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1721. AAWC Pressure Ulcer Guidelines

swab culture, swab 1 cm 2 viable wound area, avoid eschar/slough/surface exudate/edges (Gardner et al 2006; RNAO) d. If osteomyelitis is suspected obtain a tissue and/or a bone biopsy (Lewis et al., 1988; Rennert et al 2009; Whitney et al. 2006) i. Conservatively debride bone; excise ulcer necrotic tissue (Chow et al.1977; Rennert et al. 2009) ii. Remove underlying bony prominence and fibrotic bursa cavities if indicated (Rennert et al 2009) e. Use systemic antibiotics specific to sensitivity (...) report for bacteremia, sepsis, advancing cellulitis, osteomyelitis (Bergstrom et al, 1994; Chow et al., 1977; Rennert et al 2009; RNAO) f. Treat distant infections such as urinary tract, pneumonia, cranial sinus or cardiac valves in patients with or at risk of developing a pressure ulcer (Whitney et al., 2006) g. Use topical antimicrobial cleansing solutions, dressings, gels, ointments, creams and aqueous preparations effective against gram-negative, gram-positive and anaerobic organisms, e.g

2011 Association for the Advancement of Wound Care

1722. Diverticulitis

they are feeling. ? Dietary measures are also not necessary; patients can eat and drink what they are able to tolerate. ? Paracetamol can be prescribed for analgesia. NSAIDs are not recommended due to the gastro-intestinal side effects. Analgesics can mask a fever. ? Treatment with laxatives (lactulose or macrogol) is advised in the case of constipation. ? Antibiotics are not advised. ? In the case of slight or mild symptoms, follow-up takes place within several days, unless the symptoms increase, if vomiting

2011 Dutch College of General Practitioners (NHG)

1723. Caesarean Section for Placenta Praevia

is approximately 1 in 12 000 women (very rare). Frequent risks: Common: persistent wound and abdominal discomfort, repeat caesarean section in subsequent preg-nancies, readmission to hospital, minor cuts to the baby’s skin, blood transfusion and infection requiring antibiotics. Both you and your baby are at a higher risk of needing admission for intensive care. Any extra procedures which may become necessary during the procedure Cell salvage (where blood lost is collected, processed and replaced

2011 Royal College of Obstetricians and Gynaecologists

1724. Management of Sickle Cell Disease in Pregnancy

RCOG Green-top Guideline No. 61 © Royal College of Obstetricians and Gynaecologists 4.4 What is the importance of antibiotic prophylaxis and immunisation? Penicillin prophylaxis or the equivalent should be prescribed. Vaccination status should be determined and updated before pregnancy. Patients with SCD are hyposplenic and are at risk of infection, in particular from encapsulated bacteria such as Neisseria meningitides, Streptococcus pneumonia and Haemophilus influenzae. There is clear evidence (...) acid and prophylactic antibiotics (if not contraindicated). Drugs that are unsafe in pregnancy should be stopped immediately. Iron supplementation should be given only if there is laboratory evidence of iron deficiency. Women with SCD should be considered for low-dose aspirin 75 mg once daily from 12 weeks of gestation in an effort to reduce the risk of developing pre-eclampsia. Women with SCD should be advised to receive prophylactic low-molecular-weight heparin during antenatal hospital

2011 Royal College of Obstetricians and Gynaecologists

1725. The Care of Women Requesting Induced Abortion

after misoprostol for women undergoing medical abortion up to 9 weeks of gestation. 4.29 The setting for abortion should be sensitive and responsive to women’s needs, and should respect the need for privacy and dignity. 4.30 Commissioners should ensure that services meet the recommendations relating to: • B Contraception after the abortion • A and C Antibiotic prophylaxis • B Screening for sexually transmitted infections (STIs) • C Information provision after the abortion • C Counselling after (...) infection 5.9 Women should be informed that infection of varying degrees of severity may occur after medical or surgical abortion and is usually caused by pre-existing infection. Prophylactic antibiotic use and bacterial screening for lower genital tract infection reduces this risk. Breast cancer 5.10 Women should be informed that induced abortion is not associated with an increase in breast cancer risk. Future reproductive outcome 5.11 Women should be informed that there are no proven associations

2011 Royal College of Obstetricians and Gynaecologists

1726. Investigation and Treatment of Couples Recurrent Miscarriage

-trimester miscarriage and preterm birth in the general population. There are no published data to assess the role of antibiotic therapy in women with a previous second-trimester miscarriage. © Royal College of Obstetricians and Gynaecologists 5 of 18 RCOG Green-top Guideline No. 17 Evidence level 2++ Evidence level 34.8 Inherited thrombophilic defects Both inherited and acquired thrombophilias, including activated protein C resistance (most commonly due to factor V Leiden mutation), deficiencies

2011 Royal College of Obstetricians and Gynaecologists

1727. Cardiac Disease and Pregnancy

sometimes be used later than five days after sex, if it is likely to be no more than five days since you released an egg (ovulated). You may be offered an antibiotic to prevent pelvic infection. You can choose to keep using the IUCD for contraception, or it can be easily removed when your next period comes. Oral emergency contraception (the ‘morning after pill’) can be used up to five days after sex. The sooner it is taken, the more effective it is likely to be. There are two types of pill available (...) cup or forceps on the baby’s head). Caesarean section may be advised for the same reasons as in other pregnant women. Antibiotics are occasionally given to prevent infection of the heart (although they are not necessary if the birth is entirely normal, whereas they are routine anyway if delivery is by caesarean section). When can I go home? Women with GUCH usually need to stay in for a few days longer than average, to allow their heart to adjust to them not being pregnant. Clots (thrombosis

2011 Royal College of Obstetricians and Gynaecologists

1729. Operative Vaginal Delivery

obstetric anal sphincter injury in vacuum extraction (4.3% with episiotomy versus 5.5% without episiotomy) and forceps delivery (11.7% versus 10.6%). However, episiotomy was associated with a greater incidence of postpartum haemorrhage (28.4% versus 18.4%, OR 1.72, 95% CI 1.21–2.45). This conflict in findings between the two studies may be due to variations in practice of the threshold for episiotomy and use of different instruments. 5.7 Should prophylactic antibiotics be given? There are insufficient (...) data to justify the use of prophylactic antibiotics in operative vaginal delivery. Good standards of hygiene and aseptic techniques are recommended. A Cochrane review included only one randomised trial of 393 participants. There were seven women with endometritis in the group given no antibiotics and none in the prophylactic antibiotic group. This difference did not reach statistical significance, but the relative risk reduction was 93% (RR 0.07; 95% CI 0.00–1.21). 78,79 6. Aftercare following

2011 Royal College of Obstetricians and Gynaecologists

1730. Maternal Collapse in Pregnancy and the Puerperium

–73 1. Measure serum lactate. 2. Obtain blood cultures/culture swabs prior to antibiotic administration. 3. Administer broad-spectrum antibiotic(s) within the first hour of recognition of severe sepsis and septic shock according to local protocol 4. In the event of hypotension and/or lactate >4 mmol/l: a) deliver an initial minimum of 20 ml/kg of crystalloid/ colloid b) once adequate volume replacement has been achieved, a vasopressor (norepinephrine, epinephrine) and/or an inotrope (e.g

2011 Royal College of Obstetricians and Gynaecologists

1731. Cardiovascular Diseases during Pregnancy

in a hospital environment. A copper intrauterine device is acceptable in non-cyanotic or mildly cyanotic women. Antibiotic prophylaxis is not recommended at the time of insertion or removal since the risk of pelvic infection is not increased. If excessive bleeding occurs at the time of menses, the device should be removed. It is contraindicated in cyanotic women with haemato- crit levels.55% because intrinsic haemostatic defects increase the risk of excessive menstrual bleeding. 2.12.2 Sterilization Tubal (...) support services are available. The method, including the need for anaesthesia, should be considered on an individual basis. High risk patients should be managed in an experienced centre with on-site cardiac surgery. Endocarditis pro- phylaxis is not consistently recommended by cardiologists, 81 but treatment should be individualized. Gynaecologists routinely advise antibiotic prophylaxis to prevent post-abortal endometritis, which occurs in 5–20% of women not given antibiotics. 82,83 Dilatation

2011 European Society of Cardiology

1732. Paediatric complicated pneumonia: Diagnosis and management of empyema

by a chest ultrasound is preferred. Computed tomography chest scans, with associated radiation, should not be routinely used. Antibiotic coverage should treat the most common causative organisms. Additional invasive or surgical management is recommended to reduce the duration of illness in cases not promptly responding to antibiotics or with significant respiratory compromise. Choice of management should be guided by best evidence and local expertise. Video-assisted thorascopic surgery or insertion

2011 Canadian Paediatric Society

1733. Management of community-associated methicillin-resistant Staphylococcus aureus skin abscesses in children

Management of community-associated methicillin-resistant Staphylococcus aureus skin abscesses in children Uncomplicated skin abscesses in previously well children are typically managed with drainage alone. An increasing percentage of such abscesses are due to methicillin-resistant Staphylococcus aureus infections. Although definitive data are lacking, drainage alone appears to be a reasonable strategy for methicillin-resistant S aureus skin abscesses, with antibiotics reserved for infants

2011 Canadian Paediatric Society

1734. Home intravenous therapy: Accessibility for Canadian children and youth

caring for children need to be aware of the indications for home IV therapy, its requirements and limitations, as well as whether this option is available for children in their care. Where access is limited, physicians should advocate for home IV therapy for children when it is medically indicated. Key Words: Antibiotic; Home intravenous therapy; Paediatric; Parenteral nutrition

2011 Canadian Paediatric Society

1735. Guidance on competencies for spinal cord stimulation

for trial of SCS and evaluation of trial outcome 6. Indications for percutaneous/surgical electrodes and choice of pulse generator 7. Basic skills in a. patient positioning b. asepsis and infection control (hand hygiene, MRSA screening, antibiotic prophylaxis, surgical asepsis) c. familiarity with implanted SCS components d. techniques of access to epidural space e. fluoroscopic placement of single/multiple electrodes f. primary surgical techniques including securing electrodes, tunnelling, pocket

2011 Royal College of Anaesthetists

1736. Triage

audit should support national standards, e.g. pain assessment and identification of time- dependant clinical conditions such as cardiac chest pain, stroke thrombolysis and early antibiotic therapy in sepsis. Post Triage Interventions (analgesia, referral for investigation, streaming) Local policies should be in place to facilitate early administration of analgesia and referral for investigations such as radiology. Published by The College of Emergency Medicine, Clinical Effectiveness Committee

2011 Royal College of Emergency Medicine

1737. Syphilis

and progress through several stages: Early syphilis (within 2 years of infection) includes 3 stages — primary syphilis, secondary syphilis, and early latent syphilis. Late syphilis (more than 2 years after infection) includes 2 stages — late latent syphilis and tertiary syphilis. Syphilis can be cured if treated early with appropriate antibiotics — untreated, around a third of cases progress to later stages of disease which can lead to severe, sometimes irreversible, complications. Complications include

2016 NICE Clinical Knowledge Summaries

1738. Superficial vein thrombosis (superficial thrombophlebitis)

, such as application of a warm moist towel to the affected area, avoiding immobility, and elevating the affected leg when sitting. Considering referral to a vascular service for venous duplex scanning to help guide treatment and the need for further specialist intervention. Offering compression stockings (after excluding arterial insufficiency). Considering screening for a coagulation disorder in people with recurrent superficial vein thrombosis with no obvious cause/risk factor. Antibiotics are only required

2016 NICE Clinical Knowledge Summaries

1739. Styes (hordeola)

two weeks) if a malignant eyelid tumour is suspected. Offering reassurance and self-care advice if there are typical clinical features, such as applying a warm compress until the stye drains or resolves, and avoiding the use of eye makeup or contact lenses until the area has healed. Managing any co-existing conditions such as blepharitis or acne rosacea, to reduce the risk of recurrence. Prescribing a topical antibiotic only if there are clinical features of infective conjunctivitis. For a painful

2016 NICE Clinical Knowledge Summaries

1740. Sore throat - acute

but not immediately life-threatening cause for sore throat (such as cancer or HIV). Giving simple advice, if appropriate, for example, regular use of paracetamol or ibuprofen to relieve pain and fever, and adequate fluid intake to avoid dehydration until the discomfort and swelling subside. Prescribing antibiotic treatment, if appropriate. FeverPAIN and Centor clinical prediction scores should be used to assist the decision on whether to prescribe an antibiotic. Arranging specialist assessment for people

2016 NICE Clinical Knowledge Summaries

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