb˙ u}vRr˙bV XæuP llPR}o˙ Then Ivbbo}ò˙}æuP llPR}o˙ Or PPo]v U}oU Adults wæuPR}o˙oob}o}v Children N}}uuv CXF}]}vo]vo]( yy I}(v U}oU Adults uPR}o˙]b Children vr˙bV ruPR}o˙]b ræ˙bV ruPR}o˙]b u}vRbr˙V v}}uuv Refeal r Criteria R(}Rv}o}P]b(}(RuvPuvX ææ v*TrigerminalNealgia ur *v yy XæræuPv]PR XæuPv]PR Chapter DisorsOf der The Muculos s keletalSystem 223.Ob}R]b TR]b]bPvooP]b}( b ]}o}P˙XI v+ooi}]vbUu}bo˙RR]bvlvbXIu}v]+vob ]voURu}]R]bvo}b]b+vPRi}]vbX P]u˙ }b}R]b ]b boo˙ Pro ~}o PZU `R]ob }v˙ b }b}R]bu˙}}RbX sueCa yy Tu yy Iv(}vb yy IvGuu}˙R]b Symptoms yy P]v}v]˙vo]˙]v]oo˙ b yy J}]v+vb b b yy J}]vòo]vP b yy L]u]vP Signs yy L]u]vP yy J}]vòo]vP b yy J}]v+b]}v yy (}u]b D yy LPovPR]bv˙ Invtiga se tions yy Xr˙}(+i}]v Trtme ae nt Tuv}ib yy Relieve pain yy Pv}Pbb]}v yy Iu}(v}v}(i}]v yy Pv(}u]b}}uo]}vb ææ Chatep rP *DisorsOf der TheMuculos s keletalSystem Non-pharmacological treatment yy PR˙b]}R˙ yy W]PRo}bb yy Wol]vP] yy b B yy SP˙ yy Ab]}v}(˘bb]˙v}]o b G] yy Ob}}u]b yy AR}obb yy Arthrodesis Pharmacological treatment yy Av D ]o}(v PoU}]oU Adults and Children Ao˙R}o˙bvbb˙ Or ææ v*Osteoathr r itis*v AXF}]vo]( st L]vTuv ]v E RvPPA yy N}˘v U CE }oU Adults æræuPR}o˙]b Children Not indicated Or yy Co}˘] U}oU Adults uPX b Then uPrR}o˙]b Children Not indicated Or yy D]o}(v U}oU Adults æuPR}o˙}uPR}o˙ Children AN˙bV æuPR}o˙ AM˙bV v}}uuv Or yy I}(v U}oU Adults ruPvrR}o˙]b ~u˘XXP]o˙Z Children ræuP llPvrR}o˙]b ~u˘XuPlP]o˙Z Standard yy Trtme ae ntGuidelinesUwthEditionUw D]o}(v ˙b U}]oU Adults and Children Ao˙R}o˙bvbb˙ nd L]vTuv ]v E RvPPC F}v˙}(R(}oo}`]vPR˙U}vbob]o]b yy Methyl prednisolone acetateUIvro yy T]u]v}o}v UIvro yy uRb B }v UIvro Refeal r Criteria R(}uo]}b R}R}]b]o]bX X RRu}]R]b v*Rheumatoidthr ar itis*v RRu}]R]b ~RA]bZ R}v]˙bb u]]vGuu}˙]bb }(vlv}`vbXAv˘vo]PP~XPX]P'bu}l]vPU]v(}vU} u]PPb Z v}]uuv}vUo]vP}˙v}]o b R˙}R˙ vR}v]i}]v]vGuu}vo}vP`]RR}b(}˘ro uv](b}vbXI]bo]}}]vPvoo˙ob ]v]]ob vu}}uu}v]vu]oP`}uvX sueCa yy Uvlv}`v yy }]uuv A ]b} yy L]lo˙}u]v}v}(Pvvv]}vuvo(}b Symptoms yy J}]v+vb b b yy P]v(oi}]vb yy Sòo]vP}(+i}]vb yy (}u]˙ D }(+i}]vb yy L]u]}v}(u}}v yy Skin nodules yy D]8o˙]vR]vP yy ˙bE (P]o]˙ Signs yy Pb]bv˙uu] b }o˙R]b ~b˙v}]bZ}(Rvbv( yy J}]v+vb b b yy J}]vvvbb yy J}]vòo]vP b yy J}]v(}u]˙ yy L]u]}v}(i}]vu}uv yy RRu}]v}ob yy S]PvbovP}˘ro]v}ouvXPXovP]bbU]bU ]]o}oo+b]}vb ææ Chatep rP *DisorsOf der TheMuculos s keletalSystem v*Rheumatoidthr ar itis*v Invtiga se tions yy FBU C SR E yy Cr}]v level yy RRu}]F} assay yy AvvoAv}˙~ANA ˙Zb yy AvALC˙o]C]oo]vP~AvrCCPZ yy J}]vb]}vvvo˙b]b}(˙v}]o b G] yy Hb BvbC yy HIV test yy Xr˙b}(Rvbv( yy MRI}(]ob]v~}bo˘}vZ yy Uob}v}PR˙}(i}]vb Trtme ae nt Tuv}ib yy T}]vUòo]vP b v+vb b b yy T}v(}u]b yy T}o˙]b}Pb b b]}vvo}vPru}uo]}vb yy T}Pb]+b Non-pharmacological treatment yy Heat and cold therapies yy OR}bvbo]vb yy PR˙b]}R˙ yy O}voR˙ yy ]uv A yy J}]vr}}v}v yy C}boo]vPv}v yy S˙v}}u˙ yy Tv}b˙v}}u˙ yy Tv}vo]Pvuv yy R}vbP˙ b }R}ob˙ yy Arthrodesis Pharmacological treatment AXS˙u}ubbvu}Rvv`lb}v}˙}b] st L]vTuv ]v E RvPPB yy Pv]b}o}v U}oUXæruP llP}˙`]PR C}vrX Tl}}b}]bL(}}X H]PRr}bPo}}}]bu˙b]vb}uv]V]uu]rob(}uo}v ]b˙]oo˙u]v]b]vu}v]vP}}]v]`]R]]vR˙RuX yy Av Ou}o Adults uP]o˙ U}oU æææ Standard yy yy v*Rheumatoidthr ar itis*v yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw Children ANlPV rlPV ærlPV Or Eb }u}o U}oU Adults ruP]o˙ Children r˙bV r˙bV AM˙V Av D ]o}(v U}oU Adults æuPR}o˙}uPR}o˙]b Children AN˙bV AM˙bV Or D]o}(v UoU Adults uPR}o˙]b Children AN˙bV AM˙bV Or Co}˘] U}oU Adults uPX b Then uPrR}o˙]b Children AN˙b~ANælPZV AN˙b~vrælPZVæuPR}o˙]b AM˙bV Or Pu}o U}oU Adults æuPrPvrR}o˙]b Children vr˙bV ræ˙bV u}vRbr˙V Av C o]u uP]o˙ uP]o˙ æuP]o˙ ruP]o˙ ruP]o˙ v}}uuv æuPR}o˙]b v}}uuv wæruP]o˙]b v}}uuv uPR}o˙]b v}}uuv æræuPvrR}o˙]b ræuPvrR}o˙]b vruPvrR}o˙]b bouvb ææv Chatep rP *DisorsOf der TheMuculos s keletalSystem Adults and Children As required B. yy yy yy yy yy Or vE U}vbob]o]b IvG]˘]uU}vbob]o]b Ao]uuU}vbob]o]b }o]u C U}vbob]o]b G}o]uuU}vbob]o]b yy yy yy yy yy Or R]˘]uU}vbob]o]b Avl]vU}vbob]o]b U A }vbob]o]b T}]o]uU}vbob]o]b T}(]v]U}vbob]o]b v*JuvenileIdiopthic a thr Ar itis*v yy yy yy yy Maintenance treatment for symptoms present more than 6 weeks }v}˙}b] st L]vTuv ]v E RvPPB H˙}˘˙Ro}}]vU}vbob]o]b So(bo]vU}vbob]o]b MR}˘U}vbob]o]b LGv}u]U}vbob]o]b nd L]vTuv ]v E RvPPC yy C˙o}b}]vU}vbob]o]b yy R]}]v A U}vbob]o]b yy G}obobU}vbob]o]b yy Drv]]oou]vU}vbob]o]b yy M]v}˙o]vU}vbob]o]b Refeal r Criteria R(oo}b R˙b]]vb]o]b}Ru}o}P]bX 225.Jv]oI]}R]AR]b Jv]o ]]}R] R]b bob (}u v}uoo˙ Po ]uuv b}vbb R o } ]vGuu}v }( i}]vbU }v]vP b b v }R }PvbX OLvU v}vrRu ]bb R v b b]u]o(bv}˘o]vPo}vX RRu}] R]b ]v R]ov u˙bv]v }v }( R(}ubV ˙bb u] }vb R]b ~Soo[b ]bb Z U }o˙ro }vb R]b ~æ }u}i}]vbboo˙}(}RoPvbuoo+Z}]ro }vb R]b ~(` Rv æ }( u]vo˙ oP i}]vb +Z ]R }( `R]Ru˙Ru}](}}b]}vPXTR}b`]R}b] ææw Standard Trtme ae ntGuidelinesUwthEditionUw AvvoAv}]b~ANA Z bvPo˙Rlb(}]bX F} R]b }v]}vU ] ]b uv}˙ (} R]b } bv (} obv`lb(}R]Pv}b]b}uX sueCa yy v*JuvenileIdiopthic a thr Ar itis*v }]uuv A ]bb Symptoms yy M}v]vP+vb b b yy J}]v]v yy P]v(o˙b yy Rash yy J}]vòo]vP b yy F Signs yy S`}oovùi}]vb yy Rb]vP}(i}]vu}uv yy S˙bu]}vb yy F yy Macular rash yy H}bov}uPo˙ yy L˙uRv}R˙ yy S}b]bXPX]]o+b]}v yy Red eyes Invtiga se tions yy FBC yy ESR yy BUEvv]v yy L](v}vb yy Cr}]v yy RRu}]F} ~RFZ yy AvrC˙o]C]oo]vP~CCPZv}˙ yy AvvoAv}]b~ANA Z yy XrR˙}(+i}]vb yy So]ou˘u]v}v yy ORu]v b ˙b]o]b Trtme ae nt Tuv}ib yy T}}v}o]vv]vGuu}v yy T}v(}u]bvP}`R}v yy T}}v}o˘o}uo]}vb yy T}u]v]u]bPb]+b yy T}}u]bRv(}v}uob}]oo}uv Non-Pharmacological Treatment yy PR˙b]}R˙ ææ Chatep rP *DisorsOf der TheMuculos s keletalSystem yy Pb˙R}R˙ yy O}voR˙ yy D]R˙ yy Pv}vboo]vP Pharmacological Treatment yy nd L]vTuv ]v E RvPPA Co}˘] U}oU Children AN˙b~ANælPZV AN˙b~vrælPZV AM˙bV C}vrX TR o}vPru b }( NSAIDb u}Rv`}`lbZu˙vo b ]u]uvvPb]bX R(L`}`lb}(NSAIDbX ruPR}o˙]b ruPR}o˙]b v}}uuv æræ uP r R}o˙ ~u˘X uP v*JuvenileIdiopthic a thr Ar itis*v AXT}}v}o]vv]vGuu}v st L]vTuv ]v E RvPPA yy I}(v U}oU Children vr˙bV ræ˙bV u}vRbr˙V Or yy Iv}uR]v U}oU Children AN˙bV ˙Z r˙bV æuP˙Z AM˙bV Or yy N}˘v U}oU Children ANæ˙bV AMæ˙bV æ u]}Pur uP llP R}o˙ ~u˘X v}}uuv ærwXæuP llPR}o˙~u˘XP˙Z v}}uuv(}R]b}v]}v uPR}o˙ v}}uuv æuPR}o˙ like diclofenacU v}˘v BXS}]R˙}}v}o]vGuu}v ~SuvR}}v}o]vv]vGuu}v[]v~AZ}Z Av yy Pv]b}o}v U}oU Children XæruP llP]o˙}R}o˙~u˘XvuP˙Z ææı U v ]}(v ~]XX (} Standard Trtme ae ntGuidelinesUwthEditionUw Note 22-1 I(˙u}ub b }v}]u}L`lb v }(}] b bUR}v] b bX C. For treatment of chronic symptoms st L]vTuv ]v E RvPPA yy Ivro}}b}]]vi}vU}vbob]o]b yy MR}˘ U}vbob]o]b yy EtarneceptU}vbob]o]b yy IvG]˘]u U}vbob]o]b yy Ao]uu U}vbob]o]b yy AnakinraU}vbob]o]b Refeal r Criteria R(oo}b ]]]v}Ru}o}P]bX 226.Back pain v*Bcka ain* p v TR]b ]b R }uu}vb b }( } ]v } RoR (]o]bXM}RvA9}(}o`]ooRob}v]b}]vR] o](uXM}bv]Pvv`]oob}oXH}ÙA9rvA9`]ooR v`]R]v˙XI]b]u}v}]v(˙Uv˙oo}`GPbXI u˙](]]bobbRvu}vRbvR}v]](]]bu}X B}˘rP) Notes of back pain YELLOWGPb yy Pbb]u]b h }` ]vU ˘bb] ( }( u}uv v ]˙ vo]'oR}(}]u}uv yy W}lro}oub~XPX]b(}v b U}vG]bZ yy Eu}}vo}oub~XPXb]}v Uv˘]˙ U`}˙Z yy Gvo]]v~XPXRRU(PU]]vbbZ yy Db](}b]uvUo]'o]o]˙}} yy P]}b]b}b}(o}`l]vR`(}oo}`(}v˘v ]}}(u REDGPb yy Pvb AM ˙b } AN ææ ˙b }( P ˘]v]vP l ]v (} R .bu yy Pvb˘]v]vP]vb]Pv].vo˙]+v(}u]}b]b}b yy P]vR]b}vbv}uv}bv}]b]vPbo yy Gvouo]bv}}Pvo}v]}v yy Tu ]vi]bU u}bU }] b b } ]u} b }( ]uuv}b pressants yy N}o}P]o}u}u]b yy S]vo(}u]˙ yy P}v}v u}v]vP +vb b b obvP (} o}vP Rv R} vl} R]PR ˙R}˙b]uv}v sueCa yy MRv]o ~XPX ]b Pv}vU (U ]vb]o]˙U æv r r Chatep rP yy yy yy yy *DisorsOf der TheMuculos s keletalSystem vlv}`vbu}bbZ N}Pv]~XPXURv]]bUb]vov}b b ]bU}b}R˙uP }v}}Z N}vruRv]o b]vo }v]}vb ~XPXU v}obuU ]v(}vbU ]vGuu}˙R]bUPP[b]bbZ R(]bo ]v ~XPXU Pb}]vbvo ]bbU l]v˙ ]bbU }u]vo}v]buZ OR~XPXU.}u˙oP] Ub}u}(}u]b}US(l]vP _]vZ v*Bcka ain* p v Symptoms yy P]v yy N}] yy D]+b]v yy Neuropathic yy P]l]vPUvPo]vPU]vbvvob yy Eo]bR}lb}(bR}}vP yy H}}v]vP yy Nuvbb yy Aobvb}v yy Radicular pain yy Iv}vvv}(]vv(b Signs yy (}u]˙ D }(b]v yy Tvvbb]v+P]}v yy Wlvbb}(R+o]u yy Mbo`bvP]vR+o]u yy Aobvb}v]vR+o]u Invtiga se tions C]]rCR A R}uuv}v Uv}uo]Uo}`l]v IuP]vPboo˙v}}] L}`ro}]˙uU}b}}}b]b}PAN w˙b MRI}(oub]v`]R}}vb usually appropriate L}`l]vvl}]o}R˙]v P]o b }]vv}vov] Sb]]}v}(vU]v(}v} ]uuv}bb]}v MRI}(oub]v`]Rv`]R} contrast usually appropriate P]}ouP˙ b ]v C ˙v}u b yy yy yy yy FBU C SR E U Mv}˘ CRbXr˙~](TB]bZb RRu}](} æv Standard yy yy yy yy Trtme ae ntGuidelinesUwthEditionUw HLArBw ~](]vGuu}˙R]b]bZb CT scan of spine CTu˙o}Pu Po]vXr˙b}(b]v Trtme ae nt Tuv}ib yy P]vo]( yy Pv}v}(v yy Iv.}v}(v˙oo}`GPb yy Tuv}(vo˙]vPb yy Iu}uv}((v}v Non-pharmacological treatment yy Splints yy PR˙b]}R˙ yy W]PRo}bbvo](b˙oibuv yy Acupuncture yy SoR˙P]v yy O}voR˙ Pharmacological treatment v*Bcka ain* p v AXF}o](}(l]v st L]vTuv ]v E RvPPB yy Pu}o yy yy yy yy yy yy yy U}oUæuPrPvrR}o˙ Av N}˘v U CE }oU æræuPR}o˙]b Or Co}˘] U}oU uPX b Then uPrR}o˙]b Or D]o}(v U}oUæuPR}o˙}uPR}o˙ Or I}(v U}oUuPvrR}o˙ Av D ]u U}oUæuPR}o˙ Or MR}u}o U}vbob]o]b Or T]v]]v U}vbob]o]b nd L]vTuv æv Chatep rP yy yy yy yy yy *DisorsOf der TheMuculos s keletalSystem ]v E RvPPB A u]]˙o]v U }oU ~`Rv R v}R] b]Pvb v ˙u b }ubZUæræuP]o˙ Or PPo]vb U}oU}vbob]o]b r Av Tu}o U}oU æuPX b Then Ivb ˙ æræ uP ]o˙ } ær uP v R}o˙ b vbb˙V ~u˘XuP˙Z Or CodeineU}oUærvuPrvR}o˙]b Or MorphineboRU}oUæruPrR}o˙ v*Fibomya r lgia*v BXF}IvGuu}˙AR]b yy Pv]b}o}v U}oU}vbob]o]b yy MR}˘ U}oU}vbob]o]b yy R]˘]u UIVU}vbob]o]b Refeal r Criteria Iv]]ob u˙ v } ( } R }R}] b]o]bU v}bP}v}Ru}o}P]b}v b Rv˙oo}`GP]] }X 227.Fibromyalgia F]}u˙oP] ]b ]b} }( R}v]U `]b ]v v vvbbX I ˙]oo˙ bvb ]v ˙}vP `}uv ]v R R] } u]orP`}uvv+vb}(]R˘b vv˙PX F]}u˙oP] ]b ]Pv}b]b }(˘ob]}v v }Lv }b ]vvb `]R }R }v]}vbU bR b }]uuv ]vGuu}˙ R]b v }b}R]bX TR o]v]o o}v u˙ o }i ]v (} }R }ru}] ]oovbbU bR b R˙}R˙}]]bu ˙bb u] ob ˙Ru}bbU }o˙u˙oP] Ru v }R ]vGuu}˙}}]uuv]b}bX N} o R}R˙b]}o}P]o uRv]bu (} .}u˙oP] v o]b b RU ]v bPPbb R R ]b v v}uo]˙ ]v vo]v}bb]vPX AoR}PR R ]b v} (} .}u˙oP] b}u }( R ˙u}ub b X S]v ˙u}ub b vu}b v ˙ u}vP vbU uv }Pub ub ]v]]o] (} R vX Tuv ]vob v }vU b }vU Po ˘]b vu]}vbXAo`˙b}u]vRu}o}P]vv}vrRu}o}P] æv U Ru}] R]bU has U uv v o] Standard Trtme ae ntGuidelinesUwthEditionUw R˙]vRuv}(.}u˙oP]X sueCa yy Uboo˙vlv}`v v*Fibomya r lgia*v Symptoms yy CR}v]`]b]v yy Uv(bR]vPbovvbb yy Av˘]˙ yy b]}v D yy M]P]v or tension headaches yy Nuvbb}vPo]vP}(]+vb}(R}˙ yy A}u]vo]v yy C}vb}v or diarrhoea yy I]oo Signs yy Tv P}]vb ~}uu}vo˙ (}v }v R o}`bU bR}obU lvbUR]bUl}(RRUvRb]b}(R}v b Z yy M˙oP] ~u}RvRu}vRbZ Invtiga se tions yy FBU C SR E yy BUEvv]v yy U]vo˙b]b yy TR˙}]uovP b R}u}voo yy ærR˙}˘˙]u]vDoo yy V]u]vB level yy I}v]bb yy MPvb]uoo Trtme ae nt Tuv}ib yy To reduce pain yy T}PPbb]o˙}ru}]b]}v yy T}]u}bo yy T}(P Non-pharmacological treatment yy SbbuvPuv yy E˘]b yy Bov] yy Sleep therapy yy Pb˙R}o}P]lR]}oR˙ Pharmacological treatment AXF}uv}(u]o˙u}ub b st L]vTuv ]v E RvPPB æv Chatep rP yy yy yy yy B. yy C. æræuPvrR}o˙]b æræuPvrR}o˙]b vXæuPræuPvrR}o˙]b æuPR}o˙]b v}}uuv wæruP]o˙]b v}}uuv nd L]vTuv ]v E RvPPB Tu}o U}oU æuPX b Then Ivb ˙ æræ uP ]o˙ } ær uP v R}o˙ b vbb˙V ~u˘XuP˙Z vA Au]]˙o]v U}oU uPv} Then Goo˙]vb}wæuP]o˙]b For treatment of chronic or severe symptoms with anxiety ~SRuv(}u]o˙u}ub b [b}Z Av st L]vTuv ]v E RvPPB Co}vu U}oU Adults æu]}PuR}o˙~u˘XuPR}o˙Z Children N}}uuv(}R]b}v]}v For treatment of chronic or severe symptoms with depression ~SRuv(}u]o˙u}ub b [b}Z ævæ v*Fibomya r lgia*v yy Pu}o Adults æuPrPvrR}o˙]b Children vr˙bV ræ˙bV u}vRbr˙V Or D]o}(v U}oU Adults æuPR}o˙}uPR}o˙]b Children AN˙bV AM˙bV Or D]o}(v UoU Adults uPR}o˙]b Children AN˙bV AM˙bV *DisorsOf der TheMuculos s keletalSystem Standard Trtme ae ntGuidelinesUwthEditionUw Av yy yy yy v*Fibomya r lgia*v D. yy yy E. st L]vTuv ]v E RvPPB Fo}˘v U}oU Adults uP]o˙~u˘XuP˙Z Children r˙bV AM˙bV Or Au]]˙o]v U}oU Adults æræuP}v]o˙~o˙v]vPZU Then Ivb˙æuP˙ræ˙b}u˘X}(æuP Children ANv˙bV AMv˙bV Or Do}˘v U}oU Adults ruPrR}o˙~u˘XvuP˙Z Children wrw˙bV uP]o˙~u˘XuP˙Z v}}uuv æræuPR}o˙ v}}}uuv ruP]o˙~u˘XvuP˙Z For treatment of chronic or severe symptoms with myalgia ~SRuv(}u]o˙u}ub b [b}Z Av st L]vTuv ]v E RvPPB T]v]]v U}oU Adults uPR}o˙ M˙]vb}uPR}o˙L˙bw Children N}}uuv Or C˙o}v]v U}oU Adults æruPR}o˙]b Children æuPR}o˙]b For treatment of chronic or severe symptoms with neuropathic pain ~SRuv(}u]o˙u}ub b [b}Z vA st L]vTuv æv Chatep rP yy yy *DisorsOf der TheMuculos s keletalSystem ]v E RvPPB PPo]v U}oU Adults ærwæuPR}o˙oob}o}v~u˘XuP˙Z Children N}}uuv Or Gvv U}oU Adults uP]o˙ Then Ivb˙uP]o˙}u˘X}(vuPR}o˙ Children N}}uuv F. F]PrP) Fibromyalgia tender points ævw v*Fibomya r lgia*v For treatment of chronic or severe symptoms with migraine ~SRuv(}u]o˙u}ub b [b}Z Av yy ClonidineU}oU Adults ærwæu]}PuR}o˙ Children N}}uuv Refeal r Criteria R( vb v} b}v]vP } uv } R }] b]o]bX Standard Trtme ae ntGuidelinesUwthEditionUw 228.I]}R]]vGuu}˙u˙}R]b v*Idiopthic a inflammatorymyopthie a s*v TR]]}R]]vGuu}˙u˙}R]b~IIM Z˙bb u]}vv b]bbU`R]RR]˙˙uu]o b U}˘]uoubo `lvbbU ubo vPR b v R}v] ]vGuu}v ]v ubo bX TRb ]b}bU v +b u} `}uv Rv uvX AoR}PR R l P }( }vb ]b ]v R æbU R ]b}b v } v˙PXTR`}Siv]o_]bb]vRvu`RvR]o]b+ ˙u˙}b]bX Aob `]R ]vGuu}˙ u˙}R]bU R v ]vb ]bl }( v]vo]vPv}(RovPUU b }bUv}]bX sueCa yy Uvlv}`v yy }]uuv A Symptoms yy Mbo`lvbb~}vRvlUbR}obvR]bZ yy T}oo]u]vP]bb UPhvP(}uU b }R]vP(}}ib overhead yy P]v]vRubob yy CR}l]vP`R]ovP yy Ab]}v}((}} Signs yy P}˘]uoubo`lvbb yy Ab]}vvu}v] yy G}'}v[bb]Pv }G}'}v[bob ~bR}Rl}(R.vPbU o}`b}lvbZ yy SRò b]Pv ~GU v R b }v R lU bR}obUvl}(RvlZ yy PR}}bvb]bR yy Heliotrope rash yy N]ov}uo]b yy MRv][bRvb yy Alopecia yy IvboovP]bb yy Co]u }b]b]vRbl]v~o]v}b]bZ Invtiga se tions yy vC l]vboob yy AvvoAv}]b~ANA Z yy Hb BvvCb yy HIV Test yy Muscle biopsy yy MRIv b }(Rubob yy Eo}u˙}Pu~EMGZ æv Chatep rP *DisorsOf der TheMuculos s keletalSystem Trtme ae nt Tuv}ib yy T}]u}ubovPR b yy T}u]v]u]bo}vPruubouP yy T}v}uo]}vb(}uubo`lvbb yy T}uvb]+b Non-pharmacological treatment yy PR˙b]oR˙vR]o]}v}v}vb yy }]v A }(˘}b}]bvo]PR yy }] A (]vPRv]b}vb]}v Pharmacological treatment yy yy Av C o]u bouvb`]R]u]vD Adults and Children As required Or B]bR}bR}vb Adults and Children Consult specialist BXF}uv}(bR]vu}u˙}b]b ~Suv(}}v]}v]v~AZ}Z Av yy H˙}˘˙Ro}}]v Adults U}oU ævı v*Idiopthic a inflammatorymyopthie a s*v AXF}uv}(}v]}v st L]vTuv ]v E RvPPB yy Pv]b}o}v U}oUXæruP llP}˙`]PR Av yy Ou}o U}oU Adults uP]o˙ Children ANlPV uP]o˙ rlPV uP]o˙ ærlPV æuP]o˙ Or yy Eb}u}o U}oU Adults ruP]o˙ Children r˙bV ruP]o˙ r˙bV ruP]o˙ AM˙V v}}uuv Standard Trtme ae ntGuidelinesUwthEditionUw ruP]o˙ Children ærvXæuP llP~u˘XuP˙Z v*ManagementoftheHotSwollenJoint*v CXF}uv}(}v]}v`]R}] b b]bv st L]vTuv ]v E RvPPB yy MR}˘ U}vbob]o]b Or yy R]}]v A U}vbob]o]b Or yy Ivv}b]uuv}Po}o]v U}vbob]o]b Or yy Mycophenolateu}(o U}vbob]o]b Or yy R]˘]u U}vbob]o]b Refeal r Criteria R(oovb}R˙b]]vb]o]b}Ru}o}P]bX 229.MvPuv}(RH}S`}oovJ}]v TR R} `}oov b i}]v ]b }uu}v bv}v v Rb ˘vb] ]+vo]Pv}b]bXS}u}(Ru}bb]}bR]b b ~`]R(o]˙ b }(A9vZ olu]]vR]ovXL]Pv}b]b v}}uvob}i}]vuPvRX TR }uu}vb + i}]v ]b R ]P }U ˙]oo˙ } P} vv]Pv}b}vo]v]oP}vbXPvb`]RbR}R]b}˙}( R}U `}oov b v v i}]v ~} i}]vbZ `]R ]}v b }( u}uv bR}o P b R]vP b R]b vo }v }R`]bX I( o]v]o b]]}v ]b R]PRU Rv ] ]b ]u } b R]b v]vRbv}((X sueCa yy SR]b yy RR]b yy M}v}obv}v}(}o˙R]b yy IvGuu}˙R]b yy Gout}˙boR]b yy HuR}b]b yy Tu yy b]bB looo]b yy Llu] ~]vR]ovZ yy Hu}R]o] Symptoms yy F yy J}]vòo]vP b ~u}v}R]bZ æw yy yy Chatep rP J}]v]v L]u]u}]o]˙}(+i}]vb *DisorsOf der TheMuculos s keletalSystem AXF}}v}o}(]vv]vGuu}v st L]vTuv ]v E RvPPB yy D]o}(v U}oU Adults æuPR}o˙}uPR}o˙]b Children AN˙bV AM˙bV Or yy D]o}(v UoU Adults uPR}o˙]b Children v*ManagementoftheHotSwollenJoint*v Signs yy H}`}oov b vi}]v yy F yy J}]vvvbb Invtiga se tions yy FBU C SR E yy Bo}}o yy Bo}}.ou}uuv yy Cr}]v ~CRPZ yy Su]] level yy BUEvv]v yy L](v}vb yy S˙v}]oG]b](}u]}b}˙vo yy Xr˙}(+i}]v yy MRI}(R+i}]v yy Uob}v}PR˙}]]Pv}bb]}v Trtme ae nt Tuv}ib yy To reduce pain yy T}òo]vP b v+vb b b yy T}v(}u]b yy T}o˙]b}Pb b b]}vvo}vPru}uo]}vb Non-pharmacological treatment yy Rb}(+i}]vbb]vPU b bo]vb yy PR˙b]}R˙ yy J}]vb]}v Pharmacological treatment æuPR}o˙]b v}}uuv æw Standard AN˙bV AM˙bV C}vrX TR o}vPru b }( NSAIDb u}Rv`}`lbZu˙vo b ]u]uvvPb]bX Trtme ae ntGuidelinesUwthEditionUw wæruP]o˙]b v}}uuv like diclofenacU v}˘v U v ]}(v ~]XX (} BXF}}v}o}(]vGuu}v]vRbv}(]v(}v yy Pv]b}o}v U}oU Adults XæruP llP]o˙}R}o˙~u˘XuP˙Z Children XæuP llP]o˙}R}o˙~u˘XvuP˙Z Or yy Ivro}}b}]]vi}vW}vbob]o]b CXF}uv}(]v(}v]vSR]b ~Sb}v}vRSAR]b[Z Refeal r Criteria R( vb `]R v o˙ `}oov b i}]v } R }R}] P}v b }Ru}o}P]bX v*Gout*v 230.Gout TR]b}v]}vU`R]R˙]oo˙+buob`]R]}bo]bl (}b v `}uv Luv}bUbob (}u R }b]}v }( ] acid ˙bob ]v i}]vb v ]o bX G} ]v v ]vGuu}v }( R + i}]vbX I ]b }LvU v} o`˙bU b}] `]R ]b o}} ] ] oob v u˙ bv v `Rv R oo }( ] ] ]v R o}} ]b v}uoU `R]o vb `]R R]PRoob}(]]u˙v}vbb]o˙R'lb}(P} P} Gb }Lv ]PP ˙ ]vbb } b ]v ] ] oob `R]R u˙ b}] `]R o}R}o ]vPb}vU }]voPv ]v (}}b R]PR ]v ]vbU ] `]PR o}bbU R˙}v }uX sueCa yy yy O}}v}(]] ]v]b}bRR]PR b oov} `]Rob}(]vb(}v]voovo] yy M˙o}}o](vo˙uR}}o](]b}b yy Pb}]b]b yy Hu}o˙vu]b yy Cooo˙b]b(}uRu}R˙U]oo˙ b R}b}(RRu} }]}o˙uR˙bb ub yy E˘bb]˘]b yy M}o]˙v}u b ~}b]˙U]bUR˙vb]}vUo R}ob}oXZ Iu]˘}v}(]] æw is characterised by XIv]]o U r yy yy yy yy yy Chatep rP *DisorsOf der TheMuculos s keletalSystem Rvo]u]uv LvR}R˙ S}v}R˙}v DPbXPXR]]vo}}]bU˙}}˘]PbU˙]v u] yy Ao}R}o]vPb}v IvR]]vu}o]]b}bXPXLbRrN˙Rv˙v}u b æw v*Gout*v Symptoms yy E˘]vP]vvòo]vP b boo˙}(i}]v~obb]oo˙R]P} u˙+RlvUvlob}`]bbZ yy Mooi}]v]v yy J}]vòo]vP b Signs yy IvGuU`}oov b vvi}]v yy M]P}˙}o˙R]b yy T}R]]vb}Lb~Ro]˘}(RU.vPbU}bUoobU }ov}vZ yy F Invtiga se tions yy FBU C SR E yy BUEUv]v yy Su]] yy Bo}}Po}b yy Suo]]b yy Xr˙}(+i}]v yy J}]vb](}ov}o]bu]}b}˙ Trtme ae nt Tuv}ib yy To relieve acute pain yy T}i}]v]vGuu}v yy T}vv'lbvi}]vuP yy To prevent uric acid˙bo}b]}v]vb}Lb Non-pharmacological treatment yy Ou]`]PR yy R}]v]v]XPXo]Ul]v˙bUbRoo.bRv˙b˘b yy Ro}R}o]vl}AMv]bl`l~uvv`}uvZ yy }] A R]PRo˙`v b b}L]vlbv}RPb}(}}b yy Ev}P}]vlANo]b}(`]o˙v}]R˙}v yy A+i}]vbbR}oov˘}b]v}}ov]}vuvX RBPb[v]lbv+ivb}R˙ yy Ivvb R˙b]o ˘]b bR}o }] u} R˙b]o ˘]bv}P yy Iv(˙ v vo˙]vP ]}bo ~u}o] ˙v}u b Z risk factors r X Standard Trtme ae ntGuidelinesUwthEditionUw Pharmacological treatment AX yy yy G} A st L]vTuv ]v E RvPPC D]o}(v U}o Adults æuPR}o˙}wæuPR}o˙ORDERSORY Children AN˙bV æuPR}o˙ AM˙bV v}}uuv Or D]o}(vUoU Adults uP]o˙ Children AN˙bV wæruP]o˙ AM˙bV v}}uuv v*Gout*v C}vrX L}vPru NSAIDb (} u} Rv `} `lbU XPX ]o}(v b v bR}o R(} P]v }PR `]R }}v u ]vR]]} XPX }u}oX yy yy B. yy u˙ b Pb] r nd L]vTuv ColchicineU}oU æu]}PuvrR}o˙vo˙u}ub b o]~u˘XvuP }bXC}bbR}ov}}`]R]v˙bZ Or Pv]b}o}v U}oU Adults ruP(}r˙b Chronic GoutW(}oo}`]vPuv}(P} ]v E RvPPB AllopurinolU}oU uP]o˙ Then Ivb˙ uP˙ræ`lbUib](vbb˙(}vo (v}vU vo R RP ~Su U] A] SUA AM u]}u}olLZ]bR~u˘X}bıuPZ C}vræX }D v} b Aoo}]v}o vo r `lb L ]vGuu}v Rb 'o b } v GX B ]v vb o˙ }v oo}]v}oU ] bR}o }vv vR'lboX Pb]o}`}bb]vvo}R(]oX æw r Chatep rP *DisorsOf der TheMuculos s keletalSystem Refeal r Criteria R( vb } ]]v (} ]˙ u}].}v v `]PR ]vP]]v}bv}`]PR]v]]obX Pvb `]R }ru}] }v]}vb bR b T˙ ]bU R˙vb]}vU ˙bo]]u]U vo ]u]uv } v} b}v]vP } Aoo]v}o X bR}o ( } R˙b]]v b]o]b } Ru}o}P]bX 231.Pseudo-gout (chondrocalcinosis) AXF}G L]vTuv st æwæ ~CPPD Z crystals in v*Pseudorgout~chondocr alcinosisZ*v TR]b (b } 'lb }( ˙v}]b b ]v ˙ }b]}v }( Co]u P˙}R}bRD]R˙ ~CPPD Z ˙bobXM}bvb}o(uobX IRbo]lP} ]vuv˙bUvo]lP}U'lbb]b o}vPv+Rlvu}b}uu}vo˙X C}uu}v ]bl (}b ]vo uU P˙ b U b ]oovbbU R˙}]}u˙U u]}v R˙X C}ru}]]b (} R]b }v]}v boo˙ ]}boU vo v u}o] ]bb XPX ]buoo]bX useCa yy D}b]}v }( Co]u P˙}R}bR D]R˙ v}vi}]vb Symptoms yy J}]v]v yy S`}oovi}]v Signs yy S`}oovi}]v yy Tenderness yy J}]v+b]}v Invtiga se tions yy Su]] yy Xr˙}(i}]v yy M]}b}]˘u]v}v}(i}]v}bG]b] Trtme ae nt Tuv}ib yy Relieve pain yy Pvi}]v+vb b b yy ]E ]bbv}vo˙]vPu}o]vPuv Non-pharmacological treatment yy PR˙b]}R˙ Pharmacological treatment Standard yy yy yy v*Pseudorgout~chondocr alcinosisZ*v yy yy Trtme ae ntGuidelinesUwthEditionUw ]v E RvPPC N}˘v U CE }oU Adults æræuPR}o˙]b Children Not indicated Or Co}˘] U}oU Adults uPX b Then uPrR}o˙]b Children Not indicated Or D]o}(v U}oU Adults æuPR}o˙}uPR}o˙ Children AN˙bV æuPR}o˙ AM˙bV v}}uuv Or I}(v U}oU Adults ruPvrR}o˙]b ~u˘XXP]o˙Z Children ræuP llPvrR}o˙]b ~u˘XuPlP]o˙Z Or C }oR]]v U}oU Adult æu]}PubvrR}o˙ Children N}}uuv yy yy yy yy nd L]vTuv ]v E RvPPC Pv]b}o}v U}oU}vbob]o]b Methyl prednisolone acetateUIvroU}vbob]o]b T]u]v}o}v UIvroU}vbob]o]b uRb B }v UIvroU}vbob]o]b yy yy yy yy L]vTuv P}v] U}vbob]o]b MR}˘ U}vbob]o]b PR}bR}] U}vbob]o]b AnakinraU}vbob]o]b æwv Chatep rP *DisorsOf der TheMuculos s keletalSystem Refeal r Criteria SvoPb]v(}Ru}o}P]bl}R}]P}v b X 232.Systemic lupus erythematosus æw v*Systemicluythe puser matosus*v S˙bu] Lb E˙Ru}bb ~SLE Z ]b R}v] uob˙bu }]uuv ]vGuu}˙ ]bb R Rb ]o b]Pvb v (}oo}`b ob]vP v u]hvP }bX M} Rv ıA9 }( b }( SLE } ]v `}uvU}uu}vo˙}(R]o]vPPX TR]b }v]}v v o } }uo]}vb bR b } R}v] vo (]oU b]bU ˙R}b b ]bU o]b˙U oo +b]}vU vu}v]bU ou}v˙ R˙vb]}vU ]]bU u˙}]bU ol}v]U o˙uR}v]UR}u}˙}v]v]vboovP]bbX MvPuv }( SLE }Lv vb }v R ]v]]o v[b ]b]˙ b v]bbuv](b}vbX sueCa yy }]uuv A yy Gvvv]}vuvo(}b Symptoms yy FP yy Malaise yy F yy W]PRo}bb yy Rash yy Hair loss yy Mouth sores yy J}]v]vb yy Svb]]˙}bvo]PR yy S]b yy Nausea yy D˙bb] yy A}u]vo]v Signs yy L˙uRv}R˙ yy F yy Malar rash yy D]b}]bR yy FP yy ARoP] yy Arthropathy yy M˙oP] yy AR]b yy PR}}bvb]]˙bR Standard Trtme ae ntGuidelinesUwthEditionUw yy v*Systemicluythe puser matosus*v Avu] Invtiga se tions yy FBU C SR E yy BUEvv]v C yy U]vo˙b]b`]Ru]}b}˙ yy Cr}]v yy AvvoAv}]b~ANA Z yy AvrD}ovb DNA ~bDNA yy C}uouvoob yy L](v}vb yy S}U]v}]vlb}v]v} yy OR}v}˙ A bXPXE˘oNoAvPvb~ENAZ yy Hb BvvCb yy HIV screen yy J}]v]}PR˙ yy CRb]}PR˙ yy R}]}PR˙ E yy ]v B MRIlMRA Trtme ae nt Tuv}ib yy T}}v}o˙u}ub b yy T}o˙}v}ovo˙]vP]bb yy T}vv}uo]}vb yy T}}]}bb]oo}vPrub]+b}(RPb Non-pharmacological treatment yy }]v A }(˘bb]bvo]PR yy Rest as appropriate yy Ao}`r(]`]R.bR}]o yy }]v A }(}b}Pvr}v]v]vP}v]oob yy C}vboo]vPv}v E Z Note 22-2 V]v}vbP}] Ro][ ]vb ]v vb }v PRv uP v]b} o}v vl} ]uuv}bb]bX Iv vb }v ]uuv}bb]bU R u˙}v]v]v8˙R]bRu}ob}vb }RbU B ]vGvvvu}}o]vX r Pharmacological treatment AXG A vu]vvvR˙ st L]vTuv ]v E RvPPB yy MethylprednisoloneUIV]v(b]}vU~]v(b}R}Z Adults P]o˙(}ræ˙b æw Chatep rP yy *DisorsOf der TheMuculos s keletalSystem Children u}vRr ˙bV r uP llP˙ }R˙ (} v }bb ~u˘X P]o˙Z Then Pv]b}o}v U}oU Adults and Children XæruP llP}˙`]PR C}vrvX Tl}}b}]bL(}}X H]PRr}bPo}}}]bu˙b]vb}uv]V]uu]rob(}uo}v ]b˙]oo˙u]v]b]vu}v]vP}}]v]`]R]]vR˙RuX yy yy yy yy Av D ]o}(v U}oU Adults æuPR}o˙}uPR}o˙]b Children AN˙bV AM˙bV Or D]o}(v UoU Adults uPR}o˙]b Children AN˙bV AM˙bV Or Co}˘] U}oU Adults uPX b Then uP]o˙ uP]o˙ æuP]o˙ ruP]o˙ ruP]o˙ v}}uuv æuPR}o˙]b v}}uuv æruP]o˙]b v}}uuv æwı v*Systemicluythe puser matosus*v yy Av Ou}o U}oU Adults uP]o˙ Children ANlPV rlPV ærlPV Or Eb}u}o U}oU Adults ruP]o˙ Children r˙bV r˙bV AM˙V Standard yy yy Trtme ae ntGuidelinesUwthEditionUw uPrR}o˙]b Children AN˙b~ANælPZV AN˙b~vrælPZV AM˙bV Or Pu}o U}oU Adults æuPrPvrR}o˙]b Children vr˙bV ræ˙bV u}vRbr˙V uPR}o˙]b æuPR}o˙]b v}}uuv æræuPvrR}o˙]b ræuPvrR}o˙]b vruPvrR}o˙]b Av C o]u `]RV]u]vDbouvb Adults and Children As required v*Systemicluythe puser matosus*v Av TR(}oo}`]vPu]}vb`]oo]v b ]}v}Ruvb }vb]o]bX B]}o}P]DMARDb : yy Bo]uuU}vbob]o]b yy R]˘]uU}vbob]o]b yy Ivv}b]uuv}Po}o]vU}vbob]o]b N}vrB]}o}P]DMARDb : yy C˙o}R}bRu]U}vbob]o]b yy MR}˘U}vbob]o]b yy R]}]v A U}vbob]o]b yy M˙}Rv}oU}vbob]o]b yy C˙o}b}]vU}vbob]o]b Avuo]obP yy H˙}˘˙Ro}}]vU}vbob]o]b Refeal r Criteria R(oo}b R˙b]]v}Ru}o}P]bX TorP) R}uuv}vb(}b}(}vv}vo]uuv}bb] drugs in lupus Symptom Medicines to try D}bv}v RoP] A N}vrb}]ovr]vGuu}˙ Pb }] A ]vvo]v}ouv Ub]G˙ M˙oP] H˙}˘˙Ro}}]v Specialist care æ Chatep rP Symptom *DisorsOf der TheMuculos s keletalSystem Medicines to try D}bv}v LRP˙ AvvovoRlb˙b o]v Bb v(vu}v]}]vP(} R}b`]Rbo]v˙}oub Rash H˙}˘˙Ro}}]v Specialist care T}]o}]b b }T}o]ub R]b A Pv]b}o}v Pv]b}o}v PWuP˙]v]oo˙ (}W`lbU]vP]væWuP ]vuvb`lU](v]b b}v]vPVuv]bo]lo˙} ](}ob u}vRb H˙}˘˙Ro}}]v MR}˘ Po]bv]]b Refer to Specialist in refractory cases ruPv]b}o}v˙Rv ]vP}bbUo}vPRo]vb}(R] uv~}Z Avuo]ob Refer to Specialist L}`}b}}b}]b R(}˙brR]}]v Mycophenolateu}(o Ru]X }]uuv A Ru}o˙ ]vu]lR}u}˙ topaenia Renal r r C}}b}]b}Lv}uv] ˙R]}]v U or cyclophosr vWuPv]b}o}v(}W`lb ]vP]vuP]vuvb]v response to the blood test results }C˙o}R}bRu] R]˘]u Refer to Specialist Pv]b}o}v ob˙o}R}bRu] }u˙}Rv}ou}(o R(Pvo˙}S]o]b R]}]v A }u˙}Rv}o u}(o(}u]vvv R]˘]u Cvov}b˙bb u for refractory cases C}}b}]bobv}] PUXPXvvbbvUv}v obvUX r C˙o}R}bRu] C}v}b]ovWvuPv]b}o}v daily R(Pvo˙}S]o]b R]˘]u æ r v*Systemicluythe puser matosus*v NSAIDb Chapter Trumaa AndInjuries 233.Head Injuries TRb ]vi]b ]v `R]R R ob U blooU uv]vPbU ]vU } R o}} bob `]R]v R ]v u˙ + o˙ b } }PRX TR˙ }uu}v b }( R v ]b]o]˙ b]oo˙ ]v ˙}vP }oX W]R R v }( ]vb b }( u}}]lb b o] vb}UR]v]vRbP}vXH]vi]bu˙}v}o}bU u]oU u}}X b S˙u}ub v b]PvbU b òo b Ruv u}o]˙U`]oov}vR]˙ b }(R]vi˙X S]Pv].v R ]vi˙ ]b .v b GobP}` C}u So ~GCSZ }( obb Rv X H}Ù lv u]o ]vi]b b]}bo˙ b Rb u˙ }o`]RuXC}vv}bu}v]}]vP}(Rv]b]bR b]}vvRvP]lo˙X C}}b]}b R u}vb v} v.b ]v R uv }( R ]vi˙ v v} o}vP }uuv (} }v uvPuvX Sb ub ob} v} P]v ˘ ]v b }( vb}vPvPPbb]vX sueCa yy R}8]vb yy FoobUb]oo˙(}uR]PRb yy Bo}`b}RR~.PRbU]vo]vP}ub]}ovU.PRb b Z yy GvbR}`}vb yy S`}vb yy Child abuse Symptoms yy Headaches yy }`b D ]vbb yy L}bb}(}vb]}bvbb yy V}u]vP yy S]b yy Mu}˙o}bb yy LlP}(oG]}o]vP(}uRb}v}b]ob yy Iv}ov}o]PR~R}}R}]Z æ Chatep rP *Trumaa AndInjuries Note 23-1 C]](}u]bb]}vP yy L}bb}(}vb]}bvbbRæu]vb yy Pbv}((}vblooXr˙ yy Pbv}((}oloo]]vPb]Pvb yy Pb]bvlvRRbU}u]vP yy Ov]vi]b yy CSF}}R}}R]v}R} yy Eb]oo˙u}vPCR]ovUvRoo˙U}]vR yy bvA }(o]oo}o}}lLvR}uUobu] }b]b Non-pharmacological treatment yy Aboo}(}vb]}bvbbv}]}]uv yy M]v]vo]`˙Ubl}v˙}vb b vb]bvo}v if necessary yy M]v]vRo}}~]( b vR˙}vb]}R˙vb]Z yy PvR˙}Po˙u] yy Nb`]RRv}(o yy S]o] R vl `]R }oo oo ]o b]v ]vi˙ Rb v ˘o yy I(v]bv}vb]}bUv˙R}b yy R] C v æ U]b]vP v*HeadInjuries*v Signs yy Lo }( }vb]}bvbb r u˙ ˙ (}u (oo˙ }vb]}b } o˙ v}vb]}b~bRGobP}`C}u So`Rv}bb]oZ yy E˘vo b]Pvb }( ]vi]b r b]}vbU }vb]}vbU o}vbU lv]vP}vR˙bvRl}(Rb yy CSF}o}}olP(}uRblv}b]ob yy P]oo˙v}uo]brvob]U]v}]v}]o yy F}ov}o}P]o.]bro˙b]bUo}bb}(bR}]b]}v yy S]Pvb}(]b]vv]obRv]vP b }u o}}U b bo}`]vP}(Robv]Pob]}v yy ORb}]]vi]b yy Ao}R}o]R~]vb}(]v}˘]}vZ Invtiga se tions yy FBC yy BUEUv]v C yy Bo}}Po}b yy Xr˙~blooU]ob]vURbUo]bZ yy HCTv b ~ob}(}R]ovZ Trtme ae nt Tuv}ib yy T}v(R]vi˙}R]v yy T}b}]]vi]b Standard Trtme ae ntGuidelinesUwthEditionUw yy Pbb vb}Pb] (} (]vP ]( v ]b v}vb]}bX D} NOT bvb}Pb] ](R]bb(}(Rbloob ~]X](R]bG]}o}}}u]vP(}uRv}b]obU}bZ Pharmacological treatment AXF}o}`]vP}(]b]vv]ob ]v E RvPPB yy MannitolA9UIVU~u˙P]v}}vu]vbZ Adults XæruollP~XærP llPZ Children XæræuollP~XærP llPZ Or yy Hypertonic salineA9UIV~oo˙(}R]ovZ Adults and Children ræuollP}ru]vb~u˘XæuoZ B. yy v*HeadInjuries*v C. yy D. yy yy For mild pain management ]v E RvPPA Pu}o U}oU Adults æuPrPvrR}o˙]b Children vr˙bV æræuPvrR}o˙]b ræ˙bV ræuPvrR}o˙]b u}vRbr˙V vruPvrR}o˙]b For fracture base of skull ]v E RvPPA Co}˘]oo]v UIVU Adults æuPvR}o˙ Children ær˙bV æuPvR}o˙ ræ˙bV æuPvR}o˙ AM˙V vXæuPvR}o˙ For open skull fractures Au}˘]]oo]vA=Coov]A] Adults vuPR}o˙ Children æuP llPvR}o˙ vA M}v]}o UIVU Adults æuPR}o˙ Children UIVU æ Chatep rP yy *Trumaa AndInjuries wXæuP llPR}o˙ Av ]v E RvPPB B v˙ov]]oo]v UIVU Adults XrXPvR}o˙ Children æuPllPvR}o˙ EXF}PPbb]vb]]vP}v b st L]vTuv yy HaloperidolUIMU Adults ræuPrR}o˙]b ~u˘XuP]vR}bZ Children AN˙bV ræuPrR}o˙]b ~u˘XuP]vR}bZ vr˙bV ruPrR}o˙]b ~u˘Xæu]}PulP˙Z AMv˙bV v}}uuv X A}uv A }uv ]b bv }vb }( b }u]vo ]vU `R]R u˙]P]o b ]vv}vX S}u u]o }v]}vb u˙bv }u]vo b ]vX sueCa yy IvGuu}˙}v]}vbXPXv]]bUbo]vP]bUR}o˙bb yy P(}}vbXPX˙R}]UoUu yy Ivbvo}b}vXPXvPo b Rv]URb]}vbU}oob yy Hu}RPXPX}]Pvv˙Ubov yy vbA yy C}o]bXPX]U]o]˙}]vbvo yy M]o }v]}vb XPX ] l}]}b]bU Pb}rv]bU Pb]bU uo]U vu}v]U UTI U b]lo oo ]bbU v}}o ææ v*AcuteAbdomen*v nd L]vTuv L}u UIVlIMU Adults æu]}PuruPvR}o˙bv~u˘XuP˙Z Children AN˙bV æu]}PurR}o˙bv ~u˘XuP}bZ Refeal r Criteria R( oo vb `]R b]Pv].v R ]vi]b ]uu]o˙ } v}bP}vX yy Standard Trtme ae ntGuidelinesUwthEditionUw v*AcuteAbdomen*v ]bbU}R˙]UvR}˙v}u b Symptoms yy A}u]vo]v yy Av}˘] Uvbv}u]vP yy D˙bb] yy F yy Headaches yy J}]v]vb yy D]]vbb yy VP]vo]bRP yy D˙b] yy W˙u}]o}}rb]v}}ob b Signs yy DR˙}v yy F yy Hypotension yy Rapid pulse yy A}u]vo]bvb]}v`]RG]}Pb yy A}u]voP]o b b yy SvPoRv]~b]oo˙(u}oRv]Z yy TvvbbU}vvvbbvP]vP yy bv A }òb}vb yy Ivb}òb}vb yy Tvvbb]vR}rb]o}}r]v}R yy S]Pvb}(bovu}v]}u˙}]o]v(}v yy Poo}UPvR}R˙U(}vo}bb]vP]vb]looo]bb Invtiga se tions yy FBC yy Bo}}.ou(}uo]b]b yy S]lo]vPb yy CRbXr˙ yy Po]v}u]voXr˙~vb]vZ yy rv}u]vo yy Rv}uo}}Po}b yy U]v˘u]v}v yy BUEvv]v C yy Uob}vv b }(}uv Trtme ae nt Tuv}ib yy T}b]v yy To relieve pain yy T}}v}o]v(}v](bv yy T}Rvo˙]vPb æv Chatep rP *Trumaa AndInjuries Non-pharmacological treatment yy Pbvbb }Pb]vb]R}uR b ]vP]o b cases Pharmacological treatment AXF}b]}v ]v E RvPPC yy IVG]b Or yy Bo}}vb(b]}v B. yy yy PvR}o˙]b PR}o˙]b ~u˘XP]o˙Z PR}o˙]b ~u˘XP]o˙Z æuP llPR}o˙ v ]b ~u˘XwæuP æuP llPR}o˙ v ]b ~u˘XwæuP l CXF}]v(}b}vb]}vbU(}}vbv]vbvo}b}v st L]vTuv ]v E RvPPB yy Gvu]]v UIVlIMU Adults rXæuP llPR}o˙ Children XæuP llPR}o˙ D} v} P] ]( ]v } ]b obb Rv uolR}X }] A ]v vo ]u]uvX Av yy M}v]}o UIVU Adults æw v*AcuteAbdomen*v yy For pain management Pu}o UIVU Adults ANælPV AMælPV Children r˙b~ANælPZV r˙b~AMælPZV }bZ r˙b~AMælPZV lP l˙Z Or PR]]v UIMU Adults æruPR}o˙]b ~u˘XuP l˙Z Children XæruP llPR}o˙]b Or MorphineUIVlIMU Adults ræuPR}o˙]b Children æru]}PullPR}o˙]b Standard Trtme ae ntGuidelinesUwthEditionUw æuPR}o˙ Children wXæuP llPR}o˙ yy yy nd L]vTuv ]v E RvPPB L]˘}v C UIVU Adults rP]o˙ Children æuP llP]o˙ FRuv`]oov}vR]Pv}b]bX Av M}v]}o UIVU Adults æuPR}o˙ Children wXæuP llPR}o˙ v*AbdominalTrumaa *v L]vTuv ]v E RvPPB yy C]}G}˘]v UIVU Adults uP r R}o˙ ]v(b } rv u]vb ~u˙ (} ˙R}](}}vZ Children~Ub}vo˙`Rvv.}`]PRbR]blZ ær˙bV uP llPR}o˙ ræ˙bV æuP llPR}o˙ AM˙V v}}uuv Av yy M}v]}o UIVU Adults æuPR}o˙ Children wXæuP llPR}o˙ Refeal r Criteria R( oo b } R }] b]o]b v]vP }v R ]Pv}b b ]bX 235.A}u]voTu TR]bu˙bvbov}vvP]vi˙}R}uvX sueCa yy yy yy R}8]vb Gunshots V]}ov æ Chatep rP *Trumaa AndInjuries yy AXF}]v(}v}v}o st L]vTuv ]v E RvPPA yy (}˘]u C UIVU Adults wæuPR}o˙(}wr˙b Children ANu}vRb days Av yy M}v]}o UIVU Adults æuPR}o˙(}wr˙b æ uP llP }˙ `]PR R}o˙ (} wr æı v*AbdominalTrumaa *v Tu}R}uv Symptoms yy P]v yy V}u]vP yy D]bv}uv Signs yy D]bv}uv yy Tenderness and rebound tenderness yy G]vP yy T˙uv]b]}vb}v yy R}bv}òb}vb yy P}]v}(v}v Invtiga se tions yy Po]vv}u]voXr˙ yy A}u]voCTv b yy BUEvv]v C yy A}u]voob}vv b yy D]Pv}b]}vooP yy Bo}}P}]vPv}bbuR]vP Trtme ae nt Tuv}ib yy T}}(]vo}o˙]uov yy T}}ubb}ò yy T}]uP]bb yy T}v]v(}v yy To relieve pain Non-pharmacological treatment yy IvbvNG yy SP]o]}(uP]bb](vbb˙ Pharmacological treatment Standard Trtme ae ntGuidelinesUwthEditionUw Children wXæuP llPR}o˙(}wr˙b Refeal r Criteria R(oo}b PvoP}v b X 236.Closed Fractures TR]b ]b l ]v R }vv]˙ }( R }v˙ }˘ `]R b}] b}L b ]vi˙X Ab }}b } }v (b ~S b}v }v ROv (b[ZU o}b (b } v} }uuv] `]R v ]Ro]o b(o]lbl]vU}òu}bUou}bX Rbb]}v v]o]b b }v }( Rv]bu}vX Pvb bR}ovbv(}]uP]vPvobbRu}˙vu]oo˙ob X sueCa v*ClosedFrctua s*re v yy yy yy yy yy yy R}8]vb D}ub]}ov W}lo]vi]b PR}o}P]o(b Foo(}uR]PR Assaults Symptoms yy P]v yy Sòo]vP yy Iv]o]˙}u}R Signs yy P]v yy Sòo]vP yy (}u]˙ D yy Iv]o]˙}u}R yy Crepitus yy SR}l](RRbvb]Pv].vo}}o}bb yy C}v(b]}v](R]bbR}l}b}]R]vi˙ Invtiga se tions yy Hu}Po}]v yy Bo}}(}P}]vPv}bbuR]vP yy Xr˙b}(}b ]voi}]vb}vo}` yy Tu b]b Xr˙b ~C]o b]vU CRb v Po]bZ ]( ]vi˙ ]b u}b ](v]b}v(b}v}vb]}b yy CTv b ~(}(b]v}o]vPR(}oo}`]vPbZP yy Head yy Spine yy Po]b yy Fb }vi}]vb æı Chatep rP yy yy yy *Trumaa AndInjuries CTvP]}Pub~](b]Pv].vbo]vi˙]bZb MRI~}b]vo}vb}Lb]vi]b}(RlvZ A}u]voUSG~](]vr}u]vo]vi˙]bZb Trtme ae nt Tuv}ib yy T}b]Rv~bo](.bZrTLS A }}}o~ABCDEZ yy T}R b +o]u~bZ~bo]uv˘Z yy T}}b (v}v}(R+o]u~bZ Non-pharmacological treatment yy So]vvP yy PXOXPXlbo yy P(]bo]vb yy }u] Cb bo]v yy Eo}v}(o]u~bZ yy N]o }b vo .vo ]b]}v } P]o b } v}vrbP]o uvPuvRbvu yy Mv]o}vUvAvbRb]~MUAZ](}bb]o Pharmacological treatment v*ClosedFrctua s*re v AXF}]vo]( ]v E RvPPA MorphineUIVlIMU Adults ræuPR}o˙]b Children æru]}PullPR}o˙]b Or yy PR]]v UIVlIMU Adults æruPR}o˙]b ~u˘XuP l˙Z Children XæruP llPR}o˙]b Or yy Pu}o UIVU Adults ANælPV AMælPV Children r˙b~ANælPZV r˙b~AMælPZV }bZ r˙b~AMælPZV lP˙Z Or yy D]o}(v UIMU Adults PvR}o˙]b PR}o˙]b ~u˘XP]o˙Z PR}o˙]b ~u˘XP]o˙Z æuP llPR}o˙ v ]b ~u˘XwæuP æuP llPR}o˙ v ]b ~u˘XwæuP l æı Standard Trtme ae ntGuidelinesUwthEditionUw ærwæuPrR}o˙~u˘XæuP]o˙Z Children N}}uuv v*OpenFrctua s*re v nd L]vTuv ]v E RvPPB yy I}(v U}oU Adults ruPvrR}o˙]b ~u˘XuP]o˙Z Children ræuP llPvrR}o˙]b ~u˘XuP llP]o˙Z Or yy N}˘v U CE }oU Adults æræuPR}o˙]b Children Not indicated Or yy Co}˘] U}oU Adults uPX b Then uPrR}o˙]b Children Not indicated Or yy CodeineU}oU Adults ærvuPrvR}o˙]b Children N}}uuv Refeal r Criteria R( ]v]]ob `]R R (}oo}`]vP }v]}vb b}] `]R o}b (b } v }R}] P}v b V ]8o }vU (b `]R ]v o ˘vb]}vU (b }v P}`R ob v `Rv R]bv}rbo}u}u]bX 237.Open Fractures Ov (b ]uo˙ }uuv]}v }( R ( Ru}u `]R v ]Ro]o b( o]l bl]vU }ò u}bU o u}b X TRu]v}ouR]b]v(}vUvR(}U˙+}bR}o u }v ]X Iv b}u bU R P }( }v o}bb u˙ `v u}vX E˘o v}o}P]o .] b]oo˙ `Rv R ]vi˙ ]b ˘vb]X I ]b v } l R}}PR }( R + ~bZ (} }uv}vvu]}roPo}bbX æı Chatep rP *Trumaa AndInjuries æı v*OpenFrctua s*re v PvbbR}ovbv(}]uP]vPvobbRu}˙vu]oo˙ ob X sueCa yy R}8]vb yy D}ub]}ov yy Assaults yy W}lo]vi]b yy Foo(}uR]PR Symptoms yy L}o]b]v yy Sòo]vP yy Bo]vP yy E˘}b}vUubov(b] yy Iv]o]˙}u}R Signs yy Sòo]vP yy (}u]˙ D yy Bo}} yy L}v}R( yy Crepitus yy SR}l](RRbvb]Pv].vo}}o}bb yy Confusion or unconsciousness if there is shock or associated head ]vi˙ Invtiga se tions yy Hu}Po}]v yy Bo}}(}P}]vPv}bbuR]vP yy Xr˙b}(}b ]voi}]vb}vo}` yy Tu b]b Xr˙b ~C]o b]vU CRb v Po]bZ ]( ]vi˙ ]b u}b ](v]b}v(b}v}vb]}b yy CTv b ~(}(b]v}o]vPR(}oo}`]vPbZP yy Head yy Spine yy Po]b yy Fb }vi}]vb yy CTvP]}Pub~](b]Pv].vbo]vi˙]bZb yy MRI~}b]vo}vb}Lb]vi]b}(RlvZ yy A}u]voUSG~](]vr}u]vo]vi˙]bZb Trtme ae nt Tuv}ib yy T}b]Rv~bo](.bZrTLS A }}}o~ABCDEZ yy T}R b +o]u~bZ~bo]uv˘Z yy T}vv]]v(}v yy T}}b (v}v}(R+o]u~bZ Standard Trtme ae ntGuidelinesUwthEditionUw Non-pharmacological treatment yy Ru}oo(}]Pv}]b yy C}`]R]o b b]vP yy So]vvP}(+o]u~bZ yy PXOXPXlbo yy P(]bo]vb yy }u] Cb bo]v yy Eo}v}(+o]u~bZ yy o˙ E vP}(u}}vR˙b]}R˙ yy K v]o }b vo .vo ]b]}v } uvPuv Rb v uX yy SP]orvPvovbRb] yy I]P}v yy D]uv yy E˘vo.˘}v}lbo Pharmacological treatment v*OpenFrctua s*re v AXF}uv}(]v(}v st L]vTuv ]v E RvPPA yy (}˘]u C UIVU Adults wæuPR}o˙ Children æuP llP}˙`]PRR}o˙ Or yy Co]vu˙]v UIVU Adults rvuPvR}o˙(}`lb}voo]v]o]u}uv Children rvuP llPvR}o˙(}r`lb B. yy yy If the fracture is in perineal region A}v]}b]vb}vAX Av M}v]}o UIVU Adults æuPR}o˙(}˙bw Children wXæuP llPR}o˙(}˙bw C. Tetanus prophylaxis Aoovb`]R}v(bubRvb}R˙o˘]bX ~S}]b}vZX Refeal r Criteria R( }uo] (b XPX o] v ]vroU v uoo]vi]b}v}R}]P}v b X æı Chatep rP *Trumaa AndInjuries 238.D]bo}}vb v*Disloctions a *v TR]b (b } R ]bb}]}v }( o b(bX S]v R ]u}v v}rbo b }v u}b i}]vbU ] ]b ]u}v }bv}uvRv}rbob}(Ro]u~bZ]v}o L]bo}}vX sueCa yy R}8]vb yy D}ub]}ov yy Assaults yy W}lo]vi]b yy S}b]vi]b yy Foob yy Convulsions Symptoms yy P]v yy Sòo]vP yy Iv]o]˙}u}R Signs yy Tenderness yy Sòo]vP yy Iv]o]˙}u}R Invtiga se tions yy Xr˙}(+~bZ yy CTv b }MRI](]oo yy CT vP]}Pu } D}o v b ~]( bo b buv ]b v}uoZ Trtme ae nt Tuv}ib yy So](.brTLS A ~vuo](b}Z yy So]u yy AR]}vPvo˙i}]v yy AR]ob }v}(R]bo}i}]v yy Pvi}]v+vb b b Non-pharmacological treatment yy T}v yy So]vvP}(+ yy Kv]o}bvo}vRbvR] yy o˙ E vP}(u}}vR˙b]}R˙ æıæ Standard Trtme ae ntGuidelinesUwthEditionUw Pharmacological treatment v*Disloctions a *v AXAvoPb](}]bo}}vb ]v E RvPPA yy MorphineUIVlIMU Adults ræuPR}o˙]b Children æru]}PullPR}o˙]b Or yy PR]]v UIVlIMU Adults æruPR}o˙]b ~u˘XuP l˙Z Children XæruP llPR}o˙]b Or yy Pu}o UIVU Adults ANælPV PvR}o˙]b AMælPV PR}o˙]b ~u˘XP]o˙Z Children r˙b~ANælPZV PR}o˙]b ~u˘XP]o˙Z r˙b~AMælPZV æuP llPR}o˙ v ]b ~u˘XwæuP }bZ r˙b~AMælPZV æuP llPvR}o˙b]~u˘XwæuP lP˙Z Or yy D]o}(v UIMU Adults ærwæuPrR}o˙~u˘XæuP]o˙Z Children N}}uuv yy yy yy nd L]vTuv ]v E RvPPB I}(v U}oU Adults ruPvrR}o˙]b ~u˘XuP]o˙Z Children ræuP llPvrR}o˙]b ~u˘XuP llP]o˙Z Or N}˘v U CE }oU Adults æræuPR}o˙]b Children Not indicated Or Co}˘] U}oU æıv Chatep rP *Trumaa AndInjuries Adults uPX b Then uPrR}o˙]b Children Not indicated Or yy CodeineU}oU Adults ærvuPrvR}o˙]b Children N}}uuv Refeal r Criteria R(oo}uo]]bo}}vb}v}R}]b]o]bX 239.A}R}]]v(}vb æıw v*Acuteorthopaedicinfections*v A }R}] ]v(}vb U `R]R }Lv bv b uPv]bU ]vo }b}u˙o]b U b R]b U ˙}u˙}b]bU r}vrR}v]}b}u˙o]b Uvr}vrR}v]R]b b X A }b}u˙o]b v b R]b v }r˘]b ]v R bu ]v]]oXTR˙u}}uu}v]vR]ovv]vvb`]Rb]lor oo ]bbX WRv R ]Pv}b]b ]b u ]v v oU ] ]b ]u}v } ˘o]uuvrbb]}vX Staph. aureusv]u]]b account for Rui}]˙}(R}]v(}vbXTR}uu}vb}}(]v(}v]b Ru}Pv}bvu˙}]P]v(}ubl]vob]}vbvENT]v(}vbX I ]b ]u}v } } u]]oo˙ `]R }] v]}b `]R}vbb]o˙`]vP(}Rovbvb]]˙}X sueCa yy Staph. aureus yy SRX]u]]b yy Sou}voo ~}uu}v]vb]loroo]bbZ yy Haemophilus influenza yy Strept. pyogenes yy SX(o]b yy E. coli yy Ov(b yy I}Pv] yy IuovP˙ b yy J}]vb]}vb yy Fu}obo}b yy Ivr}bb}b]v(b]}vbvvb(b]}vb yy Uu]o]oboR]}v Standard Trtme ae ntGuidelinesUwthEditionUw v*Acuteorthopaedicinfections*v Symptoms yy F yy P]v yy Iv]o]˙}u}+o]u yy Sòo]vP yy LRP˙ yy R(bo}(~R]ovZ Signs yy F]o yy Sòo]vP yy Iv]o]˙}bRo]u Invtiga se tions yy FBU C SR E yy S]lo]vP yy CRP yy Bo}}o yy Xr˙}(+ yy Uob}v v b }( + ~u˙ ob} b (} P] b]}vZ yy Gu]v b vo}(b] yy MRI~](]ooZ yy Radionuclide scans Trtme ae nt Tuv}ib yy ]E ]v(}v yy Pvo}uv}(R}v]]˙ yy Pv}uo]}vb Non-pharmacological treatment yy So]vvP yy Uob}vP]b]}v yy Iv]b]}vv]vP Pharmacological treatment AX yy Avr]v(R˙ st L]vTuv ]v E RvPPB C o}˘]oo]v UIVU Adults æuPvR}o˙(}r`lb Children ær˙bV æuPvR}o˙(}r`lb ræ˙bV æuPvR}o˙(}r`lb AM˙V vXæuPvR}o˙(}r`lb vA æı Chatep rP yy *Trumaa AndInjuries C]}G}˘]v UIVU~}u]v]b}vu]vbZ Adults uPrR}o˙(}˙b Children uP llP~u˘XuPZR}o˙(}˙b Note 23-2 M}v]} BUE v v]v v (}u ]}˙ ˘u]v}vb `lo˙ `R]o }vPvu]]v yy UIVU vuP}XPR}o˙U uP llPR}o˙U uP llPR}o˙(}˙bw uP llPR}o˙(}˙bw B. F}]v]]ob`]Rv]]oo]vbvb]]˙ st L]vTuv ]v E RvPPB yy Co]vu˙]v UIVU Adults uPvR}o˙(}˙bw Children rvuP llPvR}o˙(}˙bw Av yy Gvu]]v UIVU Adults ruPR}o˙(}˙b Children r˙bV XæuP llPR}o˙(}˙b AM˙V XæuP llPR}o˙(}˙b C. For individuals with sickle cell anaemia ]v E RvPPB yy Co}˘]oo]v UIVU æıı v*Acuteorthopaedicinfections*v yy nd L]vTuv ]v E RvPPB Co]vu˙]v UIVU Adults uPvR}o˙(}˙bw Children rvuP llPvR}o˙(}˙bw Or Au}˘]]oo]vA=Coov]A] Adults XPR}o˙ Ivb}XPR}o˙(}˙bw ]v]v(}vb b Children r˙bV Ivb}XPR}o˙(}˙bw ]v]v(}vb b u}vRbr˙bV Ivb}uP llPR}o˙(}˙bw ]v]v(}vb b ˙bw ru}vRbV PuvAM˙bw V Standard yy Adults æuPvR}o˙(}r`lb Children ær˙bV ræ˙bV AM˙V vA C]}G}˘]v UIVU Adults ruPR}o˙(}r`lb Children uP llPR}o˙(}r`lb Trtme ae ntGuidelinesUwthEditionUw æuPvR}o˙(}r`lb æuPvR}o˙(}r`lb vXæuPvR}o˙(}r`lb X D AvoPb] yy v*Acuteorthopaedicinfections*v yy yy yy yy yy st L]vTuv I}(v U}oU Adults ruPvrR}o˙~u˘XuP]o˙Z Children ræuP llPvrR}o˙~u˘XuP llP]o˙Z Or D]o}(v U}oU Adults æuPR}o˙}uPR}o˙ Children AN˙bV æuPR}o˙ AM˙bV v}}uuv Or D]o}(v UIMU Adults ærwæuPrR}o˙~u˘XæuP]o˙Z Children N}}uuv Or MorphineU}oU Adults æruPrvR}o˙]b Children ræu]}PubllPrvR}o˙]b Or MorphineUIVlIMU Adults ræuPR}o˙]b Children æru]}PubllPR}o˙]b Or CodeineU}oU v Chatep rP *Trumaa AndInjuries Adults ærvuPrvR}o˙]b Children N}}uuv E. yy X CR}v]Ob}u˙o]b vCR}v]SAR]b TRb boo˙ (}u ]vo˙ ]b}bU `R]R ]vo }b}u˙o]b U b R]b }b}u˙o]b Uvr}vrR}v]R]b b R}vbbR}v]]v(}v}u˙}]}(vP]X TR v ]b boo˙ v} ]ooro}}l]vP vobb R ]b v ˘}vX sueCa yy ]o A ]v(}vb}(}vvi}]vb yy Mycobacterium tuberculosisv(vPo]v(}vb yy Iv(}R}]]uovb yy I}Pv] Symptoms yy CR}v]]bRP]vPb]vbb yy P]v yy (}u]˙ D v U r}vrR}v] XS}uu˙]b(}u v*ChronicOsteomyelitisandChronicSetic p thr Ar itis*v For control of fever Pu}o U}oU Adults æuPrPvrR}o˙ Children vr˙bV æræuPvrR}o˙ ræ˙bV ræuPvrR}o˙ u}vRbr˙V vruPvrR}o˙ Or yy Pu}o UIVU Adults ANælPV PvR}o˙]b AMælPV PR}o˙]b ~u˘XP]o˙Z Children r˙b~ANælPZV PR}o˙]b ~u˘XP]o˙Z r˙b~AMælPZV æuP llPR}o˙ v ]b ~u˘XwæuP }bZ r˙b~AMælPZV æuP llPvR}o˙b]~u˘XwæuP lP˙Z Refeal r Criteria R(}v}R}]b]o]b](R]b}oo}v}(bvv} ]u}uv]vvR}bX Standard Trtme ae ntGuidelinesUwthEditionUw v*ChronicOsteomyelitisandChronicSetic p thr Ar itis*v Signs yy Sòo]vP yy Tenderness yy (}u]˙ D yy S]vP yy CR}v]]bRP]vPb]vbb yy H˙r]Puv}v}(R]v}o Invtiga se tions yy FBU C SR E yy Xr˙ yy CT scan Trtme ae nt Tuv}ib yy ]E ]v(}v yy Rb}(v}v yy Pvv}(}u]b Non-pharmacological treatment yy W}vb]vP yy So]vvP yy SP˙ yy Sb}u˙ yy Iuovu}o Pharmacological treatment AXF}G}(]v(}v st L]vTuv ]v E RvPPB yy Co}˘]oo]v UIVU Adults æuPvR}o˙(}r`lb Children ær˙bV æuPvR}o˙(}r`lb ræ˙bV æuPvR}o˙(}r`lb AM˙V vXæuPvR}o˙(}r`lb Av yy C]}G}˘]v UIVU~}]v(b}vu]vbZ Adults uPrR}o˙(}˙b Children uP llPR}o˙(}˙b BXF}G}(]v(}v]vvb`]Rv]]oo]vbvb]]˙ st L]vTuv ]v E RvPPB v Chatep rP yy yy *Trumaa AndInjuries Co]vu˙]v UIVU Adults uPvR}o˙(}˙bw Children rvuP llPvR}o˙(}˙bw Av C]}G}˘]v UIVU~}]v(b}vu]vbZ Adults uPrR}o˙(}˙b Children uP llPR}o˙(}˙b yy yy yy nd L]vTuv ]v E RvPPB Co]vu˙]v UIVU Adults uPvR}o˙(}`lb}voo]v]o]u}uv Children rvuP llPvR}o˙(}r`lb vA C]}G}˘]v UIVU~}]v(b}vu]vbZ Adults uPrR}o˙(}˙b Children uP llPR}o˙(}˙b Or Au}˘]]oo]vA=Coov]A] UIVU Adults XPR}o˙U Ivb}XPR}o˙(}˙bw ]v]v(}vb b Children v v*ChronicOsteomyelitisandChronicSetic p thr Ar itis*v CXF}G}(]v(}v]vvb`]Rb]looo]bb st L]vTuv ]v E RvPPB yy Co}˘]oo]v UIVU Adults æuPvR}o˙(}r`lb Children ær˙bV æuPvR}o˙(}r`lb ræ˙bV æuPvR}o˙(}r`lb AM˙V vXæuPvR}o˙(}r`lb Av yy C]}G}˘]v UIVU~}]v(b}vu]vbZ Adults uPrR}o˙(}˙b Children uP llPR}o˙(}˙b Standard yy Trtme ae ntGuidelinesUwthEditionUw r˙bV vuP}XPR}o˙U Ivb}XPR}o˙(}˙bw ]v]v(}vb b u}vRbr˙bV uP llPR}o˙U Ivb}uP llPR}o˙(}˙bw ]v]v(}vb b ˙bw ru}vRbV uP llPR}o˙(}˙bw PuvAM˙bw V uP llPR}o˙(}˙bw vA C]}G}˘]v UIVU~}]v(b}vu]vbZ Adults uPrR}o˙(}˙b Children uP llPR}o˙(}˙b D. For pain relief ~Sb}v}v]vo](]vRAOR}]Iv(}vb[Z Refeal r Criteria AoovbbR}o(b}}v}bb b]o}v}R}] b]o]bX v*Cellulitis*v X Cooo]b Cooo]b ]b v ]v(}v }( bl]vU b].oo˙ R u]b v v}b b boo˙(}oo}`]vPl]vRbl]vbR]v( b `}v}]l˙]vUv]oUR}vU]vb]}lb`vR}b (}uRob[b(}}X I u˙ + v˙ }( R }˙U ] +b R oPb u}bo˙X Ob]˙ v oPòo]vP b ]bl (}bX I ]b ]u}v} o } }b}u˙o]b Uv}]vP(b]]bvDV]vTR}u}b]b~DVT sueCa yy Streptococcus pyogenes~R}uu}vbbZ yy Staphylococcus aureus Symptoms yy P]v}+ yy Sòo]vP}(R+b yy Rv]vP}lv]vP}(R}o˙]vPbl]v yy Bo]b]vP yy Uob yy F yy R]P}b yy Malaise yy V}u]vP yy Confusion Signs yy Sòo]vP}(+ v ZX Chatep rP yy yy yy yy yy yy yy yy *Trumaa AndInjuries Bo]bb L}o]bvvbbvbl]v}o}RvP L}o]bùR Uob]vo]vPR`b EvoPvvP]}voo˙uRv}b Uvo˙]vPb O+vb]`}v F AX Ivi]bZ BX yy v*Cellulitis*v Invtiga se tions yy FBU C SR E yy CRP yy Bo}}o yy FbvPo}}Po}b yy Gu]v b vo}(]bRP yy Xr˙}(+ Trtme ae nt Tuv}ib yy To relieve pain yy T}}v}ov]R]v(}v yy T}]b}b]vP}v]}vb yy T}v}uo]}vbo]lo}vv}b}u˙o]b Non-pharmacological treatment yy RbvoR+](}bb]o yy Covvbv˙}v`}vb yy Iv]b]}vv]vP](b(}ub yy D]uv yy So]bl]vPL~](]v]Z Pharmacological treatment F}]vo]( ]v E RvPPB ~S b}v (} ]v o]( ]v RCo}b (b[ v Tu v Av]}R˙(}]v]]obob v}PR}b }vb st L]vTuv ]v E RvPPC Au}˘]]oo]v U}oU Adults æuPrPR}o˙(}˙bw Children vr˙bV ræ˙bV AM˙V æuPR}o˙(}˙bw æuPR}o˙(}˙bw vXæuPR}o˙(}˙bw væ Standard yy yy v*Cellulitis*v yy yy CX yy Trtme ae ntGuidelinesUwthEditionUw Av Foo}˘]oo]v U}oU Adults æuPvR}o˙(}˙bw Children AN˙bV r˙bV AM˙bV nd L]vTuv ]v E RvPPC C}ru}˘˙o U}oU Adults væuPrR}o˙(}ær˙bw Children r˙bV vr˙bV ræ˙bV AM˙V F}Iv]]ob`]Rv]]oo]vooP˙ ]v E RvPPC E˙R}u˙]v U}oU Adults æræuPvR}o˙(}˙bw Children r˙bV rw˙bV AM˙bV Or Co]vu˙]v U}oU Adults æruPvrR}o˙(}˙bw Children r˙bV u}vRr˙bV Av]}R˙(}vb`R}]u]bb]}v st L]vTuv Au}˘]]oo]vA=Coov]A] Adults XPR}o˙U Ivb}XPR}o˙]v]v(}vb b Children r˙bV Ivb}XPR}o˙]v]v(}vb b u}vRbr˙bV Ivb}uP llPR}o˙]v]v(}vb b ˙bw ru}vRbV æræuPvR}o˙(}˙bw æræuPvR}o˙(}˙bw vXæræuPvR}o˙(}˙bw væuPrR}o˙(}ær˙bw æwuPrR}o˙(}ær˙bw uPrR}o˙(}ær˙bw uPrR}o˙(}ær˙bw æræuPvR}o˙(}˙bw æuPvR}o˙(}˙bw æuPvR}o˙(}˙bw æruPvR}o˙(}˙bw rvuP llPvR}o˙(}˙bw UIVU vuP}XPR}o˙U uP llPR}o˙U uP llPR}o˙ v Chatep rP yy yy yy yy PuvAM˙bw V uP llPR}o˙ Then Au}˘]]oo]vA=Coov]A] U}oU Adults PR}o˙ Children AN˙bV ælæuPR}o˙ r˙bV æuo}(læwuPbvb]}vR}o˙ r˙bV æuo}(luPbvb]}vR}o˙ u}vRbr˙VuP llP~}(u}˘]]oo]vZR}o˙ AMu}vRbV æuP llP~}(u}˘]]oo]vZR}o˙ And ]v E RvPPB C o}˘]oo]v UIVU Adults æuPvR}o˙ Children ær˙bV æuPvR}o˙ ræ˙bV æuPvR}o˙ AM˙V vXæuPvR}o˙ Then Foo}˘]oo]v U}oU Adults æuPvR}o˙ Children ær˙bV æuPvR}o˙ ræ˙bV æuPvR}o˙ AM˙V vXæuPvR}o˙ v*Cellulitis*v yy *Trumaa AndInjuries nd L]vTuv Au}˘]]oo]vA=Coov]A] UIVU Adults XPR}o˙U Ivb}XPR}o˙]v]v(}vb b Children r˙bV vuP}XPR}o˙U Ivb}XPR}o˙]v]v(}vb b u}vRbr˙bV uP llPR}o˙U Ivb}uP llPR}o˙]v]v(}vb b ˙bw ru}vRbV uP llPR}o˙ PuvAM˙bw V uP llPR}o˙ Then Au}˘]]oo]vA=Coov]A] U}oU Adults PR}o˙ Children AN˙bV ælæuPR}o˙ vw Standard Trtme ae ntGuidelinesUwthEditionUw r˙bV æuo}(læwuPbvb]}vR}o˙ r˙bV æuo}(luPbvb]}vR}o˙ u}vRbr˙VuP llP~}(u}˘]]oo]vZR}o˙ AMu}vRbV æuP llP~}(u}˘]]oo]vZR}o˙ yy yy Av C o]vu˙]v UIVU Adults uPvR}o˙}vuPR}o˙ Children rvuP llPvR}o˙ Then Co]vu˙]v U}oU Adults æruPvrR}o˙ Children r˙bV u}vRr˙bV æruPvR}o˙ rvuP llPvR}o˙ For methicillin resistant Staph. aureus ]v E RvPPB yy Vv}u˙]v UIVU Adults PR}o˙˙bo}`]v(b]}v}R}~u˘XP]o˙Z Children u}vRr˙bV uP llP ˙ ]v ]] }bb vr R}o˙~u˘XP]o˙Z Refeal r Criteria R( oo b `]R uv (]oU }uo]}vb } o}v ]]vP]uvvPL]vP}ob}PvoP}v b X D. v*Neotiz cr ingFaciitis s *v X N}]vPFb]]b I ]b ]o˙ }Pbb] ]vGuu}˙ ]v(}v }( R (b] `]R }Pbb]}v b }( R bl]v vv}b b b ~ob} lv}`v bRGbRrvP []bbZX I ]b o]( RRv]vP }v]}v v ]( v} }o˙ uvP u˙ (oX I ub uvP b v uPv˙X I ]b }uu}v ]v R ]uuvr}u}u]bXP b X]bUHIV sueCa yy M]˘]o]v(}vb yy SXb yy SRXb yy Co}b]]u(]vPvb yy }]b B v Uuo]Pvv]bX Chatep rP *Trumaa AndInjuries v*Neotiz cr ingFaciitis s *v Symptoms yy P]v yy F yy Sòo]vP yy D]bRP Signs yy F yy Sòo]vP yy D]bRP`R]Ru˙}bb vP]v}b}ov yy Sl]v}o}RvP Invtiga se tions yy FBU C SR E yy CRP yy Bo}}o yy Rv}uo}}bP yy HIV v]vP b yy Gu]v b vo}(]bRP yy Xr˙ yy BUEvv]v C Trtme ae nt yy Rbb]~So](.bZ yy ]E ]v(}v yy Tvo˙]vPb Non-pharmacological treatment yy SP˙ yy D]uv yy GL]vPv}G} Pharmacological treatment AXF}]}v}(]v(}v st L]vTuv ]v E RvPPB yy Co]vu˙]v UIVU Adults vuPR}o˙(}`lb}voo]v]o]u}uv Children rvuP llPvR}o˙(}r`lb Av yy Au}˘]]oo]vA=Coov]A] UIVU Adults XPR}o˙(}`lb}voo]v]o]u}uv Children r˙bV v uPrX P R}o˙ (} `lb } vo o]v]o]u}uv u}vRbr˙bV uP llPR}o˙U(}`lb}voo]v vı r Standard ]o]u}uv ˙bw ru}vRbV o]u}uv PuvAM˙bw V ]o]u}uv yy Trtme ae ntGuidelinesUwthEditionUw uP llPR}o˙(}`lb}voo]v] r uP llPR}o˙(}`lb}voo]v r nd L]vTuv ]v E RvPPB Vv}u˙]v UIVU Adults PR}o˙˙bo}`]v(b]}v}R}~u˘XP]o˙Z Children u}vRr˙bV uP llP ˙ ]v ]] }bb vr R}o˙~u˘XP]o˙Z Note 23-3 v*HandInfections*v yy D}b]vPM}].}vb Rvo]u]uvPæuP llP]v]oo˙V(R}b}v b vo(v}vU bu P ooU v ]vb}vo}}}oV }b]vP ]vobvP (}u ˙ }ıvR}bUv]vP}v]˙ b }(]u]uvX yy D}b]vPC}vb]}vb Gvo }b]vP }uuv}vP P l˙ IV ]] vr R}o˙V u˙ ]v b }v b]b }( }˙ `]PR } } R] R]PR}PR obV ]vb }˘]]˙}bPANP l˙ PlobruP v lLV}PRobæruP lLVR}ÙIv(}bD]bb S}]˙}(Au]v}RP]o]vbP}PRbæruP lL B. For pain relief ]v E RvPPB ~S b}v (} ]v o]( ]v RCo}b (b[ v Tu v Ivi]bZ Refeal r Criteria R( oo vb } R obU Pvo } }R}] P}vb b b b}}vbRvRbvb]X X HvIv(}vb TRb uPv]b v ] o˙ ]Pv}b]b v }u uvX SRX b b}vb]o (} R ui}]˙ }( b v ] ]b }uu}v]vuvo`}lbU(ubv.bRu}vPbX TR˙vobb].b]uo}]v(}vb b X v r Chatep rP *Trumaa AndInjuries S]uo]v(}vb yy Iv(}vb }( ]bo RovPo ob Fo}vb ~ob} ( } b `R]o}`}ob]v(}vZ yy P}v˙R]~vR}v]Z yy Sr]Ro]o o]bb v scesses yy Herpes yy SPvo}ub yy Cvo ]v(}vb ~(}u b u }( R] (}oo]ob v `b PovbZ S]v(}vb sueCa yy yy yy yy r r yy yy yy yy yy Sv}b˙v}]b Fb]ob }bA }u˙o]b R]b bA A L˙uRvP]b v oo] ]v (}vb yy C}u]v}vb yy C}uo]}vb}(]v(}vb r Staph. aureusv]u]]b Strept. pyogenes FvP] V]bb N}r IvR}v]˙bRu˙v}]v}(X v*HandInfections*v Symptoms yy P]v yy Sòo]vP yy Bo]b]vP yy F yy Sl]v]b}o}}v yy L}bb}((v}v Signs yy F yy Sòo]vP yy Tenderness yy D]bRP yy S+vbb Invtiga se tions yy FBU C SR E yy CRP yy Bo}}o yy Rv}uo}}bP yy Gu]v b vo}(]bRP yy Xr˙ yy N]oo]]vPb(}R}v]}v˙R] v Standard Trtme ae ntGuidelinesUwthEditionUw Trtme ae nt Tuv}ib yy ]E ]v(}vo˙vPPbb]o˙ yy Pv}uo]}vbbR+vb b }( b Ri}]vbvu] b Non-pharmacological treatment yy Eo}v}(R+Rv yy BvP]vP yy P}` yy PR˙b]}R˙ yy SP]o]vP}(b yy Fb]}}u˙]v}uuv˙v}u b Pharmacological treatment Staph.infections v*HandInfections*v AXF}uv}(b]uo st L]vTuv ]v E RvPPB yy Foo}˘]oo]v U}oU Adults æræuPvR}o˙(}wr˙b Children ær˙bV æuPvR}o˙(}wr˙b ræ˙bV æuPvR}o˙(}wr˙b AM˙V vXæuPvR}o˙(}wr˙b yy B. yy yy nd L]vTuv ]v E RvPPB Co]vu˙]v U}oU Adults æruPvrR}o˙(}wr˙b Children r˙bV u}vRr˙bV æruPvR}o˙(}wr˙b rvuP llPvR}o˙(}wr˙b For treatment of suspected severe Staph. infections st L]vTuv ]v E RvPPB Co}˘]oo]v UIVU Adults æuPvR}o˙(}wr˙b Children ær˙bV æuPvR}o˙(}wr˙b ræ˙bV æuPvR}o˙(}wr˙b AM˙V vXæuPvR}o˙(}wr˙b nd L]vTuv Co]vu˙]v UIVlIMU Adults v Chatep rP rvuPR}o˙(}˙b Children ˙br˙bV u}vRr˙bV C. yy *Trumaa AndInjuries ærvwæuPvR}o˙(}˙b XwærvXæuP llPvR}o˙(}˙b For treatment of chronic paronychia st L]vTuv ]v E RvPPB I}v}o U}oU Adults uP]o˙(}˙bw Children AN˙bV uP]o˙(}˙bw u}vRr˙bV ræuP llP]o˙(}˙bw C}vrX Ub}(]}v}o]bb}]`]R}voo˙o](rRRv]vPo]r}˘]]˙X M}v]}o](v}v`R]o}vo}vPuR˙X yy yy yy yy yy nd L]vTuv ]v E RvPPB Fo}v}o U}oU Adult æruP`lo˙ Children r˙bV ˙br˙bV Or C o}]u}o U}]oU Adults and Children Ao˙rR}o˙}+ Or N˙bv uU}]oU Adults and Chidren Ao˙rR}o˙}+ Or }v}o E uU}]oU Adults and Children Ao˙rR}o˙}+ Or C]o}]}˘ uU}]oU Adults Ao˙rR}o˙}+ Children AN˙bV v*HandInfections*v yy Av M]}v}o vU}]oU Adults and ChildrenAN˙b Ao˙R}o˙}+ æruP`lo˙ rvuP llP`lo˙ v o˙rR}o˙}+ Standard Trtme ae ntGuidelinesUwthEditionUw AM˙bV yy yy vL]vTuv ]v E RvPPC GriseofulvinU}oU Adults æuP]o˙~}o]v]v(}v b Z(}`lb Children r˙bV ~u˙}o]v]v(}vb b Z(}`lb u}vRr˙bV `}]]}bb(}`lb vA M]}v}o vU}]oU Adults and Children Ao˙R}o˙}+ v}}uuv æ uP }v ]o˙ } ]v `} ]] }bb uP llP ~u˘X æ uPZ }v ]o˙ } ]v v*HandInfections*v X D F}uv}(Pvo}u b st L]vTuv yy Copper sulphate stone (blue stoneZU}]oU Adults and Children Ao˙}R+b]R}o˙ Or ]v E RvPPB yy H˙}}b}v uUXærXæA9U}]oU Adults~XærXæA9Z Ao˙rR}o˙}+~bZ Children~XærA9Z Ao˙rR}o˙}+~bZ Or yy Clobetasol propionateu~XæA9ZU}]oU Adults Ao˙rR}o˙}+~bZ Children AN˙bV o˙rR}o˙}+~bZ AM˙bV v}}uuv Or yy uRb B }v ]}]}vu~XæA9ZU}]oU Adults and ChildrenAM˙b Ao˙R}o˙}+~bZ Refeal r Criteria R(}}]b]o]bb](v}bv}]u}X v Chatep rP X *Trumaa AndInjuries Tuberculosis in orthopaedics væ }b] v*Tuculos ber isinorthopaedics*v Tuberculosis v + oo }vb v i}]vbX TR b]v ]b +]v æA9}(oobXI+booPb}uu}v]vR˘ub}(PX M˙ }r˘]b `]R ou}v˙ TB ]v b}u b v ob} ]v HIV vbX TRu˙}b]R]b}˙}(}v`]RTB]v(vX sueCa yy Mycobacterium tuberculosis yy Mycobacterium africanum yy Mycobacterium bovis Symptoms yy P]vb]oo˙v]PR yy Sòo]vP yy (}u]˙ D yy N]PR`bb yy L}`P( yy CR}v]}PR yy W]PRo}bb Signs yy Sòo]vP yy Tenderness yy (}u]b D yy D]bRP]vPb]vbb yy Cold abscesses yy Mbo`bvP Invtiga se tions yy CRbXrR˙}o}ou}v˙TB yy Xr˙}(Rb yy SulPb]`bR]vPb(}AFBb yy FBU C SR E yy MRI}(b~](]ooZ yy B}vvb}Lb]}b˙(}ovR]b}o}P˙ yy Mv}˘ test Trtme ae nt Tuv}ib yy ]E ]v(}v yy Pvv}(}u]˙ yy Pv+vb b b Non-pharmacological treatment yy PR˙b]}R˙ yy So]vbl}bbl}˙ilb Standard Trtme ae ntGuidelinesUwthEditionUw yy ]v]vP D }(b yy D]uv yy Arthrodesis Pharmacological treatment AXF}}vvi}]vo}b]b ~Sb}v}vRTo}b]b[Z B. For pain relief ]v E RvPPB ~S b}v (} ]v o]( ]v RCo}b (b[ v Tu v Ivi]bZ Refeal r Criteria R(}}]b]o]bb}}vb]Pv}b]b]buX æX R]lb and Osteomalacia v*RicketsandOsteomalacia*v Rickets ]b b ˙ (]o }( }b}] } o](˙ ]v P}`]vPb}v b ovP ]v b}Lv]vP v `lv]vP }( }vbU } ˘u } }o}vP]u]vrD.]v˙X Ob}uo] ]bbvoo˙]b]ov]vRblooo˙uX sueCa yy V]u]vrD .]v˙}P yy R]vl~v]}vo]bR}uu}vbZ yy Mob}}v yy Rbvo]PR yy V]u]vrD resistance yy V]u]vrD dependence Symptoms yy Uboo˙v}v yy P]v]vR`]bb Signs yy Mov}]bR`]R]b}o}R] yy (}u]b D yy Suoo(}P yy Sòo]vP}(`]bb yy RR]}b˙ Invtiga se tions yy Su]u]vrDoo yy Suo]u yy Suv]vR}bRoob yy Xr˙}((}u}vb v Chatep rP *Trumaa AndInjuries Trtme ae nt Tuv}ib yy C}u}o]vPuv yy Pvv(}u]b Non-pharmacological treatment yy N]}vob}v] yy SP]o}}v Pharmacological treatment AX yy For rickets st L]vTuv ]v E RvPPA V]u]vrD U}oU Adults and Children æræ u]}Pu ~æ r Uv]bZ ]o˙ (} r u}vRb vo Ro]vP]bòoo]b b R yy v*RicketsandOsteomalacia*v B. F}]lb]vvb`]Ruob}}v yy V]u]vrD UIMU Adults and Children r˙bV rUv]b]o˙ r˙bV ræUv]b]o˙ Or yy V]u]vrD U}oU Adults and Children rUv]b]o˙b}v]˙ b }(}v]}v Av C o]u U}oU Adults and Children ræuP]o˙ CXF}vb`]R}b}uo] st L]vTuv yy V]u]vrD U}oU Adults ræ Uv]b ]o˙ (} r u}vRb vo Ro]vP ]b òo b lished Or yy V]u]vrD UoMU Adults Uv]b]o˙(}ru}vRbvoRo]vP]bòoo]b b R Refeal r Criteria R( } ]]]v v }R}] P}v b }v ]Pv}b]b ]b uX vw r Standard vX Trtme ae ntGuidelinesUwthEditionUw Scurvy v*Scvy* ur v Scurvy ]b uorb˙bu ]bbU `R]R u˙ bv `]R }v˙ (}u]b v b}L b ]vPX I ]b b ˙ ]˙ .]v˙ }( V]u]vrC ~b}] ]ZX I ]b Po}oo˙ bv ]v R o}`ru]o ]v}u}v]bX Pbv}v u˙ uU }v R ]Pv}b]b ]buURuv]b+v`]vPX sueCa yy V]u]vrC .]v˙ Symptoms yy P]vvòo]vP b }(o}vP}vb Signs yy Tvvbb}(RoPb yy Bo]vP Pub yy Sòo]vP}(o}vP}vb Invtiga se tions yy Xr˙ yy V]u]vrC assay Trtme ae nt Tuv}ib yy C}.]vb yy C}(}u]˙ Non-pharmacological treatment yy F]b]R]vV]u]vrC XPX}vPb yy SP˙}}(}u]b Pharmacological treatment AXF}b˙ st L]vTuv ]v E RvPPC yy V]u]vrC U}oU Adults æuPrR}o˙~u˘XP]o˙Z Children r˙bV æuPrR}o˙~u˘XP]o˙Z r˙bV æuPrR}o˙~u˘XæuP]o˙Z u}vRr˙bVæuP]o˙rR}o˙~u˘XæuP]o˙Z Refeal r Criteria R(oo}b ]]]vv}R}]b]o]bX v Chatep rP wX *Trumaa AndInjuries Osteoporosis AXF}o}`(]bl st L]vTuv ]v E RvPPA yy Co]u `]RV]u]vrD Adults U}oU vı v*Osteoporosis*v Ob}}}b]b ]b˙bb u]bloo]bR] b ˙o}`}v ubb v buoo b }(]}}v }( }v bU `]R }vbv ]vb]v}v(P]o]˙v]o]˙ b }(XR]bl}((b]b R]PR]voo˙]v]]ob`]R}}òl]vPovv]b]}vX S}u ]bl (}b ]vo vo R] (bU v P r b]oo˙ `}uv L uv}bU bu}l]vPU o}R}o bU ]uu}]o]}vU ]v ]vl }( ]u]vrD v o]uU }o}vP }] b bU R˙R˙}]]bu U R˙R˙}]]buU ˙rI ]b uoo]bURu}]R]bUuob}}v˙v}ub b Uvo}`(u}o vlB}vM]voDvb]˙~BMDZX useCa yy Iuov`vv`}v(}u}vv}o}vl}`v yy B}vu]voo}bb yy L}`}vvb]˙ Symptoms yy Bl]v yy Iv]o]˙}òlL˙]]o(oo Signs yy (}u D o]ub yy Fb yy S}}]vPvb Invtiga se tions yy Xr˙b}(`]bblR]b yy B}vM]voDvb]˙~BMDv Zb yy QvCTv b Trtme ae nt Tuv}ib yy MvPuv}(vo˙]vP]bl(}b yy Pv}v}((b yy o˙ E uv}((b Non-pharmacological treatment yy D]˙~]vl}(o]uv]u]vrD}v]v]vP(}}bZ yy TR L](b˙o CRvPb ~( } ]bl (}b ]v R uo }Z Pharmacological treatment Standard Trtme ae ntGuidelinesUwthEditionUw ruP]o˙}(Co]u B. vrIU]u]vrD]o˙ yy For moderate fracture risk ]v E RvPPA Co]u `]RV]u]vrD U}oU Adults ræuP]o˙}(Co]u vrIU]u]vrD]o˙ C. For high fracture risk Note 23-5 F}v˙}(RR]bo}Ù}vbob]o]b v*SicklercellVaos rocclusiveCrisis*v yy H}u}vouvR˙~HRT yy }Pv Eb R˙ ~ETZ yy B]bR}bR}vb yy Calcitonin yy So}Pv b }u}o}b yy Dv}bu yy S}vu yy T] Refeal r Criteria R(oo}b R˙b]]v}}R}]b]o]bX X Z (SERMsZ Sickle-cell Vaso-occlusive Crisis TR]b ]b ]v(o }uo]}v }( b]loroo ]bbU ]v ˙ }b}v }( buoo o}} bob ˙ ˙boo] b]lo oob o]vP } ]bRu] ]vi˙ } ob }PvbU ]vo]vP }vX TR }v ]v ]b boo˙]8o}]bvP]bR(}u}b}u˙o]b sueCa yy P˙}Pv]]v(}v yy Malaria yy DR˙}v yy Svu] yy Sbbvv˘]˙ Symptoms yy B}v]v yy F yy S]loroovu] Signs yy B}vvvbb yy F v X Chatep rP *Trumaa AndInjuries Invtiga se tions yy FBU C SR E yy CRP yy S]lo]vPvHEo}R}b]b~](v}]}bo˙lv}`vZ yy Bo}}.ou}R]D]Pv}bTb yy U]vo˙b]bvo yy BUEvv]v C yy Bo}}ovbvb]]˙ Trtme ae nt Tuv}ib ~Sb}v}vRS]loCooD]bb Non-pharmacological treatment Ev}PG]]vl ~Sb}v}vRS]loCooD]bb Pharmacological treatment AXTuv}(vo˙]vPMo] ~Sb}v}vRMo] ~RDT Z(}uo]b]b [Z [Z [Z v*Acula sa v rNeoscr is*v BXF}uv}(}R]v(}vb ~S}]b}vZ CXF}R˙}v ~Sb}v(}Ru}o}P]ouv]vRS]loCooD]bb D. For analgesia ~Sb}v(}Ru}o}P]ouv]vRS]loCooD]bb Refeal r Criteria R( oo vb `]R }uo]}vb } ]]]vU R˙b]]v b]o]b}Ru}o}P]bX ıX boA N}b]b TR]b]b}vR˙b o}}bo˙X sueCa yy N}vru yy S]loroovu] yy Iv(}vWR]b b yy So] ]o (u}o ]R˙bb l bo] (u}o epiphyses yy HIV yy P}o}vP}] b b yy Alcohol abuse yy Vbo]b yy I]}R] v [Z [Z Standard yy yy Tu yy yy Trtme ae ntGuidelinesUwthEditionUw o}uvo D ˙bob]}(R] D]bo(u}ovl(b D]bo}}vb }(i}]vb v*Acula sa v rNeoscr is*v Symptoms yy P]v]vR+i}]v yy L]u]vP Signs yy L]u]vP yy Tvvbb}vi}]vu}uv yy (}u]˙ D yy LPovPR]bv˙ Invtiga se tions yy Xr˙ yy MRI Trtme ae nt Tuv}ib yy Tvo˙]vPb yy Pv}Pbb]}v yy Ev}P}˙ yy P]vo]( Non-pharmacological treatment yy PR˙b]}R˙ yy Wol]vP]`Rvo}ò]u]b]v}o yy SP˙ yy C}}ubb]}v yy Ob}}u]b Pharmacological treatment AXF}]vo]( st L]vTuv ]v E RvPPA yy N}˘v U CE }oU Adults æræuPR}o˙]b Children Not indicated Or yy Co}˘] U}oU Adults uPX b Then uPrR}o˙]b Children v Chatep rP yy yy *Trumaa AndInjuries Not indicated Or D]o}(v U}oU Adults æuPR}o˙}uPR}o˙ Children AN˙bV æuPR}o˙ AM˙bV v}}uuv Or I}(v U}oU Adults ruPvrR}o˙]b ~u˘XXP]o˙Z Children ræuP llPvrR}o˙]b ~u˘XuPlP]o˙Z BXF}v}v}(}v}oob Pu]}v U}vbob]o]b AlendronateU}vbob]o]b v*OsteogenesisImperfecta*v Refeal r Criteria R(}vR]Pv}b]b]bu}}R}]b]o]bX 250.Osteogenesis Imperfecta TR]b ]b ob} lv}`v b ]'o }v ]bbX I ]b Pv ]b} R]b˙o}`}vubbUbloo(P]o]˙vv(bX sueCa yy Gvu}vo]vP}(}ooPv(}u}v Symptoms yy Ivbbv˙]vP Signs yy Bo]bRbo yy Dvv}Pvb]b ]u( ~o]bRrP˙ } ˙oo}`]bRr}`v }o}}v}(RZ yy Moo(b`]Roob(}u}v yy B}v(}u]b Invtiga se tions yy Xr˙W˙B rPu~uoo(b]+vPb b Z Trtme ae nt Tuv}ib yy MlR]o}u(}o yy Pvv(b yy Pv(}u]b v Standard Trtme ae ntGuidelinesUwthEditionUw Non-pharmacological treatment yy Counsel parents yy Splints yy ˙B Rvo]vPRv]b yy SP]ov}vv}}v}((}u]b Pharmacological treatment AX yy F}v}v}((b st L]vTuv ]v E RvPPB AlendronateUIVU Children Consult specialist B. yy v*Burns*v For pain relief Pu}o U}o}oU Children vr˙bV æræuPvrR}o˙ ræ˙bV ræuPvrR}o˙ u}vRbr˙V vruPvrR}o˙ Refeal r Criteria R(b}}v]Pv}b b ]b]bu}]]]vv}R}] b]o]bX 251.Burns A v ]b b]oo˙ }v b }( R bl]vX Iv ]v b]}vb b bR b v}b b bU ubo v }v u˙ ]v}oXTRvu˙b.]o}v]vP}vR˘v}( R]vi˙XTR]b}v]}vU `R]RvRvP b +b}v+ }oUvvu}b}(RuXI+b˙}vPv.}o ]vu}bvb R˙ubuvP}o˙b}RR˙vv }R]v}uoo](X sueCa yy D˙R~.Z yy WR~bobZ(}uR}o]]bUub Ub}bX yy Eo]o~o}`}R]PR}oPZ yy CRu]o~]bvolo]bZ Symptoms yy P]v~˙]v b b.]o˙vobb]vvbZ yy Sòo]vP yy D]8o˙]vR]vP yy Bo]bb v Chatep rP *Trumaa AndInjuries AXF}vb`]RT}oB}˙S(~TB A SAZ}(obbRvA9]v R]ovvæA9]vob Note 23-6 yy Uvb}R˙o˘]b yy ~S}v b }vRTvb }R˙o˘]b[Z væ v*Burns*v Signs yy Shock yy IvRo}vo ]vi˙ ~v vbo R]bU b}} ]v R R}U R}bvbb }(R}]volob]vbuZ yy Sòo]vP yy Bo]b(}u}v yy CR]vP}(b~vbZ yy GCE RvPb~o]ovbZ Invtiga se tions yy FBCvb]lo]vP yy BUEvv]v C yy W}v`b yy Bo}}Pbb yy CRbXr˙ Trtme ae nt Tuv}ib yy Pv(R]vi˙(}uvb yy Relieve pain yy Roo}bG] yy Pv]v(}v}(v`}v yy A]Ro]vP}(Rv`}v yy }] A }uo]}vb Non-pharmacological treatment yy Ru}o}R]vP(}u+ yy P+vvv]vP`](]oooo]vP}b`˙ or it is reduced yy I( Ru]o ]b ]v }` (}u bR ] }+ R + v vvv]vP` yy S]`˙ yy L]vo]bbo}v yy D}v}o˙v˙ub}}]vuv yy A+o]ubbR}oo yy G}}v]}v yy Pb˙R}o}P]oR˙ yy PR˙b]}R˙ yy Rbvb Pharmacological treatment Standard Trtme ae ntGuidelinesUwthEditionUw yy L]o}oG]b yy bvbD `]RS]oSoR]]v yy OoAvoPb] yy yy yy v*Burns*v yy yy yy Pu}o U}oU Adults æuPrPvrR}o˙ Children vr˙bV æræuPvrR}o˙ ræ˙bV ræuPvrR}o˙ u}vRbr˙V vruPvrR}o˙ Or N}˘v U CE }oU Adults æræuPR}o˙]b Children Not indicated Or Co}˘] U}oU Adults uPX b Then uPrR}o˙]b Children Not indicated Or D]o}(v U}oU Adults æuPR}o˙}uPR}o˙ Children AN˙bV æuPR}o˙ AM˙bV v}}uuv Or I}(v U}oU Adults ruPvrR}o˙]b ~u˘XXP]o˙Z Children ræuP llPvrR}o˙]b ~u˘XuPlP]o˙Z Av Foo}˘]oo]v U}oU Adults æuPvR}o˙(}`lb Children ær˙bV ræ˙bV AM˙V æuPvR}o˙(}`lb æuPvR}o˙(}`lb vXæuPvR}o˙(}`lb v Chatep rP *Trumaa AndInjuries BXI(RPvRbvb~TBSAZ}(u}RvA9]vR]ovv æA9]vob Note 23-7 yy Au] yy Uvb}R˙o˘]b yy ~Sb}v}vRTvb }R˙o˘]b[Z yy Rbb]˙oovPIVG]b]uvb]vPPlov[b(}uo~˘ TBSA˘W]PR}(PvZP]v]vR(}u}(˙boo}]b yy Iv ob P] Ro( }( oo }o G] ]v .b R}b (}u R u }( ]vi˙vR}RRo(]vvR}bbR]vPbo yy Iv R]ov ]o˙ G] ]uv} R ooG] (} b] }vvu]v]b}b R]vPb b ovXA9˘}b]v yy bvbD `]Rb]oboR]]v yy O]}]AvoPb] yy yy BX yy yy MorphineUIVU Adults XæræuPR}o˙ Children XuP llP~u˘XæuPZR}o˙ Or PR]]v UIVU Adults æræuPR}o˙XL}`}b]vRoo˙X Children uP llP~u˘XæuPZR}o˙ Av C o}˘]oo]v UIVU Adults æuPvR}o˙(}˙bw Children ær˙bV ræ˙bV AM˙V v*Burns*v yy r A- saline æuPvR}o˙(}˙bw æuPvR}o˙(}˙bw vXæuPvR}o˙(}˙bw I(RPvRbvb~TBSAZ}(u}RvA9]vR]ovv æA9]vobWvooP]}v]]oo]vb Co]vu˙]v UIVU~](v]booP]}v]]oo]vZ Adults rvuPvR}o˙(}˙bw Children rvuP llPvR}o˙(}˙bw vA M}v]}o UIVU Adults æuPR}o˙(}˙bw vw Standard Trtme ae ntGuidelinesUwthEditionUw Children wXæuP llPR}o˙(}˙bw CXI(RPvRbvb~TBSAZ}(u}RvA9]vR]ovv A9]vob~}vb]vbb Z Note 23-8 yy yy yy yy Au] Uvb}R˙o˘]b ~Sb}v}vRTvb }R˙o˘]b[Z Rbb]˙oovPIVG]b]uvb]vPPlov[b(}uo~˘ TBSA˘W]PR}(PvZP]v]vR(}u}(˙boo}]b yy Iv ob P] Ro( }( oo }o G] ]v .b R}b (}u R u }( ]vi˙vR}RRo(]vvR}bbR]vPbo yy Iv R]ov ]o˙ G] ]uv} R ooG] (} b] }v v u]v]b b } b R]vPb o v XA9 ˘}b ]v læ saline yy bvbD `]Rb]oboR]]v yy v*Burns*v yy yy yy yy r (}˘]u C UIVU Adults wæuPrXæPR}o˙(}˙bw Children æuP llPR}o˙(}˙bw Av M}v]}o UIVU Adults æuPR}o˙(}˙bw Children wXæuP llPvR}o˙(}˙bw Av Ou}o Adults uPR}o˙ Or Eb }u}o Adults uP]o˙ UIVU UIVU F}VT D }R˙o˘]b Ev}˘]v USCU Adults uP]o˙ Children u}vRbr˙bV ru}vRbV NeonatesV uP llPR}o˙ XæuP llPR}o˙ XæruP llPR}o˙ v Chatep rP yy D. Or D o]v USCU Adults æv]b]o˙ Children r˙bV u}vRr˙bV NeonatesV yy yy yy }R˙o˘]b[Z st L]vTuv Gvu]]v UIVU Adults ruPR}o˙(}˙b Children r˙bV XæuP llPR}o˙(}˙b AM˙V XæuP llPR}o˙(}˙b Or L]]u C UIVU Adults rPR}o˙ Children u}vRr˙bV æuP llPR}o˙ Neonates r˙bV æuP llPR}o˙ wr˙bV æuP llPR}o˙ AM˙bw V æuP llP]o˙ Av M}v]}o UIVU~}bb]v]]vb}vBX}Z Av Co}˘]oo]v UIVU~}bb]v]]vb}vBX}Z nd L]vTuv M}vu UIVU Adults XærPR}o˙ Children r˙bV XærPR}o˙ vı v*Burns*v yy æræv]b]o˙ v]bllPR}o˙ v]bllPR}o˙ If a burn is clinically infected Note 23-9 yy Au] yy Uvb}R˙o˘]b yy ~Sb}v}vRTvb yy Tl`}v`bb vo}}(}ovbvb]]˙vP b yy G]IVFo]b yy G]IVAvoPb]b yy SIVAv]}b yy *Trumaa AndInjuries Standard Trtme ae ntGuidelinesUwthEditionUw v*Wounds*v u}vRr˙b~ANælPZVXærPR}o˙ u}vRr˙b~AMælPZVruP llPR}o˙ Neonate AN˙bw V uP llPR}o˙ AM˙bw V uP llPR}o˙ Or yy Au]l]vUbo}ÌV}ræu]vbU~u}v]}buAu]l]voobZ Adults wXæuP llPR}o˙~u˘XXæP]o˙væP}bZ Children yy r˙bV wXæ uP llP ˙ R}b ~u˘X æ uP R}o˙UvæP}bZ Refeal r Criteria R( oo b }( vb `]R R (}oo}`]vP R]bb } b]o]bX PorR]lvbbvbu}RvA9}(TBSA Dvb}(v˙vPX Bvb ]v}o]vP(URvbU(UPv]o]U]vuU}ui}i}]vb CRu]ovb Electrical burns Av˙v`]R}v}u]vu]v`R]Rv}bPb b ]bl }v IvRo}v]vi˙ Iv(vb Bvb `]Rr˘]bvP]bUvo(]oX 252.Wounds A `}v ]b l ]v R }vv]˙ }( b ]v R }˙X I u˙ ]v}o}o˙]vP]Ro]uo]lbl]vXW}vbboo˙˙b ]vi˙X T]bb+]vov}b b bUubobvv}vbXI u˙ buoo } oP v u˙ } b.]oX I u˙ oU u˙ }vu]v`]R]v}R(}]Pvu'v}u]v(X sueCa yy MRv]oPvbXPX(}uobb}lv](UPvbR}U]vbU }vb]}v (}u ov ]vi˙X W}vb u˙ (}oo}` bvl } ]vb ]bUv]uo}Ruv]b yy CRu]oPvbXPX}vP b ]b}olo]bU}R}}b]Ru]ob yy TRuo]vi˙bovP]vvb Symptoms yy L}o]v yy Bo]vP yy D]bRP}(b](]v( v Chatep rP *Trumaa AndInjuries B}˘rP) Wound management yy Iuu]o}b}(`}vb]bP}}UR]b]bv}]bo](R`}v ]b]˙}o]lo˙}}u]v(XPXPvbR}`}vbUv]uovRuv ]bv`}vb}vR}b}oXTR˙bR}ov}`v b X yy WbR Rvb òo v ` ]o b Po}bX Cov R `}v `]R vb b}o}vXS]˙`}vb`]Rvbb}o}vv]]P`]R]o R˙}Pv}˘]vbo]vX yy I(R]b}(PoUPob}b ]]vR`}vUu}RuPvo˙XL]L oo Gb }( bl]vU ov v RuU ˘]b oo b v } R `}v`]R]o b PX yy AvbRb]u˙]X yy D}v}bE}oU`R]R]b}R]]vv˘}bbv}vvbb˙ } oob bD ]v( `}v b }Lv b v `]R v}uo bo]v } }]}v ]}]v o}}vX Tl`}v `b (} ov bvb]]˙ b ]( }bb]o v b Au}˘]]oo]v ~Au}˘˙]oo]vZ `R]o `]vP (} bob }( `}vo Pharmacological treatment st L]vTuv ]v E RvPPC v v*Wounds*v Signs yy L}oòo]vP b vvvbb yy L}}l(}}R]vi]bXPXURURbU}uvU}vUvb yy u]v D R R˙b]o R]bb }( R `}v XPX b]U b]U shape and depth Invtiga se tions yy Hu}Po}]voo](vRbo yy G}v}bbruRo}}](]v] yy Xr˙ }( ]vi u˙ ] } o } }b}u˙o]b v bone fractures yy W}v`b (}ovbvb]]˙](`}v]b]v( Trtme ae nt Tuv}ib yy T}}v}oo]vP yy To relieve pain yy T}v}]v(}v yy T}}P]vbvb yy T}}u}`}vRo]vP Non-pharmacological treatment yy Ao˙]o b b]vP}o]vPb]v]bR]vi }}v}oo]vPX yy I(o]vPo b v]v.U]bR}oo]PX~R}( b }v]}}b o]vP]b]b}PZ yy Bo]vP(}u}}Rb}lrbuoo]}(]o b P]vR b}lvblRv}]}v]X Standard Trtme ae ntGuidelinesUwthEditionUw yy v*BitesandStings*v Tvb }R˙o˘]b (} oo }voo˙ }vu]v `}vbU (}o o}`˙}}b}b}( b vb}˘}]}] b ~Sb}v }vRIuuv]b}v[Z vA yy Pu}oU}oU Adults æuPrPvrR}o˙ Children vr˙bV æræuPvrR}o˙ ræ˙bV ræuPvrR}o˙ u}vRr˙V vruPvrR}o˙ vA yy IVG]bvo}}vb(b]}v]b X vA yy Au}˘]]oo]v~Au}˘˙]oo]vZU}oU Adults æuPR}o˙ Children vr˙bV æuPR}o˙ ræ˙bV æuPR}o˙ ˙V vXæuPR}o˙ Refeal r Criteria C}uo]`}vb~XPX`}vbb}]`]R(bU]]b]}v }(v}vbUo}}bobvvbZX 253.B]bvSvPb SNAKEBITE M}b bvl ]b v}vr}]b}v}bX V]b R }uu}vb }( b }]b}v}bbvl]b]v}]oA(]XORbR}bv `bvlbXAoob}(bvl]b~v}u}blv}vrv}u}bZbR}o }b (} ob v R}bX Iv(˙ R ˙ }( bvl ]( }bb]oX D}v[o˙}}uR}v(vPulbVR}ùoo(vPulbboo˙ ]v] v}vr}]b}v}b ] `Rb }v } `} (vP ulb bPPb }]b}v}b ]X I ]b ]u}v } u]v `RR vv}u}v Rb }XTR}o}(}v]bv]v]b]}v}Rb]}(R] }v}b]o]bbv}}]X sueCa yy Snakes Symptoms yy P]v yy Bo]vP yy Sòo]vP v r Chatep rP yy yy yy yy yy yy *Trumaa AndInjuries F]vvP Dlr}o}]v Headache Muscle ache F L}bb}(}vb]}bvbb Signs (Poisonous snake bites) Cardiovascular: yy H˙}vb]}vUbR}lU]R˙Ru]b yy S}vv}b ˙bb u] o]vPU (}u ] b]U u}b v }o `}vbURu] yy Dl]v(}uu˙}Po}]v]v]vboRu}o˙b]b L}o+bP yy R]}Pbb]}v}(òo]vP b }u}RvRo(}(]'vo]u yy Bo]b]vPUv}b]bv]b]vP yy Fb]o}uuvo]b}v}v]'v]P]b Invtiga se tions yy Fooo}}}v yy Rvo(v}vb yy u]vb `R}o o}} o}hvPb~oræ uo }( o}} ]v ] X b F]o}o}Lu]vb]uo]b]v}Pooo}}Z yy L](v}vb Trtme ae nt Tuv}ib yy T}o]]vvv˘]˙ yy T}b}Rb]}v}]o}v](]v] yy T}}vRvb +}(Rbvlv}u yy T}v}v˙ b ]v(}v Non-pharmacological treatment F]bA] yy Iuu}]o]}vlbo]vvP}(R+o]uX D}v}u}Ro]u R Rb v ]'v r R u} ] ]b u}U R (b R }]b}v bXC˙Rb}v}vR b vRo]u}]PR b ] }( `}}X I( ] ]b ]ooU ` ]b ]v o}R v o ] v v*BitesandStings*v Neuromuscular: yy v]o C vo˙b]br}b]bU}Rou}oP]UbobR yy Bo b]}˙ o˙b]b r }}o]vPU v ]v]o]˙ } R properly yy Iu]}vb]}bvbbUb]b yy Mv]vP]bu yy Tvv+ b ubob Standard Trtme ae ntGuidelinesUwthEditionUw }vR]X yy CovR`}vvR b vX R A R}b]o yy U bB U b lù yy Ab v[b ]`˙U R]vP v ]o}v ~ABC }( b]}vZ F}}ov}u}b]bP yy Covb]}(]`]Rvbo}}v}b}v` yy D}v}'u}bl}ulv˙]v]b]}vbRb]}(R] yy L `}v }vV v `}vb b]oo˙ o]lo˙ } ]v(X yy I( R bvl ]b ]v. b v}vr}]b}v}b } R ]b bv }( òo]vP b }˙bb u]b]PvbLvR}bR b v yy SP]o]uv`Rv] Pharmacological treatment st L]vTuv ]v E RvPPB v*BitesandStings*v AX Iv]}v(}vrv}uuv Pbv }( ˙u}ub b v b]Pvb }( o}o v ˙bb u] +b }( vv}u}vX yy Avrbvlbu~ASSZr}o˙ov Hb]}v˙˙~vo]vPZ Tb}brXuoUv}b b U}(} b vR˙o˘]b ASS ær uo ~ær u}obZ v]vP }v ]˙ b ˙ IV ] ]v XıA9 NlS } æA9 ˘}b D } r R}bX M}v]} b]Pvb v as required Note 23-10 N]vivrv}u]v}}l.vP yy yy yy yy yy yy B. yy M}v]}vv}P H˙}}ou]bR}lr˙boo}]bl}oo}]blo}} (bD }( Ru}bb]b r o}hvP (}bl(bR (}v Pobulo lets Rb]}˙]bbr}˘˙Pvl]vlvo AvrvbR˙U Tv}oUIMUXæuoX b Av D]uU}oUæruPX b For Pain relief Pu}oU}oU Adults æuPrPvrR}o˙ Children v r Chatep rP yy vr˙bV ræ˙bV u}vRbr˙V Or M}R]vUIVUIMUSCU Adults uPX b Children AN˙bV AM˙bV *Trumaa AndInjuries æræuPvrR}o˙ ræuPvrR}o˙ vruPvrR}o˙ u]}PubllP ru]}PubllP CXPv}v}(}v˙ b ]v(}v yy Au}˘]]oo]v~Au}˘˙]oo]vZU}oU Adults æuPR}o˙(}æ˙b Children vr˙bV æuPR}o˙(}æ˙b ræ˙bV æuPR}o˙(}æ˙b ˙V vXæuPR}o˙(}æ˙bN r Refeal r Criteria R(oovb`]Rb]}˙(]oUR(]oUvo(]oU uboo˙b]bUubov}b]bUo]vP}]vboRu}o˙b]b} P]}voR}b]o(}b]o]bX SNAKESPITINTHEEYES TR olrvl } } R b]hvP } ˙bb ]b v}u ]v} R˙b}(]b]uX I]]}v b }(R˙bvu˙}viv]b b vv o]vvbb](v}`bR`˙]uu]o˙X Trtme ae nt yy I]PR˙`]Rv˙o]]]oo~Ùu]olUbo]vZX yy Ivbo ]o vrv}u ~}v } . b }( S}]u CRo}] XıA9ZX yy T}vo b b]}v`]R}]ov]}b~Sb}v}vRE˙ Ivi]b[Z SCORPIONSTING S}]}v vPb b o b]vPo ulU v R vPb b ˘uo˙ ]v(oX Symptoms yy P]vRb]}(] væ v*BitesandStings*v Note 23-11 C}}b]}b}(o]'o}v}o]vP}]b}v]vP˘]vvPv R˙o]b]bX}] A v}v]vb]b}(Pvo]o]vPX Standard yy yy yy Trtme ae ntGuidelinesUwthEditionUw L}o]òo]vP b V}u]vP A}u]vo]v v*BitesandStings*v Signs yy E˘bb]bo]}v yy S`vP yy R]b]}v yy S]vPorv`}v Trtme ae nt Tuv}ib yy To relieve pain yy T}u]v]vR˙}v yy T}vb Non-pharmacological treatment yy ]v D (}}b}vX yy P]}ubb}vRX yy G]Rvov˙}(G]b}]vl Pharmacological treatment st L]vTuv ]v E RvPPC yy Pu}oUAb]]vUI}(v}D]o}(vU}oU Av yy A9L]}]v~L]Pv}]vZUræuo(}o}o]v.o}v}o]]v BEANDWASPSTINGS Mi}]˙ }( v `b vPb b }vo˙ } o}o] ]vX TR˙ u˙ }b]}voo˙ b ooP]}vbU `R]R u˙ o} vR˙o˘]b `]R o}o ]vU Pvo] ]U R˙}vb]}vU v ]8o˙ ]v R]vP b o }( }vR}bbu v }u }( R Po}hbX R D u˙}X Symptoms yy L}o]]vRb]}(vP b Signs yy Sòo]vPb] yy U] yy Hypotension yy D]8o˙]vR]vP yy }vR}b B bu Trtme ae nt Tuv}ib yy To relieve pain yy T}uvPvR˙o˘]b](vbb˙ v Chatep rP *Trumaa AndInjuries Non-pharmacological treatment yy ]v D (}}b}v yy P]}ubb}vR yy G]Rvov˙}(G]b}]vl yy IvR}( b vP b u}vP b (}ubl]v˙]vP b XD}v} pull it out Pharmacological treatment st L]vTuv ]v E RvPPC yy vo]v A USCU~PZXæruoX b yy P}uR]vUIMU Adults æuPX b Children XæræuPX b yy H˙}}b}vUIVUruPvR}bo](vbb˙ yy For shock IVG]b v*BitesandStings*v For pain Pu}oU}oU Adults æuPrPvrR}o˙ Children vr˙bV ræ˙bV u}vRbr˙V Refeal r Criteria R( oo vb `]R vR˙o˘]b `R} uv yy æræuPvrR}o˙ ræuPvrR}o˙ vruPvrR}o˙ v} b}v]vP } HUMANBITES Huv ]b ~`R]R boo˙ } ]vP .PRbZ o } ]v(}vbU `R]R ]( vPoU ou}b ]v]o˙ } R]PRo˙ U b v}]vP ob]}v }vu]v ˙ u]˘ }( }] v v}] }Pv]bubX A o]o˙ ]vG] ] }v R Rv } ob`R bR}o }vb]}vu]v b X Symptoms yy P]v yy Sòo]vP yy Bo]vP yy FU](]bP]v( Signs yy TR]ubb]}v}v]'vb] vw Standard Trtme ae ntGuidelinesUwthEditionUw yy v*BitesandStings*v W}v Trtme ae nt Tuv}ib yy To relieve pain yy T}v˙}v˙ b ]v(}v Non-pharmacological treatment yy Cov`}vR}}PRo˙ Pharmacological treatment st L]vTuv ]v E RvPPC yy Tvb}R˙o˘]b~Sb}v}vRTvb}R˙o˘]b[Z yy Foo}˘]oo]vU}oU Adults æuPvR}o˙(}˙bw Children ær˙bV æuPvR}o˙(}˙bw ræ˙bV æuPvR}o˙(}˙bw AN˙V vXæuPvR}o˙(}˙bw Av yy Au}˘]]oo]v~Au}˘˙]oo]vZU}oU Adults æuPR}o˙(}˙bw Children vr˙bV æuPR}o˙(}˙bw ræ˙bV æuPR}o˙(}˙bw AM˙V vXæuPR}o˙(}˙bw Av yy Pu}oU}oU Adults æuPrPvrR}o˙ Children vr˙bV æræuPvrR}o˙ ræ˙bV ræuPvrR}o˙ u}vRbr˙V vruPvrR}o˙ Note 23-12 AbPvooU}v}`}vb b (}uRuv]X Refeal r Criteria R(](R]bv}b]vP(b]]bX DOGANDOTHERANIMALBITES MuuobU ]vo]vP }PbU u˙ ˙ R ]b ]bX So] (}u v ]v( v]uo }v]vb oP vub }( R ]b ]b `R]R ]b ]v}oR}PR ]Uo}vU} l]vRbl]vXTR]bob} v Chatep rP *Trumaa AndInjuries ]bl }( vb v }R ]o ]v(}v (}oo}`]vP R ]b }( v˙ uuuoX Symptoms yy P]v yy Sòo]vP yy Bo]vP yy FU](]bP]v( Signs yy TR]ubb]}v}v]'vb] yy W}v Trtme ae nt Tuv}ib yy T}o}v yy T}v]b]v(}v yy T}v}R]v(}vb yy T}v˙}v˙ b ]v(}v Non-pharmacological treatment U } }] ~]( v} ]}bo˙ ]uuv]bZ vb Iuuv]b}v~Sb}v}vRTvbIuuv]b}v[Z vı v*BitesandStings*v Immediate local care WbRb]`]Rb}v` Aoo]vi]brbl]vPu]v}]bvRb b Uui}]bv Rb b ]v R bu `˙ ˙ R}}PR ]]P}v `]R }]}b u}vb }( bo]v b}o}v } ovb]vP `]R ]u] ob Ro}R˘]]vb}o}v Pharmacological treatment st L]vTuv ]v E RvPPA yy Foo}˘]oo]vU}oU Adults æuPvR}o˙(}˙bw Children ær˙bV æuPvR}o˙(}˙bw ræ˙bV æuPvR}o˙(}˙bw AN˙V vXæuPvR}o˙(}˙bw Av yy Au}˘]]oo]v~Au}˘˙]oo]vZU}oU Adults æuPR}o˙(}˙bw Children vr˙bV æuPR}o˙(}˙bw ræ˙bV æuPR}o˙(}˙bw AM˙V vXæuPR}o˙(}˙bw yy yy Standard Trtme ae ntGuidelinesUwthEditionUw Iv]}v(}b}(R]bIuuv}Po}o]vvR]b]v I bR}o uu R v} ˙ v]uo ]b ]bU oR}PRR}bb]]o]˙bR}o}v]vu]v(}˙v]uo]XTR uv}]]bvv}v}RR]v˙}(Rbv}( R]b]b]vRv]uovRIuuv]b}v}( b RvX TorP) Iv]}v(}b}(R]bIuuv}Po}o]vvR]b]v C}v]}v}(Av]uo Tuv D]vP}b}v V]v}v procedure Iuuv}Po}o]v u]v]b}v N}uo N}RvPL ˙b D}v}]v G].b}b N}uo C}v.ub]Pvb}( ]bL˙b Iv]]v}v ]vv}v.b b]Pv}(]b]v v]uo G]}]vP} P]o]vbo}` v}v.ub]Pv]v v]uo ]v]]v}v }b ](v]uo]b v}uo}v˙æ P]}]vP} P]o]vb }vv ]v}vP]u P]}]vP} P]o]vb ]uu] ]v}v P]}]vP} P]o]vb v*BitesandStings*v uA }('l S}vPb]]}v}( rabies R]b}v.u Rabies R]bIuuv]b}v}b˘}b yy yy Pvb]v`]R]vobR˙b Day 0 Iv.o`}vv}v`}v`]R R]b]uuv}Po}o]v~IUllP}˙`]PRZV vA R]bIuuv}Po}o]v~IUllP}˙`]PR˙Z IM]vi}vV uoR]b]v˙IM]vi}v ˙D ~}v˙˙} ˙wZ uoR]b]v˙IM]vi}v Pvb`]Rv}]v}v}u}Rv˙bb]v ]v}v Day 0 Iv.o`}vv}v`}v`]R R]b]uuv}Po}o]v~IUllP}˙`]PRZV v Chatep rP yy *Trumaa AndInjuries Av R]bIuuv}Po}o]v~IUllP}˙`]PR˙Z IM]vi}vV uoR]b]v˙IM]vi}v˙bD UwUU Note 23-13 ]v E bR}`bR`RvR]b]v]b]vi]v}RPooP]}vR ]b }}b}vbX Ao`˙b b R o}] uboU } ]v buoo R]ov R v }ooR]PRU}P]RIM]vi}v}(]b]vX Ao`˙b}uoR]b]vu}v]}]vP(}uXCRl]o]o]˙}( uv(}Rv˘v F]b}b }( vr]b]v u˙ P]v `R]ob}b]vP (}bv } bv}(]b]vR}P TRbP]o]vb`]R}b R}( b R]bIuuv}Po} o]v}(Ruv}]P]vvRuv]o}]oo]b]vX F}R}( b }R}bbl]vP]v(}uRPRu]b} SMOPo]HoR]RRP]}vo}D]b]ooX r r r RABIESIMMUNISATION P}R˙o ]uuv]b}v bR}o }+ } R}b R]PR ]bl ~PXo}}˙+ b `}l]vP`]R]b]bUv]uoRvobU]v˙ P}vb b U v `]oo]( }8b o]lo˙ } ˘}b } ]b }( }bb]o˙ ]v(`]ov]uobZX R]b ]vU IMU uo }v R }( ˙b U w v B}}b}bb bR}oP]v˙r˙b Refeal r Criteria R(}˙v`Rv˙u}ub b }(]b]v b X v*Shock*v yy æX Shock SR}l]bo]v]o}( b ooo˙b(v}vbob }(b ]ovP o}} }ou o]vP } }v ]v o]˙ }( }˘˙Pv v }R v]vb } ]o }Pvb `R]R ]( }o}vP ob } ]b]o uoo}Pv(]oX sueCa yy yy yy yy H˙}}ou]XPXRu}RPU}u]vPU]R}U]vbvo }b}v ]}Pv] C XPXu˙}]o]v(}vUMbb]ou}v˙u}ob ObXPXP]]ou}vUvb]}vvu}R}˘ Severe sepsis Symptoms yy Thirst yy Fo]vP(]v yy Po]}vb yy S`vP yy Restlessness v Standard Trtme ae ntGuidelinesUwthEditionUw yy v*Shock*v Co}]vP}(}vb]}bvbbU}v(b]}v Signs yy Aobvb}]u yy Poo} yy C}o˘u]b yy Collapsed peripheral veins yy TR˙]UobANıu yy H˙}vb]}vUS˙b}o]BPAMıuuHP Invtiga se tions yy Svb ](b]b]bb yy CXRUGCE vR}]}Pu E ](]}Pv]bR}lb yy S}b o]lFBU C BUEUv]v C v LFT ]b }v } v˙vPuvv}Ru Trtme ae nt Tuv}ib yy To reverse shock yy T}]`˙ b UR]vPv]o}v yy T}v}uo]}vbvuoo}Pv(]o yy To prevent death Non-pharmacological treatment yy Raise foot end of bed Pharmacological treatment ]v E RvPPC AX H˙}}ou]bR}l Ivb R oPb } vvo ~b] } vZ ]v R oPb ]v ]b]oXT`}vvou˙]vbb]bb (}]IV]v(b]}v R]b]vb }P b }]vb]v(b]}v yy Give colloids yy Iv Ru}RP]b }bbruR o}} ]b ( ]v R uvub]`]R˙boo}]bXPXv}uobo]vX yy R]vPboUIVU Adults wuollP}˙`]PR Children ~Sb}v}vRMvPuv}(R˙}v b [Z yy yy yy N}uobo]vbR}oP]v]lo˙vbo}`}vo˙`RvBP]bb v]vG}`]bX Adults and older children XæruollPR}}(]v SuooR]ov uollPR}}(]v R]b C Ro}u}v]}R]v}X O˘˙PvUvboo˙}˙(]oublbUvLlu]v v Chatep rP yy *Trumaa AndInjuries C}vv}u}v]}BPUobv]v} MULTIPLEORGANYSFUNC D TIONSYNDROME TR]b]bo](rRv]vP}uo]}v}(bR}lXD]+v}Pvbu˙ +u}o˙}o˙ b ]vR}bb(}oo}`bP yy CNSrEvRo}R˙ yy HrTR˙R˙Ru]b yy Pou}v˙rRb A ]}˙F]o rARDS yy K]v˙rTo A N}b]b yy Gb}]vbvorIobUPvb yy L]rIbRu]Rb yy Bo}}rD]bbu]vIvboC}Po}v yy M}o]rH˙Po˙u]UH˙}Po˙u] yy Iuuv˙bb urIuuvb]}v Refeal r Criteria R(oovb}R}]R˙b]]vb]o]bX v*Shock*v v Chapter Geneal r Emeger ncies 255.AAooP]R}v~AvR˙o˘]b ) Av ooP] }v } vR˙o˘]b ]o˙ b]o }v]}v ]( }uo˙X AvR˙o˘]b o} `]R]v u]vb }( ]vi}v } ]vPb}v }( u]]vb } }v `]R ooPvX Pb}vb `R} ` }( R ]bl }( vR˙o˘]b } ]v(}u }( }]v ubbU v u˙ PR R b }( v ]vR]v~vo]vZvX sueCa yy B}}R]vbvPb b yy DPbXPXv]]oo]vbUboR}vu]b yy V]vb yy AvbXPXbvlbuUvrvbbu yy Ivv}b}vbu] yy F}}bo]l(}} b UP}vvbU(]X Symptoms yy S]R]vP yy U]obR yy 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]bo]b b RXF}P˙ b UR(}U]ubP]vIV}Ru}( ]v}v}(vbRb]Ub}R`]R b Rv]} (}}vu]v}v}bX sueCa yy Staphylococcus aureus yy StreptococcusbX yy Enterobacteriaceae~GIZ yy Anaerobes~GIZ yy C}Pob vP R˙o}}] b ~b]oo˙ ] P˙ b Uv ]uov}vP˙ b ZUX Objectivse yy Pv]v(}vb yy Pv}uo]}vb Indictions a P}vIv]}vb yy v]]b A v]vbvo}b}v yy SP˙}vR}o}vvu yy SP˙}vR]o]˙ yy Gb}r}b}RPov}}rR˙vPoP˙ b (}]v}u yy H˙b}u˙ yy SP˙]vRbv}(b yy Pvb`]RRuR]bb yy Pvb`]R}vPv]oR]bb vw Standard Trtme ae ntGuidelinesUwthEditionUw v*AntibioticProphylaxisinSuger yr *v Iv]}vb A yy IuovP˙ b `R}bRb]bv]]uovbb yy ]}b C oP˙ b yy vCb b}v P}bb]oIv]}vb yy TR}]P˙ b yy N}bP˙ yy SP˙}vRPv]}r]v˙ yy TuP˙ b ChoiceofAntibiotics TRv]}R}bvubP yy Hv]o]˙P]vbRv]R}Pvb yy N}b]o˙]vvu]}]ob]bv yy HR]PR}vv}vRb]}(]v(}v yy (o˙ Bb u}o]bv˘ yy H(`}˘]}}vb b yy +}o B ToærP) CR}]}(Av]}b(}}R˙o˘]b SURGICALPROCEDURE REGIMEN v]}u˙ A l Uv}uo] v]]b Au]]oo]v UIVU Adults P Children vr˙bVæuP AMæ˙bVæuP And M}v]}o UIVU M}v]}o Uoo˙U Adults æuPb]vPo}b]v}v}(vbRb] Children wXæuP llPb]vPo}b]v}v}(vbRb] O Adults P}vR}(}P˙ b Children æræuP}vR}(}P˙ b Rb}v}(R}o}v }u}}b }ò Gvu]]v æuP llP And § UIVU M}v]}o UIVU § Adults æuP Children wXæuP llP O v Chatep ræP SURGICALPROCEDURE *AntibioticProphylaxisInSuger yr REGIMEN M}v]}o And (}˘]u C UIVU~}bbub}Z UIVU § Adults XæP Children vuP llPb]vPo}bX O C]}G}˘]v UIVU~}u]v]b}vu]vbZ Adults uPrR}o˙ Children uP llPR}o˙~u˘XuPZ And M}v]}oUIVU B]o]˙P˙ b S]vPo}b}(Gvu]]v And (}˘]u C UIVU~bub}Z UIVU~bub}Z H˙b}u˙ S]vPo}b}(M}v]}o Dvo}b(} vb`]RRo }bRbbURu R]bU b ob defect and patent ductus arteriosus UvL}oAvbRb]P æuP Au}˘]]oo]v ~Au}˘˙]oo]v ZU}oU UIVU Adults P}vR}(}} Children vr˙bVXæP æ˙bVwæuP Pvb`]RPv]]oo]vooP˙}`R}R]u} Rv}v}bPv]]oo]v]vR]}bu}vRV Co]vu˙]v U}oU Adults v uP Children ær˙bVuP AMæ˙bVæuP Pvb`R}RR]}bEv}]b Adults Au]]oo]v UIVUP And Gvu]]v uP]v}v Then UIVU Au}˘]]oo]v U}oU æuPvR}boX vı v*AntibioticProphylaxisinSuger yr *v Adults æuPX b Children wXæuP llPX b Standard SURGICALPROCEDURE Trtme ae ntGuidelinesUwthEditionUw REGIMEN Children Au]]oo]v UIVU vr˙bVæuP AMæ˙bVæuP And Gvu]]v TRv~vR}boZ UIVUuP llP Au}˘]]oo]v U}oU vr˙bV AMæ˙bV æuP æuP UvGvoAvbRb]P Au}˘]]oo]vA=Coov]A] Adults XP]v}v Then UIVU Au}˘]]oo]v U}oU v*AntibioticProphylaxisinSuger yr *v æuPvR}boX Children ær˙bVA*}(o}b AMæ˙bVAH}(o}b I(vRb}bRo}]}bo˙R v}]bUAu]]oo]v UIVvGvu]]v Pvb`R}ooP]}v]]oo]v}`R}RR u}Rvb]vPo}b}(Pv]]oo]vIv]}bu}vRP Co]vu˙]v UIVU Co]vu˙]v U}o}IVUæuPvR}bo Adults uP}obu]vb]v}v}æu]vb (}}URv Children vuP llPX b uP llPvR}bo væ UIVX Chapter ManagementofcuteA Pain v 257.MvPuv}(P]v A P]v ]b v vobv bvb}˙ v u}}vo ˘]v b}] `]Ro}}vouP b XMv˙(}b]vGvR(o]vP vu}}v}(]vvRb(}b˙(}ub}v}b}vXP]v]b `RRv˙bb ]]bX A]v~b}}b}R}v]]vZ]b.vbobvP(}obb RvRu}vRbv]b }v}˘]}buo] b (}u]v.ob bRub UP˙ b U}]oovbbX MvPuv }( ]v ub ]v]]o] } R v v bR}o ]vo voPb] b òo b uv }( R vo˙]vP }v]}vX S]o 'v}v ub P]vU v }vb lv ]v }]]vP ]vo]( ]v R]ovU R oo˙UPvv `}uvU b òo b R}b`]R}vvR}vo]bbUvR}b`R}}] }ov}RR]b}˙}(vb bX sueCa yy Tuubo}bloo]vi˙ yy SP˙ yy Bvb yy L}vo]˙ yy Headache yy S]loroo]b]b yy M˙}]o]v(}v yy }uv A XPXvb yy J}]v]vGuu}v yy ORb Symptoms yy Dv}vRvo˙]vPb Signs yy Dv}vRvo˙]vPb Invtiga se tions yy Dv}vRvo˙]vPb væ Standard Trtme ae ntGuidelinesUwthEditionUw v*ManagementofcuteA Pain*v Trtme ae nt Tuv}ib yy Rbb]Rv](vbb˙ yy Relieve pain yy Tv˙vo˙]vP]b} Non-pharmacological treatment yy Po+]vu}b}u(}o}b]}v`R}] yy Eo}v}(+`R]v] yy So]vvP`Rv]v] yy C}o}ù}ubb`R]v] yy Reassurance Pharmacological treatment yy Pu}o yy N}vrS}]oAvrIvGuu}˙DPb~NSAIDSZ yy O]}]b yy No}lb`]Ro}ovbRb yy Mou}ouv AXPu}o ~Au]v}Rv ) Adults Oral: XærPvR}o˙~u˘XP lR}bZ F} ob }˙ `]PRAM v lPU }b ]b æ uP llP v R}o˙ ~u˘X v uP llP lR}bZ RoP PvR}o˙~u˘XP lR}bZ F} ob }˙ `]PR AM vlPU }b ]b æ uP llP v R}o˙ ~u˘X v uP llP lR}bZ IV (Intravenous): SR}oP]vbo}ò˙}æu]vb PvR}o˙~u˘XP lR}bZ F} ob }˙ `]PRAM v lPU }b ]b æ uP llP v R}o˙ ~u˘X v uP llP l˙Z P]]}bb Oral: ChildrenP æuP llPvR}o˙~u˘XvuP llP lR}bZ Neonates P r æ uP llP r R} o˙ ~u ˘ X uP llP l R}bZ RoP Sub}o}b}o}]vP}b]bP]v~F]b}b }vo˙Z L}]vP}b(}R]ovvFoouv}vb]buP llPX IV (Intravenous): SR}oP]vbo}ò˙}æu]vb Children}˙`]PRANlP`]PRP æuP llPvR}o˙~u˘XvuP llP lR}bZ væ Chatep rvP *ManagementofcuteA Pain Children}˙`]PRAMlPv}RP}(u}vRbP wXæuP llPvR}o˙~u˘XuP llP lR}bZ BXN}vrS}]oAvrIvGuu}˙DPb~NSAIDSZ Note 26-1 NSAIDb bR}o b `]R }vX (} B vP b v˙ v }v NSAIDbU }v ubulbRv]b v} o]lo˙ +˙Rb+b }(RNSAIDSX S}u}(R+b b }(NSAIDSPr yy E˘bo]bb yy Cboo˙b(v}v yy A+bvo(v}vWvo b o}}G}` yy T]PPb}vR}bbu]vb}uRu b vb yy CbG]v}v TR Rv }vvb } R]}bo (˙ b }( R OX C r bo ]vR]]} P} }( NSAIDSX TR }uuv}vb R R]b P} }( PbbR}ov} P]v}vb`]R]bRu]R]bb}} bo]bbX yy Adult D]o}(v U}oUæræuPR}o˙}wæuPR}o˙ Or RoUæuPR}o˙}uPR}o˙ Or IMUæræuPR}o˙}wæuPR}o˙~u˘XæuP l˙Z yy I}(v U}oU Adult uPvrR}o˙ Children ruP llP]o˙]v]]}bb~u˘XXP˙Z C. Opioids TRbb(}]v b X Tu}o Adults yy væ v*ManagementofcuteA Pain*v TRb NSAIDS bR}o not P]v } ob P}b }( vbU ]vo]vP R (}oo}`]vPPr yy Pvb`]Ro]bb yy Pvb`]R}Po}v}o]vP}oub yy Pvb`R}]bl}(}b}o]vPP}vb]oo}u]b yy Pvb`]R]u]vo(v}v}vb`R}]bl}(P}]vP]v} vo(]o~Pvbb Z yy Pvb`]RR(]oX yy PPvv`}uvUoo˙]vRR]]ubU]b o˙ b o}b of the patent ductus arteriolosis yy SR}ob`]R]vb}v]voo˙vbX r r Standard Trtme ae ntGuidelinesUwthEditionUw OroUæruPrvR}o˙~u˘XuP]o˙Z v*ManagementofcuteA Pain*v yy PR]]v UIMU Adults æræuP~}˘XuP llPZR}o˙XL}`}b]vRoo˙ Children uP llP~u˘XæuPZR}o˙ yy PR]]v UIVU Adults æuP](vbb˙`]R}v yy MorphineUIVU Adult ruP}ob]( b vbb˙`]R}v yy MorphineUIMU Adults æruPR}o˙ Children XuP llP~u˘XæuPZR}o˙ X D No}lb`]Ro}ovbRPvb yy L]}]v yy B]]v EXMou}oTuv Note 26-2 D]+vP}b}(Pbv}PR b }]vXTR]b]vbbR +vb}( b ]vo](R b ]bo]u]}R}bP}(RPRv P]vXTR]bo]u]b]b+vbb`Rvbo}vX yy Pu}o AvO]}] Or yy Pu}o AvNSAID Or yy Pu}o AvNSAIDAvO]}] Refeal r Criteria I(vo˙]vP}v]}v}bv}]u}}]vo](]bv}R] `]R}uuv}bbX væ Chapter ommon C Malignancies w 258.Breast Cancer bB v ]b R }uu}vb v +vP `}uvX o˙ E }v }( R]b v ]b }bb]o R}PR u}vRo˙ b bo(r ˘u]v}vv]b}uuv(}`}uv}(R]or]vPPX P]}]v]vP b R}PRo]v]o˘u]v}v b ]b](} `}uv o}` ˙b ~ ]v ˙ ˙bZ v ˙o˙ (} `}uv } ˙bX Muu}PR˙ ]b }uuv ˙ ˙b (} `}uv ˙bv}X F]uvu}o]b]ooURv[buv ]b b}vo] v vb }v R ]}o}P]o R]bb }( R u}UP b }(]bbv}Rv(}bXT`}v}(b cancers]vGRv}]vuobX B}˘wrP) yy yy yy yy yy yy yy yy yy yy R]bl(}b Fuo˘b AP Gv]b}b]}v~Fu]o˙R]b}˙}(vb Z P]}bb}voR]b}˙}(vb P}o}vP˘}b}}b}Pv o˙ E uvR Luv}b Nulliparity Ob}PvR˙~}vbUHRT H]PR(]vlUAo}R}ov}} Z sueCa yy Uvlv}`v Symptoms yy Lu]vRb yy CRvP]vb]}bR}(b yy Sòo]vP]v˘]oo yy Sòo]vP}(o]u yy P[}vP yy Skin nodules yy Uo}v vææ Standard yy yy yy Trtme ae ntGuidelinesUwthEditionUw N]o]bRP N]o}v uE lo}v}(v]o}}o Signs yy ou bB yy P[}vP yy Sl]vR]vPUv}ob}o}v yy N]o}v yy Bo}}˙v]o]bRP yy Poo˘]oo˙v}b B}˘wrP) yy yy yy yy yy yy yy S˙u}ubvb]Pvb}(ub]bb B}v]v PR}o}P]o(b Bl]v PoP] C}PR W(}uLvPubb Rob B bvbb(}uoo+b]}v HeadacheU }u]vP ubb]b o }vb]}bvbbU o}o]]vP b]Pvb W (}u ]v B v*Btsare Cancer*v Invtiga se tions yy Muu}PR˙ yy Uob}v}PR˙}(Rb yy F]vvob]}v(}˙}o}P˙ yy Core biopsy Trtme ae nt Tuv}ib yy Achieve a cure yy Pvo}ov]bvubb]b yy P}o}vPb]o]vub]bb yy Ro]]vvb+]vP Non-pharmacological treatment yy Pb˙R}o}P]ob}v}vboo]vP yy Poo] yy SP˙ yy Radiotherapy Pharmacological treatment yy CRu}R˙ yy H}u}voR˙ yy Iuuv}R˙ Refeal r Criteria Aoo b }( b v ub ( (} b]o]b 'v}vX væv Chapter Geneal r ManagementOf Poisoning 259.General Management of Poisoning P}]b}v]vP bvb R Ru(o +b }( }˘] u}vb }( v˙ vb }vR}˙XIvuv˙bU}vo˙u]o˙u}ub b vb]Pvb`]oo o}X H}Ù b }]b}v]vP bR}o o`˙b }vb] u]o uPv˙ b]v R b]}v u˙ ]o˙ }o } }u ]oX Mv˙Rb}}]b}v]vPvv`]Ro˙]v]}v }(P}}b}vPvouvubbXS˙u}ubv b]Pvb }( }]b}v]vP v }v R b]. ˘}bU v u˙ o}oU ˙bb u]U}}RX+b E u˙}]uu]o˙U}ob R}b}˙b oX TR ]˙ b vb }v uv˙ (}bU ]vo]vP R vb UR route}(˘}b~]vPb}vU]vRo}vU]vi}vUuo o]}vU XZU R dose and }v }( ˘}bU v environmental factorsX O]v]vPR}]P]vo}v]v}buo}(Rvb ]b}Lv u}bRo(oUo}vP`]RR}}PRR]b}˙vR˙b]o˘u]v}vv o}}˙ vo˙b]b } o}}l (} R]b (b }( }]b}v]vP `]R b].PvbX J]]}b}( b v}b(}}]b}v]vP`]Rb].vbb u˙ }Pvouvubb}vRb.v]vPbX A P}]b}v C}v}o Cv ˘]bb ]v GRv } b} RoR }(bb]}vob ]v o}]vP }vo v uo˙ P]b b (} ]Pv}b]b vuv}(}]b}v]vPX sueCa yy H}bR}oRu]ob yy Pb]b yy M]}vb yy T}˘]ovb yy Vv}u}b]bvvPb b yy T}˘]o}R}ob yy Ivb]oRu]ob væw type of v} Standard Trtme ae ntGuidelinesUwthEditionUw v*Geneal r ManagementofPoisoning*v Symptoms yy NauseaU}u]vP yy D]R} yy A}u]vo]v yy D]8o˙]vR]vP yy Po]}vb yy Skin rash yy Headache yy Confusion yy LRP˙ U`lvbb Signs yy Av}uo]ob]Pvb~obUuUb]}˙Z yy Suoo]ob~u]}b]bZ yy LP]ob~u˙]b]bZ yy E˘bb]`vP b yy H˙bo]}v yy Fv]v}v yy D]R} yy WR]vP yy FobR˙bl]v yy DR˙}v yy Shock yy L}`]v}~}o]P]Uv]Z}v}v yy A}u]vovvbb yy Jv] yy Aouv}v yy Tu}b yy S] yy C}u Invtiga se tions yy Bo}}Po}b~v}uZ yy FBC yy BUEvv]v C yy U]vo˙b]b yy ECG yy L](v}vb yy Co}hvPu yy C}Po}v}.o Note 28-1 IvbP}vb bR}o ]v]]o]b } R ˘}bX TR P}]b}vb C}v}o Cvvl}o]v]oRu}o}P]bu˙]b]vb].bX væ Chatep rP *Geneal r ManagementOfPoisoning v*Geneal r ManagementofPoisoning*v Trtme ae nt Tuv}ib yy P}]b]}v yy P}]P}}b} yy Pv}o]u]b}}v yy EvRvo]u]v}v yy Pv}uvP}PvuP yy Pvv Non-pharmacological treatment yy A]`˙}}v yy }vu]v}v D yy ]v D v(}o}bu}v]}]vP yy Rbb]}v`Rvvbb˙ yy Gb]oP](]v] yy }v E v}vboo]vP Pharmacological treatment AXGb}]vbvo}vu]v}vU}]b}v]vPb}v}}o overdose st L]vTuv ]v E RvPPC yy R}o A }` U}oU Adults and Children æP]v]oo˙~P llPUu˘XPP]v Z æ b P læuobo˙]v` Then ræP˙rvR}b]b Note 28-2 P}vbP }vbv}}uuvUu}b+`]R]vrR}b}(]vPb}vV C}v]v]}vbP yy Av˙b]}v]bl~XPXl}bvU}u yy Pvb ]bl }( Pb}]vbvo Ru}RPU (}}v } }b}v ~XPX]vPb}v}(bZ Z ~Soo}`}vv}b(}b].}]b}vbZ TorP) Pbv}v}(}uu}vP}]b}vbvR]Av}b Class T}˘]˙v}u b Av}~bZ O]}]b Suoo]obUoRP˙l}u }òb}vbU respiratory depression Bv}]]vb LRP˙ l}u depression Ub]}˙ U No}˘}v for respiratory depression Fouv]o for respiratory depression væı Evidence RvP A C Standard Trtme ae ntGuidelinesUwthEditionUw Class T}˘]˙v}u b OPv} r R}bRl uC Pb]b ~CR}o]vP] PvbZ E˘bb]bo]}vUbU vbU}u]vP U]R}U ]v}vU˙]U `R]vPUP]}v}}u b]UR˙}vb]}vUubo `lvbbA=lr(b]o}v Atropine for ˙]U ˘bb]bo]}vU U }`R]vP A D]u P]}vUb] for A OPv}Ro}]v l Chlorinated Hydrocarbon Pb]b Uboo˙}vbP vbU}u]vP U]R}U ]]vbbURRU Rb b ]UP]}vU Roo]v}vU]b U}u u}U}PRUR˙}vb]}vU ]˙bR˙Ru]UbRU voA=lrR(]o D]u for P]}vUb] CR}ob˙u]v Nr˙o˙b]v U R}uPo˙ A v*Geneal r ManagementofPoisoning*v ~XPXTD U lindaneU heptachlorU endosulfanUZ P˙R]v P˙R}] Ivb]b and Bv]vP}vPo]vP]vR u}RURb b ]bU u}bUb]U}u Pb}]vbvoU b R˙]UR˙}vb]}vU ]R}b]bU˘bb bo]}vUR˙rG˘] Av}~bZ Evidence RvP }] A o]vP b Rv} P]]vPvo]vU bou}oU }Ruov b u]}vb D]u P]}vUb] S˙u}u U for A W(]v rb A v}Povb ~XPXuv˙ }]b}vbZ B]b]vPUo]vP(}u PubUv˙}Ro]vPU RRUGvlb} }u]vo]vUoo}U bR}lUorPv}u]b PR˙}uv]}v if oINR FbRF}vPobu A=lr`R}oo}} transfusion if severe o]vP BoRUb}bU PvbUv corrosives (acids olo]bZ NauseaU}u]vP U}o obUu}RlR}l }u]vo]vUPb}]v vo b o]vPUbR}lU RobbvbbUR˙] KNPOvo]v relieved P}}vu inhibitor A=lrHro}l~XPX Rv]]vZ Avru(} vbU}u]vP r }] A P(}ub]bU R}o Pb]oP v C C if B C U Chatep rP *Geneal r ManagementOfPoisoning Class T}˘]˙v}u b Av}~bZ Evidence RvP Pu}o NauseaU}u]vP U }u]vo]vA=lr vvbbUR(]oU }Po}R˙UbR}l M˙˙u}u b Nr˙o˙b]v Avrub P}}vu inhibitors B I}v NauseaU}u]vP U ]R}U}u]vo]v A=lrvvbbUo}}˙ ub]b}}}ob b UbR}lU R(]o (]}˘u]v Db Avrub P}}vu inhibitors A P ~R]]Z M}Rvl}R}]v A=lrobURobbvbbU R˙}˘]U`R]vPU }u]vo]vUvo (]oUR(]o N}v}bVP] ˙u}u b v b} D]o˙b]bu˙ indicated B v*Geneal r ManagementofPoisoning*v }] A Pbouvo }˘˙Pvvobb v]bR˙}˘]} ]vu}lb respiratory distress T}˘]o}R}ob ~uRv}o U R˙ovPo˙}o Cyanide Z LRP˙ U}u UbR}lU ]u]]b]}v~uRv}o renal failure (ethylene Po˙}oZ HeadacheU}v(b]}vU vbU}u]vP UR r obbvbbUb]U}u U shock Refeal r Criteria R(vb(}b]o]buvPuv](R˙}v}]u}`]R Pvob}}](R˙]b].v}bX v ZU Ethanol or F}u]}o D]o˙b]bu˙ indicated H˙}˘}}ou]v S}]uTR]}bo( B or B Chapter MedicinesUseInTheElderly ı 260.M]]vbUb]vREoo˙ Pb]]vP (} }o vb bvb v] RoovPbX Mv˙ u]}vbv} b`]Rb]o}vb}(Pro RvPb]vRb}}vU]b]}vUu}o]buUv˘}v}(R Pòo b R b R˙b]}o}P]+b}(RPXIvoUR˙b]}o}P] RvPb]v}˙}u}b]}vUvovR(v}vbo˙]o}ob ]vu]v]vPRvPb]vPoobvR]bl}(bPvb ]vRoo˙X TR ]b ob} R ]bb }( uoru}]]˙ ]v R oo˙U `R]R ob } R b]]vP }( uoo u]}vbX TR u} u]}vb b](}voo˙b}vURR]PRR]bl}(+b b v }RP]v}vbX TR RBb ]][ ~TR Au]v G]]b S}]˙ bB C]] U E˘ PvoZ P]b o]b }( u]}vb }vb] ]v}](}}ovbV]R}( b ]v+vb}b R]PR ]bl(}vbb X sof ueCa seDrugvAd vents E yy P}o˙Ru˙ yy Ub}(]v}]u]}vb yy Uvo]}v}(}]u]}v yy Tvb]}vb]vhvPb b Management Tuv}ib yy PvbDP A vbE ~ADEZ Pvubb yy }v E }vP(} b Roo˙vR](u]o]b}P]b yy P}PR]b}˙l]vP˙RRoR}] yy Qo]˙ubb}(Pb]]vP yy }]v A }(]v}]u]}vb yy }] A b}(]v]u]}vb yy M}v]}]vP(}b]+bvPoob v Chatep rıP *MedicinesUseInTheElderly yy yy yy yy yy yy yy }]v A }(PrPvPr(}}]v}vb Iv}ouv }( R vl(u]o˙ v ]vP}v }( v values M]vvv }( v o]b }( oo u]}vb R v ]b vo˙b]vP P]}] R}o˙Rv P Rlrb[V ]XX ]vbvb } ]vP oo ]oo }'ob v }v]vb }v R u]o ]b] ~]vo]vP u˙ lb v }v]vbZV Rb bR}o Rl P]vb R u]}vo]b Pvb bR}o u ` }( }vo P }v(b]}vb ]XX b}vro]lvubUo}}lro]l]oobUv}u]v}vu]}vb Iv(}uvb}(}RPv]vvvubU]vo]vPboo]vPU bòobRb}vb(}l]vPR]u]}vb M]]v}Pv]b˙b RRu]bUvob}Ro(o ]vvb]vPRvblR]u]}vb}o˙ v*MedicinesUseintheElderly*v B}˘ırP) M]}vQb}vCRlo]b XIbRo]v]}v(}R]bu]}vM XIb]`}l]vPM XR A b]+bM XIbRvl]vPRu]}v}vo˙M æXD}bRu]}vvou}v]}]vPM vXIb]oo b vM B}˘ırP) P]v]ob}(R}voDPPb]]vP(}Eoo˙Pvb XP]}]oo˙v]`Ru]}vo]b XW}l`]RR}uuv]˙Ru]b XR E v}Ru]}v XC}vb]vP b v~A}( b DEZ v˙v`v˙u}u b æXS]uo](˙Ru]}vP]uv vXS}vu]}vuUo}`b}bb]o}b v Chapter LocalAnathe se ticgeA nts 261.L}oAvbRAPvb L}o vbR ~LAZ Pvb Pb R b]o˙ o}l v vbu]bb]}vX TR˙ b } }] vbRb] } b]. b }( R}˙vvob}b(}voPb]X L}o vbRb ob} +vbu]bb]}v ]v u}} vbV RvU u}} `lvbb u˙ } (}oo}`]vP o}o vbRU v]vP }v Rb]}(o]}vX Adrenaline ]b } o}o vbRb } o˙ b}}v v Rb}o}vPR]}vXTRbo}vv}v}(vo]v} o}ovbR]bPUX L}o vbRb `]Rvo]v bR}o v b `RR o}} bo˙ ]b ˙ v ]b XPX bR}o v} b (} ]P]o v o}lbXTR˙ob}}v]v]]v]vv}bP]}vovbRb] ~IVRAZ X C}uu}vo˙LAb ]v b }brP]}vo]Pv}]vv]]vX AXL]}]v (Lignocaine) yy vP A r]}vb}(}v yy }v D r}R} yy M˘]uu}b}(o]vo]}]vruP llP~}˘XuP]voZ yy M˘]uu}b}(o]}]v`]Rvo]vrwuP llP yy L]}]v ]bv}}uuv(}b]vovbRb] B. yy yy yy Bupivacaine vP A ro}vPvP D]bvPbr]}}˘]Ubo}`}vb}(}v M˘]uu}b]buP llP~(}}Ro]vv`]Rvo]vZ Note 30-1 B]]v bR}o`]R b }vX(}u A Pvob]u bU]vo]]A9]b+(}Ruv}(]}}˘]]˙X CXR}]]v yy vP A ro}vPvPUob]}}˘] b yy M˘]uu}b]buP llP r v Chatep rP *LocalAnathe se ticgeA nts Ubb}(o}ovbRPvb yy Topical yy L}o]v.o}v yy Nerve blocks yy Ivv}bP]}vovbRb] yy S]vovbRb]~bRv}]o}lZ yy E]ovbRb]lvoPb] yy No]b}v(}vbR]vP]`˙ yy Ivv}b}v}(o]Pv}]vbvvR˙Ru] Pv}v}(o}ovbR}˘]]˙ yy Ao`˙bb](}]vivPU}v]vv]vbo ]vi}v yy D}v}]vioP}oubu yy C}v`Rv]vivP]v}b}(R]PRbo]˙ væ v*LocalAnathe se ticgeA nts*v Symptoms and signs of local anaesthesia toxicity yy P]r}ovPo]vPUvv]bUo]PRRvbb yy V]bo]bvbUbobR yy Ao }vb]}bvbbU b]bU o}bb }( }vb]}bvbbU b]}˙ arrest yy H˙}vb]}vU]R˙Ru]bU]b Tuv}(o}ovbR}˘]]˙ yy S}]vi}v}(LA yy SABC ~A]`˙UR]vP B UC]o}vZ}(b]}v yy G]A9}˘˙PvXI(vbb˙]vv yy G]M]}ou ~ræuPZ}]u~æruPZ}b]bXI( b]b b]bU v vbRb v P] R]}v}v r uP llP } u}u]}ouvo˙bU]vvvov yy T]}bo ]vb]o]˙ `]R IV G]bU ]v}}bU v `Rv ]]v }}]]v Rb v bU P] Ivo]] A9 b]vP P]uo}` yy I(]}bb UCPR b voo(}Ro Ub}(A9]vo]]]vuv}(o}ovbR}˘]]˙~(}oo}` ing bupivacaine or ropivacaine) Iv]}v}}Rb]ubb}o]v}P yy G] v ]vv}b }ob }( Ivo]] A9U Xæ uollP (b ~}˘X uo(}wlPvZ yy Sv]v(b]}v}(A9Ivo]]XæuollP lu]v~}˘Xuo }u]vb(}wlPvZ yy R]v]o}ob`]æu]v]vobU](]o}v has not been restored yy M˘]uu}b}(uollP}(Ivo]]A9bR}ov}˘ - Chapter StructuoaredAp chtothe SeriouslyIllChild 262.S}R A }RS]}bo˙IooCR]o A b]}bo˙ ]oo R]o ]b }v `R}b ]ob }u}u]bX A }R b ]vu]v]vPRbvbv(o b uvPuv }( R R]o ]b vbb˙X R] buv v Pv ]vv}vRui}]uvb]vR}RX T]P]vP b}}v L R] ]o ]v R}b]o (} uPv˙ b]Pvb o]l b b]}˙ ]bb } }u v ]}]˙ b]Pvb o]l R]PR uUobb bvbb}]v b ]b]u}vX Pbv}vb}(b]}b]oovbu˙ b obb].vR(}oo}`]vP }ou bV ]`˙lR]vPU ]U bR}l v v}o}P]o ]b]o]˙X The structured approach includes: yy P]u˙buv yy Rbb]}v yy S}v˙buv yy EuPv˙uv yy .v] D AIRWAYlBRETHING A PROBLEMS sueCa yy yy yy yy SPvu}v] }vR]}o]b B U]`˙}b}v}]} b ORb SignsAndSymptoms yy Dvb}v}v]}v oaApr ch yy P]u˙buv yy CvR]oblMIv]b]`˙v˙ yy Cv]v(v˙MIv]b]`˙v˙ yy A˙ }( R]vP b ˙ b]}vU b]}˙ U PvvPU]vb]}˙}˘]}˙v}]bbUG]vP}(Rovb] v Chatep rP yy yy yy yy *StructuoaredAp chtotheSeriouslyIllChild +vb E b }( R]vP ]b b ˙ R b}vbU Rb ˘vb]}vv}u]vo˘b]}v F]vo +b }( ]v b]}v u]v (}u R RUbl]v}o}vuvob Pob }˘]u˙ b]oX A }v b }( obb Rv ıA9 `R]o R]vP]}obbRvıæA9`R]oR]vP}˘˙Pv]b˙o}` H]PR G}` }˘˙Pv bR}o P]v } oo R]ov `]R b]}˙ ]8o˙}R˙}˘]XIvR]o`]R]vvo}vUPo ubl}˘˙Pv}v}]v}vu˙] CIRCULATIONlCARDIOVASCULAR WRvv}uo]oo˙.oou]bu}Rv}vb b URvR ]b v} }ou `]R ] }X ]C b }u]vvo˙ }b }v˙ b } R˙}˘] } R˙}}ou]X P]u˙ u˙}]o ]bb ]b X sueCa yy Heart failure yy AR˙Ru]b ~RR˙Ruv}uo]bZ oaApr ch yy P]u˙buvU`]RP}]o}vV yy Heart rate yy Pob}ou yy C]oo˙.oo yy Bo}}b yy L}}l (} R˙]U ˙]U v}uo ob }ouU R˙}vb]}v } R˙vb]}vU R}uPo˙U uub v ]Ro}u yy CRlR+b}(]o}˙]v˙}v}R}Pvb˙ vw v*StructuoaredAp chtotheSeriouslyIllChild*v Invtiga se tions yy CRbXr˙ yy ]o A o}}Pb yy PlG}`~](Ru b }bb]]o]˙Z Management I( R]v o]L } i` Rb v b ]`˙ Rv } b}U }R`]b }vb]]v}v RESPIRATORYV ]( o˙ v}]bb RU ]`˙ (oo }( }vb b U b}v] Harsh stridor `]R l]vP }PR v b b]}˙ ]bbU u}o]lo˙}]`˙}b}vUvo]b`]Rvo]v~æuo }(P]v}˘˙PvZ I( ˙u}ub b R bv }vb v R ]b R]b}˙ }( ]vRo}vU }vb]o˙vPo(}]Pv}˙XCoovENTP}v b ]uu]o˙ CR]ov `]R R]b}˙ }( Ru b v b]}˙ ]bb ] vo]bou}oXæuP}æuP](w˙bobv}˘˙Pv Standard yy yy yy Trtme ae ntGuidelinesUwthEditionUw Rl]vPRb]}˙ bl]vvvu uvobv]v˙} v*StructuoaredAp chtotheSeriouslyIllChild*v Invtiga se tions yy Uo}o˙b yy CRbXr˙ yy ECG yy Fooo}}}v yy Bo}}o Management yy bA]`˙bvR]vP(}}uuv]vP˘vo] ubbP yy I(] } ]b v}b}v]vP} CPRU}vb] R ˙ }(]`˙vR]vPb} SHOCK~INAQUA DE TECIRCULATIONZ sueCa yy yy yy SPb}v]b D]R} Cardiac disease Management Rbb]}vW˙R]o]vbR}lbR}oR}˘˙PvR]PRG}` XVv}b}]v}bb}bbR}o}]vvv]v(b]}v}( v}uobo]vuollPP]v Iv }`b]vbb `]R b]PR]vP b]}vb Rl o}} bP v ] ov b XT]l}]}b]b`]RIVv}uobo]vv]vbo]v Iv v v}vb]}b R]o `]R ]v}]v ]ob }vb] }] }]b}v]vPXT˙vo}˘}vX Gb}]vbvoP Uboo˙ bvb `]R bR}l (}u G] o}bbX S˙u}ub ]vo }u]vP U }u]vo ]v } o}}˙}}ob b V b]Pvb u˙ ]vo}u]vovvbb}ubbXC}vb]P]o b ]vv}v G] }obb }( G] } bR}l R]ov ]( .b }v v} +X C}vb]IVv]}b]vbR}lR]ov`]Rv}}]}bG]o}bb NEUROLOGICALDISABILITY sueCa yy yy yy yy yy Sb ]ob ~}vv}b b]b `]R} P]v]vP }vb]}bvbbZ Mv]vP]b EvRo]b S}lb]vS]loCooD]bb oC uo] v Chatep rP *StructuoaredAp chtotheSeriouslyIllChild and X X SYSTEMICUSE CA S sueCa yy yy yy yy P}]b}v]vP~]vPb}v}(l}bvU}}b]bU]bb Uu}o H˙}Po˙u] ~R]vl}(uo] b Z D]l}]}b]b AvP]}r}u Symptoms yy RbRU]obR yy F yy A}u]vo]v yy V}u]vP yy E˘bb]R]b}˘bb]]vl]vP Signs yy SR˙}v yy Dv]b]}v yy Suoo}(l}vb]vR yy P]vr}]v]obUoP]ob yy Tachypnoea yy S]PR]vPb]}vb yy H˙}Ru] yy H˙Ru] vı Z v*StructuoaredAp chtotheSeriouslyIllChild*v Signs yy Altered conscious level yy Convulsions yy Ao]ob]v]˙ yy Av}uo}b yy Mv]vP]bu yy P]oo}u yy Hypertension Invtiga se tion yy Uvo}o˙ yy Bo}}bP yy Bo}}o Management yy I(o}ò}}bPUP]æuollP}(A9˘}b˙]]v(b]}v yy P}o}vP .b W P] o ]uX I( }vob]}vb b]b P]v b ]ob }}}o b]vP Rv}]}vU Rv˙}]v u]}ouIV]vR}X yy I(]v}(]b]vv]oX b G]Mvv]}o yy Iv R]o `]R b }vb]}b oo v }vob]}vb }vb] uv]vP]b XG](}˘]ulA]o}] Standard Trtme ae ntGuidelinesUwthEditionUw Trtme ae nt Tuv}ib yy Dvb}vRb Note 31-1 I(]Pv}bob}]v}}]b}v]vPRvuPv˙uvvuPv ˙uv}(b].}]b}vb}ubu}vXI(R]b}˙vb]Pvb}]v } ] l}]}b]bU Rv v}uo bo]v ]b R ]v]o G] } b}PR `]R]vbo]vX r Non-pharmacological treatment yy Reassure or console the child yy Tu`}l Pharmacological treatment v*StructuoaredAp chtotheSeriouslyIllChild*v AXO˘˙Pv therapy st L]vTuv yy S]}bo˙]ooR]ovu˙vbouvo}˘˙PvX B. yy Convulsing child ]v E RvPPA L}u } ]uU Rv}]}vU } Rv˙}]v u]vR} CXSbuv]vP]b ]v E RvPPA yy (}˘]u C D. yy yy yy Suspected Croup ]v E RvPPA Nebulised adrenaline vA ˘uRb D }v Or Pv]b}o}v EXSbRu Ab ]v E RvPPA yy Sou}o yy I}]u}u] yy H˙}}b}v yy Pv]b}o}v yy Au]v}R˙oo]v Refeal r Criteria R(Rb]}bo˙]ooR]o}R}]b]o]bX vw } u]}o r FORMS GhanaNationalDrugsProgramme MinistryofHealth Feckaedb onStandardTrtme ae ntGuidelines~STGZ Peona sr l Details 1. FooNu 2. PR}v 3. Eu]o Organistion a Details X OPv]b}vNu Feckaedb 5. H]vP lSTG T}]}D]bb C}v]}v 6. C}uuvb} Fl 7. P]}]˙ H]PR 8. }( D bu]bb]}v ˙D M}vRY M} L}` Notes TR}uo(}uvbv}P TRP}PuuMvP GRvN}voDPbP}Puu Ministry of Health PXOXB}˘MBæ U A GRv Ivob}vb ]u]o}P gndp@ghndp.org TR]b(}uvob}.oo}vo]v}o}P www.ghndp.org/stgeml/feedback N}PY}u˙R}}b}bu](l]R}vo]v}]u]oX SvTuvG]o]vbFl(}u vw Standard Trtme ae ntGuidelinesUwthEditionUw GhanaNationalDrugsProgramme MinistryofHealth Feckaedb onsentia E lMedicinesList~EMLZ Peona sr l Details 1. FooNu 2. PR}v 3. Eu]o Organistion a Details X OPv]b}vNu Feckaedb 5. H]vP lT]ol Medicine 6. C}uuvb} Fl 7. P]}]˙ H]PR 8. }( D bu]bb]}v ˙D M}vRY M} L}` Notes TR}uo(}uvbv}P TRP}PuuMvP GRvN}voDPbP}Puu Ministry of Health PXOXB}˘MBæ U A GRv Ivob}vb ]u]o}P gndp@ghndp.org TR]b(}uvob}.oo}vo]v}o}P www.ghndp.org/stgeml/feedback N}PY}u˙R}}b}bu](l]R}vo]v}]u]oX vw EbvoM]]vbL]bFl(}u FORMS REPORTING FORM FOR ADVERSE EVENTS FOLLOWING IMMUNISATION (AEFI) MOH-Ghana Health Service/Food & Drugs Authority SMC/SMD/GEN- 10/1.0 Reporting: Sub-District: AEFI Reporting ID Number Region Code District Code District: Year Serial Number No If no, state other source of information: A. PATIENT DETAILS *Name : Sex: Region Yes Vaccination Card/Booklet M *Date of birth (DD/MM/YYYY): _ _/_ _/_ _ _ _ F OR Age at onset: Mother’s Name (if child): Years Months Days OR Age Group: < 1 Year 1 to 5 Years Years *Address (landmarks and other contact information): Contact Phone No: Vaccination centre: >5 Community: Severe local reaction >3 days Seizures febrile Abscess Sepsis Encephalopathy Toxic shock syndrome Thrombocytopenia Anaphylaxis Fever≥38°C Other (specify)................................ ¶ *Serious : *B. DESCRIPTION OF AEFI beyond nearest joint afebrile Date AEFI started (DD/MM/YYYY): __ __ / __ __ / __ __ __ __ Time AEFI started Hr Min Signs and symptoms- please give a summary of the case, including any prior disease(s)/condition and patient’s medicines before vaccination) Indicate treatment given for the AEFI: *C. OUTCOME OF AEFI Yes No; è If Yes Death Life threatening Disability Hospitalization Congenital anomaly *Outcome: Recovering Recovered Recovered with sequelae Not Recovered Died If died, date of death (DD/MM/YYYY): __ __ / __ __ / __ __ __ __ Autopsy done: Yes D. DETAILS OF ALL VACCINE (S) ADMINISTERED *Name VACCINE(S) *Date and time of *Route (if *Lot / Vaccination injection Batch indicate No. L/R site) Date Time Manufacturer Expiry Date Other important medical event (Specify________________________________________________ ) Unknown No Unknown DILUENT (if applicable) Manufacturer *Lot / Expiry Date and time Batch Date of No. reconstitution Date Time E. REPORTER DETAILS *Name: Profession/Designation: Name of Institution: Tel No.: Today’s Date: _ _ /_ _ /_ _ _ _ Signature: For District Level Office Date Report Received: _ _ /_ _ /_ _ _ _ Investigation needed: Yes No For National/Central Level Office Date Report Received: ___ /___ /______ Checked by: Designation: If yes, date started: _ _ /_ _ /_ _ _ _ Checked by: Designation: Comments (include results of Causality Assessment): ¶ All serious AEFIs & AEFI clusters (two or more cases of the same adverse event related in time, place or vaccine administered) should be investigated. *Mandatory fields Vaccine Safety/AEFI Surveillance Ministry of Health / Ghana Health Service/Food and Drugs Authority April 2017 vw Standard vw Indxe AB A Abatacept ææw ABC ı Uvæ A}u]voTu æ A}u]voo}b]b v Av}uoVP]voBo]vP Av}uoVP]voD]bRP AB O A}}v æı Uv Uv Uv u]v}Rv A væ Acetylcysteine v U Aciclovir æ Uæı Uv Uv AvVoP]b wv A]Iuuv.]v˙ D S˙v}u ACT Uı Uı Uı Av}u˙]vD CR}o A P}` Acupuncture æv A}uv ææ Uvæ AooP]R}v~AvR˙o˘]bZ ]o BA S]o}v]b }vR]b BA CRb A S˙v}u~ACSZ w C}}v˙ A S˙v}u C˙bA b v E]Po}hb A æı Go}uo}vR]b A Acute heart failure v Uw HbA w K]v˙ A Ivi˙ ı Uv L}` A A}u]voP]v o˙uR}] A olu]~ALLZ u˙o}] A olu]~AMLZ N}]vP A UoG]vP]]b r}v A rR}v]}b}u˙o]b r}vrR}v]R]b b }R}] A ]v(}vb }bA }u˙o]b æıw Uv w w Uv Uvw U Uvı Uv v æw Uvæı Uv v æı vı Uw U U Uw U wı Uı U wæ wæ æv æıw Uv æıw Uv æıw Uv Uv Uv Ob A M] æı RRu A F v Uv Uv R]b bA æıw Uv S]vb A ]b æv S˙u}u A C}v}o Ao]uu ææw Uæv Adapalene w A]b}v[b]bb w ADHD w AivRu}R˙ w Adrenaline æw Uæ Uvæ Uv vo A Ivb8]v˙ w U Ao b]}˙ ]bb ˙v}u b ~ARDSZ w bP˙ A ı AIDS v Uıæ AKI ı U Uæ Uv Aov}o æ Uæ Uæ Ao}R}o]o]]u D Tuvb Alcoholic Hallucinosis ı Ao}R}o]S]b ı Ao}R}oW]RòS˙v}ub ı Ao}b}vvP}v]bb æ Alendronate v Uv U Ao(}b]v AoP]vr}v]v]vPv]b v AooP]R]v]b wæ Uwı Uæv Allopurinol wæ Uw Uwı Uæw AoRro}lb æ Ao}ou Auo˙}] æ Uæ Uæ Auv}R} Au]v}R˙oo]v w Uv Uvw Au]}}v ææU Au]]˙o]v v Uı Uæ Uv Uæv Uævæ U æv Auo}]]v ı Uæ Uæ Au}]b]b U Au}]˙bv˙ Au}]L]Ab Au}˘]]oo]v U Uv Uı Uw U Uv Uæw U 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T]v]b æ U] vw Uw Uw Uw Uv Tinea corporis æ Tinea cruris æ T]vuvu æ V Tinea pedis æ Uæ V]vrbb}] o˙ }o]}u˙o]b T]vVb]}o} æv Uæw ~VAPPZ ı T]v]}o VP]v]b wæ Uwv T]}}]u æ Vobv æ T]v]]v æv VooHD]bb TMJ æı Vv}u˙]v w Uıw Uı Uıı Uv Uv T}]o]u ææw V]oo æı Uv Uv Tocolysis ææ V]ooW}b]b æı T}[bo˙b]b ıw V]}bu wı T}(]v] ææw Vb}]o}b æ Uæ T}ou] ı Vb}r}ob]}v]v]bb w T}vb]oo]b w Uæ VDRL æ Uvæ Uv T}˘]o}R}ob væw Uv Vu]o v Uæı Uv T}˘]]uov}o˙b]b~TENZ w VP} ı Uv T}˘]uorv}oP}] æ VboNb æ T}˘}obu ıæ V]]}R}o TPHA v V]oPo]v ı Tu}o æ Uw Uıæ Uæv Uævæ Uvæ V]v]bv ı U Tv˘u]] v Uw V]oSl]vIv(}vb æw vb]v]bRu]'l~TIAZ ı V]u]vA æı Uv U Uæ Uæ Tvb}b]}v}(RG]bA ~TGAZ V]u]vAbouv}v v TuAvIvi]b æ V]u]vBv w Uwæ TuvIvH˙}Po˙u] ı V]u]v.]v˙ BD væ T}vuv æ V]u]v B ~H˙}˘}}ou]vZ v Uv Uvæ Tv}]v w æv T]u]v}o}v ææ Uæwv V]u]vrC v T]}ou v v U U U U U INDEX V]u]vrC.]v˙ v V]u]vrD v Uvw Uvı Uv V]u]vK v Uvw Uv V}u]vP U Uæ U Uı U U Uæ Uw Uı Uæ Uæ Uæv Uæw Uæ U Uı Uıw Uı U U Uı Uw Uææ Uvæ Uı U Uı U U Uı Uw Uı U Uæ Uv v Uv U U Uı Uı Uıv U Uw w U Uv Uıæ Uıı 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