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GHANA-STG-2017-1

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Republic of Ghana

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b}(]R}u˙`}bv}}o}vPR}v]}v˘]vb]o
]ubvb ~S b}v }v RCb[ o}`ZX Evub v o˘b
bR}ov}P]v}vb`]R]R}X
sueCa
]R}
A ~AM`lbZ
yy Iv(}vb
yy V]oPXPX}]b
Uv}}]b
yy ]o
B PXPXSou}voo
bXU SR]Poo UCu˙o}
Vibrio cholerae
yy P}}}oPXPX Entamoeba histolytica~u}]b]b
yy DPr]vPXPXv]]oo]vb
Chronic diarrhoea (> 2 weeks)
yy CR}v] ]v(}vbP XPX u}]b]b
U o}b]bU }}v]b
]v(}vb`]RHIV
yy Fv}voPXPX]]o}`o˙v}u
b
yy IvGuu}˙PXPXo}o]bU}Rv
C
[b]bb
yy Mob}}v˙v}ub
b
PXPXR}v]vb
yy Mo]Pvv˙PXPX}o}vv
yy Ev}]vPXPXR˙R˙}]]bu
U]}v}u]v}R˙
yy DPr]vPXPXo˘bUNSAIDb
Symptoms
yy Fv`˙}}ob
b
yy Bo}}}ub]vR}}o
b
X
Z
UE. coliU
Standard
yy
yy
yy
Trtme
ae ntGuidelinesUwthEditionUw
Pbv}((
Reduced urine output
Ab}]}u]vP
Signs
obA
yy Avu]
yy W]PRo}bb
yy Av}˘]
yy Ooob]}vbXPX}oobUv]]b]b
yy Sl]vob]}vbXPX˙Ruv}}bu
yy S]Pvb }( R˙}v
~˙ u}b uuvbU }v ]v bl]v
P}U]oo˙.ooAN}vb
b UR˙]U}boR˙}vb]}vZ
yy EvoPR˙}]
yy A}u]voubb
yy Roubb
B}˘rP)
D]Pv}bob(}D]R}
v*Diarhoea*v
yy D]R}
WITH}u]vP
Uo}`P(`]Rv}ub]v}}ob
b P}vb]
]o]v(}v
yy D]R}
WITH }u]vP
U (U }u]vo ubU o}} v ub ]v
}}ob
b P}vb]]o]v(}v
yy D]R}
WITHo}}vub]v}}o
b WITHOUT(P}vb]u}
biasis
yy P}(b]R}bv~]`}}ob
b WITH
Z }u]vP
era
yy D]R}
WITH˘bb]}u]vP
~b]oo˙](]vu}Rv}vuu
}(RR}bR}o}P}ZP}vb](}}}]b}v]vP
yy D]R}
bvvP `]R }o vl} bl]v ob]}vbU `]PR o}bb X }
o}vP]}P}vb]HIV
yy D]R}
ovvP `]R }vb}v ]v obP }vb] }`o uo]P
nancy
r
r
: consider cholr
r
TR(}oo}`]vPov}b bRP}(R˙}v
children with diarrhoea:
TorP)
Abuv}(P}(R˙}v
Abuv}(P}(R˙}v
A9DEHYDRATION
in
in children with diarrhoea
]vR]ov`]R]R}
AMæA9
Nil
ærA9
M]oru}
ANA9
Severe
C}v]}v
WooUo
RbobbU
irritable
LRP]U
v}vb]}bUG}˙
Eyes
N}uo
Sunken
V˙bvlvv
dry
M}Rv}vP
Moist
D˙
V˙˙
LOOKTA
Chatep rP
*Disorsof
der theGatrs ointetina
s lTrcta
Abuv}(P}(R˙}v
]vR]ov`]R]R}
A9DEHYDRATION
AMæA9
Nil
ærA9
M]oru}
ANA9
Severe
Thirst
D]vlbv}uoo˙U
not thirsty
TR]b˙U]vlb
Po˙
D]vlb}}o˙
Goes back
]lo˙L
]vR]vP
G}blbo}`o˙
L]vR]vP
Goes back very
bo}`o˙L
]vR]vP
TRv
Rbv}b]Pvb}(
R˙}v
I(RvRb
`}}u}b]PvbU
]vo]vPob
}vb]Pvvo]vU
R]bb}u
R˙}v
I(Rv
Rb`}}u}
b]PvbU]vo]vP
ob}vb]Pv
vo]vUR]b
R˙}v
b
W]PRv
and use
TuvPovA
W]PRvv
bTuv
PovB
W]PRvv
bTuv
PovC
FEEL
Skin
CIDDE E
TRETME
A NTPLAN
Invtiga
se tions
yy FBC
yy Bo}}.ou(}uo]b]b
yy S}}o}v˘u]v}v
yy S}}o(}ovbvb]]˙
yy Bo}}vv]v
Trtme
ae nt
Tuv}ib
yy T}vR˙}v
yy T}oo}bG]
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 K}v]vPb
b
ov
yy Iu}b}voR˙P]vXPXRv`bR]vPL}]o
yy A G] ]vl r }o v ]vv}b b vbb˙ ~S
b}v}vRFo]uvPuv(}R]ov`]R]R}[Z
yy M]v]vv]}vv
b }o
v*Diarhoea*v
(}u
A IvPMvPuv}(CR]oR}}IoovbbUWHO
Standard
Trtme
ae ntGuidelinesUwthEditionUw
Pharmacological treatment
AX]o
B Pb}v]b
mucus in stools)
~(U}u]voubUo}}v
Note 1-1
N} v]}b ] (} b ]o Pb}v]b
}v]bRu]v]uvX
yy
yy
v*Diarhoea*v
yy
X A R˙
st
L]vTuv
]v
E RvPPA
C]}G}˘]v
U}oU
Adults
æuPR}o˙(}æ˙b
Children~(}ooR]oPP}bZ
æuP llPR}o˙(}æ˙b
nd
L]vTuv
]v
E RvPPA
(}˘]u
C
UIVU
Adults
wæuPR}o˙
Children
æuP llP}˙`]PRR}o˙
Neonates
AN˙bw V
AM˙bw V
Then
(}˘]u
C
U}oU
Adults
æuPR}o˙(}ær˙bw
Children
r˙bV
r˙bV
æuPR}o˙Z
u}vRbr˙bV
æuPR}o˙Z
æuP llP}˙`]PRR}o˙
æuP llP}˙`]PRR}o˙
æuPR}o˙(}ær˙bw
æ uP llP }˙ `]PR (} ærw ˙b ~u˘X
uP llP }˙ `]PR (} ærw ˙b ~u˘X
Note 1-2
Sbvb]}v v }vo˙ P]v} R]ov } u}vRbU R}`R IVv
P]v}v}vbX
BX
yy
Au}]˙bv˙
~v
b (]o]vP}b}v}
u]]ouv(}]oPb}v]b
based on stool microscopy)
]v
E RvPPA
M}v]}o
U}oU
Adults
uPR}o˙(}æ˙b
Children
within 2 days or
r
Chatep rP
r˙bV
rw˙bV
r˙bV
C.
yy
yy
yy
*Disorsof
der theGatrs ointetina
s lTrcta
uPR}o˙(}æ˙b
uPR}o˙(}æ˙b
uPR}o˙(}æ˙b
D.
Zincbouv}v(}]R}
]v
E RvPPA
yy Z]vbouvU}oU
Adults
Not required
Children
ANvu}vRbV
uP l˙(}r˙b
AMvu}vRbV
uP l˙(}r˙b
Refeal
r Criteria
R(vb`R}(]o}]u}U}P`}bUb]R˙(}
]R}X R( oo vb `]R R}v] ]R} } b]o]b
(}(Ro}vvuvPuvX
Trtme
ae ntalgorithm
Fluid management for children with diarrhoea
uTvPoN}
R˙
Wv}v
A
yy CR]ov(o˙
b R}u
yy Ivbu}R}P]R}urbG]bo]l]`Ul}l}Ub}U
æ
v*Diarhoea*v
CholeraP}(b]R}~]`}}o
b ZA=}u]vP
st
L]vTuv
]v
E RvPPA
TetracyclineU}oU
Adults
æuPvR}o˙(}˙b
Children
N}}uuv
Or
D}˘˙˙o]v
U}oU
Adults
uPR}o˙(}˙b
Children
N}}uuv
Or
E˙R}u˙]v
U}oU
Adults
æuPR}o˙(}æ˙b
Children
AN˙bV
æuPR}o˙(}æ˙b
vr˙bV
æræuPR}o˙(}æ˙b
rv˙bV
æuPvR}o˙(}æ˙b
u}vRr˙bV
æuPvR}o˙(}æ˙b
NeonatesV
XæuP llPvR}o˙(}æ˙b
Standard
yy
yy
yy
yy
yy
Trtme
ae ntGuidelinesUwthEditionUw
`UvOoRR˙}vSo~ORS
]bbB bR}oP]vu]ol
b
vORS
G]buRbR]o`vb}(ooRG]b
CR]obR}o}vv}(
AblRu}R}v}RRoR(]o]˙](RR]oPb`}bU
bu}`˙}}ob
b U}u]bo˙U}ub˙R]b˙U
b}]vlb}}o˙}]bv}']v˙b
Ivbu}R}vR}`}v]R}
ZX
ORSvo˙}uuv (} b ]v u]o } u}]R}
Rbb}]uvPo}b}vv}v~o}`}bu}o]˙ZX
How to prepare ORS
ORSP D]bb}o R }vvb }( }v bR }( ORS ]v v uo }
uobv]vP}v˙}(ORSX
yy T} P v uoU b buoo ~ uoZ b}L ]vl }'ob } ]P
}'o
yy T}PuoUbLu]vo`}'o
TRR]o}obR}o]vlASMUCH}(]R
b lbR`vbXI(R
R]o}u]bURu}RbR}o`]}u]vbvP]]P]vX
v*Diarhoea*v
TorP)
Tuv˙Fo]TR˙rPovA
P
A
ORSBb]Au}v
ORS(}˙˘}}o
b
passed
AM˙b
æuo}u}
æWuo
W˙b
uo}u}
Wuo
uo}u}
Wuo
AN˙b
uTvPo
R˙
u]o
}v
Wv}B u}
For the child with mild-moderate dehyd}v
Uuse treatment Plan B
yy Child to be treated in the health facility
yy G]ORS }R.bR}bbR}`v]vRTo(}PovB
yy I(R]o}u]bU`]u]vbvP]v
b
yy C}vv`]R}RG]bRR]o`]oo
yy Ivbu}R}}vv(]vP
b
](R]o]b]vP
b
yy Ob}}ob
b bv}v˙
yy CRl(}b]Pvb}(`}bv]vPR˙}v
yy I(˙b}u+˙U]uvb}}uRG]RbvP]vb}}b
ORSvro
yy Rb}(
b R˙}v
LR}b
yy I(o]v]oRb
b ]u}`]Rv}R˙}v
rP}}ovA
yy I(R]boo
b u]oru}R˙}v
ovB
yy I(}v]}v]b`}bv]vPrP}}ovC
v
Chatep rP
TorP)
*Disorsof
der theGatrs ointetina
s lTrcta
Treatment by Fluid Therapy - Plan B
W]PR
AMvlP
vAMlP
rAMlP
WılP
AP
U}u}vRb
u}vRb}
u}vRb
u}vRb}
˙b
˙b}æ
years
Au}v
}(ORS
ruo
rwuo
wrıuo
ıruo
UbRR]o[bP}vo˙`Rv˙}}v}lv}`R`]PRXTR}˘]uu}v}(ORS
]~]vuovZ ob}oo˙uoo˙]vPRR]o[b`]PR~]vlP˙Z wæ
Treatment Plan
R˙
}vCSW
yy A R]o `]R b R˙}v
]b Pv uv `]R IV
G]b]vR}b]o
yy I( R R]o v ]vlU P] ORS
˙ u}R `R]o R IV o]v ]b ]vP
set up
yy S IV G]b ]uu]o˙X G] uollP R]vP [b o
}U](v}]ooUv}uobo]v}R}oouvG]~æPPZU
]]bR}`v]vRTo(}PovCo}`P
yy I(˙}vv}P]R}uvvvv}vbb }Pb]
U(}RoR(]o]˙Rv}b}X
yy
yy
yy
yy
yy
yy
yy
yy
Rbb R R]o ˙ r R}bX I( R˙}v b ]b v}
]u}]vPU P] R IV G] u}]o˙ Rv b ]v R To
(}PovB
Aob}P]ORS
~}æuollP}˙`]PRlR}b}}v
Z R
b R]o
v]vlPboo˙LrR}b~]v(vbZ}WR}b~R]ovZ
Rbb v ]v(v L v R}b v R]o L R}bX Cobb](˙
R˙}v
X TRv R}}b R }] ov ~AU U
B } CZ }
}vvuv
R]o
Ab R}o˙XI(v}]u}]vP}R˙}v
]b`}bU]vb
drip rate
D} v}}b R IV G]b vo R R]o Rb v }b}]v
R ORS (} ob R} v R ]b ]u}uv ]v R o]v]o
}v]}v
C}vv ORS
}v uv ov B v }vv } }b R]o
voR]oRbv}b]Pvb}(R˙}v
URvu}}PovA
S]R} u˙ }uo]˙ ulG] o}bb
}uv] ˙ o}bb }( }bb]u ~R˙}lou]Z } }v R }R
RvU]u]vo(v}vo]vP}]}b]bvoo}}
}bb]u~R˙lou]Z
WRv R v ]b b]vP u}vb }( ]vU }o˙
]v]vPP}}vo(v}vU}bb b]u}v]v]vP(}}bbR
}}v
b `v(bR(]b~XPXvvZ
I(R]bo]v]ovl}o}}˙]v}(R˙}lou]
b
U
}bb]ubR}oP]v˙R]vv}b}b]vP}bb]u
Ro}] }vo˙ ]v R}b]oX P}bb]u }v]v]vP G]b bR b
w
v*Diarhoea*v
yy
b}o}v
Standard
yy
Trtme
ae ntGuidelinesUwthEditionUw
Ro(vPR
b
}`
D [bb}o}v}R]vP [bo
I(}bb]o]v(vbvR]ovbR}o}vv}}b
]vPR]}}(]R}
TorP)
u˙
Treatment by Fluid Therapy - Plan C
P
A
F]bP]uollP]vP
TRvP]wuollP]vP
Iv(vb~AMu}vRbZ
R}
æR}b
Children
~u}vRb}æ˙bZ
u]vb
A*R}b
R}v](]oob]boo
b ˙`l}v}oX
Note 1-3
Avr]R}o u]]vb o]l M]b K}o]v
U ]Rv}˘˙o
o}u]
bR}o v} b ]v R uv }( ]R} ]v R]ov v
o]lo˙ } } u} Ru Rv P}}X S]u]oo˙U v]} }vb `]R
l}o]v}v}(v}Ro]vRuvPuv}(]R}X
v*RotavirusDisseandDiarhoea*v
9.
R}]b
Disease and Diarrhoea
Rotavirus ]b R u}b }uu}v b }( b ]R} ]v ˙}vP
R]ovX I }vb (} u} Rv R] }( oo R}b]o]}vb }(
R]ov obb Rv æ ˙bX I }b ˙ }v `]R lb `v R
˙u}vRb~DurMRZXCR]ov]v(˙P}˙b
vr]v(}vb}uu}vX
sueCa
yy
RotavirusPæ˙b}(}]b lv}`v}bANıA9}(oob
`}o`]
Symptoms
yy F
yy V}u]vP
yy P}(b`˙]R}
yy Thirst
Signs
yy Sunken eyes
yy D]u]v]bRbl]vP}
yy Ao}vb]}bvbbUv]vP}vRP}(R˙}v
Invtiga
se tions
yy }v
D }( }]b vPv ]v }}o
b
˙ v v˙u ]uuv}b˙b
~EIAZ
Trtme
ae nt
Tuv}ib
yy C}}v}(G]vo}o˙.]b
l}]v
U }]v
U
Chatep rP
*Disorsof
der theGatrs ointetina
s lTrcta
yy Rouv}(}vrP}]vPG]o}bb
yy v]}v
A
}vuov]}v
Non-pharmacological treatment
yy H}urbG]bXPXu]ol
b
U}]PbU}}v]vl
yy N]}vP(bv}o]vPR]b}UP]v˘
uo˙(}`lbLR]b}
Pharmacological treatment
AX
ORS and Zincbouv}v
~Sb}v}vRD]R}
[Z
Refeal
r Criteria
yy P}} b}vb } R˙}v }bb ~bb]vP u} }}ob
b
Rv
]vl]vPZ
yy P}}]vl]vP
yy Bo}}]v}}o
b
yy P}}(]vP
yy Ao}vb]}bvbbl}vob]}vb
yy D]R}
v}u]vP
}vv]vP(}AN˙b
r
10. C}vb}v
Iv PvoU }vb}v (b } }`o u}uvb R
]v(v } }}ob
b
R ]8o } bX TR ]b P ]v]]o
]}v ]v v}uo }`o R]bV R(} uRb]b bR}o o] }v
RvPb]vR}`oR]X
D]R}
ovvP `]R }vb}v u˙ ]v] oP }`o
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}`o˙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˙}`o(}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}`o }b}v ~OP]o] ˙v}u
b
(}uv˙b
v*Constiption
a *v
Symptoms
yy Iv]o]˙}u}}`ob
yy Pbb]vPR}}ob
b
yy Iv(vb]vP}(}}ob
b
yy S]v]vP}}}ob
b
yy Fo]vP}(]v}uo}v}(}`o
yy Iv]o]˙ } b GbU }o]l˙ }u]vo ]v `]R } `]R}
}u]vP
Signs
yy Fv R]PR ]R }`o b}vb r b uRv]o }`o
}b}v
yy bv
A }`ob}vbro˙
b ]ob
yy S]Pvb }( ]}v]b ~Pvo]b vvbbU P]vP v }v
vvbbU(}]b}vZrbbPvPv}b}`o
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}(`UrR}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}`ob}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 (}`U 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}v`oo}`]vP
b
yy D]8o˙`oo}`]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]u`oo}`
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]vb`o}}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 `oo 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˙]v`oo}`]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˙`oo}`]vP
b
~]v`}b}vo˙]vP
Gu˙bPPbGORDZ
yy RPP]}v}(]vPbu]o
yy D]8o˙]v`oo}`]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]u`oo}`
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]vbvRv`oo}`
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}`o}}vo˙(}v}vR}]oL
ov]vP
yy M}]]bRP
yy S`oo]vPvb
yy P]vo]]}v}]R~]b
v]Z
yy D]b}u(}L}v]vP}`ob
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 S`oo]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}]bU`ub]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]r`UubRlvl˙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 `oo
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 `oo
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}`o}}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}`o
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}`o(}}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] `]R`o }( 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˙ `]R`o }( 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]`]R`o}(}+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}`u]}PubluoUvRv}bv}o}]v}(R}}˘
]]˙vu]vbo]v]oo˙`oo
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 `oo 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}˙`oo]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}]o`o(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 `oo 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}`u}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 `oo(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}`oo}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 S`oo]vPb]}(o}}}oo}v~b}u}bZ
yy P]vo]u]vPu}uv
Signs
yy Poo}
yy E˘bb]o]vP
yy L}o]b`oo]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}`o}˙}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]vo`oovi}]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}`oP
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˙`oo]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}`oo]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}`oo]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}
`oo]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}(Rv`o˙]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` `oo]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}`oo]vP
b
`R]Ru˙`˘v`v
yy J``oo]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 ~`oZ ]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]b`oov}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}`UR]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}`IV}(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}`o]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}`U]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 `oo}`]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}`U
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}`oo}`
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}`U ] 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 v`ooX TRb ]vo }o}U ]˙U uU b]}vU
RU o}} bPU ]v }U v}( }`o 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}`o
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˙`u]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}`oubA=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
Ub`uo}}~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 S`oo]vP}(R
yy Iv]o]˙}u}o]u}o˙
yy Poo}
Signs
E˘vb]CSvu
yy D]+b `oo]vP
b
}( RbvvP }( Ro
b Ru˙˘v
beyond cranial suture lines
CRoRu}u
yy LP`oo]vP
b
}(Ro
b R]b]b }}vRo(v}bv}
˘v˙}vRu]o]v
SPooRu}RP
yy D]+b`oo]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
S`oo]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 L`oo]vP
b
o}v~b}vv}bb}o}v}r˙bZ
Cephalhaematoma
yy Reassure parents
yy L`oo]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 S`oo]vP}(R˙o]b
Signs
yy ˙E ]bRPU`R]Ru˙ov
yy Rvbbv`oo]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
`oo
R]}v
T}R}U
i`Uub}
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
`oo
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}`ob}vbro˙Iob
yy CRb`oovvbbrubo}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~R`oZUuPX
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 `oo (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}`ubuv
]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 S`oo]vP}.uvbb}(+o]u~boo˙v]ooZ
yy P]v]vR+o]u
yy Mild fever
Signs
yy S`oo]vP}(+o]u
yy D]+vo`uR
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 S`oo]vP}(voP~}]vZ
yy Co(`oo]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
}l`ol}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}`o]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]oo`oo]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
S`oo}`]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 `oo}`]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 S`oo]vP}(R(vo}`˘u]b~u˙bv]vR]ov
o}`vu}vRbZ
yy A}u]vo`oo]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}`o˙
Children
N}}uuv(}R]b}v]}v(˙
b ]bv}`ooo]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 `oo 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}`URbv}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}`IV`]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}`IV`]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]bl`ol]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}`U 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 LP`oo]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}`U }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}`o˙~} 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 `oo 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}`oo]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]`u]}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 `oo 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 GPool`ubob}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}`Ub
}( R b]}b v }( R ]v(}vU v]} uv bR}o
]uu]o˙
b
b}vlv}`oP}(Ru}b}ob
}Pv]bu v R v]}b b (} ]buvX L}o lv}`oP }(
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}`Rb`oo]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}`o}}}˘˙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 Sou}o
U]vRoU
Adults and children
u]}PuU+bb}Lvbv
yy
yy
yy
Av
Fob}v
lSou}oU]vRoU
AdultsvR]ov}æ˙b
lærælæu]}PuV+R}o˙
Or
Bb}v]
lF}u}}oU]vRoU
Adults
vlXæu]}Pu~r+bR}o˙Z
Children}æ˙b
lXæu]}Pu~r+bR}o˙Z
v*Bonc
r hialthma
As *v
yy
Av
MontelukastU}oU
Adult
uP]o˙
Children
}æuPPvob]o˙
vA
Pv]b}o}v
U}oU
Adults
r uP ]o˙ v ]o }`v bo}`o˙ } r `l ]} } o}`
u]vvv]o˙}b}(æuP]o˙X
Children
uP llP]o}+˙æuP˙R]˙U]vP}æruP]o˙
}ov]o˙Uo}`b}b}bb]o`]R}}}l]vP'lb
wı
Standard
Trtme
ae ntGuidelinesUwthEditionUw
Note 8-5
R]`uv˙rvu}vRb`]R]`}]vP
b }`vuv](
o]v]b˙u}u
b
r(}Rbu]v]uo˙u}ub
b
~AMrubu}vRZX
Aoo vb `]R R}v] Ru
Ab
bR}o ] }vv}b }v v
}vboo]vP˙Ru]ouX
Refeal
r Criteria
Iv ˘}vU ( vb ]( v} ]u}]vP } ]o˙
]}vPL]v]ouvPuv}b]o]bX
Aoo ]bRP o]vb bR}o (}oo}` `]R]v }v `l v
(}b]o]bo]v](}}vvX
F} R}v] Ru
b ( vb `]R b]bv ˙u}ub
b
}
b]o]b o]v] ]v P]}vo } ˙ R}b]oU v vb `R} R
v˘}vb`]R]v(`˙bl`lb}(R}R(}
b]o]bv]`}(R]uvX
Aob} ( `Rv v ]b u} Rv }v }b }( }o
v]b}o}v]vu}vRbX
61. }vR]b
BA
v*Acuteonc
Br hitis*v
TR]b (b } v ]vGuu}v }( R }vR]o u}bX I ]b
}Lv (}v ]v b}]}v `]R b]}˙ ]v(}vX M}b
b } v} ] v]}bU R}`U 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}l`ooR˙
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
Adults
PR}o˙(}ær˙bw
Children
AN˙bV
OvælæoR}o˙(}˙bw
r˙bV
æuo}(læwbvb]}vR}o˙(}˙bw
r˙bV
æuo}(lbvb]}vR}o˙(}˙bw
Chatep rP
yy
yy
*Disorsof
der theRespirtor
a ySystem
u}vRbr˙VuP llP~}(u}˘]]oo]vZR}o˙(}˙bw
AMu}vRbV
æuP llP~}(u}˘]]oo]vZR}o˙(}˙bw
F}R]ov}oR}b}(R}v]}]v]v(
b
}vb~}vR}vu}v]Z
Or
E˙R}u˙]v
U}oU~(}]v]]obooP]}v]]oo]vZ
Adults
æræuPvR}o˙(}˙bw
Children
r˙bV
æræuPvR}o˙˙bw
r˙bV
æuPvR}o˙˙bw
vu}vRbr˙bV
æuPvR}o˙˙bw
Or
A]R}u˙]v
U}oU
Adults
æuP}v]o˙(}˙b
Children
uP llP}v]o˙(}˙b
r
v*Chroniconc
Br hitis*v
Av
O˘˙Pv
˙B vbo}vPbUrvLlu]v
Or
FublUrLlu]v
Or
N}vrRublUræLlu]v
Refeal
r Criteria
R(oo}uo]b}(}vR]b}b]o]bX
yy
62. 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]o`ooR]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 CRb`oovvbb
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`]R`o
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}`IVU
Adults
uP b ]vPo }bU }v L u]vb ]( vbb˙X
G]v]v}oP]vbo}`o˙}ræu]vbX
Children
r˙bV
uP b b]vPo }bU }v L
u]vb](vbb˙XG]v]v}oP]vbo}`o˙}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}`o˙}ru]vb~}˘]uo˙XæuP˙ b
}vbZ
Children
ru]}PullPbo}`o˙}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}`o˙ v} P Rv æ uP lu]vX ~u˘X P
o}]vP}bZU
Then
M]vvvUuPvrR}o˙
Children
r˙bV]v]oo˙UuP llPbo}`o˙v}PRvæuP l
u]vX
Then
M]vvvUæruP llP]o˙~u˘XuP]o˙Z
ru}vRb
v
V]v]oo˙UuP llPbo}`o˙v}PRvuP l
lP lu]vX
Then
M]vvvUXæræuP llPR}o˙
NeonatesV ]v]oo˙U uP llP bo}`o˙ 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}`obb].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}`IV}}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}`ob}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}`o˙}
]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]R`oS˙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 `]R`o
Zb b
yy F ~]v(}v]}vbZ
yy }`b
D ]vbbUo}vb]}bvbb~u]vo˙]vo}R}o`]R`oZ
yy D]b}]v}vv}v(b]}v~u]vo˙]vo}R}o`]R`oZ
yy S`vP
yy Tu}b~u]vo˙]vo}R}o`]R`oZ
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}`o˙}ru]vb~}˘]uo˙XæuP˙ b
}vbZ
Children
ru]}PullPbo}`o˙}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]R`o (}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}`U
˘]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}`uv}vv˙u}bRoRP]bX
Tuvub(}obu}vRbLu]bb]}v}(˙u}ub
b
(}
.b]b}XH}`Uo](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}`]R`o
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}`IVlIMU
Adults
XæræuPib}u˘X}(uP]vR}b
Or
yy Bv}]v
UIVlIMU
Adults
r uP bo}`o˙ } 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}`o˙ } r u]vb ~}˘]uo˙ Xæ uP ˙
}vb
b Z
Children
ru]}PullPbo}`o˙}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}`o˙]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]R`oS˙v}ub
TRb } (}oo}`]vP bv `]R`o (}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]R`o
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
`o]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]R`o
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`]R`o˙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`]R`o˙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`]R`oUo}vP
}vb]vob]vl~}R}bZvP}˙bX
sueCa
yy Sv `]R`o }( 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[}v`oobXZ
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}`o˙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}`o˙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}`IV}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 `o]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}`o˙}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
`]R`o ˙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]R`o+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`]R`o
yy Crash~(PUG+U]vbboU]vPbZ
yy W]R`o~GvPu}}vvP˙oobU]vPbU]b
boU}}}vv}vZ
yy E˘v}v~b]bv}(`]R`o(bUPoo˙b]]vPZ
yy OvbPvrR}b~}]v
ZVrR}b~uRu]vbZ
yy }v
D P So `lb (} `]R`o 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`]R`o
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`]R`o
yy Ablv}P
yy Rb}vb(}bvvP(}`]R`ouvPuvR]bu
yy Pb˘]vbUvlv}`oPv(b}(`]R`o
yy P]]o]˙}}`]R`]R`ov]buvX
yy Fu]o˙b}bvb}]ov`}lb]oo(}`]R`ouvP
yy P}vo]b}(o
b `]R`o
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}(`]R`o˙u}ub
b
rvv]b
yy R]bv}u]o]vv}v
BXMvPuv}(`]R`o˙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 ]( `]R`o ˙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~XPX`ol]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(o`oo]vPb
b
}vRbl]v`R]Ru˙]bRP
pus
yy F
Signs
yy S`oo]vPb r ovU `uU 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~(`obb `]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}(}`obvo}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}`U 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]vob`oo]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]vob`oo]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}`obUb}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}`o˙}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}`o]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}o`oo]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˙`oo]vP
b
}(Rbl]v}v˙
b
}Rob}(R]bu]vXR
E ]b}}(`Rou˙ob(`u]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] ˙ `oo]vP
b
}( u}b uuv bR b R
˙o]bU o]bU Rvb v }R b }( R }˙X TR `oo]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}`ob}]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]R`o}(]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}v`oo}`
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}`oo}`
b
Then
yy Pv]b}o}v
U}oUb}
Children
uP llPvR}o˙voo}`oo}`
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]o`o}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}`U}]oU
Adults
Ao˙rR}o˙oobRb}ob
Children
Ao˙rR}o˙oobRb}ob
Or
Co}]u}o
UA9}`U}]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]`U
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}`U `]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
N`o˙]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]bl`ol]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}`U ]
]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]b`oobR}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
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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
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]uov ]v DKAU b]oo˙ o}` }bb]uX I ]b }uu}v b }(
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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}`U]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
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yy S˙u}ub}(]v(}v}}Rvo˙]vP}v]}v
v*DiabeticKetoacidosis*v
Signs
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~˙bl]vUbl]vP}}bvlv˙bZ
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yy ]v
E }(]v(}vUvP˙
b U}l
b
Invtiga
se tions
yy Rv}uo}}Po}b~boo˙ANuu}olLZ
yy U]vPo}b~boo˙ANA=Z
yy U]vl}vb~boo˙ANA=Z
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vo(]ov}bb]uu˙R]PRZ
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yy Foo o}} }v ~]b `R] oo }v `}o bPPb ]o
]v(}vZ
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Trtme
ae nt
Tuv}ib
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yy T}oRo}o˙o}bbUb]oo˙}bb]u
ı
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Chatep rP
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MvPuv}(D]K}]}b]b~DKAZ
TorP)
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is necessary
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in the table
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}`]]o˙
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rvP
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TRLU
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hourly
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if required
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Standard
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Trtme
ae ntGuidelinesUwthEditionUw
RP]u(}uvP]vPD]K}]}b]b]vCR]ov
CHILDREN
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insulin and Sor
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M]v]v]vP
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}(Rbo]]vPob [
in the table
o}`Z
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oo`]
D
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if blood level
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infusion over
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if required
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Chatep rP
B}˘rP)
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b
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Sample Sliding Scale Chart
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b
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}B rbu v]}b (} b ]v(}vb ~S
}]b}vZ
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r
v*DiabetesinPrgna
e ncy*v
BX
r
Refeal
r Criteria
I( R ]v b}b (} uvP]vP R vU b
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IV}IML}v.u]vPo}}Po}bv]vl}voobv(
}v˙P]}vo}R]vPR}b]oX
I( R v u]vb }u}b } (]ob } b u}vb
}(]vb]uvPuvU(}P]}vo}R]vPR}b]o(}
(RX
100.Diabetes in Pregnancy
~S b}v }v RD]b ]v PPvv˙[ v ROb] v
Ob]D]b}b[Z
ıw
Standard
Trtme
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 `oo b R}b }v o}vPrvP }o vrR˙Po˙u]
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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
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elderly
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yy Uvb}uR˙b]o}r]˙
yy E˘bb]o}R}o]vl
Symptoms
yy D]]vbb
yy Bo]b]}v
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yy Po]}v
yy S`vP
yy SRl]vP}(RRvbv}˙
yy Uv}vb]}bvbb
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yy I]]o]˙vv}uoR]}b]oo˙]vR]ov
Signs
yy S`vP
yy Tu}b
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Invtiga
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Trtme
ae nt
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yy T}]o˙}b o}}Po}boob}v}uo
ı
Chatep rP
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b
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RvvP]vvPv}uoo˙
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yy r b}}vb }( Pvo bP } b }( bP } A*
}'o }( b}L ]vl ~bPr}v]v]vPU v} R] [ ]vlbZ } ]v]
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b ovb
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or snack
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b u]oR˙}Po˙u]ULu]vbXI(
v}]u}uv]b}bU(}
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b
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nd
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b U
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u}vRr˙bV
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v*Trtme
ae ntrInducedHypoglycaemia*v
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st
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æA9b}o}v
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b
ıı
r
Standard
Trtme
ae ntGuidelinesUwthEditionUw
Refeal
r Criteria
I( R v }b v} b}v } R } uv
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102.Dyslipidaemia
v*Dyslipidaemia*v
TR ]b uo ]v o]vl]vP R]PR o}} R}ob}o oob }
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C o D]bb ~CVDZ vbU ]vo]vP u˙}]o ]v(}vU
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b
~ }u]v}v }( ob }( R (}oo}`]vPV
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yy E˘bb]o}R}o]vl
yy H˙}R˙}]]bu
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b
Symptoms
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yy A}u]vo]v(}uvbo}R˙]Po˙]u]
Signs
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yy Ob]}voo˙
yy WR]bR]vP}vR}v~}vobZ
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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
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b
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b
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st
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yy S]ubv
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B.
yy
yy
yy
Moderate CVD risk - Diabetes and CVD risk equivalents
]v
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}bA v
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ruP]o˙
Or
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r
r
v*Dyslipidaemia*v
Tuv}ib
yy T} R ]bl }( o]v]o R}bo} ]}bo vb
and related deaths in:
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yy Iv]]ob `R}Rb+CVDv~b}v˙v
}vZ
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} 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˙
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U}oU
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ruP]o˙
Refeal
r Criteria
R( oo vb `R} u]v }b] R P ob b]
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103.Goitre
v*Goitre*v
AP}]
]b `oo]vP
b
}(R(}v}(Rvl }voPuv}(
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b
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b }v}vrbP]o
uv }( v]Pv v uo]Pvv P}]b ]b ˙ (oo o]v]o buv
v ]vbP}vbX Tuv ]b v} vbb]o˙ ˙ ]vb]vP ]}]v
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sueCa
yy S]uov}vr}˘]P}]
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yy TR˙}]v}oburv]Pv}uo]Pvv
Symptoms
yy S`oo]vP]vRvl
yy R]vP
B
v`oo}`]vP
b
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yy S˙u}ub}(R˙}R˙}]]bu
~Sb}v}vRH˙}R˙}]]bu
yy S˙u}ub}(R˙R˙}]]bu
~Sb}v}vRH˙R˙}]]bu
Signs
yy D]+b~bu}}RZ}v}o~]PoZR˙}]`oo]vP
b
yy S]Pvb}(R˙}R˙}]]bu
~Sb}v}vRH˙}R˙}]]bu
yy S]Pvb}(R˙R˙}]]bu
~Sb}v}vRH˙R˙}]]bu
Invtiga
se tions
yy TR˙}](v}vbW(TU(TUTSH
or
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[Z
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yy
yy
yy
yy
yy
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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 `oo 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}`ob~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 `oo 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}`o}`}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}`o˙}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(}vbb`oo]}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 `oo 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 `ol]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(}o`oo]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(}o`oo]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
`oo]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
}`o }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}}lbv`oo
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˙b`oob]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}`obU}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}`o˙}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 `oo 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}`o˙}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}`o˙]vuPv
b
r
Treatment of convulsions not responding to Magnesium sulphate
Av
]v
E RvPPA
yy D]u
U IVU uP bo}`o˙ }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}`o˙
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 S`oo]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 `oor]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]v`oo}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}`UPo]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}`U 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 LP`oo]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}`IV~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}`IVUæruPR}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}`o˙}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}`U 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}`IVUæruP~}(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}`o˙~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}`o˙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}`IVUæruPUu]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}`o}}}Pbb](]]bo˙`ooo]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}`o˙ 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}`o}}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]R`o(}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}`Ubuoo˙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 Voo`oo]vP
b
yy P]v}v]v}v
yy L}`}u]vo}l]v
Signs
yy Av}uoP]vo]bRP
yy Voo`oo]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}`A}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}`UL˘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 (}u }( (uo Pv]o
v bv ]v GRvX WR]o R ]bb ]b voU ]v GRvU R
bv }( v + v]vP
b
˙bb u Rb bo ]v u}b b
bvvP o `]R v ]bbX Iv o} }v]bU R
]v]v }( ]o v Rb (oov }vb]o˙ } Po
v]vP
b
}b ~XPX P bu
U ]bo ]vb}v `]R ]U
HuvP]oo}uV]b
HPV ZX
b
V]v}vP]vbvrb]vPHPV
]v(}v]bR]ouR}
(} ]u˙ v}v }( ]o vX Tuv }( ]o v
]b R b]b }( P˙v}o}P]o }v}o}P]b v ]}R]bX
Tuv ]vob P˙
b vl} ]}v vl} Ru}R˙X
SP˙]v}obu}o}(Rvou}b`oobRo˙uRb
]v]vP R ~WR]u[b R˙b}u˙
ZX TR]b ˘vb] P˙
b
bR}o ] } }vo˙ ˙ ]v b]o]bbX R]}v uv
}Lv]v}obo}o]o]]]}vX
sueCa
yy Huv]oo}u]b
~}vb(}A9}(bZ
yy Associated risk factors include:
yy S˘o}u]b]˙
yy MooR]o]Rb
yy Iv(}vb`]RHbS]uo˘H}u]v]b˙IIUHIV
yy Su}l]vP
yy L}`b}]}r}v}u]b
yy Fu]o˙R]b}˙
Symptoms
yy ˙u}u
Ab
~]Pv}b}v}v]ov]vP
b
Z
yy S˙u}u~v]bbZ
yy Av}uoP]voo]vP
yy Iv`vPouvbo]}b
yy AL˘o
b ]v}b
yy P}buv}boo]vP
yy Av}uoP]vo]bRP
yy L}`}u]vo]v
yy P]v]vP˘o
b ]v}b
yy W]PRo}bb
yy U]v˙˙u}ub
b
XPX˙b]U(v˙U]v}vvv
yy Rectal pain
v
Chatep rP
*Gynaologic
ce
alDisorsder
w
v*Ccinoma
ar
ofthevix
Cer *v
Signs
yy o˙
E ]bbP}bE ]}v}(]˘}RvPb}(R}v]]]b
yy Llv ]bbP Uo } (vPvP ]o ob]}v }v
bou˘u]v}v
Invtiga
se tions
yy Cervical biopsy
yy FBCvb]lo]vPb
yy Bo}}vo}o˙b
yy Suv]v
C
yy Su]]
yy CRbXr˙
yy Uob}v}(K]v˙b
yy CTSvv}MPvRb}vvIuP]vP~}}v}b
vub}b RovPbvo]Z
yy Po]˘u]v}vvvbRb]
yy C˙b}b}˙ v }}b}˙ `]R } `]R} ]}b˙ } oo}`
]bo]b}v}(b]o}ou}b
Trtme
ae nt
Tuv}ib
yy T}vou}
yy T} b }( u} b `]R R ]u }( ]vP R
disease
Non-pharmacological treatment
yy SP˙
yy Radiotherapy
yy }u]v}v
A
}(P˙
b Uv]}R˙
Pharmacological treatment
]v
E RvPPA
yy AivRu}R˙
~Sb}v}v(oo}`Z
Refeal
r Criteria
Aoovb ub (} b]o]b(}o}v} ]
}vP
b }(]bbvu}
b }(uvXTuv}(]v}u
}(R]˘]b}v
b ]vR}b]ovb]o]buX
Chapter
Disorsof
der theKidneyand
Genitourinayr System
X
Go}uo}vR]b
A
TR]b]b]bR]b
b ˙uP}RPo}uo.o}v
bU `R]R b }]v v o}} } ol ]v} R ]vX
MRv]bub (} R Po}uo uPu˙ ]uuvru]X TR]b
}v]}vu˙b}]`]RR˙vb]}vvG]v}vX
sueCa
yy P}b}}o
b ]v(}vb~R˙vPo}bl]v]v(}vbZ
yy Iv(]bb
yy OR]oIv(}vbXPXbou}voo
yy Hb
B]bUHbC]bUHIV
yy Pb]XPXSR]b}b}uUMo]
yy S˙bu]ob˙Ru}bb
v}Rbo]b
Symptoms
yy AR]b}˙}(]vP]v(}v
yy Gvo]}uu}bul}vR˙b
yy Rob
B bvbb
yy Av}˘]
~b}uubb}]`]R}u]vP
yy F
yy S]b
yy Scanty urine
yy Hu]
Signs
yy Ou
yy Oo]P]~]v}oubAMuol˙Z
yy Hypertension
yy Hu]
yy Dl}o}]v
yy Acute heart failure
yy C}u
Invtiga
se tions
yy U]vo˙b]b
v}u]vo]vZ
Chatep rP
yy
yy
yy
yy
yy
yy
yy
yy
yy
yy
*Disorsof
der theKidneyandGenitourinayr System
S]uv bR}`b ˙R}˙bU ol}˙b v ]˙ }( b
]vo]vP˙R}˙b
P}]v]boo˙obRv
b P lR}bu˙]vRvR}
vP
FBC
BUEvv]v
C
TR}ob~]vR]ovu˙(o
b Z
CRbXr˙~u˙bR}`ou}v˙}uZ
ECG
Iuuv}o}P˙~XPXANA
UAvDbDNAZ
ASO~vb}o˙b]vObZ
Uob}v}(l]v˙b
AX
yy
v*AcuteGlomerulonephritis*v
Trtme
ae nt
Tuv}ib
yy T}]v(˙v}b Rb}(vo]vi˙
yy T}vv}v}o}uo]}vb
Non-pharmacological treatment
yy b B
yy So]}v
b ]v]
yy C}v}oG]ovP
Adults
C}v}oG]v}v˙]vP
b ]o˙G]]vl} uoob
]}b˙[b]v}X
Children
Rb]G]b}uolu}(}˙b(v]}b˙[b
]v}X
Pharmacological treatment
F}G]v}v]vP}br]v(}bGo}uo}vR]b
]v
E RvPPB
F}bu]
U}o}IVU
Adult
uP]o˙U]vb]vP}uP]o˙
Children
u}vRr ˙bV r uP llP l˙ ]v]oo˙X Ivb ˙ r uP llP
R}o˙}u˘X}(vuP llP˙Uv}}˘uP˙X
Neonates
XæruP llP}R}o˙Vu˘XuP llPX
BX F}R˙vb]}v]vP}br]v(}bGo}uo}vR]b
yy To}}~S
b b}v}vRH˙vb]}v
[Z
Refeal
r Criteria
R( oo vb `]R }uo]}vb }( vo (]oU b]
failure and hypertensive encephalopathy R ]b (}oo}`]vP }b
]v(}bPo}uo}vR]b}R˙b]]vb]o]b}vR}o}P]bX
ı
Standard
Trtme
ae ntGuidelinesUwthEditionUw
Pvb `]R }R b bR b ob vR]b } ˙bb u]
bo]bUbR}oob}(}R˙b]]vb]o]b}vR}o}P]bX
135.NR}S˙v}u
TR]b}v]}v]bb}]`]R}]v]]v˘b}(
b rXæP lXw
u ]o˙ }uv] ˙ R˙}ou]vu]
vR˙}PooX
b D]bbR}o`]R
b }vvv}
P]v}v
b ]vR]ov`]RvR}˙v}u
b
X
sueCa
yy
yy
v*NephroticSyndome
r *v
yy
yy
U }uU R˙o]]u]
P]u˙Go}uoD]bb
yy M]v]uoRvP]bb
r}uu}v]vR]ov
yy F}ovbPuvoPo}uo}bo}b]b
yy Muv}bvR}R˙
yy Muv}b}o](Po}uo}vR]b
Iv(}vb
yy ]o
B ~P}b}}o
b ]v(}vZ
yy V]orHb
BvU
C HIV
yy Pb] ~
Plasmodium malariaeUSchistosoma mansoniU F]o] r
sisZ
S˙bu]D]bb
yy D]buoo]b
yy S˙bu]LbE˙Ru}bb
yy Au˙o}]}b]b
DPro
yy N}v}]o
b vr]vGuu}˙Pb
Symptoms
yy o˙
E u}v]vP(]o8vbb
yy Gvo]}˙`oo]vP
b
yy F}u˙v}(]v
yy W]PRP]v~v]vv}voZ
yy P}}
Signs
yy P]}]oU]RoUPv]o}u
yy Ascites
yy Poo+b]}v
yy P}]v uov]}v oo˙ ]v R]ov `]R o}vP v]vP
b
disease
Invtiga
se tions
yy U]vo˙b]b
yy BUEvv]v
yy Suou]v
yy Suo]]b
yy FbvPo}}Po}b
ı
Chatep rP
yy
yy
yy
yy
*Disorsof
der theKidneyandGenitourinayr System
S}o}P˙rHb
U
B U
C HIV
Hb electrophoresis
Avvov}˙~ANA
Z
Uob}v}(l]v˙b
Trtme
ae nt
Tuv}ib
yy T}o]˙u}ub
b
yy T}vo˙]vP}v]}v
yy T}vvuvP}uo]}vb
yy T}o˙}Pbb]l]v˙uP
Non-pharmacological treatment
yy Restrict salt intake
yy }]v
A ]VXvrXP llP}˙`]PR}(bobb}]v
~PPbU uU .bRU ]˙}bZ ˙ (} o v r P llP
day for children
Pharmacological treatment
v*NephroticSyndome
r *v
AXF}}v}o}(}u
st
L]vTuv
]v
E RvPPC
yy F}bu]
UIVU
Adult
ruPrR}o˙~u˘XvuP]o˙Z
Children
R(}b]o]bX
N}r
IvR]ovU(}bu]]b]v
b }viv}v`]Rou]v]v(b]}v}vo˙]vb
}uX
yy
B.
yy
yy
Or
F}bu]
U}oU
Adult
uP]o˙U]vb]vP}uP]o˙Vu˘XuP]o˙
Children
R(}b]o]bX
For control of resistant oedema
F}bu]
UIV}}oX~b}(}obvR]ovZ
Av
M}o}v
U}oU
Adults
XæruP}v]o˙
Children
R(}b]o]bX
ı
r
Standard
Trtme
ae ntGuidelinesUwthEditionUw
N}r
D]b bR}o b `]R }v v v} P]v b }v ]v vR}
˙v}u
b
]vR]ovX
C.
yy
yy
For control of proteinuria
L]b]v}]o U}oU
Adult
æruP]o˙
Av
Pv]b}o}vU}oU
Adults
uP llP]o˙
Children
v uP lu } uP llP ]o˙ ~u˘X uPZX F} o}vPru uvP
uvU(}]]]vX
v*AcuteKidneyInjuy*
r v
N}r
C}}b}]b bR}o P]v } R]ov v bo ob `]R u]v]uo
RvPvR}˙v}u
b
˙b]o]bb}vo˙X
Refeal
r Criteria
R( oo vb } R˙b]]v b]o]bU ]]]v }
vR}o}P]b]uu]o˙L]Pv}b]bv]o]b
b }vX
136.AK]v˙Ivi˙
A K]v˙ Ivi˙
~AKI Z ]b u R Rb v}` o R u
Rvo
A
F]o~ARFZXIb]bbv]v
b vo(v}v
}]vP } ]} }( R}b } ˙b bovP ]v uo}v }(
v]}Pv}b `b}b v ]b}v }( o}} }ouU o}o˙
v]rbovX
TR ]+vo ]Pv}b]b }( AKI
]vob vo }u]U vo
~]v]vb]Z v }b vo ~}b vR}R˙Z (}ub }( AKIX TR
u}b ]u}v ]bl (} (} R o}uv }( AKI ]b R bv
}( r˘]bvP R}v] l]v˙ ]bbX OR Rv P}} u]o
`]R }]v }( }ou }v}vU v}v }( R˙}vb]}v
v }]v }( vR}}˘] PvbU v} b]. ]vv}vb R
v o]o˙ u}vb } v R o}uv }( AKIX D]vP
uvPuvU]b G]]vv}RbR}ou]v]vX
AKI Rb v P
b ˙ R K]v˙ D]bbP Iu}]vP Go}o
O}ub ~KDIGO
ZU AKI `}l]vP P} (} ]˙
b }]vP } R
]]o}`P
KDIGO AKI DEFINITION
Ivi˙Ub}vRAKINC]]
ı
r
Chatep rP
SP
*Disorsof
der theKidneyandGenitourinayr System
Suv]v]]
U]v}]]
XærXıubbo]v}]vb}(AN
vXu]}u}o
AMXæuollP lR}(}vrR}b
XrXıubbo]v
AMXæuollP lR}(}
ANR}b
Xubbo]v}]vb]vub
v]v}ANæXvu]}u}olLO
]v]}v}(]o˙b]b
AMXuollP lR}(}ANR}b
Ov](}ANR}b
sueCa
ı
v*AcuteKidneyInjuy*
r v
Obstetric
yy S}}v
yy P}brbvb}v
yy Sroub]lEoub]
yy P}buHu}RP~PPH
Z
yy HELLP~Hu}o˙b]b
EoL]Ev˙ubL}`PooZS˙v}u
Gynaecological
yy B]ooo]P}v}(b(}oo}`]vP}u]voR˙b}u˙
Medical
yy Go}uo}vR]b
A
yy Hu}o˙b]b
due to:
yy Malaria
yy Iv(}v
yy Hou]]vb
yy Typhoid fever
yy GvPD .]v˙
yy D]R}
U}u]vP vR˙}v
Surgical
yy Hu}RP
yy P]}v]b
yy Pvb
A
yy Ob}R˙
yy Bvb
Symptoms
yy Nauseav}u]vP
yy Oo]P]
yy Anuria
yy Ou
yy b D
yy Moo]]v
b u}R
yy Hiccups
yy CRvP]vu}}
yy Fovl]v
yy FP
Standard
Trtme
ae ntGuidelinesUwthEditionUw
yy
v*AcuteKidneyInjuy*
r v
D]R}
Signs
yy Uboo˙v}b].b]Pvb
Invtiga
se tions
yy U]vo˙b]b
yy FBC
yy BUEvv]v
yy Su]]
yy Bo}}o
yy U]vo
yy A}u]v}ro]ob}vv
b
yy Po]vXr˙}(}uv
Trtme
ae nt
Tuv}ib
yy T}}Pv]bv}b]ob
yy T}v(Rvo]vi˙
yy T}u]v]vv}uoo}o˙vG]}ouu]o]
yy T}u}}˘]`b(}uR}˙~]o˙b]bZ
Non-pharmacological treatment
yy N]}vPG]}]v}(R]PR]}o}P]ooP}]vl˙]v
obXIvR]ovXrP llP}(obb }]v
b l˙
yy D]o˙`]PR]vP
yy M]v]vG]ov
yy `B }( R˙lou] r }] }bb]u }v]v]vP (}}b XPX
vvbU}}v
Pharmacological treatment
st
L]vTuv
]v
E RvPPC
AXTuv}(R˙}}ou]
yy S}]uCRo}]
Or
yy R]vPb o
v}u]vP
Or
yy Bo}}vb(b]}v
Or
yy Pobuouv
UXıA9UIVU
~]( R ]b v} R˙lou]Z ]v b }( ]R}
~]vo]vP
b
Z
~]vb}(vbb ZX
N}r
IvR]ovUP]ruollPG]}obbX
BXT}rbo]bR]b]bLG]ouv
yy F}bu]
UIVU
ı
Chatep rP
*Disorsof
der theKidneyandGenitourinayr System
Adult
ruPX
b
Children
ruP llPX
b D}v}X
C.
yy
yy
yy
Control of hyperkalaemia
Adult
Co]u
Po}v
A9UIVUruoUbo}`IVU}ræu]vb
vA
S}ooIvbo]v
UIVUv]b]væruo˘}b
D
æA9
vA
S}]u]}v
UIVUXA9~æuE]væuorZ uollP}æu]v
utes
r
N}ræ
D}v}u]˘o]uPo}vv]}v]vRbuo]˙˙bb uX
yy
yy
yy
v*AcuteKidneyInjuy*
r v
yy
Children
Sou}oUvo]bU~(Z
ANælPV
æuP
AMælPV
XæuP
Or
Co]u
Po}v
A9UIVUXæruollPUbo}`IVU}æru]vb
Av
S}oo Ivbo]v
UIVUXv]b ]væuo˘}b
D
A9UP]XæræuollP l
R}XKo}}Po}bræuu}olLX
Av
S}]u]}v
UIVUXA9~æuE]væuorZ uollP}æu]v
utes
r
N}rv
D}v}u]˘o]uPo}vv]}v]vRbuo]˙˙bb uX
D.
Tuv}(R˙vb]}v]bblvRo}R˙
~Sb}v}vRH˙vb]}v
[Z
N}rw
Iv]}vb(}]o˙b]b
yy }vPb
C
R(]o
yy Pou}v˙Ou
yy Eo}o˙ v}uo]b b]oo˙ R˙lou] v} }v}oo ˙ }v
uvb
b
yy Metabolic acidosis
yy Uu]˙u}ub
b
~b]bU]]bZ
yy H˙vb]C]bblEvRo}R˙
ıæ
r
Standard
Trtme
ae ntGuidelinesUwthEditionUw
Refeal
r Criteria
Aoo vb `]R o]v]o ]v]}vb (} ]o˙b]b ub (
}uo˙}v`]R(]o]b(}]o˙b]bX
137.CR}v]K]v˙D]bb
v*ChronicKidneyDisse*a v
CR}v] K]v˙ D]bb
~CKD Z (b } l]v˙ uP }( u}
Rv u}vRb}vX TR o˙ P
b }( CKD ]b boo˙ ˙u}u
b
v R}PR o}}˙ b }( bu v]v v
u}v
b
}( Go}uo F]o}v R ~GFRZ
U ubuv }( ]v
ou]v v]v } v v]vP
b
}( ]v]]ob ]vb ]bl
bR b R}b `]R R˙vb]}vU ]b uoo]b } b R]b}˙ }(
Po}uo}vR]bX
CKD u˙ uv](b ]R b ]v v}uo]b ~XPX b]bv
u]}ou]v]U }]v]U Ru]ZU o}} v}uo]b ~XPX
ovv]vvub GFRAMıuolu]vlXuw Z
vob l]v˙RvPb}vob}v}PR˙X
F} oo Pb
b }( CKD
U vb bR}o v}P } b
bu}l]vPU`]PR](}bURlo]]bvUv}]NSAIDb
v}RvR}}˘]PbX
TorP)
SP
æ
sueCa
yy
yy
yy
yy
yy
yy
yy
yy
SPb}(CR}v]K]v˙D]bb
Db]}v
GFR
~uolu]vlXwuZ
K]v˙uP`]Rv}uo}]vbGFR
ANı
K]v˙uP`]Ru]o}v]vGFR
vrı
M}}v]vGFR
ræı
S}v]vGFR
ærı
K]v˙(]o
AMæ
Chronic hypertension
CR}v]Po}uo}vR]b
D]buoo]b
Ob}R˙
Renal calculi
P}o˙˙bl]v˙]bb
T}˘]vb~PbURbUR˙uobUXZ
C}vvb]bb
Symptoms
yy N}v]vRo˙Pb
b
yy R'v}vv}vv}v
yy Av}˘]
UvbU}u]vP
ıv
Chatep rP
yy
yy
yy
yy
yy
yy
yy
yy
yy
*Disorsof
der theKidneyandGenitourinayr System
Gb}]vbvoo]vP
Hiccups
Rob
B bvbb}v˘}v
Thirst
N}]U}o˙]
MboubC
PbRb]
P]b
Ivb}uv]
ıw
v*ChronicKidneyDisse*a v
Signs
yy LRP˙
yy Bo]vP
tendency
yy Poo}
yy Hypertension
yy P]]b
yy P]Rov}R˙
yy P]Ro}u
yy ]˘]b
Ab
~G]vPu}Z
yy Ivbbl]v]Puv}vvl}˘}]}v
Invtiga
se tions
yy FBU
C S]lo]vPUBo}}.ou}uuv
yy U]vo˙b]b
yy Bo}}UUEo}o˙bUSuv]v
C
yy Co]u
UPR}bR
yy FbvPo}}Po}b
yy L]]b
yy CRbXr˙
yy Uob}v}(l]v˙b
Trtme
ae nt
Tuv}ib
yy T}R}v]l]v˙]bbo˙]vo
b ]v]]ob
yy To control hypertension
yy T}}v}oo}}Po}b
yy T}uvPvo˙]vPb
yy T}v}uo]}vbv(R`}bv]vP}(l]v˙(v}v
Non-pharmacological treatment
yy }]
A vR}}˘]vbXPXNSAIDb
URou]}v
yy D]o˙ ]vl }( G] }( v uo } ]}b ˙ [b ]v } (}
ob~uolu}˙b(]vR]ovZ
yy Restrict salt intake
yy Rb]]˙}]v}PullP l˙
yy }]
A }bb]u}v]v]vP(}}bXPXvvb
yy D]o˙b]b~(}vR}o}P]bZ
Standard
Trtme
ae ntGuidelinesUwthEditionUw
Pharmacological treatment
AXT}}v}oG]}o}
st
L]vTuv
]v
E RvPPC
yy F}bu]
U}o}IVUruP]o˙
B.
Treatment of hypertension
~Sb}v}vRH˙vb]}v
C.
Treatment of renal anaemia
~Sb}v}vRAvu]
]vCR}v]K]v˙D]bb
D.
Control of hyperkalaemia
Adult
Co]u
Po}v
A9UIVUruoUbo}`IVU}ræu]vb
vA
S}ooIvbo]v
UIVUv]b]væruo˘}b
D
æA9
vA
S}]u]}v
UIVUXA9~æuE]væuorZ uollP}æu]v
utes
yy
yy
yy
[Z
[Z
v*ChronicKidneyDisse*a v
N}r
D}v}u]˘o]uPo}vv]}v]vRbuo]˙˙bb uX
yy
yy
yy
yy
Children
Sou}oUvo]bU~(Z
ANælPV
æuP
AMælPV
XæuP
Or
Co]u
Po}v
A9UIVUXæruollPUbo}`IVU}æru]vb
Av
S}oo Ivbo]v
UIVUXv]b ]væuo˘}b
D
A9UP]XæræuollP l
R}XKo}}Po}bræuu}olLX
Av
S}]u ]}v
U IVU XA9 ~æ uEZ } æ u]vbU r uu}ol
lP~ruollPZ
N}rı
D}v}u]˘o]uPo}vv]}v]vRbuo]˙˙bb uX
Refeal
r Criteria
R( oo vb `]R ]b}b]vP (}b v }uo]}vb }
R˙b]]v b]o]b } vR}o}P]b (} (R .v] uvPuv
}( R}v] l]v˙ ]bbX R( oo vb ]]vP ]o˙b]b }
vR}o}P]bX
ı
r
Chatep rP
TorP)
CKD
STAGE
138.Avu]
SCDE RIPTION
CTION
A
K]v˙uP`]R
v}uo}GFR
D]Pv}b]bvuvPSo}`}Pbb]}v
˙uo}bBP}v}oUAvvo(}oo}`
UGFRUU]vo˙b]bvU]vP}]v
v]v}ubuvb
K]v˙uP`]R
u]oo˙bGFR
uEb }Pbb]}vvuvPb
Pb
Moderately decreased
GFR
uEb v}uo]}vbPI(HAM
P lLRlF]v
UB v(}oXAvvo
Rl}(buo]uUR}bRv
PTHXR(](GFRAGuolu]vlXw
So˙bGFR
P(}l]v˙ouvR˙P
Refer
K]v˙F]o
K]v˙ouvR˙PD]o˙b]b}
vbov}vPR(
]vCR}v]K]v˙D]bb
Avu]
o}b o˙ ]v R }b }( CR}v] K]v˙ D]bb
~CKD Z v ]b vo˙ v]bo ]v vb `]R CKD P
b æ ~EvrbP
l]v˙]bbZXTRov}(vu]R]PRoob}(Po}uo
.o}v~GFRZ
~]XXCKDP
b r]bZ oo˙o}`]v]v]]ob(}u
RPvo}o}vXAvu]}(CKD]b]u]o˙b˙.]v˙
}( ˙R}}]vX TR l]v˙b R ui} b} }( ˙R}}]v
vU b vo (v}v o]vbU }}v }( ˙R}}]v o]vb
}}}vo˙X
TR}PR ˙R}}]v .]v˙ ]b }uu}v u}vP vb `]R
vu]]vCKDU}R}vovb }v]vP]b}bbR}o
]v.}˘o](]v]oo}v˙]ob]v(}]b}b
}R Rv ]}v .]v˙ } ˙R}}]v .]v˙X C}}v }(
vu]]vCKDvb]u}bb]ovo]˙}(o](X
sueCa
yy .]v˙
D }(˙R}}]v
yy R oo }v
b (}u u]}bo ]bb (}u ]b }
hypertension
yy IvbPb}]vbvoo]vP
yy Ivb}˘]bo]vP}bR}voob]o
Symptoms
~Sb}v}vRAvu]
[Z
ıı
u
v*AnaemiainChronicKidneyDisse*a v
æ
*Disorsof
der theKidneyandGenitourinayr System
Suu˙}(uvPuv}(]}bPb
b }(CKD
Standard
Trtme
ae ntGuidelinesUwthEditionUw
Signs
~Sb}v}vRAvu]
[Z
Invtiga
se tions
yy FBC
yy Ro}˙}v
yy Tvb(]v}v
b
yy Su(]v
yy Stool occult blood
Trtme
ae nt
Tuv}ib
yy T}R]vu]v]vPrvPHoo}(rP lL
Non-pharmacological treatment
~Sb}v}vRAvu]
[Z
Pharmacological treatment
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
]vo]vPR}b`]R]v`oo]vP]bbRRo
b RbX
C}vPv]o v}uo]b }( R Pv]}r]v˙ ]b}b
R]ov } UTI
X P}v UTI ]v R]o } v UTI ]b (R
}Pv]oo}vX
.v]
D uv }( UTI
vb }v o v bvb]]˙
}bX H}`U u]]o uv u˙ ]v] `R]o `]vP
R}X
sueCa
yy u]
B }u]
b
yy U]v˙ }b}v XPX voP }b ]v o uobU
}b]}Roob]v]v(vblR]ov
Symptoms
yy Fv]v(o]v}v
yy Hu]
yy Co}˙l(}obuoo]vP]v
yy V}u]vP
yy Suprapubic pain
yy F ru˙b]bvvv˘o]v~]vR]ovZ
yy TR u˙ (]vP }oubU ]R}U v (]o } R] b
`oo~]vR]ovZ
Standard
Trtme
ae ntGuidelinesUwthEditionUw
Trtme
ae nt
Tuv}ib
yy T} o] ˙u}ub
b
bR b (v ]v ~S b}v }v RF[
vRP]vMvPuv[Z
yy T}]Pv
b
yy T}v}uo]}vb
yy T}]v(˙vb`]Rv}uo]b}(RPv]}r]v˙
Non-pharmacological treatment
yy L]o}oG]b}v}PP}}]v˙}
yy Pb}voR˙P]vv}ov]vPL(}v
Pharmacological treatment
AX
yy
v*Urinayr Trcta Infection*v
yy
Tuv}(Uv}uo]UTI
st
L]vTuv
]v
E RvPPC
C]}G}˘]v
U}oU
Adults
æuPR}o˙(}˙bw ~(uoZVr˙b~uoZ
Children
æruP llPR}o˙V~u˘X}(wæuP]o˙]v`}]]}bbZ
Or
(}˘]u
C
U}oU
Adults
æræuPR}o˙(}ær˙bw ~(uoZVr˙b~uoZ
Children
r˙bVæuPR}o˙(}ær˙bw
r˙bVæuP llPR}o˙~u˘XæuPZ(}ær˙bw
u}vRbr˙bVuP 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
u]]vbv}u}RuRvP}}XD}}bURu]bvb vbb
vRoR]vb˙Rl]vPR]uvRb]vR}b]o}
R}vbuvXTRu]]vbo]bo}`u˙vo
b
]u]uvvubR(}}b }v}b]]vvb
`]R ]}vP vo (v}vX Aoo u]]vb ]v R]b o bR}o
}bb}vl]v˙(v}v~buGFRZX}]
A }v}u]vb
}( vR}}˘] u]}vb v ]bX M}v]} vo (v}v (}
v ]vPuvX Pvro]bl (}b (} oo Rb u]]vb
]vo PU r˘]bvP R}v] l]v˙ ]bbU }ou o}vU v
}vvb}(vR}}˘]u]]vbX
v*MedicinesandtheKidney*v
X
U b]bv
Standard
Trtme
ae ntGuidelinesUwthEditionUw
v*MedicinesandtheKidney*v
M]}v
R]blF}
PR}R˙b]}o}P˙
Pv}v
Aciclovir
H]PR}bUIV
bolus dose
D}b]}v}(A]o}]
crystal
r]vo}b}v
v(}]}(]vbo
]vGuu}v
W˙bovR}R˙
}˘]uoo}R˙
}]
A }ob}bU
P]}R˙}v
~u]v]v]v
}ANwæuolR}
So}`P]v(b]}v
}rR}b
u]v}Po˙}b
A
]b
~XPX
Pvu]]vZ
D}bU}v
and frequency of
u]v]b}vX
Concurrent renal
]bRu]}
u]v]b}v
}(vR}}˘]vbX
L]]bb
obu
}vv}v
ANuP lol
Iv}˘]uoo
u]v}Po˙}b]}v
}v]}v]R}bR}o]]U
o]}uPo]vU
v}˙l]v}
RooXW]R]vooU
uobW]
}˘]]˙rAKI
M]v]vR
vPXG]}v
daily dose if
necessary
AvP]}vb]v
C
}vvP
E
v˙u
]vR]]}bl
AvP]}rvb]v
Receptor
blockers
~XPXL]b]v}]o l
L}bv
Z
Vb}}vb]}v
WrvoARF
Avoid in bilateral renal
artery stenosis
Non Steroidal
Avr]vGu r
u}˙Pb
~NSAIDb XP
Z X
I}(v
V}ou
vb}]u
o}vX
D]bX
LP}bv
o}vPR˙X
Severe liver
disease
Hu}˙vu]oo˙
]vAKI
due to
b}}vb]}v]
}bPov]v
}}v
Acute and chronic
o}]vo
vR]bU`]R}
`]R}vR}
˙v}u
b
X
D]}˘]]˙rR}v]
]vbovR]bv
papillary necrosis
Radiocontrast
D}bv
frequency
Obu}o]˙}(
}vbu]
H]PR}bu}o]˙U
uoo˙b}}vb]
}vUvb}
]vR]lv]vP
b
o}}
}(HvoW]vb
}˘˙Pvuv
}]
A }b]}v
}(]b
}]
A oP}b
r
H˙}v(}v
Lu]v]b}v
Acetylcysteine
unproven
Chatep rP
*Disorsof
der theKidneyandGenitourinayr System
M]}v
R]blF}
PR}R˙b]}o}P˙
Pv}v
MR}˘
Acidic urine
H]PR}b
P]]b]vR]v
and induces tubular
]vi˙
P]}R˙}v
Alkaline urine to
HANwX~L}(æA9
˘}b
D
]v`
A=rvuu}o}(
NHCO˙
C]bov
L}`Ro}]U
R]PR}b
CRo}]]v]br}b]}v
o˙HO
rR]PRo˙R˙}˘˙o
]o]CYPæ
WDNA]vi˙ooo
death
NR}Pv]]b
]vb]]bUH˙}uP
vbu]~u˙
b]bvZ
Mesna
D}b
PA
P}b}
AKI
D]b
Hypertension
Iv(}v
Tenofovir
PG
bD Uv
Maintain in
]vbrHETE]
RvP
}}v
}]
A PbR
Wb}}vb]}v
]b~CYPA
Pv}v}(HO
]vR]]}bZ
bovP]vo
Co]u
channel
PoR]}v
blockers
WbGFRU
]bRu]}oob
}]vP
b }(R
Po}uo]U}o]}v
}(RobUv(}o
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}`UR˙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}`U]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}`o}`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
TRb`oo]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 S`oo]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 `oo]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 `oo]vPb
b
XPX R˙}}ob v
bu}ob
yy H`oo]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 `oorlv}`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}`o˙ } r u]vbU }˘]uo˙ Xæ uP
˙}vb
b ZRv(
Children
XuP llPX
b ~P]vbo}`o˙}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(vbXIv`oo]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}`o]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}`U]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}`u˙
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]R`ouR}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}o`oo]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 `oo
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
S`oo]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 `oo]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}`o]ub(}uv]bb
Signs
yy Poo}
yy WbvP
yy Poooubb
yy Pool]v˙(}u]}b}vvR˙}vR}b]b
yy L˙uR}u}(o}`o]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}`U]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}`o]ub}]v]o]˙}`ol
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]vo`oo~(}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}`U]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 `oobR}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]bb`oo]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 `oo 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}`U }`]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 `oo]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}`U 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 Voo`oo]vP
b
yy P]v}v]v}v
yy L}`}u]vo}l]v
Signs
yy VP]vo]bRP
yy Voo`oo]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}`A}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]vo`oo]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
v`oor.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 `oo.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}o`oo]vP
b
yy Scrotal pain
yy URo]bRP
yy D˙b]
yy Fv˙}(u]]}v
yy F
Signs
yy S}o`oo]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]vob`oo]vP~bZ
Signs
yy IvP]vo`oo]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]R`oo]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]vob`oo]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} `oo]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}`A}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.
For Genital Herpes
~S b}vb } v RGv]o Uo S˙v}u ]v CR]ov[ (}
æı
Standard
Trtme
ae ntGuidelinesUwthEditionUw
uv}(Gv]oHb[Z
v*STIrrelatedAnorRectalRelatedSyndome
r sinChildren*v
GenitalWatsr inChildren
~Sb}v}vuv}(RGv]oWb[]vobXP}}R˙oo}}˘]v
vIu]]u}v}b]vR]ovZ
Scabies
~Sb}v}vRP]b[Z
PubicLice
yy MoR]}vo]]XæA9]v}bb
Ao˙}`R}o}˙voo}`}˙voo˙XWbR}+L
R}b}}v]PRXRL`l
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
Chapter
HIVInfectionsandAIDS
w
180.HIVIv(}vvAIDS
A] Iuuv .]v˙
D
S˙v}u
~AIDS Z ]b o P
b }(
]v(}v `]R R Huv Iuuv .]v˙
D
V]b
~HIV ZX I v +
}R ob v R]ov }Lv ]b}b]vP Ru } }}v]b
]v(}vb v ]v uo]Pvv]bX C}r]v(}v `]R o}b]b ~TBZ
v Hb
B oo˙ (v ]v HIV ]v( ]v]]ob v
ubvb (}]voobX
TRu]v]bl(}b(}HIV
lAIDS u]vvbu]bb]}v˙˘RvP
}( }˙ G]b v o}} }b R}PR ˘o
b }vU vb(b]}vU
vorbl ]vi˙U v}vrb]o P]o
b
b v u}R } R]o
vb(X
HIV ]v(}v ]b vo˙ v} oX H}`U (} b}vb o]]vP
`]R HIV ]v(}v ~PLHIVZ
U + vr}]o R˙ ~ARTZ ]b
]oo }v˙r`] ] vb R P]}vo v ]b]
oo]v}Ro]v]RoR(]o]b}`R]Roo]Pv}b
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
SvTuv~vL]vTuvZ(}HIVrAIDS
Medicines
C}uuvb
F]bAov
Z]}]v
Lu]]v
E
u]]]v
L}]v]
v]
A
I(TDF.bb o]vX
I(LPVl`bb(}HIV]v.b
o]vUTV
bA l
S}vAov
Tenofovir +
Lu]]v
(or
E
u]]]v
ZA=
L}]v] l~}
v]
A
lZ
+
(or
ZA=
l~}
lZ
v
I(VZD b.bo]vX
C}vb]]A ](v
has used both Tenofovir and
Z
]}]v
v*HIVInfectionandAIDS*v
~AZTZA=
~TCZA=
~EFVZ
Standard
Trtme
ae ntGuidelinesUwthEditionUw
BXS]o}v]}vb
TowrP)
SvTuv]vb]o}v]}vb(}HIVrAIDS
v*HIVPostxpE osureProphylaxis~PEPZforxpe osedhealthcone
sarep l*v
C}v]}v
R}uuv}v
HIV }r]v(}v`]R
Hb
BX~Sb}v
}vRHbB[Z
TR}uuvP]uv
bRooPLu]]v
TenofovirA=(]v
E
DoHIV
rvHIVr}
HIVr]v(}vb
}D R]v+vbb
}(v}vrvo}b]Pb
(Nevirapinev(]v
E
Z]v
HIV r]v(}v}u]v}v
of nucleosides and protease
]vR]]}bbRbLPV}
TV
A lbR}oX
b
Refeal
r criteria
R( oo HIV
GRvX
C}uuvb
+
Lu]]v
P]vb}RHBV
vHIV
and Tenofovir
}b] vb } v ] uv v ]v
181.HIV Post Exposure Prophylaxis (PEP) for exposed healthcare
personel
P}br˘}b }R˙o˘]b ~PEPZ ]b bR}ru v}]o
uv } R o]lo]R}} }( HIV ]v(}v L }vo
˘}b˙vvPRo]b
b Ruv}(]v(}v}vvPv`
]v(}vX PEP b + ˘}b } HIV ]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}`E˘}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 `oo R˙ `]R G]b XPX `U (] i]bU
o]PR}]PUS]r`_}}}vu]ol
yy M]v]vv]}vU}vvr(]vP
b
]v]b
yy T]b}vPRR]oX~W}`o`]Rol`u`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
v`ooUv}˘]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
`oo}`]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}`o]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 ub`oo}`
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 v`o˙ ]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
AooN`o˙
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 `oo 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}`ob~}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}`U(}.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
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˙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
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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˙
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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]˙}`ol}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]bU`uob}(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˙vovv`oo}`
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˙vovv`oo}`
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}`o˙ ˙ 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}`o˙˙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}`o˙ ˙ 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}`o˙ ˙ 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}`o˙˙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}`o˙˙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}`o˙˙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}`o˙˙]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˙vovv`oo}`
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˙vovv`oo}`
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˙vovv`oo}`
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}`U 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}`u}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}`oR]
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}`u}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}`u}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}`u}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}`u}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}`u}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
CR`obR}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}`ob`]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}`U 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˙]v`oo}`]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˙vPo`oo
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}`oo}`
b
Children
æuP llPvR}o˙(}˙bw ](v]bo}`oo}`
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}`U ] ]b ]u}v } ]Pv}b
}}o
b R˙vP]bb]v]u˙P]]b}b]vRR}
~}R˙vPo v ]}vb]oo bZ b `oo 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˙]v`oo}`]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}b`oob`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˙]v`oo}`]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
]]b`oo
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}`oo]vP
b
}(bv}vb
yy F
yy Chills
Signs
yy E˙Ru}b`oo]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 `oo]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}`oo}`
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]o`oo]vP
b
`]RG}}}(Ru}Ro`]R}u
yy P}]vP}vP
yy }}o]vP
D
}(bo]
yy F
yy Chills
Signs
yy Tvbvvi``oo]vP
b
yy B}ro]l.uvbb}(i``oo]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``oo]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``oo]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}`o˙}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}]v`oo]vP
b
yy L]u]vP
Signs
yy L]u]vP
yy J}]v`oo]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 S`oo]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}]v`oo]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}]vU`oo]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}]v`oo]vP
b
yy F
Signs
yy S`}oov`ui}]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}`UA9rvA9`]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 SR`o 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}]v`oo]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}`oo]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]vv`oo]vP
b
boo˙}(i}]v~obb]oo˙R]P}
u˙+RlvUvlob}`]bbZ
yy Mooi}]v]v
yy J}]v`oo]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 `oo 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}`U 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 }`ob}vb
yy Ivb}`ob}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}`ob}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}`o
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}`ou}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 S`oo]vP
yy Iv]o]˙}u}R
Signs
yy P]v
yy S`oo]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 }`o 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 S`oo]vP
yy Bo]vP
yy E˘}b}vUubov(b]
yy Iv]o]˙}u}R
Signs
yy S`oo]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 S`oo]vP
yy Iv]o]˙}u}R
Signs
yy Tenderness
yy S`oo]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 S`oo]vP
yy LRP˙
yy R(bo}(~R]ovZ
Signs
yy F]o
yy S`oo]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 S`oo]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 oP`oo]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 S`oo]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 S`oo]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]b`uR
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 S`oo]vP
yy D]bRP
Signs
yy F
yy S`oo]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}`UIv(}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 S`oo]vP
yy Bo]b]vP
yy F
yy Sl]v]b}o}}v
yy L}bb}((v}v
Signs
yy F
yy S`oo]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 S`oo]vP
yy (}u]˙
D
yy N]PR`bb
yy L}`P(
yy CR}v]}PR
yy W]PRo}bb
Signs
yy S`oo]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 S`oo]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]b`ooo]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 `oo b
lished
Or
yy V]u]vrD
UoMU
Adults
Uv]b]o˙(}ru}vRbvoRo]vP]b`ooo]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]vv`oo]vP
b
}(o}vP}vb
Signs
yy Tvvbb}(RoPb
yy Bo]vP
Pub
yy S`oo]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}}`ol]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]˙}`olL˙]]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}`U}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}`o]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 S`oo]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 S`oo]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}`IV}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 `oo 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}o`oo]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}`uoo(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 S`oo]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}(`oo]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 l`u
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 }(
`oo]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~`Uu]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]`oo]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 S`oo]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 S`oo]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 S`oo]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 F]ov]r}o`oo]vP
b
yy D]8o˙]vR]vP
yy WR
yy Collapse
yy Syncope
Signs
yy AvP]}r}u
yy D]8o˙]vR]vP
yy }vR}b
B
bu`]R`R
yy Tachycardia
yy Hypotension
yy C}oouu˙˘u]b
yy F]o}u
yy U]
yy Cyanosis
v
]b o](rRv]vP
can
Chatep rP
*Geneal
r Emeger ncies
Invtiga
se tions
yy FBC~}b]v}R]o]Z
yy Sl]v]l(}
b b].ooPvb
yy Sub].IPE
Trtme
ae nt
Tuv}ib
yy S]`˙bUR]vPv]o}v
yy Rb˙u}ub
b
yy Ru}R}+v]vPb](}bb]o
yy R]o˙]vvv}v}uo]ob]Pvb
Non-pharmacological treatment
yy }]
A RooPv
yy Rbb]}v
Pharmacological treatment
yy
yy
yy
yy
AvR˙oR}v
st
L]vTuv
]v
E RvPPB
O˘˙Pv
˙B vbo}vPb
Or
Fubl
Or
N}vrRublU
rvLlu]v
rLlu]v
ræLlu]v
Av
Adrenaline~E]vR]vZUIMU
Adults
XrXæ uo }( P b}o}v ~]XX ræ u]}PubZ ](
vbb˙ ˙ u]vb v `R]o u}v]}]vP o}} b
and pulse
Children
Xuo}(Pb}o}v~]XXu]}PubZ
Rb(}obX
Av
H˙}}b}v
UIVU
Adults
ruPvrR}o˙U}}v}ov˙oooP]}vRu˙
occur
Children
AooPbV
uP llPvR}o˙(}}bbUv}}˘
æuP l˙
Then
Pv]b}o}v
U}oU
Adults
væ
v*AcuteAllegic
r Rection
a ~AnaphylaxisZ*v
AX
Standard
Trtme
ae ntGuidelinesUwthEditionUw
uP]o˙(}˙bv}+
Children
uP llP]o˙(}˙bv}+
yy
yy
v*AcuteAllegic
r Rection
a ~AnaphylaxisZ*v
Av
P}uR]v
R˙}Ro}]UIMU
Adults
æuPLR}b](vbb˙U
Then R}o˙(}R}b
Children
˙br˙bV
vXærXæuPrR}o˙(}R}b
AM˙bV
v}}uuv
Or
CRo}Rv]u]v
UIMU
Adults
æruPvR}o˙~u˘X}(uP]o˙Z
Children
vr˙bV
æuP}u˘X}(}bb]vR}b
vu}vRbrv˙bV
XæuPU
AMvu}vRV
æu]}PullP~u˘XXæuPZ
BXAvR˙oR}v`]R]`˙
b }b}v
Av
yy Sou}o
Uvo]bU
Adults
æuPrvR}o˙vob}o
Children
XæuPrvR}o˙vob}o
Or
yy Au]v}R˙oo]v UIVU
Adults
æuP}u]vbURv}vv}b]v(b]}v˙(b}Xæ
uP llP lR}(}R}b](vbb˙
Children
ræuP llP}u]vbbo}`}ob]vi}v}˙]v(b]}v]v
æuoS}]uCRo}]
XıA9UIVUrvR}o˙(}R}b
CXAvR˙oR}v`]RR˙}vb
b
]}v
Av
yy N}uo bo]v
U XıA9U IVU Lr LU u]v ˙ o]v]o b
uv
Refeal
r Criteria
R( } ]b] } P]}vo R}b]o ]( ˙u}ub
b
}( vR˙o˘]b
b]bL]o]]vP
b
RvvP]]vP]v]ouvX
v
r
Chapter
AntibioticProphylaxisIn
Suger yr
æ
256.Av]}P}R˙o˘]b]vSP˙
Av]} }R˙o˘]b
(b } R u]v]b}v }( v]}b ]v
vb } R ]bl }( ]} b]bX TR u]v b }(
u}]]˙vu}o]˙]vP˙
b ]b]v(}b}uo]}vbX
Av]} }R˙o˘]b
]b ]v]]v b `Rb]b ]b ˘
v}oR]b}bb o}o}Pvo]b+bX
F} }R˙o˘]b } +U v]}b ub P]v (}
}vu]v}vlbo}Ro]b}bb]ou(}]v(}v
]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
}`o
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 `oo 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 `oo 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}`u}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}`o˙}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}`o˙}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
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AP
Gv]b}b]}v~Fu]o˙R]b}˙}(vb Z
P]}bb}voR]b}˙}(vb
P}o}vP˘}b}}b}Pv
o˙
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Z
sueCa
yy
Uvlv}`v
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yy S`oo]vP]v˘]oo
yy S`oo]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
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bB
yy P[}vP
yy Sl]vR]vPUv}ob}o}v
yy N]o}v
yy Bo}}˙v]o]bRP
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B}˘wrP)
yy
yy
yy
yy
yy
yy
yy
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ubb]b
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yy F]vvob]}v(}˙}o}P˙
yy Core biopsy
Trtme
ae nt
Tuv}ib
yy Achieve a cure
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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
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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}`U b }]b}v]vP bR}o o`˙b }vb]
u]o uPv˙ b]v R b]}v u˙ ]o˙ }o } }u
]oX
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b]Pvb }( }]b}v]vP v }v R b]. ˘}bU v u˙ o}oU
˙bb u]U}}RX+b
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oX
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dose and }v
}( ˘}bU v
environmental factorsX
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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
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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
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A
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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
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LRP˙ l}u
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respiratory
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respiratory
depression
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Standard
Trtme
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Class
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Ethanol or
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MedicinesUseInTheElderly
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260.M]]vbUb]vREoo˙
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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
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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):
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Months
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Community:
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febrile
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Toxic shock syndrome
Thrombocytopenia
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Fever≥38°C
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beyond nearest joint
afebrile
Date AEFI started (DD/MM/YYYY): __ __ / __ __ / __ __ __ __
Time AEFI started
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Min
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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 /
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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
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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
vwæ
Standard
v

Uv Uvæ Uææ Uæw Uæ Uæw Uæ Uæv
væ Uvı Uvæ
Au]]oo]v ıı Uıı Uv Uvı Uvæ
Au˙o}]}b]b
ı
ANA ı Uı UæææUææ Uæv Uæw
A
vu]
Uv Uv Uv U Uw U Uv
ı Uıı U Uæw
Avu]IvPPvv˙
Anaerobes æı Uvw
Anakinra ææw Uæv Uæwv
AvoPb]]vL}
v Uw
AvR˙o˘]b
U Uw Uv Uv
AvP]}vb]vC}vvPEv˙uIvR]]}
ı
AvP]}vb]vR}Bo}l
ı
Aniridia
Av}˘]
U Uw Uæ UææUv U Uıv Uæv
Antenatal Care ı U U Uw U Uı
Av]}P}R˙o˘]b]vSP˙
æ Uv U
æ Uvw
Av}Po}v
ı Uv Uı U U Uv
AvW˙o] ]oo]v ~CCPZ v
body ææ
AvrD}ovb DNA
æw
AvDRRIuuvGo}o]v
v
AvNoAv}]b~ANAZ
ææ
Av˘]˙
U Uı U Uæ U Uæ Uı
U Uæ Uv Uw U Uı U Uvw
Uææ Uææ Uæv Uæv Uævæ Uv
Av˘]˙D]b}b
A}]bb}v
ARR}bUob
æ
Apnoea Uı
Ao]BR]}Avo˙b]b~AAZB
}bA u
w
Aqueous soap w
AR˙Ru]b
æv Uv Uvw
uR
A
æ Uw Uı Uı
uR
A A=Lu(v]v
Uı
u]b
A ]v]v C}u]v}v TR˙ ~ACTZ
ı Uı
Artesunate
Uæ Uw U Uı Uı Uı
ı
bvA A=Au}]]v
U
ARoP]
ı Uæw Uæ
Arthrodesis ææ UæææUv
Arthropathy æı Uæw
AR}obb
ææ
Ascites v Uı U U Uv Uw U Uæ U Uæ
ı
Ab]G]uo}v
w
ASD
U
AbR˙˘]
Ab]}vvu}v]
Uw Uæv
Aspirin
Uv Uw Uv Uı U U U
U
Uw
wı
w U UææUıw
æ U Uı Uwæ Uwv Uw Uw Uwı
Uw U Uvw
U ˘]
A
v U Uv
v]
A
v
Atenolol v Uı U Uæ Uæ Uæ Uæı
Atherosclerosis æ U
}u}˘v
A
}]
A uE
w Uwı U
}bA v
U U U
]o
A F]]oo}v
ı U Uw Uı Uæv Uæw
æ Uæı Uv
]o
A G'
æv Uæ Uæı
Atropine Uı Uæ Uææ Uæw Uv
'v}v
A
.]
D H˙]˙ D]b}
U ~ADHDZ
w
Su
Ab D]b}
Avascular Necrosis v
r R]}]v
A
ææUææw Uæw Uæ Uæ
A]R}u˙]v
æ Uı Uw Uw Uw U Uv
U Uæ Uv Uwv Uwv U Uæw Uæv
æ Uæ Uæw
}}b
A u]
U
U B
}Ab u
]˘]b
Ab
Ru
Ab
Uv
Uwæ Uw
vw
Bl]v
w Uæv Uvı Uvæv
]o
B Ev}]bvP}R˙o˘]b]vDv
˙b
æ
]o
B Sl]vIv(}vb
æ
]o
B P]v}b]b
æı Uwæ
]}b
B
æ
}]b
B
v
B]uuo
B]u`oo}`
b
v U
GBC
U
B }v
wı
U o}ub
o}uRb
B
}v
wı
B [b˙v}u
b
æ
UR
o]uu
B
æ
v}GuR]]
B
ı Uæ
v]Pv
B
P}bH˙ob]
v]Pv
B
P}bH˙ob]~BPHZ
vR]v
B
v˙ov]]oo]v
v
vR]v
B
Pv]]oo]v
æ
B
U v}]v
vR˘}o
B
v}]]vb
B
væı
v}]]v
B
`]R`o
ı
v}]
B ]}u}v}]vuv
v}˙o
B
}˘]
w
B
Uæ
U v}]v
U
U
U
U
r
Uv
U
Uı
æ Uææ
INDEX
v˙o
B v}
vı
Co]uCRvvoBo}lb
æ Uı Uæ
v˙ov]]oo]v
B
w Uıw Uææ
Co]uPo}v
ıæ Uı
v˙o
B Pv]]oo]v
ı
Co]u˙}R}bR]R˙~CPPDZ
æwæ
ro}lb
B
ı Uæ
Co]u`]RV]u]vbouvb
D
ævı Uæ
rRu}o˙
B
}}]
b
ı
Cu˙o}
uRb
B }v
U Uv Uææ Uæw Uææ U Candesartan
Uı Uæ
æwv Uv
Candida æ Uææ U U Uææ
RuRb
B
}v
æv
Candida albicans
Uææ
B]o]˙]bb
Candidiasis vı Uw Uwv Uææ
B]o]]v
æ Uv Uæv U U U U Uæ
Cvv]b`]R`o
ı U
B]o]]vvRo}R˙
æU U
Cu
v
B]]]v
æ
u]v
ææ
B]}oD]b}
v
Cu]v
U U Uı Uv Uææ
B]RbR˙˘]
ıw
C]u}o
v
B]RIvi]b
Carbocysteine
Uw
B]b}˙o
C}ov
ı U
B]b}}o}o
v U Uı Uæ Uæ Uæı
]v}u
C
}(RC]˘
v
B]bR}bR}vb
ævı Uv
]C AR˙Ru]b
U
B]v]o(]o~BVFZ
Cardiac failure v
Bol}b
væ
Cardiac neurosis
Bo]vP
Uv Uv Uvæ Uv Uvw Uı U U U ]}Pv]
C
bR}l
U U U
w Uıw Uæ Uæw Uæ Uæı Uv
]}uPo˙
C
Bo]vPD]b}b
væ
]}u˙}R]b
C
Uæw
Bo]vPo
Carvedilol
Uæ
Bo}} vb(b]}v
Uvæ Uw Uv U Uw U Cataract
Uæ
ı Uæw
.˘]u
C
wv
Bo}v
b
v
(}˘]u
C
v Uıı Uı Uıı Uæ Uvw
B}]ob æ
L]]u
C
ıı
B}vM}`F]o
v
L]˘}v
C
æ Uv U U Uw Uı U U
B}oob]b
wv U U U Uıv Uı Uıı Uæ Uæ
˙R˙Ru]b
B
æv
(}˘]u
C
Uv Uw U U U Uw U
˙]
B
ı
Uæw Uæı Uæ Uæ Uæv Uæ Uæ Uæı U
CvbB
vææ
æı Uv Uvı
}u}]v
B
Co}˘]
ææ Uææv UææıUæv Uæwv Uæwı Uæı U
}vR]o
B
Ru
Ab
wæ
æıv Uv Uv
}vR]b
B
]b
w Uı
Cooo]b
ı Uw Uv
B˘]bu
æı
Cvoo˙vPPvb
æ
Bb}v]
w Uwı Uæ Uæv
CRoRu}u
v U U Uæ
Boo}buR]P}]
vw
}bC ]vouv]vP]b
ıæ
Boo}bR}v
w
}o]u
C
ææw
B]]v
væ Uv
C]]b
wv
v}R]v
B
C]}rF]obA
æ
Bl]' [bo˙uR}u
w
]]v
C
v Uv Uv Uw Uw Uw
Bvb
ı Uv Uv Uvæ
]u]
C
v Uwv
b]bB
æw
CRu}b]b
ææ
Bo]Uo
ı Uı Uæ
chest pain Uvı Uæ Uv Uæ Uw U Uw
CRbP]v
U
R]lv}˘
æı
C
CR]lv}˘
v Uv
CR˘]
æ Uw
CR]oR}}Iuuv]boD]bb
Cou]vo}}v
Uv Uw
CRou˙]R}ub
v Uw
Calcitonin v
Chloral hydrate
Co]u
æ Uı Uæ Uæ Uıw U Uıæ Uıw U CRo}uRv]}o
w Uıw Uææ Uæ Uæ
ı Uæ Uææv Uæv Uævı Uæ Uvw Uvı Uv
CRo}]}˘]
vw
Standard

CRo}R˘]]v
v Uwv
vı Uvæ
C
Ro}R˘]]v
b}o}v
v Uwv
Cocaine
U U Uı U
Chlorinated Hydrocarbon v
Codeine Uı Uw U Uæv Uæı Uæıw Uv
CRo}Rvu]v
w U
C}]v}v]v]vP}PR}vb
CRo}Rv]u]v
vı Uv Uv Uw Uv
Codeine phosphate w
CRo}}u]v
U U U Uw
C}Pv] BR]} TR˙
æ U U U
Cholera æ
æ Uv Uw U U
CR}obiv]
v
Colchicine v Uæw Uæwv
CR}ob˙u]v
w Uv
Cold sores æw
Chondrocalcinosis æwæ
Colonoscopy
CR}v]HbA
C}u
U U U U Uı U Uv Uv U
CR}v]Ru
Ab
w
ıv Uæ Uæ Uvæ Uvæı Uv Uv Uv
CR}v]}vR]b
B
C}u]v }viP }b}Pvb v }
r
CR}v]Hb
Pb}PvU æ
CR}v] l]v˙ ]bb ~CKDZ
w U Uıv U C}uu}vC}o
vw
ı Uıı U
C}uuv]˙]vu}v]
w
CR}v]o˙uR}]olu]~CLLZ
wæ
C}uoo]vP ]v]}vb (} R R}] }( v
r
CR}v]u˙o}]olu]~CMLZ
wæ
hypertensives ı
CR}v]Ob}u˙o]b
v
Concentrated red cell transfusion vw
CR}v]ObM]
æ
C}vPv]oHD]bb
CR}v]P]}}voIv(}vb
æ
C}vPb](]o~CCFZ
R}v]˙o}vR]b
æ
C}viP}b}Pvb
w Uæ
CR}v]SAR]b
v
C}viv]b
Uææ Uæv Uæw
C]o}]}˘
æ Uææ Uv
C}vb}v
ı Uv U U Uæv
C]o}]}˘}ou]v
æ Uææ
C}vDub
w Uwı U
C]vv]]v
æ
Conversion disorder væ
C]}G}˘]v
U Uæ Uv Uw U U U Convulsions Uıw U Uıv Uı U Uı U
w U Uı Uæ Uæ Uæ Uv Uv Uv U ıæ UæıæUvı
v Uvı
OPD
C
U U U Uw
C]bov
æ
Copper sulphate stone v
C]o}u
ı
C}voUo
æv
Co]R}u˙]v
Uæ Uæ Uæ
C}}v˙HD]bb
Clavulanic acid æw Uvæ
C}}v˙b}bbu
Co]vu˙]v
w Uı Uw Uwæ Uı Uı U Corona virus vw U
ıw Uæw Uæı Uæ Uæ Uæ Uæw Uæı Uæıı U C}˙v]u]RR]
ı
v Uv Uv Uvı Uv Uvw Uvı Uvæ
C}br+vbb
Clobetasol propionate v
C}b}R}v]b
Co}u](v]
C}PR
U U Uw U Uvw Uwæ U U
Co}vu
ævæ
ı Uw Uw Uææ Uæw Uæ Uæw Uvæv
Clonidine
Uævw
CPPD æwæ
o}]}Po
v
Crash
Co}]}Po
v Uı
Cr }]v
æ U Uv Uw UæææU
Co}bFb
æı
ææ Uæw
Co}b]]u(]vPvb
v
v]v
C l]vbrMB~CKrMBZ
v U U U
Co}b]]uv]
v Uw
ææ
Co}]u}o
æ Uææ Uæv Uvı U U U Crepitus æı Uæı
wv Uv
v]b
C u
Co}˘]oo]v ıı U U Uı U Uæw Uæ U Croup æw Uvw
æı Uæıı Uv Uv Uvw Uv Uvw Uvı
Cryoprecipitate v
C}PobvPR˙o}}]
b
vw
C˙}}bv}(}uvb
ıæ
C}Po}v(}
v
CSM ıæ Uı
C}ru}˘]o
w Uw U Uv U Uı U CbR]vP [b S˙v}u
w Uæ Uw U U U
ı U Uv U U Uæ Uæ Uææ Uæw U
æ Uæ Uæ Uæv Uæ Uæıı Uv Uv Uvw U Cyanide v
vw
INDEX
Cyanosis
U Uv Uıw U Uw U
Uæv Uæ Uæ Uv
C˙o]]v
æ Uæ
C˙o}v]v
æv
C˙o}R}bRu]
ı U Uæ Uæ
Cyclosporin æ Uææw Uæ
C˙bb
æ U Uv Uw U
C˙}uPo}]b
w
Uwv
U D]P]oo˘u]v}v
D]P}˘]v w Uı Uæı Uv
D]R˙}u]b]v]vrP]]v
D]o}˘v](}
D]Rv}˘˙o
D]RR]
Uı Uı
D]RR]v}˘]v
ı
D]o}]
æ Uæ
D]b}]u
wı
D]bo}}vb
æıæUv
D
]b}˙u]
DC}b[b˙v}u
b
D]b}bO(TRMbo}blooS˙bu
ææ
Do]v
v U Uvı
D]b}bO(TRRb]}˙S˙bu
vw
}]v
D o(
D]b}b}(RSl]v
æ
DrD]ub
U
D]bbu]v ]vbo }Po}v ~DICZ
TD
v
v Uv Uv
}uvb
D o]]R}b]b
D]]vbb
v U Uæw Uv Uı U U U
D V]v TR}u}b]b ~DVTZ
U Uæ U æv
v Uw U U Uv Uv
D]]vbbvBol}b
v
DR˙}v
U U Uæ Uv Uw U U U U DKA æ Uı
Uı Uæ Uvı Uw Uw U U Uæ U U U DMARDb
æ
v Uı Uı Uw U U Uv Uw Uı U D}u]v
v Uv Uv Uw Uæ Uæw Uæw Uæv Uv U D}u]}v
w Uæ Uæ
væ Uvı
D}˘}]]v
Do]]uTuvb~DTZ
D}˘˙˙o]v
æ Uw Uw Uwv U Uæv
Dob]}vb
U
Drv]]oou]v
ææw
Dv}bu
v
DPT
DvoC]b
æ
DPr]vo]]vi˙~DILIZ
ææ
b]}v
D
Uı U Uı Uæ Uv Uw U DPb]bvo}b]b~DRrTBZ
vw
U Uv Uw Uvw Uw U Uæv Uæv U DPbvRL]
ææ
ævæ Uvæı
DP]o]˙
b vP
b ~DSTZ
w
Dub
vw Uw Uwı U U Uæ Uv
bDNA
æw
DubR(}u]b
vw
Do}˘v
æv
(]}˘u]v
Db
v
D}voob
Dbu}bb]v
vw Uv
VT
D P}R˙o˘]b
æ
˘uRb
D }v
æ U U Uæv Uæw Uı U VT
D Tuv
æ
æv Uvw
D˙bR]
˘}uR}Rv
D
D˙bo]]u]
w U
˘}b
D
Uw Uw Uı U Uw Uıı U U D˙buv}R
æ
Uıı U U Uææ Uıæ Uı Uæ Uı U D˙bb]
Uæ Uæw Uæv
ı Uı Uæv
D˙bRP]
w Uı U Uæı
˘}b
D bo]v
U Uı Uæv
D˙bv}
æ U U Uw U Uæ
D]b Moo]b
w Uı Uvw Uw U U
Uı Uæ Uı Uıv
E
D]bMoo]b]vPPvv˙
D]K}]}b]b
U Uæ Uı Uvı
Eæu
D]R}
U U Uı Uı U Uı Uw Uı U U
E N}bAvTR}D]b}b
ææ
ı Uæı Uvæ Uv
R˙u}b
E
]b
v Uı
D]u
æ U Uı Uıı Uæ U U U oub
E ]
ıv U Uæ U U Uı
Uæ U U U Uv U U Uæ U }v}o
E
v
æı Uææ Uæv Uv
uE
wæ Uæ Uv Uæ Uvw Uw Uwı U
D]o}(v
w Uw Uıæ U Uv Uw U U
U U U Uæ Uvæv
ææ Uææ Uææv UææıUæv Uævæ Uæw Uæw Uæw U (]v
E
v Uv
æwv Uæwı Uæı Uæıv Uv Uv Uv Uvæ
Eu˙u
Uı Uıæ
vwı
Standard

Eu]]]v
v Uv
Enalapril æ
Ev}}vR]oTB
wæ
Ev}]vvM}o]D]b}b
Ev}]v v u}o] ]b}b `]R ˙
}uo]}vb
æ
Ev}u]}b]b
æ U
Endosulfan v
Ev}˘]v
ı Uæ Uv U U
Evu}R]b}o˙
U U
Entecavir
Enteric fever wı
Enterobacteriaceae vw
Enterococci v
Ephedrine æ
E]u]]b
æıw Uv
E]u}R˙}v
æ
Epilepsy Uvæ Uıv U U U
Uı U
E]bo]b
æv
E]b˘]b
æ
E}]v
]v
bE rB
w
bPob
E ˙
æ
oE ˙b(v}v
U
P}u]v
E
v
Erysipelas ı Uw
E˙Ruuo(}u
w
E˙Rbu
Uæ
E˙R}u˙]v
æ Uæ Uv Uv Uw
v Uwv Uw Uæ Uæw Uv Uwv
æ Uv
Escherichia coli Uv Uıæ Uæıw
Eb}u}o
U Uw U Uı
æwı Uv
Esotropia æ
}Pv
Eb R˙~ETZ
v
Etanercept ææw Uæv
Ru}o
E
w Uwæ
Ethanol v
R]v˙ob
E
]}oA=o}v}Pbo
w
Ethinylestradiol + norethisterone w
R}b
E ˘]u]
R˙ov
E
Po˙}o
v
Etoposide ı U
Eusol v
E˘RvPvb(b]}v
E˘}}]
æ
E˘v P}Puu }v Iuuv]b}v ~EPIZ
Uv
E˘}bK}R˙
æ
E˘vb]CSvu
E˘r˙u]o}vb
˙E D]b}b
æ
F
Fwæ v
F]ov}v]
U
w
FuoIv(o]˙
F]b}]uPo}v}uo˘
F]v
æ Uıı
F}b(u
v Uw
F}bPo}v
U
Uv
F}bboR
v Uw U U
F
U Uw U Uw Uwv Uw U Uı Uı
ı Uıæ U U U Uæ Uv Uw Uw U
U Uı Uı U U Uæ Uæw Uæı
v Uw Uwæ Uæv Uv Uwı U U Uv
w Uw Uw Uwı U U Uıæ Uıv Uæı
æ Uæ Uæı Uæw Uæı Uæ Uæv Uææ Uæw
æw Uæw Uæw Uæv Uæı Uv Uvı Uv Uv
U Uæ U vı
F]}u˙oP]
æv Uæv Uævw
F]o]b]b ı
F]vb]
F]IvOv
U
Fo]o˙b]b
ı
Foo}˘]oo]v ææUı Uv U Uv Uæ Uæ
v Uvw Uv Uv
Fo}v}o
ı U U Uwv Uæv Uv
Fouv]o
væı
Fo}}]v}o}vb
ıı
Fo}˘v
Uæ Uw Uæv
U Uv U FovR]˘}o
Uæv Uæ U FoRv]v
Fob}v
wı Uæ
F}o v bPuvo Po}uo}bo}b]b
Uææv Uævı U ~FSGSZ ı
F}bAvvoC
F}o.]v˙
D
væ
F}o]A]
v Uvæ Uw U Uw U
F}oo]o]b v
F}u]}o
v
F}]Pv}˙]vR˙
æ
Fb
æ Uæı Uæı Uæı Uvı
FbRF}vPobu
æ Uvw Uv Uı Uv
Fou]vvo](]o
FvPoSl]vIv(}vb
æ Uæ
F}bu]
Uv Uw U U Uı Uı
ı Uı
Fvo
æ
Fvo}b]b
v
Fb]]]
æ
G
Uæ
v
Gvv
GvPv
ævw
Uv
Uæ
U
U
U
U
U
U
U
U
U
INDEX
GvooP]vo]b
w
Gastric ulcers
Gb}v]b
U Uı Uv
Gb}rb}RPoRG˘D]bb
GvoEuPv]b
v
Gvo]bAv˘]˙D]b}b
Gvu]]v
Uw Uıı U
U Uæw Uæ Uæ Uæw
vı Uvæ
Gb}vo]b
U
Go}u
æv Uæ Uæı
Go]vou]
ı Uı
Go]o]
ı
Go]u]]
ı
Go}uo.o}v~GFRZ
Go}uo.o}v~GFRZ
GoP}v
ıı
Go}brvrR}bR R˙}Pvb ~GvPDZ
.]v˙
æ Uv Uv U Uv
Uı
Glycerol
Glyceryl trinitrate v Uı
Gnathopathy w
Goitre
U Uæ Uv
Gold salts ææw
G}o]uu
ææw
Gonioscopy æı
Gonococcus v
Gonorrhoea wv
G}'}v[bob
æv
G}'}v[bb]Pv
æv
Gout ı U U Uæw Uæw
Granisetron æ Uı U
G[b]bb
æ
Griseofulvin æ Uæ Uæ Uv
Guaifenesin
G˙v}o}P]oD]b}b
æ
H
HuR}b]b
æw
Huub]b
æ
Hu}o}P]oD]b}b
v
Hu]
v U Uæ U
Hu}o˙b]b
æ Uv U Uı
Hu}R]o]A
vw Uv
Hu}R]o]B
v
Hu}R]ob ]vGv
ı
æı Uæ Uæw Uæı Uæıw
Hu}R]obIvGv˙D]bb
Hu}˙b]b
w Uw Uı
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