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Archive for the ‘Anti-Infectives’ Category.

APPROACH TO PATIENTS WITH ACUTE CONJUNCTIVITIS: PRINCIPLES OF MANAGEMENT

HistoryCertain historical features can help narrow the diagnostic etiology of a red eye and rapidly determine the need for patient referral. The medical history should include questions regarding the following:- Change of vision (“Can you read ordinary print with the affected eye?”)- Eye pain- Photophobia- History of eye trauma- Contact lens use- Time course of illness- Environmental or work-related exposures- Eye itching- Eye discharge- History of upper respiratory tract infection- Sexual history/history of sexually transmitted diseases- Medication history- Allergies- History of eye disease
Ocular ExaminationThe patient with a red eye should be examined in a well-lit room. The physician should carefully observe and examine the face and eyelids and search for regional lymphadenopathy. The ocular examination should focus on the following:- Measurement of visual acuity – If acuity is diminished, the physician should suspect a more worrisome diagnosis (angle closure glaucoma, infectious keratitis, uveitis) and immediately refer the patient to an ophthalmologist.- Examination of the pupils – The size and reactivity of the pupils should be closely observed. A fixed or nonreactive pupil should prompt immediate referral to an ophthalmologist.- Examination of the anterior segment – The clinician should note the presence of any discharge, appearance of the cornea, and pattern of redness. If either ciliary flush (circumcorneal injection) or hypopyon (a layer of leukocytes in the anterior chamber) are seen, urgent referral to an ophthalmologist is required.- Fundoscopic examination – This is usually not helpful in the differential diagnosis of the red eye.*32/348/5*

WHAT TO DO WHEN THE KIDS GET SICK: WHEN THE CHILD HAS A FEVER

Warning: Do not give aspirin to children with viral infections. Parents still commonly administer aspirin to their feverish youngsters despite widespread publicity about the risk of developing a rare but often fatal disorder called Reye’s syndrome when children with viral infections take aspirin. If an analgesic (painkiller) or antipyretic (fever reducer) is needed for a child under the age of twenty-one, acetaminophen (Tylenol being the best known brand) should be used, not aspirin.
Keep in mind that fever is a mechanism the body uses to heal itself. Pediatricians say that unless a child’s fever exceeds 102 °F (which rarely happens with a simple cold) or the child is very uncomfortable, there is little to be gained and possibly something to lose from giving medication to reduce it. Reducing the child’s fever does not produce the improvements in comfort, appetite, or fluid intake that parents might expect. However, children with a history of fever-induced seizures should be given an antipyretic. Give only acetaminophen at the correct dosage for the child’s weight once every four to six hours.
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