Acute Rhinosinusitis

  1. Sinusitis is a clinical diagnosis. Patients typically present with purulent nasal discharge and facial pain or other URI symptoms.
  2. The vast majority of patients with acute rhino sinusitis will be viral in nature and will not benefit from antibiotics
  3. Patients with prolonged symptoms, more than 7-10 days, without improvement or continued fevers past 2-3 days should be considered for antibiotic treatment as should those who are immunocompromised.

 

MYTH: Cough syrups prevent coughs

There is NO GOOD EVIDENCE for or against the effectiveness of OTC medications in acute cough. Studies have reported adverse effects of these medications and described infrequent, mainly minor side effects such as nausea, vomiting, headache and drowsiness.

How Long Does a Cough From Respiratory Illness Last?

It is completely normal and expected to have a cough for 2 or even 3 WEEKS after onset of illness!!! It is also important to emphasize to your patients that they should ONLY seek care if they are having worsening symptoms or have alarm symptoms (i.e. High fever, bloody or rusty sputum, and/or worsening shortness of breath)

EM Don’ts

  1. Avoid CT of the head in asymptomatic adult patients in the emergency department with syncope, insignificant trauma and a normal neurological evaluation.
  2. Avoid CT pulmonary angiography in emergency department patients with a low-pretest probability of pulmonary embolism and either a negative Pulmonary Embolism Rule-Out Criteria (PERC) or a negative D-dimer.
  3. Avoid lumbar spine imaging in the emergency department for adults with atraumatic back pain unless the patient has severe or progressive neurologic deficits or is suspected of having a serious underlying condition, such as vertebral infection or cancer with bony metastasis.
  4. Avoid prescribing antibiotics in the emergency department for uncomplicated sinusitis.
  5. Avoid ordering CT of the abdomen and pelvis in young otherwise health emergency department patients with known histories of ureterolithiasis presenting with symptoms consistent with uncomplicated kidney stones.

Do Patients with Strep Throat Need to Be Treated with Antibiotics?

Background: Streptococcal pharyngitis is a common presentation to primary care and Emergency Department physicians. Every year, millions of patients are treated with antibiotics for pharyngitis. However, less than 10% of these patients actually have strep pharyngitis (Barnett 2013).

Antibiotics for acute maxillary sinusitis in adults

Antibiotics for acute maxillary sinusitis in adults

Anneli Ahovuo-Saloranta, Ulla-Maija Rautakorpi, Oleg V Borisenko, Helena Liira, John W Williams Jr, Marjukka Mäkelä

Published Online: 11 FEB 2014

About 80% of participants treated without antibiotics improve within two weeks. Clinicians need to weigh the small benefits of antibiotic treatment against the potential for adverse effects at both the individual and general population levels.