TAHO - Special Senses

TAHO - Special Senses - What is motion sickness - Set of symptoms associated with motion experienced in travel - Motion sickness symptoms - Due to dissonance between the sensory input from the vestibular organs in the inner ears and eyes - Symptoms of motion sickness - Pallor - Clammy, cold sweating - Dizziness - Nausea and vomiting - Increased saliva production - Pharmacological options for motion sickness ? - Antihistamines - Anticholinergics - Headlice diagnosis - A LIVE HEADLICE needs to be found in order to make a diagnosis - Headlice treatment - A physical insecticide, such as dimeticone 4% lotion (Hedrin). A traditional insecticide, such as malathion 0.5% aqueous liquid (Derbac-M). Wet combing with a fine-toothed head louse comb (such as the Bug Buster comb) - Scabies - A parasitic skin infection - Intense itching - Scabies treatment - Permethrin 5% - Consider a symptomatic treatment for the itching ( topical crotamiton ) - Nappy rash - An irritant dermatitis - Caused by sustained contact with urine or faeces - Also caused by irritants in soap, detergents, bubble bath, fragrant baby wipes 1/6 - Nappy Rash management - Advising the parents/carers on self-management strategies, such as using a nappy with high absorbency; leaving nappies off for as long as possible; changing the nappy frequently and as soon as possible after wetting or soiling; using water, or fragrance- and alcohol-free baby wipes; drying gently after cleaning; avoiding potential irritants such as soaps and bubble bath - Treatment of Nappy Rash - Hydrocortisone 1% cream - Imidazole cream if the rash persists or if there is suspected candiasis - Bacterial Skin infections - Cellulitis - Bites - Folliculitis - Acne - Impetigo - Ulcers - Viral skin infections - Warts - Herpes simplex - Herpeszoster - Fungal Skin infections - Tinea - Cellulitis - Indicates a non-necrotising inflammation of the skin and sub cutaneous tissues - Localised pain, swelling, tenderness, erythmia and warmth - Cellulitis treatment - Antibiotics - For streptococci infections, beta lactam antibiotics are used (amoxicillin and cephalexin ) - For patients allergic to penicillin, clindamycin or a macrolide (clarithromycin or azithromycin) is used - Severe cases, parenterally cefuroxime or ceftriaxone 2/6 - 0= 1.5% infection rate - 1= 2.9% infection rate - 2= 6.8% infection rate - 3= 13.0% infection rate - Surgical site infection scoring system - Treatment of surgical site infection - Subcutaneous fungal infections - Involve the deeper layers of the skin: dermis, subcutaneous tissue and even bone - Mycetoma= chronic infection of the subcutaneous tissue of the foot, characterised by discharging sinuses filled with organisms - Chromoblastomycosis= characterised by raised crusted lesions affecting the skin and subcutaneous tissue of the limbs - Shingles diagnosis - There is usually a prodromal phase with abnormal skin sensations and pain in the affected dermatome (area of skin served by an individual nerve). The pain can be described as burning, stabbing, or throbbing; can be intermittent or constant, and may be so severe it interferes with sleep and quality of life. Headache, photophobia, malaise, and fever (less common) may also occur as part of the prodromal phase. - Consider assessing pain intensity using a validated pain assessment scale, such as the Visual Analog Scale. Note that in immunocompromised people, rash may be severe, long-lasting, or affect multiple dermatomes. - Consider the need for oral antiviral treatment 3/6 - Shingles treatment - If admission or immediate specialist advice is not indicated, consider the need for oral antiviral treatment (aciclovir, valaciclovir, or famciclovir). Prescribe an oral antiviral treatment within 72 hours of rash onset for people with any of the following criteria: immunocompromised, non truncal involvement, moderate/ severe pain, moderate/ severe rash - Antiviral treatment - Aciclovir= 800mg 5 times a day - Bites treatment - Mammalian bites are treated with broad spectrum antibiotics + metronidazole (outpatient) - Severe cases= IV Ampicillin or Piperacillin or Tazobactam plus metronidazole for inpatients - Prophylaxis is given for 5-7 days - Treatment of established infection 7-10 days - Broad spectrum antibiotics such as - Aquatic lacerations and puncture treatcephalosporin (ceftazidime) or fluoroment quinolone (Ciprofloxacin or Levofloxacin) - Folliculitis - Inflammatory cells in the wall and ostia of the hair follicle, creating a follicular based pustule - Eosinophilic folliculitis - Result of an autoimmune process against the sebocytes or some component of the sebum, commonly seen in AIDS patients - Pre disposing causes of Folliculitis - Humidity - Occlusive clothing - Underlying skin disease - Iron deficiency - Diabetes 4/6 - Treatment of Folliculitis - Avoiding occlusive emollients - Avoid plucking, shaving or waxing - Localised staph infections can be managed by incision and drainage of large furuncles and abscesses and local application of antiseptics - Oral antibiotics prescribed for more recurrent or extensive infections ( flucloxacillin ) - Some patients need additional treatment with Rifampicin and Clindamycin - Acne - Non infectious form of Folliculitis due to follicular obstruction by a keratin plug - Topical treatments of Acne - Benzoyl peroxide gel - Systemic treatments of Acne - Tetracycline antibiotics are the most effective ( Doxycycline and Minocycline) - Oral combined contraceptives are effective in females - Isotretinoin is effective for severe acne - It's initiated at a dose of 0.5mg/kg/d for 4 weeks and increased as tolerated until a cumulative dose of 120-150 mg/kg is achieved - Psoriasis - Common chronic, scaly rash - Genetic disposition and environmental influence - Common ages= late teens and in the 50's - 5% of people with psoriasis develop joint pain or psoriatic arthritis - Genetic influences of psoriasis - 50% of people with Psoriasis will know of another affected family member - patients with family history develop psoriasis earlier in life than those without family history 5/6 - Immune system becomes overactive - Excessive production of T-helper lymphocytes TH1 cytokines, particularly the TNFa - How does psoriasis occur ? - Enhanced vascuolisation and growth of extra blood vessels occurs within the skin causing it to turn red - There's also increased skin cell turnover causing scaling and thickening of the skin - Other factors affecting Psoriasis - Stress - Infection - Injury - Hormones - Medications - UV light - Obesity - Alcohol and smoking - Treatment of Psoriasis - Sun exposure - Baths - Emollients - Occlusive dressings - Rest - UV treatment 6/6