Chapter 49 Flashcards
How would a patient with acute rhinosinusitis (ARS) present?
Fever, Unilateral facial pain/pressure, maxillary toothache, purulent nasal discharge, Following acute upper respiratory infection, nasal congestion/obstruction
What would suggest a bacterial superinfection?
Persistent and Worsening ARS after initial improvement suggesting a super infection resulting in acute bacterial rhinosinusitis (ABRS)
What are the causes of unilateral facial pain?
Periodontal abscess, facial/orbital cellulitis, cavernous sinus thrombosis
What would the focus physical examination show?
Fullness in the right Tympanic membrane, tender right maxillary area, purulent nasal discharge
In addition to increasing right facial pain how does ABRS patient present?
Acute upper respiratory infection that initially improves but becomes worse
When should laboratory or radiologic investigations be done for ABRS patients?
If complications are present or diagnosis is uncertain
What should be done immediately after physical examination?
Empiric antibiotics against the most common pathogens
What are the clinical diagnosis criteria for ABRS?
Persistent symptoms _> 10 days without improvement.
_> 5 days of worsening symptoms after initial improvement of viral URI.
Severe symptoms _> 3 days (high fever 102, 39, purulent nasal discharge or facial pain for _>three days
What is the empiric antibiotic therapy for ABRS?
PO Amoxicillin-Clavulanate For seven days. If penicillin allergy then consider doxycycline or respiratory fluoroquinolone (Levofloxacin or moxifloxacin
What are the support of therapy for ABRS patients?
Analgesics, nasal saline irrigation, topical glucocorticoids and adequate hydration (decongestants are optional)
What is the appropriate way to order nasal saline irrigation?
Normal Saline solution, inhalation, continuous
What Topical steroid is necessary for this patient?
Mometasone, Topical continuous
