04. OTC BOOK Related RED Flags PDF

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Summary

1 RELIEF:Following can take sumatriptan ● 18- ● Established and stable pattern of migraine ● Migraine for at least one year ● Had at least 5 or more attacks ● Diagnosed by doctor ● Treatment failureRED FLAGS/REFERRAL FOR CNS PAIN: ● Migraine with OC ● Frequent migraine ● Severe headache of &...

Description

1. PAIN RELIEF:

Following can take sumatriptan ● 18-65 ● Established and stable pattern of migraine ● ● ● ●

Migraine for at least one year Had at least 5 or more attacks Diagnosed by doctor Treatment failure

RED FLAGS/REFERRAL FOR CNS PAIN: ● Migraine with OC ● Frequent migraine ● Severe headache of >4 hrs duration ● Suspected ADR ● Suspected meningitis ○ Neck stiffness ○ Visual disturbance ● Associated with injury/trauma ● Children under 12 years Red Flags/ refer for musculoskeletal conditions ● Arthritis ● Back pain associated with abnormal urination ● Back pain radiating to leg ● Suspected fracture ● Head injury ● Treatment failure ● Adverse drug reaction

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2. ANTACIDS AND GASTROINTESTINAL MAIN GI OVERALL RED FLAGS ➢ Difficulty swallowing Blood in vomit ➢ Bloody diarrhoea ➢ Vomiting with constipation ➢ Weight loss ➢ Sustained alteration of bowel habit 1. ● ● ● ● ●

Abdominal pain: continuous severe pain lasting >1hr. mild/moderate lasting on/off for 7 days. swelling -- associated with hernias Over 45ys v 55yrs and suffering persistent dyspepsia (NICE) recent weight loss vomiting/constipation /diarrhoea + persistent abdominal pain ● blood in vomit or stools (red or coffee grounds) ● abdominal pain + chronic back pain babies ○ projectile vomiting, constipation, diarrhoea ○ Gastro-enteritis (inflammation of the stomach and intestines)

02. Referral points for indigestion: Caution: - 1st time dyspepsia age 45 yrs + ?? Refer: ● over 55yrs and with alarm signs or persistent unexplained symptom ● Persistent vomiting ● loss of appetite ● difficulty swallowing ● feeling of lump in throat ● Gastrointestinal bleeding

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03. Referral points for Constipation: ● illness and unable to work ● children/babies who exhibit ill symptoms ● blood in the stool ● continuous severe pain lasting more than 2 days ● weight loss ● diarrhoea ● self medication not effective after 4-5 days ● fever/night sweats ● nausea/vomiting 04. Diarrhoea: Referral points for diarrhoea ● Babies ○ ensure bottles are properly sterilised and making the feeds properly ○ if 3 weeks -

04. When to Refer Children and adults in cold and flu? children noisy breathing/wheezing croup or whooping cough ear tugging persistent / extremely high temperature ● persistent nocturnal cough ● ● ● ●

adults Asthmatics??? OK short term – Be cautious!!! Earache Coloured mucus Dyspnoea and/or chest pain Suspected influenza in - infants & elderly Cardiac or lung disease

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5. EYE CARE: Eye conditions: Subconjunctival haemorrhage Bacterial Conjunctivitis (discharge,crust around usually while waking up) Allergic Conjunctivitis (seasonal, runny nose, no discharge but itchy) Irritable Conjunctivitis (usually by shampoo, make up) Dry Eye syndrome Stye Blepharitis Acute open glaucoma Acute closed glaucoma Keratitis Iritis

Referral points ● Moderate to severe pain

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○ secondary cause must be excluded Marked redness of the eye ○ the greater the redness, the more likely it is that there is a serious secondary cause Ciliary injection ○ expansion of the deep vessel around the limbus giving the eye a blush discolouration Reduced visual activity ○ any loss of visual activity, may indicate a secondary cause Severe photophobia ○ of unexplained origin

Ear conditions: Ear wax Otitis externa Otitis media Vertigo Otitis interna What are the referral points for ear presenting complaints? ● Internal Ear Pain ○ likely infection ● Foreign body ○ suspect particularly in children ● Otitis media ○ ear pain, if eardrum perforated, purulent smelly discharge ● Cholesteatoma ○ eroding epithelial tissue in mastoid, discharge ● Mastoiditis ○ patient feels unwell

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○ has marked hearing loss ○ mastoid tenderness or swelling ● Neoplasm ○ if swelling in the ear canal that bleeds easily on contact and crusting lesions ● Referred pain ○ may originate from sphenoidal sinus, teeth, neck or throat ● Barotrauma ○ possible in divers or patients who have recently flown or had a blow to the ear ● Skin conditions ○ Seborrhoeic dermatitis ○ Atopic dermatitis ○ Dermatophytosis ○ Psoriasis

Oral thrush: Miconazole C/I with: ● Warfarin ● Sulphonylureas ● Phenytoin Pregnant/Breast-feeding

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