Rhinosinusitis.xml

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Author:
dohertys
ID:
195976
Filename:
Rhinosinusitis.xml
Updated:
2013-02-25 22:20:49
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100priority topics family medicine
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100prioritytopics family medicine
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  1. Using Sx to diagnose Acute Bacterial Rhinosinusitis (ABRS)?
    • Need 2 major symptoms, 
    • 1 must be O or D – nasal obstruction or discharge
    • More than 7 days symptoms of sinusitis or suddent worsening of Sx after 5-7 days (biphasic illness)
    • (Consider ABRS under any one of the following conditions:
    • 1. worsening after 5-7 days (biphasic illness) with similar symptoms
    • 2. symptoms persist more than 7 days without improvement
    • 3. presence of purulence for 3-4 days with high fever
  2. Red flags in ARDS for urgent referral?
    • Altered mental status
    • Headache
    • Systemic toxicity
    • Swelling of the orbit or change in visual acuity
    • Hard neurological findigns
    • Signs of meningeal irritation
    • Suspected intracranial complications: meningitis, intracranial abscess, cavernous sinus thrombosis
    • Involvement of associated structures – periorbital cellulitis, pott’s puffy tumor
  3. Symptoms of sinusitis? (major Sx)
  4. Major symptoms: PODS
    • P – facial Pain/pressure/fullness (pain)
    • O – nasal Obstruction
    • D – nasal purulence/discoloured postnasal Discharge
    • S – hyposmia/anosmia (Smell)
  5. Treatment of mild to moderate rhinosinusitis/ABRS?
    May use INCS (intranasal corticosteroids) as monotherapy. If no improvement after 72 hours, use antibiotics.
  6. Treatment of severe ABRS?
    ICNS + antibiotics
  7. First line choice of Abx? In Pen allergic Pt?
    • Amoxicillin
    • Pen-allergic - Septra (TMP/SMX) or a macrolide
  8. 2nd line Abx if treatment failure or concerned with resistence?
    • Fluoroquinolone or Amox-Clav combo.
    • Resistance more likely if:
    • recent abx use (<3 months)
    • daycare exposure
    • chronic symptoms
  9. When is treatment failure?
    • After 72 hours of treatment with no improvement.
    • Change class of abx if treatment failure.
  10. Adjuncts in ABRS?
    • analgesics (tylenol, NSAIDS)
    • INCS
    • Saline irrigation
    • Decongestants
  11. Prevention strategies?
    handwashing, education, environmental awareness
  12. When to consider referral?
    • No response to 2nd line abx therapy
    • Suspected chronicity
    • persistent severe Sx
    • Repeated bouts with clearing b/w episodes
    • More than 3x/ year (recurrent)
    • Immunocompromised host
    • Allergic rhinitis evaluation for immunotherapy
    • Anatomic defect causing obstruction
    • Nosocomial infection
    • Assumed fungal or neoplasm
  13. Why wait until 7 days?
    • More likely to be a viral infection
    • Abx side effects:
    • diarrhea
    • interferes with contraception
    • allergy
    • yeast infections
  14. What to do for recurrent ABRS?
    CT scan/refer for expert assessment.
  15. How to stratify ABRS symptoms?
    • • Mild: occasional limited episode
    • • Moderate: steady symptoms but easily tolerated
    • • Severe: hard to tolerate and may interfere with activity or sleep.
  16. What is objective criteria for ABRS on imaging?
    • presence of an air/ fluid level or complete opacification.
    • Mucosal thickening
    • alone is not considered diagnostic.

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