Paediatrics - Queensland Health - Queensland Government

More documents

Recommendations

Info

Ear problems 600 Traumatic rupture of the ear drum Related topics Trauma to teeth Head injuries Eye injuries Fractured mandible / jaw 1. May present with • A history of the injury e.g.: - - a blow to the side of the head or an explosion, i.e. a pressure wave - - penetrating injury e.g. a sharp stick - - water forced into ear e.g. a fall from a height into water • Pain in the ear, reduced hearing and / or bleeding from the ear • Dizziness and nausea 2. Immediate management • Management of life threatening injuries 3. Clinical assessment • Obtain a complete patient history: -- ask about the circumstances and mechanism of injury -- time, date of occurrence and when first noticed -- does the patient have decreased hearing? • Perform standard clinical observations + -- conscious state if applicable • Perform physical examination. See Assessment of the ear -- note other injuries if present 4. Management • Consult MO who will advise antibiotic ear drops if water penetrated the perforation e.g. fall into water. The ear should be kept dry until healed. Antibiotic eardrops are not necessary if hole was caused by dry trauma (blow to head) 5. Follow up Review in 2 days and then weekly If perforation not healed in 2 weeks, consult MO 6. Referral / consultation Consult MO on presentation and if perforation not healed in 2 weeks Controlled copy V1.0 Primary Clinical Care Manual 2011
Ear problems Foreign body / insect Recommend The main danger of a foreign body in the ear lies in its careless removal [11] Related topics Otitis externa 1. May present with • Foreign body or insect in ear canal 2. Immediate management Not applicable 3. Clinical assessment • Obtain a full history including circumstances (accidental, purposeful, incidental finding) • Perform standard clinical observations • Examine the ears. See Assessment of the ear 4. Management • Consult MO unless small object and seen to be near external ear opening and easily removable using e.g. nasal packing forceps • Larger foreign bodies and those further down the canal require special equipment and training for removal and may even require a general anaesthetic (send to hospital with ENT facilities) • A live insect in the ear canal should be drowned using Sofradex® eardrops or cooking oil or 2 mL of 1% lignocaine introduced by the blunt end of a syringe or via a cut-off ‘butterfly’ needle (or other plastic tubing is also effective) [11]. Do not syringe with water as can cause insect to swell • After removal of foreign body or insect, instil Sofradex® ear drops to prevent infection secondary to the trauma caused to the skin of the ear canal Schedule 4 Sofradex ® ear drops (Dexamethasone 0.5 mg / Framycetin Sulphate 5 mg / Gramicidin 0.05 mg / mL) DTP IHW / SM R&IP / IPAP Authorised Indigenous <strong>Health</strong> Workers and Isolated Practice Area Paramedic must consult MO / NP Scheduled Medicines Rural & Isolated Practice Registered Nurses may proceed Form Strength Route of administration Recommended dosage Duration Ear drops See above Topical - drops 3 drops tds - qid 7 days Provide Consumer Medicine Information Management of associated emergency: consult MO Administration tip • The patient should lie with their head on a pillow for several minutes after administration to allow the drops to gravitate to the bottom of the ear canal • Apply tragal pressure (pressing several times on the flap of skin in front of ear canal) after the drops have been instilled to assist the drops through the perforation Primary Clinical Care Manual 2011 Controlled copy V 1.0 601 [10]
Page 1 and 2:
Section 6 Paediatrics
Page 3 and 4:
Paediatric presentation History and
Page 5 and 6:
Paediatric presentation Presentatio
Page 7 and 8: Paediatric presentation Standard cl
Page 9 and 10: Paediatric presentation Physical ex
Page 11 and 12: Child with fever Fever is usually a
Page 13 and 14: Child with stridor Stridor is a har
Page 15 and 16: Any history of significant trauma?
Page 17 and 18: Meningitis Meningitis Recommend Co
Page 19 and 20: 6. Referral / consultation Consult
Page 21 and 22: Respiratory problems • For the ch
Page 23 and 24: Respiratory problems 1. May present
Page 25 and 26: Respiratory problems 4. Management
Page 27 and 28: Child < 3 months Contact MO immedia
Page 29 and 30: Immune complications Acute post st
Page 31 and 32: Immune complications Schedule 4 Ben
Page 33 and 34: Immune complications Acute rheumat
Page 35 and 36: Immune complications Australian gui
Page 37 and 38: presence of RHD Place person on Re
Page 39 and 40: Ear problems • Clean the ear usin
Page 41 and 42: Ear problems Acute otitis media (A
Page 43 and 44: Ear problems Schedule 4 Roxithromyc
Page 45 and 46: Ear problems 4. Management • Give
Page 47 and 48: See Simple analgesia back cover Ear
Page 49 and 50: Ear problems 6. Referral / consulta
Page 51 and 52: Ear problems 5. Follow up Children
Page 53 and 54: Ear problems Ear discharge in the p
Page 55 and 56: Ear problems 4. Management • Cons
Page 57: Ear problems Schedule 4 Flumethason
Page 61 and 62: Gastrointestinal problems Acute gas
Page 63 and 64: Gastrointestinal problems 4. Manage
Page 65 and 66: Gastrointestinal problems • Bottl
Page 67 and 68: Gastrointestinal problems Nutrition
Page 69 and 70: 5. Follow up Review 1 - 2 days aft
Page 71 and 72: Gastrointestinal problems Intestin
Page 73 and 74: Gastrointestinal problems Schedule
Page 75 and 76: Gastrointestinal problems 4. Manage
Page 77 and 78: Gastrointestinal problems Intussusc
Page 79 and 80: Gastrointestinal problems • Perfo
Page 81 and 82: Gastrointestinal problems Backgroun
Page 83 and 84: Schedule 2 Folic Acid Gastrointesti
Page 85 and 86: Urinary tract problems References 1
Page 87 and 88: Urinary tract problems ○ where no
Page 89 and 90: Bone and joint problems 3. Clinical
Page 91 and 92: Abuse and neglect 2. Immediate mana
show all

Paediatrics - Queensland Health - Queensland Government

Create successful ePaper yourself

Delete template?

Save as template?