Treat and Refer - Gastroenteritis

Question 1

Under the TnR CPG, when can a pt be suspected of having gastro?

Answer 1

Acute onset of diarrhoea ( ≥3 loose or fluid BM in 24hrs)

With associated symptoms of nausea/vomiting, abdo cramping, lethargy and fever.

Question 2

What might blood in the stool indicate?

Answer 2

Bacterial/parasitic infection, GIT haemorrhage.

Question 3

What other emergency can mimic the symptoms of gastro?

Answer 3

Hyperglycaemic emergency.

Question 4

If diarrhoea lasts _____, pt should be referred for further investigation.

Answer 4

> 48hrs

Question 5

How should pts be managed to exclude potentially serious diseases if they have recently returned from overseas?

Answer 5

GP.

Question 6

Most causes of gastro in adults are _______.

Answer 6

Viral.

Question 7

Should sports drinks be advised as oral rehydration for gastro pts?

Answer 7

No. Inappropriate balance of sugar/electrolytes - suggest gastrolyte.

Question 8

When are antibiotics indicated for ?gastro pts?

Answer 8

If bacterial/parasitic infection suspected - pts will likely have a high fever >40, severe abdo cramping and bloody diarrhoea.

Question 9

How long should work/school be avoided if ?gastro?

Answer 9

> 48hrs after symptoms resolve.

Question 10

Pts should be advised to seek further medical attention if, after ______hrs, symptoms have not improved or are worsening.

Answer 10

48hrs from symptom onset.

Question 11

If ondansetron administered, advise pts of potential for _______ and to call an ambulance immediately if this occurs.

Answer 11

EP effects.

Question 12

When is Treat and Referral of gastro contraindicated?

Answer 12

PT REQUIRES HOSPITAL ASSESSMENT:

1. Significant dehydration requiring IV fluid
2. Potential GI bleeding
3. Severe and constant abdo pain
4. BGL >17

SYMPTOMS MAY BE DUE TO DDX

5. Absence of diarrhoea
6. PHx inflammatory bowel disease (Crohn’s, colitis)

PT AT HIGHER RISK OF COMPLICATIONS

7. Pregnancy
8. Comorbidities (diabetes, immunocompromised)

Question 13

What are the actions for a Treat and Referral of Gastroenteritis?

Answer 13

1. Provide pt with self-care advice and health info sheet
   - Provide oral rehydration, refer to pharmacist
2. Refer pt to GP for review if:
   - Symptoms do not improve in >48hrs
   - Recently returned from overseas
   - Temp >40
3. If severe N+V, consider 4mg ODT Ondans
4. Confirm pt understand advice given

Question 14

When should a pt be referred to their GP with ?gastro?

Answer 14

• Symptoms do not improve in >48hrs
• Recently returned from overseas
• Temp >40