Guest guest Posted May 30, 2004 Report Share Posted May 30, 2004 Lee, Just because the strep test was negative, that doesn't mean it's a viral infection. With the history it seems like a bacterial infection to me, as there are many other bacteria that thrive in this environment and to treat as a viral infection could potentially have long term effects for the patient. Platform Medic 01224 402000 Ext 3175/3176 " lee oshea " <leeoshea1000@ho tmail.com> cc: Subject: Viral or Bacteria 30/05/2004 05:58 Please respond to RemoteSupportMed ics Hey up Group, Can someone tell me please. If a patient comes to clinic compaining of 6 day history of : 1. sore throat 2. Enlarged anterior cervical lymph nodes 3. Apyrexial 4. Bilatteral Pus on both tonsills with eryrthema 5. Has long history of Tonsillitis Is this more likely to be bacterial or viral. The reason i'm asking is my PA and i disagree that firstly i think its bacterial due to the pus( however the strep A test was negative). Can someone tell me please how can i differenciate which is bacteria and which is viral. I was on the understanding if pus was present then it must be bacterial. My PA says it's viral due to the test being negative for strepp A. Anyones input to increase my knowledge would be greatly appreciated and i can put this debate to bed. Thanking all in advance, Lee O'Shea Kuwait >From: " cpfmedic " <cpfmedic@...> >Reply- > >Subject: Re: Heartstart 3000QR >Date: Sat, 29 May 2004 17:03:12 -0000 > >, >e-mail the sales and marketing dept. of the manufactureurs U.K >offices and ask for a copy of the instructions in a pdf file or >similar. > >Regards > > > > > Hi > > > > Would someone be so kind as to help me with a very minial task. I > > have started work on a plateform which has a HearStart 3000QR in >the > > sick bay. > > On performing my user checks as we all do, I found that the time >was > > out by 1 hour. I checked the paper work that was with it but this >was > > not of much use. > > I have searched high & low for the complete idiots guide but have > > failed. > > So the question is, can some one send me instructions on how to > > change the time as the next comdination of buttons I press will > > probably result in me blowing something up? > > > > many thanks > > > > Sayell > > Thankyou, Lee O'Shea Kbr Paramedic Government operations logcap III Email:leeoshea1000@... Email:leeoshea@... Mobile phone: 965-970-5083 _________________________________________________________________ Express yourself with cool new emoticons http://www.msn.co.uk/specials/myemo Member Information: List owner: Ian Sharpe Owner@... Editor: Ross Boardman Editor@... ALL list admin messages (subscriptions & unsubscriptions) should be sent to the list owner. Post message: egroups Please visit our website http://www.remotemedics.co.uk Regards The Remote Medics Team Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 30, 2004 Report Share Posted May 30, 2004 Lee, Sounds more Bacterial to me. Possibly the Strep A test is negative as Haem Strep " B " is more a causative agent. Good luck & break out the Pen V:-) KF --------------------------------- Messenger - Communicate instantly... " Ping " your friends today! Download Messenger Now Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 30, 2004 Report Share Posted May 30, 2004 Strep A is a common cause of tonsiliitis but also the most dangerous; the need to take swabs is mostly related to the over prescription of antibiotics for every person complaining of a sore throat but most importantly because Strep A can cause acute rheumatic fever and post streptococal glomerulonephritis. This patients problem may have been initiated by a viral infection but pus formation is the consequence of a bacterial foci. In your location and with this presentation I would have thought the use of antibiotics would have been appropriate ( Phenoxymethylpenicillin i.e Pen V 500mg qds for up to 10/7 are U.K recommendations) You'll have to see whether the patient prersents in a more acute state! Depending on your facilities, and the travel and immunisation history of this patient, exclude Diphtheria, Epstein Barr Virus and Scarlet Fever ( all produce 'tonsillitis'symptoms'). Regards Algeria > > > Hi > > > > > > Would someone be so kind as to help me with a very minial task. I > > > have started work on a plateform which has a HearStart 3000QR in > >the > > > sick bay. > > > On performing my user checks as we all do, I found that the time > >was > > > out by 1 hour. I checked the paper work that was with it but this > >was > > > not of much use. > > > I have searched high & low for the complete idiots guide but have > > > failed. > > > So the question is, can some one send me instructions on how to > > > change the time as the next comdination of buttons I press will > > > probably result in me blowing something up? > > > > > > many thanks > > > > > > Sayell > > > > > > > Thankyou, > Lee O'Shea > Kbr Paramedic > Government operations logcap III > Email:leeoshea1000@h... > Email:leeoshea@h... > Mobile phone: 965-970-5083 > > _________________________________________________________________ > Express yourself with cool new emoticons http://www.msn.co.uk/specials/myemo Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 30, 2004 Report Share Posted May 30, 2004 In article <20040530155717.89809.qmail@...>, Steve Garrett <frontiermed04@...> writes >Lee, > >My 2 cents would be that you can't tell by looking. > > That is correct. Quite a lot has been written on this. Those that say pus=bacterial are wrong, it is one of those old myths of medicine that live on through mis-information. There are criteria for assessing acute pharyngitis. Guidelines vary a little. The following is from the BC guidelines: More likely to be strep: Age 3-14 years Recent fever (> 38 °C) Absence of a cough Exudative pharyngitis/tonsillitis Anterior cervical adenitis Current group A strep epidemic Recent close exposure to group A strep Age 45 years or older Less likely to be strep: Afebrile Cough Coryza/conjunctivitis Hoarseness Discrete oral ulcerative lesions Diarrhea Next question is 'why treat?' Some of the reasons are: • prevention of suppurative and other complications • prevention of acute rheumatic fever • rapid reduction of infectivity to limit spread of group A beta- hemolytic streptococcal infections • abatement of clinical signs and symptoms • decrease antibiotic resistance by minimization of inappropriate antimicrobial usage. **Note** prevention of post strep glomerulonephritis is not on this list - treating strep throat is said not to reduce the risk of developing this complication. Next question is 'when should I treat?' Answer is - there is little urgency, waiting 24-48 hours is unlikely to change much (I would add that my view might change on this, as it does with many things, in a wilderness/adverse environment). There is usually time to get a throat swab or rapid strep test done (remember most are viral, antibiotics can have serious and minor but irritating (esp in adverse environment) side effects. The BC guidelines for pharyngitis are quite good (server is down this morning though) http://www.healthservices.gov.bc.ca/msp/protoguides/gps/throat.pdf Regards all -- Dr Jel Coward The UK Wilderness Emergency Medical Technician and Command Physician course is 7-13 November 2004 at Glenmore Lodge, Aviemore, Scotland http://www.wildmedic.org http://www.wemsi.org jel@... 'There's no such thing as bad weather - just bad clothing " Anon Norwegian Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 31, 2004 Report Share Posted May 31, 2004 My name is Luke and I am a nurse in the US in a community hospital in land. I would also suggest obtaining a sexual history on the patient. The symptoms may be secondary to a sexually transmitted disease, i.e. Gonorrhea or syphilis. That is my 2 cents. Thanks, Luke Re: Viral or Bacteria In article <20040530155717.89809.qmail@...>, Steve Garrett <frontiermed04@...> writes >Lee, > >My 2 cents would be that you can't tell by looking. > > That is correct. Quite a lot has been written on this. Those that say pus=bacterial are wrong, it is one of those old myths of medicine that live on through mis-information. There are criteria for assessing acute pharyngitis. Guidelines vary a little. The following is from the BC guidelines: More likely to be strep: Age 3-14 years Recent fever (> 38 °C) Absence of a cough Exudative pharyngitis/tonsillitis Anterior cervical adenitis Current group A strep epidemic Recent close exposure to group A strep Age 45 years or older Less likely to be strep: Afebrile Cough Coryza/conjunctivitis Hoarseness Discrete oral ulcerative lesions Diarrhea Next question is 'why treat?' Some of the reasons are: • prevention of suppurative and other complications • prevention of acute rheumatic fever • rapid reduction of infectivity to limit spread of group A beta- hemolytic streptococcal infections • abatement of clinical signs and symptoms • decrease antibiotic resistance by minimization of inappropriate antimicrobial usage. **Note** prevention of post strep glomerulonephritis is not on this list - treating strep throat is said not to reduce the risk of developing this complication. Next question is 'when should I treat?' Answer is - there is little urgency, waiting 24-48 hours is unlikely to change much (I would add that my view might change on this, as it does with many things, in a wilderness/adverse environment). There is usually time to get a throat swab or rapid strep test done (remember most are viral, antibiotics can have serious and minor but irritating (esp in adverse environment) side effects. The BC guidelines for pharyngitis are quite good (server is down this morning though) http://www.healthservices.gov.bc.ca/msp/protoguides/gps/throat.pdf Regards all -- Dr Jel Coward The UK Wilderness Emergency Medical Technician and Command Physician course is 7-13 November 2004 at Glenmore Lodge, Aviemore, Scotland http://www.wildmedic.org http://www.wemsi.org jel@... 'There's no such thing as bad weather - just bad clothing " Anon Norwegian Member Information: List owner: Ian Sharpe Owner@... Editor: Ross Boardman Editor@... ALL list admin messages (subscriptions & unsubscriptions) should be sent to the list owner. Post message: egroups Please visit our website http://www.remotemedics.co.uk Regards The Remote Medics Team Quote Link to comment Share on other sites More sharing options...
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