First Nations Flashcards
How are scabies transmitted?
From person to person by skin-to-skin contact-the more parasites on a person, the greater the chance for spread-can also spread from clothing and bed linen but scabies do not survive for long once they are off the skin
What is a classic symptom for scabies infection?-what are the main areas on the body infested by scabies?
Extreme pruritis, especially at night-main areas: web spaces between fingers, flexor aspect of wrists and elbows, axillae, male genitalia and women’s breasts-infants and children can have atypical lesions that are generally distributed but are still usually concentrated on hands, feet, and body folds
How do you make a definitive diagnosis of scabies?
Skin scrapings from burrows or other lesions and examine under a low power microscope-look for mites, feces or eggs
What factors place the Aboriginal population in all countries (both rural and urban) at risk of scabies infections? (8)
- Crowded housing, shared beds and crowded schools/day cares2. Failure to recognize infestation3. Limited access to medical care4. High peds population5. Faulty application of treatment regimens6. Failure to treat close contacts7. Failure to eradicate scabies from clothing and bed linen8. Lack of running water
What is the treatment of scabies?
- 5% permethrin cream (needs to be 5%!!!! Cannot use the 1% used for treating head lice)-apply to skin and wash off after 8-14 hrs (8 for 6 yo)-repeat application 1-2 weeks later if live mites are still seen-one dose is curative usually-take a bath or shower, dry off, then apply to entire body ESPECIALLY to skin folds, fingernails, toenails, behind the ears and groin, face and scalp-contraindicated in infants
What are possible medications used for treating scabies in infants?
- Permethrin (1st line, preferred) - do not use in infants under 3 months
- Sulphur in petroleum jelly
What is the incubation period of scabies?
3 weeks…so if you come into contact with scabies, you may not start showing symptoms until then!
What is the evidence on Ivermectin for treatment of scabies?
Needs only single oral dose but only acts at certain stages of the life cycle of the parasite (whereas permethrin acts at all stages)-so far, it is not licensed in Canada and is not recommended currently over permethrin
What is the most common complication of scabies infection?
Secondary bacterial skin infection
What are the 3 categories of inhalants in inhalant abuse?
- halogenated hydrocarbons (ie. hairsprays, varnish, cooking sprays, etc.) (moon gas, poor man’s pot, hippie crack, whiteout)2. nitrous oxide (whipping cream aerosols, balloon tanks) (ie. whippets, shoot the breeze)3. volatile alkyl nitrites (angina medications, room odourizers, etc.) (ie. poppers, thrust, climax)
The majority of inhalant related deaths are caused by which inhalants?
- gasoline2. air fresheners3. propane/butane
What are the effects of inhaling volatile alkyl nitrites (ie. poppers, climax, thrust)?
Vasodilatory effects = hypotension and syncope, sensations of warmth and flushing, sphincter relaxation and penile engorgement in young men for anal sex
What is the leading cause of death among inhalant abusers?-mechanism of death?
“Sudden sniffing death syndrome” = cardiac arrhythmia caused by:1. disrupted myocardial electrical propagation caused by the inhalant which is worsened by hypoxia2. inhalants also sensitize the heart ao adrenaline so when a user is startled during inhalation (such as being caught), a burst of adrenaline can cause them to have cardiac arrest
What are long term effects of chronic abuse of inhalants? (6)
- Irreversible neurological effects: damage of myeline and neuronal membranes by lipophilic chemicals-cortical atrophy, brainstem dysfunction with irritability, tremor, ataxia, nystagmus, slurred speech, deafness2. Cardiomyopathy3. Distal renal tubular acidosis4. Hepatitis5. Bone marrow toxicity (from hydrocarbons)6. Pulmonary toxicity (emphysema, wheezing)
What is the CRAFFT screening tool?
Screens for abuse of alcohol and drugs-C (car): Have you ever ridden ina car by someone including yourself who was high or drunk?-R (relax): do you ever use alcohol or drugs to relax, feel better about yourself or fit in?-A (alone): do you ever use alcohol or drugs while you are by yourself or alone?-F (forget): do you ever forget things you did while using alcohol or drugs?-F (family): do your family members or friends ever tell you you should cut down on your drinking or drug use?-T (trouble): have you ever gotten into trouble while you were using alcohol or drugs?**2 or more yes answers indicates potential substance abuse problem
What is the rate of smoking among first nations people in Canada compared to the general Canadian population?
First nations: 59% compared to general Canadian population of 20% (3x higher)-in 15-17 yo First nations teens, rate is again 3x higher (more common in girls than boys)
What are the main complications of smoking? (4)
- Myocardial & vascular disease 2. Chronic lung disease (COPD, lung cancer)3. Development of T2DM with faster progression of complications in diabetics who smoke4. Increased risk of fires
What are the complications of postnatal exposure to second hand smoke? (5)
- Increased LRTI2. Increased acute otitis media3. Increased asthma4. decreased lung growth5. increased risk of SIDS
What are the complications of perinatal exposure to smoking during pregnancy? (6)
- Increased number of perinatal deaths2. Increased preterm deliveries3. Placental insufficiency4. Congenital abnormalities5. Increased risk of learning disabilities/ADHD6. Increased risk of nicotine dependence in adolescence for child
In what age group is the highest prevalence of tobacco use?
Youth 15-24 yo
What are the current anti-smoking strategies put in place by provinces? (6)
- Smoke free public and workplaces2. Health warnings on tobacco products3. Hiding tobacco products at stores (shower curtain law)4. Banning tobacco advertising and displays5. Taxing tobacco at high level to deter regular smoking among adolescents6. Efforts to standardize legal age limits and penalties for selling to minors
What are the 5 steps to quitting smoking?
- Get ready2. Get support3. Learn new skills and behaviours4. Get medication and use it correctly5. Be prepared for relapse or difficult situations
What are the 5 As in the role of the health care professional in smoking control?
- Ask about tobacco use2. Advise urge to quit3. Assess willingness to attempt quitting4. Assist counselling and pharmacological therapy (nicotine patch or bupropion)5. Arrange follow up
What is the main difference between community acquired MRSA vs. healthcare associated MRSA?
CA-MRSA:1. generally more suspectible to antimicrobials (with exception of beta lactams)2. Can produce cytotoxins capable of inducing tissue necrosis
What are the common risk factors for community acquired MRSA? (7)
- Overcrowding2. Frequent skin to skin contact between people3. Participation in activities that result in abraded or compromised skin surfaces4. Sharing of potentially contaminated personal items5. Challenges in maintaining personal clealiness and hygiene (ie. due to water shortages or lack of clean water)6. Limited access to health care7. Exposure to antibiotics
What is the medical management of infected scratches/furuncles/impetigo with MRSA?-what about abscesses secondary to MRSA?
Infected scratches/furuncles/impetigo: 1. Wet warm compresses2. Washing with warm soap and water3. Consider topical antibiotics depending on local sensitivity patterns or for more severe infections, use oral antibioticsAbscesses:1. Incision and drainage +/- antibiotics
True or false: decreasing microbial carriage by decolonization reduces the recurrence of community-acquired MRSA-what are methods of decolonization?
FALSE! -methods of decolonization: nasal mupirocin, antiseptic baths with dilute bleach baths or chlorhexidine, oral rifampin-overtime, CA-MRSA in some communities has shown resistance to mupirocin and there is concern that using rifampin could increase drug-resistant TB in high risk communities-studies re: bleach baths’ effectiveness and safety are on the way
What is ONE vaccine that can help prevent severe MRSA infections?
Seasonal influenza vaccine!! Encourage this for all children since in MRSA-endemic communities, there is a risk for severe MRSA pneumonia following an influenza infection
What recommendations can you make to patients and families about how to manage MRSA skin and soft tissue infections to prevent spread?
- Keep wounds covered with clean, dry bandages. If you can’t cover, then exclude from contact sports or child care until wound drainage stops or wounds are healed2. Dispose of used dressings in a plastic-lined garbage container with sealed lid immediately after they are removed3. Hand hygiene before and after changing dressings4. Bathe regularly and change clothes and bedding often5. Avoid sharing personal items like towels, bedding, clothing and bar soap6. Seek medical attention if fever or other signs of illnes develop or if a lesion doesn’t improve within 48 hrs of starting treatment7. Regular cleaning of contact surfaces in the home with household cleaner or detergent
True or false:When a patient has been diagnosed with CA-MRSA, we should test everyone else in the household to determine carriage rate.
FALSE! This is not helpful.