1. No category

11/2005
WMT International Treatment Protocol
HEENT
Disease
Headache
Conjunctivitis, acute
Cinjunctivitis, Inclusion (Trachoma)
Acute Otitis Media
(AOM)
Otitis Externa
Criteria
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•
History
No infections
Carries?
Vision Problems?
Red conjunctiva
+/- Purulence
No eyeball pain
Vision OK
•
•
•
•
Swollen conjunctivae
Cobblestone conjunctivitae
Scarring
Mainly adults & teens
•
•
•
Dull, red eardrum.
Eardrum may bulge or retract.
No light reflex.
•
•
Swollen ear canal.
Drainage
Treatment
Peds: No treatment. Look for cause.
Adult: APAP 325mg 1-2 po qid prn
#30
Neonate < 4d: Assume gonorrhea.
Ceftriaxone 25mg/kg/day x 7d.
Treat mother and partners.
Peds: Erythromycin Opthalmic tid x
7d. 3 tubes.
Adults: Erythromycin Opthalmic tid x
7d. 3tubes.
Peds: Erythromycin Opth Ointment
tid x 14d. 6tubes + Erythromycin
250mg po qid #56.
Adults: erythromycin Opth Ointment
tid x 14d. 6tubes + Doxyclycline
100mg po bid #28.
Peds: amoxicillin 6-13 mg/kg tid x
7d. (can break capsules)
Adults: Amoxicilllin 250mg tid #21.
Peds: Ear drops (Polymycin B +
Neomycin + Hydrocortisone) 1 gtt
qid.
Adults: Same as peds.
•
Alternative
Adults: ASA 325mg 1-2 po qid #30
Neonate: Aqueous Penicillin G
250,000 u IV qid x 7d.
Peds: Erythromycin 12.5mg/kg po qid
x 14d.
Adults: Doxycycline 100mg po bid #
28 or Erythromycin 250mg po qid
#56.
Adults: Tetracycline Opth. Ointment
tid x 21d. (in-country) + Tetracycline
250mg qid #84.
Peds: TMP-SMX 5mg/kg (TMP
component) bid or
Ceftriaxome 50mg/kg IM x 1.
Adults: TMP-SMX DS bid #14 or
Erythromycin 250mg qid #28.
Peds: Consider adding Amoxicillin or
Erythromycin as in AOM.
Disease
Acute Sinusitis vs URI
Allergic Rhinitis
Upper Respiratory Infection (URI)
Acute Gonococal Pharyngitis
Acute Pharyngitis
Oral Moniliasis (Thrush)
*Cottage cheese of the mouth-if see in
in adult, think HIV*
•
•
•
•
•
•
•
Criteria
14 days duration.
Purulent nasal discharge.
Face pain.
Red, swollen nasal passage.
Rhinorrhea, clear.
Sneezing
Conjunctival edema.
•
•
•
Rhinorrhea, coryza.
Sneeze, cough.
Low grade fever.
•
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•
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.Exudate ‘shaggy”
Less pain
Urethritis
Conjunctivitis
Red pharynx, enlarged tonsils
Exudate
Fever
Pain
Primarily in newborn and infants
up to 6mo.
White patches on tongue and
mouth, hard to remove.
•
Treatment
Peds: Amoxicllin 6-13 mg/kg tid x
10d.
Alternative
Peds: TMP-SMX 5mg/kg (TMP
component) bid x 10d.
Adults: Amoxicllin 500mg tid #30.
Adults: TMP-SMX DS bid #20.
Peds: Diphenhydramine syrup 1.5
mg/kg pot id 1 bottle.
Adults: Chlorphreniramine 4mg tid
#30.
Peds: Oral rehydration.
Adults: Diphenhydramine 50mg hs
#10.
Peds:
Adults: Oral rehydration
Adults: Ciprofloxacin 500mg po now
#1 + Doxycycline 100mg po bid #14.
Adults: APAP 325mg 2 po tid for
pain #30 or Diphenhydramine 50mg
hs for sleep #10 or APAP #3 ½ tab po
qid for cough #10.
Adults: Ceftriaxone 125mg IM now +
Doxycycline 100mg po bid #14.
Peds: Amoxicillin 6-13mg-kg tid x
7d.
Adults: Penicillin V 500mg qid #40.
Peds: TMP-SMX 5 gg/kg (TMP
component) bid x 7d.
Erythromycin 250mg qid #40.
Infants: Nystatin suspension 1000,000
u/ml ½ tsp pot id x 5-7d.
Peds & Adults: Consider HIV. See
physician.
Respiratory
Disease
Acute Bronchitis
Asthma
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•
•
•
Criteria
Productive cough
Fever
Rhonchi which clears with cough
No consolidation
Intermittent wheezing, reversible
Treatment
Peds: Amoxicillin 6-13mg/kg tid x
7d.
Adults: Doxycycline 100mg po bid
#14.
Alternative
Peds: TMP-SMX 5mg/kg (TMP
component) bid x 7d.
Adults: TMP-SMX DS bid #14 or
Amoxicillin 500mg tid #21.
Peds: Albuterol nebulizer tx +
• Albuterol syrup 0.1 mg/kg tid to
max 2mg tid +/
• Prednisone 2mg/kg/d x 4d then
1mg/kg/d x 4d.
• Return in 3 days.
• Hydrate
Peds & Adults: Treat suspect
infection as per acute bronchitis
Adults: Albuterol nebulizer tx +
• Theophylline Ext. Release 300mb
bid #60 +/• Prednisone 10mg 4qd x 4d then
2qd x 4d #24.
• Return in 3 days.
Bronchitis (RSV)
•
•
•
< 5yrs of age
Marked expiratory wheezing
Respiratory distress: retract
Pertussis (Whooping Cough)
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Cough < 14d
Afebrile
Not asthma
Cough: whoop
Foamy sputum
Cough
Fever
Evidence lung consolidation
Possible pleural pain
Pneumonia
Chronic Cough
Peds; Oral rehydration. Albuterol
nebulizer tx. Return tomorrow. May
use antibiotics, steroids. See
Physician.
Peds: Erythromycin estolate 10mg/kg
qid x 7d.
Adults: Erythromycin 500mg qid #28.
Neonate: Ampicillin 50mg/kg IV q
8hr + Gentamycin 2.5mg/kg IV q 8hr.
Peds: < 8yr: Amoxicillin 6-13mg/kg
tid x 7d. Return 1-3 days.
2tsp 2-3x/day
Peds: TMP-SMX 5mg/kg (TMP
component) bid x 14d.
Adults: TMP-SMX DS bid #28
Peds: < 8yr: C-R Bicillin IM 1.24m
900/300 + Erythromycin 10mg/kg o
tid #21. Return 1-3d.
Respiratory (cont’d)
Disease
Pneumonia (cont’d)
Tuberculosis
Criteria
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•
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•
Treatment
Peds > 8yr: Erythromycin 250mg po
qid #28. Return 3days.
Severe: Erythromycin + Ceftriaxone
500mg IM x 3d. Return tomorrow.
Productine cough + fever > 2wks
+
Failure to respond to bronchitis tx
+ ESR > 30
May have ehmotysis + wt loss
Positive chest x-ray
Alternative
Peds > 8yr: Amoxicillin 250mg pot id
#21.
Adults: Doxycycline 100mg po bid
#14 or Amoxicillin 500mg tid #21.
Adults: Erythromycin 500mg po qid
#28.
Severe: Erythromycin + Ceftriaxone
1mg IM x 3d. Return tomorrow.
All: Refer to tuberculosis center
Adults: Tetracycline 500mg po qid #
40.
Ketek 2tabs 1x/d x 5d
Malaria Treatment
Sierra Leone
*Recommended treatment for uncomplicated Malaria
Age
Infants < 1 yr
1-6yrs
7-13 yrs
14yrs >
Day 1
AS ( ½ ) AQ ( ½ )
AS ( 1 ) AQ ( 1 )
AS ( 2 ) AQ ( 2 )
AS ( 4 ) AQ ( 4 )
Day 2
AS ( ½ ) AQ ( ½ )
AS ( 1 ) AQ ( 1 )
AS ( 2 ) AQ ( 2 )
AS ( 4 ) AQ ( 4 )
Amodiaquine (AQ) 153mg
Artesunate (AS) 50mg
Day 3
AS ( ½ ) AQ ( ½ )
AS ( 1 ) AQ ( 1 )
AS ( 2 ) AQ ( 2 )
AS ( 4 ) AQ ( 4 )
Cardiovascular
Disease
Arrhythmia
Congestive Heart Failure (CHF)
Treatment
See physician
Peds: See physician
•
Criteria
Per auscultation
Wet rales or crackles
Peripheral edema without other
cause eg. Kidney or live disease
UA- no proteinuria
Hypertension, Mild
•
BP < 150/100
Hypertension (HTN), Moderate
•
BP > 150/90 x 3 or BP 150/100 –
180/120
Adults:
• Low salt diet
• Recheck BP
• Refer for follow-up.
Peds: see physician
Hypertension, Severe
•
•
•
•
BP > 180/120 or not controlled on
1-2 drugs
Adults:
• Low salt diet + Furosemide 40mg
po q d #360 +
• KCL Ext release 10meq po qd
#360. Refer for follow-up.
Alternative
Adults:
• Low salt diet +
• HCTZ 25mg po qd #360
Adults: HCTZ 25mg po qd #360.
recheck 5days + consider adding 2nd
drug. Refer for follow-up.
Adults: Methyldopa 250mg qd #360
or Resperine 0.25 mg po qd #360 or
Atenolol 50mg po qd #360.
Pregnant: Methyldopa 250mg po qd
#200. Refer for follow-up 1 week.
Adults:
• HCTZ 25mg po qd #360 +
• Atenolol 50mg po qd #360
• Return 3-5 days
Adults: HCTZ 25mg po qd #360 +
Methyldopa 250mg po qd #360 (May
increase Methyldopa to 500mg po qd)
OR
Murmur
•
Per auscultation
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•
Criteria
Distended abdomen or
Pruritis or
Worms seen
Imperative tx
• Refer for follow-up
See physician
Resperine 0.25 mg po qd #360.
Treatment
Peds < 2 yr: consult physician
Peds 2-5yr: Albendazole 400mg ½ tab
po x 1
5 yr – adult: Albendazole 400mg po x
1. TREAT HOUSEHOLD.
DO NOT GIVE ALBENDAZOLE
Alternative
Peds < 2 yr: consult physician
Gastrointestinal
Disease
Intestinal parasites (pinworm,
roundworm, hookworm, ascaris)
Peds 2 yr – adult:
Mebendazole 100mg po bid #6
MEBENDAZOLE TO PREGNANT
WOMEN
Dietary changes
Mild Dyspepsia
•
Intermittent indigestion or
heartburn
Adult: Avoid offending foods +
Antacids 2 quid prn # 60.
Moderate Acid-peptic Disease
• Gastritis
• GERD
• Peptic Ulcer
• Disease (PUD)
Severe Acid-peptic Disease
• Gastritis
• GERD
• Peptic Ulcer Disease
•
•
•
Daily indigestion or heartburn
1 week or more duration
Night-time symptoms
Peds: Ranitidine 75mg po q hs # 20.
Peds: Cimetadine 200mg po q hs #30
Adults: Ranitidine 150mg po q hs #
20.
Adults: Cimetadine 400mg po q hs
#30.
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•
Daily epigastric pain
1 month or more duration
GI bleading
Weight loss
Peds > 10 yr: Ranitidine 150mg po
bid # 60 + Albendazole 200 – 400mg
x1
Peds: Cimetadine 200mg po bid # 60
+ Mdbendazole 100mg bid # 6.
Adults: Ranitidine 150mg po bid # 60
+ treat for H. Pylori:
• Pepto-Bismol 2 tabs po qid #112
+
• Tetracycline 500mg po qid #56 +
• Metronidazole 500mg pot tid #42.
Adults: Cimetadine 400mg po Bod
#60 + treat for H. Pylori:
• Pepto-Bismol 2 tabs po qid #112
+
• Tetracycline 500mg po qid #56 +
• Metronidazole 500mg po tod # 42.
Diarrhea, Mild
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•
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•
< 1 week
< 5 % dehydration
< 3 liquid stools / day
Afebrile, alert
Peds: neg UA
Infant < 2 yr: Supplement
breastfeeding with oral rehydration
solution (ORS) + recheck tomorrow
Peds > 2 yrs: ORS + recheck 2-3
days.
AdultsL ORS + TMP-SMX DS 1 po
bid #6.
Adults: ORS
Treatment
Infants < 2yr :
• Supplement breast milk with ORS
+
• Amoxicillin 6-13mg/kg po tid x
5-7 d +
• Recheck tomorrow.
Alternative
Infants < 2 yr:
• Supplement breast milk with ORS
+
• TMP-SMX 5mg/kg (TMP
component) po bid x 5-7 d
• Recheck tomorrow.
Peds > 2yr:
• ORS +
• TMP-SMX 5mg/kg (TMP
component) po bod x 5-7 d +
• Recheck tomorrow.
Peds > 2yr:
• ORS +
• Amoxicillin 6-10 mg/kg tid x 7 d
or Amoxicillin 250mg po tid # 21
• Recheck tomorrow.
Adults:
• ORS +
• TMP-SMX DS po bid # 14 +
• Metronidazole 500mg po quid x
10 d # 40 +
• Return in 3 d.
Adults:
• ORS +
• Tetracycline 500mg po qid #40 (in
place of TMP-SMX)
• Albendazole 400mg po q d # 5
(for Giardia in place of
Metronidazole).
• Return in 3 d.
Gastrointestinal (cont.)
Disease
Diarrhea, Moderate
Criteria
•
•
•
> 1 week
< 10% dehydration
> 4 liquid stools / day
Diarrhea, Severe
•
•
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> 2 weeks or
> 10% dehydration or
> 10 liquid stools / day
Infants < 2yr :
• ORS in clinic or feeding tube
hydration +
• TMP-SMX 10 mg (TMP
component) po bid x 7 d +
• Room in.
Peds > 2yr:
• ORS in clinic or feeding tube
hydration +
• TMP-SMX 10 mg (TMP
component) po bid x 7 d
• Consider adding Metronidazole
15mg/kg po tid
• Return tomorrow or room in.
Infants < 2yr :
• IV hydration +
• Ampicillin 200mg/kg IV q 6 h +
• Room in.
Peds > 2yr:
• IV hydration +
• Amoxicillin 13mg/kg po tid or
Ampicillin 1 gm IV q 6 h +
• Albendazole 200-400mg po q d #
5+
• Room in.
Gastrointestinal (cont.)
Disease
Diarrhea, Severe
(cont.)
Constipation, Mild
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Criteria
> 2 weeks or
> 10% dehydration or
> 10 liquid stools / day
Treatment
Adults:
• ORS in clinic +
• Ciprofloxin 500mg po bid # 20 +
• Metronidazole 500mg po qid # 40
+
• Return tomorrow.
•
•
1-2 bowel movements per week
Nontender abdomen
Peds:
• Dietary adjustment
Adult:
• Dietary adjustment
• DOSS 250mg qd #30
Constipation, Severe
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•
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Bowel movement < 1 per week
Abdomen nontender
Rectum not obstructed
Peds: consult physician
Adults:
• Mineral oil 30ml BID # 4oz. +
• DOSS 250mg qd # 30
Alternative
Adults:
• IV hydration
• TMP-SMX DS BID #20 +
• Metronidazole 500mg po qid # 40
+
• Room in.
Genitourinary
Disease
Urinary Tract Infection (UTI)
(Cystitis)
Pyelonephritis
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Criteria
Dysuria & frequency
+ Uninalysis
Can cause fever & diarrhea in a
child
Fever
Flank or abdominal pain
+ Urinalysis
Treatment
Peds: Amoxicillin 6-13 mg/kg pot id
x 5d
Alternative
Peds: TMP-SMX 5mg/kg (TMP
component0 po bid x 5d.
Adults: TMP-SMX DS 1 po bid #6
Adults: Amoxicillin 500mg 6tabs po
x 1 or Doxycyline 100mg po bid #6.
If pregnant within 2 weeks of EDC:
Ciprofloxin 250mg po bid #14.
Peds: ORS + TMP-SMX 5mg/kg
(TMP component) pobid x 14d.
Peds: Amoxicillin 13mg/kg pot id x
14d
Peds unable to take po:
• IV hydration +
• Ampicillin 50mg/kg IM or IV q
8h+
• Gentamycin 2.5mg/kg IM or IV q
8h x 14d.
Peds unable to take po:
• IV hydration +
• Ceftriaxone 25mg/kg IM or IV q
12h x 14d.
• May switch to protocol when
patient able.
Adults: Ciprofloxin 500mg po bid
#28.
Adults unable to take po:
• IV hydration
Adults:
• Ceftriaxone 1gm IM or IV q d x
14d.
• May switch to protocol when
Vaginitis – no exam
Vaginitis-examined, Monilial
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•
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Vaginal discomfort
Discharge
Normal abdominal exam
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Pruritis
Thick, white cheesy discharge
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•
Criteria
Copious, foamy discharge
Fishy or malodorous
• Ampicillin 2mg IV q 8h +
• Gentamycin 1.5mg/kg IV q 8h.
Peds: consult physician
Adults: (not pregnant)
• Miconazole vaginal tab q hs #7 +
• Metronizadole 500mg po bid #14.
• Pregnant adult: Miconazole
vaginal tab q hs #14.
Peds: consult physician
Adults: Miconazole vaginal tab q hs
#7.
patient able.
Pregnant adult: Betadine vaginal
douche qd x14d.
Genitourinary (cont’d)
Disease
Vaginitis-examined, Trichomonas or
bacteris
Gonorrhea (GC)
Urethritis, non gonococcal
Pelvic Inflammatory Disease (PID)
Syphillis
•
•
Purulent urethral discharge
Purulent cervical drainage or
purulent prostatitis
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Older men
Non-purulent discharge
Lower abdominal or pelvic pain
Tender cervix or adenexa
+ Bowel sounds
Normal urinalysis
-Pregnancy test
Painless chancre or ulcer on
genitalia
Treatment
Peds: consult physician.
Alternative
Adults: Metronidazole 500mg po bid
#14.
Peds: Consult physician
Adult: Betadine vaginal douche q d x
14d.
Adults: Ciprofloxin 500mg po x 1 +
Doxycycline 100mg po bid #14
Adults: Doxycycline 100mg po bid
#14.
Peds: consult physician
AdultsCeftriaxone 125mg IM x 1 +
Doxycyclline 100mg po bid #14.
Adults: Erythromycin 500mg po qid
#28.
Adults: Ciprofloxin 500mg po bid
#28 + Metronidazole 500mg po bid
#28.
Adults: Ceftriaxone 250mg IM x 1 +
Doxycycline 100mg po bid #28.
Peds: consult physician
Adults: Benzathine penicillin G 2.4
million u IM x1.
Adults: Doxycycline 100mg po bid
#28
Musculoskeletal
Disease
Myalgias or arthralgias, minor
Osteoarthritis
•
•
Criteria
History
Minimal physical findings
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•
•
•
Painful joints
Hx trauma or weight-bearing
Osteophytes
Adults > 40yrs
Treatment
Alternative
Peds: no tx
Adults: APAP 325mg 1 or 2 po qid
#30.
Adults: APAP 235mg 1 or 2 po qid
#100
Adults: Ibuprofin 400mg po bid #20
Adults: Ibuprofin 400mg po bid #60
Neurological
Disease
Meningitis
•
•
Criteria
Fever, headache, stiff neck,
altered consciousness
Cerebrospinal fluid: increased
glucose, + WBC’s + bacteris.
Treatment
Peds: Dexamethasone 0.4mg/kg IV q
12h, 1st dose 15 min before antibiotic
+ Ampicillin 50mg/kg IV q 6h +
Ceftriaxone 50mg/kg IV q 12h.
Adults: Dexamethasone 0.4mg/kg IV
q 12h, 1st dose 15 min before
antibiotic + Ceftriaxone 2gm IV q
Alternative
12h.
Seizure
•
•
General shaking with loss of
awareness
Focal shaking
Staring or falling episodes
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Criteria
Child or young adult
Polydipsia, ployuria
Weight loss
↑ Blood glucose
↑ Urine glucose
Adult
Polydipsia, polyuria
+/- weight loss
↑ Blood glucose
•
•
•
•
Symmetrically enlarged thyroid
Non-tender
Normal pulse
Adult
•
Prophylaxis for contacts: Cipro
500mg po x 1.
Peds: ule out infectious cause.
Phenobarbital 2-3mg/kg po bid for
12mo.
Adults: Complete neuro exam by
physician. Phenytoin 100mg 1 q am, 2
q pm #1100.
Endocrine
Disease
Diabetes Mellitus Type 1
Diabetes Mellitus Type 2
Goiter
Treatment
Refer to medical facility
• Diet instruction
• Hydration
• Glucotrol XL 5mg po qd #360.
• Return 2d.
• Refer to medical facility.
Adult: Iodized salt
Alternative
Dermatological
Disease
Impetigo
•
•
Criteria
Multiple crusts
Pruritic
Treatment
Infants: Scrub lesions gently with
disinfectant soap and water +
Amoxicillin 6-14 mg/kg pot id x 5d.
Severe infants: Scrub lesions gently
with disinfectant soap and water +
Erythromycin 10mg/kg up to 250 mg
po qid x 7d.
Severe Peds: CR Bicillin 600,000 u
IM + return 2 days.
Scabies
Pediculosis (Lice)
•
•
•
Multiple small lesions
Pruritic
Adults: Advise scrubbing +
Erythromycin 250mg po qid #28
Peds < 2yr: Permethrin 5% cream:
Apply head to foot. Wash off 8-14hrs.
Parasitic arthropods in scalp and
Peds & Adults: Linadana 1% lotion
neck to toes, leave on 12hrs + may
repeat in 1 wk. Treat household.
Peds & Adults: Lindane 1% shampoo
Alternative
Infants: Erythromycin 10mg/kg po
qid x 7d or Mupirocin 2% Ointment
apply tid 5d.
hair areas
10 min wash. May repeat in 1wk.
Treat household.
Criteria
Dry, scaly skin, itches
Typical areas
Treatment
Peds: Hydrocortisone cream 1% bid
#15 gm tube.
Alternative
Peds: Chlorphreniramine syrup
2mg/5ml: ½ tsp qid # 4 oz.
Adults: Triamcinolone cream 0.1%
bod #30 gm or #60 gm tube.
Peds 5-12yr: Chlorphreniramine 4mg
po qid #20.
Severe Adult: Prednisone 10mg 2 tab
q d x 10d, then 1 q d x 10d #30.
Adults: Chlorphreniramine 4 mg po
qid #40 or Diphenhydramine 50mg po
q hs #20.
Tolnaftate cream bid x 14d
Dermatological (cont’d)
Disease
Eczema
Tinea
• Capitus-head
• Corpora-body
• Crura-creases feet
Acne
•
•
•
Raised, scaly anular lesions with
central clearing
Miconazole Cream bid x 14d.
Seborrhea (dandruff)
•
•
•
14yr to adult: tetracycline 250-500mg
bid #60
Selenium shampoo twice a week.
Pruritis
•
•
< 14yr old
Whiteheads & blackheads
Oil scales on scalp, eyebrows or
ears
+ itching
Generalized itching
Look for cause: scabies, tinea, eczema
Adult: Erythromycin 500mg bid #40
•
Dry skin
Peds: Diphenhydramine 1.5mg/kg pot
id x 7d.
Adults: Diphenhydramine 50mg po q
hs #20
Adults: Diphenhydramine 50mg tid
#30
Treatment
Peds: Chloroquin phosphate syrup
85mg base/5ml – 10mg/kg (max
600mg) po now, then 5 mg/kg in 6hr,
then 5mg/kg po q d x 2d.
Alternative
Cerebral or Adult, severe: Inable to
take po: Quinine Gluconate 15mg/kg
IV over 4hrs, them 7.5mg/kg IV over
4hrs, then q 8h x 72hrs or until able to
take po.
Systemic Febrile Illness
Disease
Malaria
•
•
•
Typhoid
•
•
•
•
Tetanus
•
•
Criteria
Periodic fevers q 1-3days, often in
pm
Headache, body ache, but few
localizing signs
+ Malaria smear
Malaise, headache, sore throat,
cough
Diarrhea or constipation
Bradycardia
Negative UA + malaria smear
Difficulty swallowing
Jaw stiffness
Adults: Chloroquin phosphate 250mg
salt-4tabs po now, then 2 tabs po in
6hr, then 2 tabs po q d x 2d #10.
Peds: TMP-SMD 10mg/kg (TMP
component) now, then 5mg/kg po bid
x 14d.
Adults: Ciprofloxin 500mg po bid
#20.
Adults severe: In shock altered mental
status: Dexamethasone 3mg/kg IV
now, then 1mg/kg IV q 6hr x 8 doses
+ Ceftriaxone 2.0 gm IV q d x 5d.
Immediately move to a quiet place.
Minimize stimuli. Tetanus immune
Adults: TMP-SMX DS po bid #28
•
•
•
Muscle spasms, rigidity
Convulsions
Neck extension in children
globin (Hypertet) 5,000 u IM. Start IV
0.9% NaCl or lactated ringers.
Peds: Penicillin G 50,000 u IV q 6h.
Adults: Penicillin G 6,000,000 u IV q
6h + Diazepam 5-10 mg IV q 1-2 h
prn muscle spasms. Start tetanus
immunization.
Adults: Chlorpromazine 25-5-mg po q
6hr.
Treatment
Neonate: Ampicillin 25mg/kg IV
q 6 h + Ceftriaxone 25mg/kg IV q 12
h.
Alternative
Systemic Febrile Illness (cont.)
Disease
Septicemia
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Criteria
Fever
Hypotensive
Normal UA
No localizing signs
Peds: Ceftriaxone 25mg/kg IV q 12 h.
Adults: Ceftriaxone 1 gm IV q 12 h.
General
Disease
Anemia
Animal Bite
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Criteria
Pale conjunctiva, nailbeds
Low HcT/Hb
+ hemoccult
+ malaria smear
Treatment
Peds: Albendazole + Ferrous sulfate
300mg qod # 30.
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+ HX of bite
Open or infected wound
Peds: Clean & debride.
Erythromycin 250mg qid # 28.
Tatanus toxoid. Tetanus
immunization if no Hx immunization.
Adults: Albendazole + Ferrous sulfate
BID # 60.
Adults: clean & debride.
Erthromycin 500 mg qid # 28.
Tetanus toxoid. Tetanus
immunization if no Hx immunization.
Infected Wound
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Wound > 6hrs
Dirty, purulent
Clean and debride.
Peds: Amoxicillin 6-13mg/kg pot id.
If no tetanus immunizations:
a) Peds tetanus immuniglobin 4u/kg,
b) Tetanus toxoid or Td IM.. Be sure
Alternative
Treat Malaria if smear +.
Treat acid-peptic disease if
hemoccult +.
Peds: AMoxicillin 6-13mg/kg
tid x 7 d or Rocephin.
Adults: Amoxicillin 500mg tid
# 21 or Cephtriaxone 125 mg
IM q d x 3 d then oral as
indicated
to give at different site than tetanus
immune globin. If had tetanus
immunization, give pediatric tetanus
toxoid to Td IM.
Adults: Amoxicillin 500mg: 4 po now
then 1 po tid # 24. If no tetanus
imminixationL a)Tetanus
immuniglobin 250u IM, b) Tetanus
toxoid IM. Be sre to the at different
site that tetanus immuniglobin. If had
tetanus immunization, give adult
tetanus toxoid or Td IM.
General (cont.)
Disease
Malnutrition
HIV
Well Baby Check
Pregnancy
Immunizations
Criteria
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Often disseminated herpes or
Non vaginal yeast infections
or
Lymphoma or
Kaposi’s sarcoma
Nutrition assessment
Exam: look for acute
infection / congenital defect.
Exam
BP Check. If elevated do UA
Treatment
Counseling. Food if available
Comfort care.
Start tetanus immunization.
Worm medication if appropriate
Adult vits with Iron 1 po q d #300
Alternative