How To Cure Your Sinus Infection

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Read What A Chronic Sinusitis Sufferer Wants To Share That You Always Wanted. How He Has Treated Himself For Sinus Pain, Headaches, Bad Breath, Facial Pain And Sore Throat Without Any Nasal Spray.The Real Truth Is Something Which Your Eyes Have Not Seen, Your Ears Have Not Heard Read more...

KillSinus Sinus Treatment Doctor Say Buy This Treatment Summary


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Your Complete Drug Free Treatments For Sinusitis

Heres what you'll discover inside: The real cause of your sinus problems (acute & chronic) and how you can make just 5 simple changes to stop them from coming back. How to clear your sinus congestion naturally and holistically. Its not a treatment where you have to wait and sit for hours at the doctors waiting room. 4 stimulation techniques to release your body's own natural pain killers and to open up your nasal cavities. Why costly antibiotics and corticosteroid can do more harm than good causing yeast infection that you dont want! What never to eat during the healing process certain food may contain natural chemicals that can aggravate your existing problems. How to make your own natural sinus spray for relief safely and effectively with simple ingredients. How you can change a few of your habits to treat, control and prevent future flare-up. Why 37 million Americans and many people worldwide are affected with severe sinus problems and the numbers are growing every year. How to find the right health practitioner who cares and wants to know. How to make simple home-made nasal irrigation without preservative.

Your Complete Drug Free Treatments For Sinusitis Summary

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Author: Larisa Callaghan
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TABLE 1175 Signs and Symptoms in Children with Sinusitis

Acute, severe infections of the sinuses are infrequent during childhood. Such patients often have a history of headache and an elevated temperature. Findings include fever, localized swelling and or erythema, and facial tenderness. A mucopurulent discharge usually accompanies severe sinusitis but may also indicate a nasal foreign body when unilateral. Mild, subacute sinusitis is encountered more commonly than the severe form during childhood. This type of infection usually manifests as a protracted cold. Rather than improving in 3 to 7 days, these children persist with the symptoms of an upper respiratory infection beyond 2 weeks. They have a nasal discharge, which may be serous or mucopurulent. Fever is infrequent.


Mucopurulent Sinusitis

Sinuses communicate with the nose through tiny openings. Therefore, a nasal infection sometimes spreads to one or more sinuses, causing a swelling of their inner surfaces. This is termed sinusitis. Symptoms of sinusitis include- 1. Pain in the forehead (in case of frontal sinusitis) or in the cheek (in case of maxillary sinusitis). This pain, which is quite severe, is made worse by stooping, moving the head or coughing. Moreover, it may radiate into the ear, the eye or the teeth.

Evidencebased infectious diseases

Having led the developments in both classical and clinical epidemiology, is current infectious diseases practice evidence-based We believe the answer is somewhat . We have excellent evidence for the efficacy and side effects of many modern vaccines, while the acceptance of before-after data to prove the efficacy of antibiotics for treating bacterial meningitis is ethically appropriate. In the field of HIV medicine we have very strong data to support our methods of diagnosis, assessing prognosis and treatment, as well as very persuasive evidence supporting causation. However, in treating many common infectious syndromes -from sinusitis and cellulitis to pneumonia - we have many very basic diagnostic and therapeutic questions that have not been optimally answered. How do we reliably diagnose pneumonia Which antibiotic is most effective and cost-effective Can we improve on the impaired quality of life that often follows such infections as pneumonia

Endotracheal intubation

Nasotracheal intubation involves directing an ETT through the nasal passage and into the trachea. It can be done blindly or with a fiberoptic bronchoscope. It is done without the assistance of a laryngoscope and has been advocated by some to be the method of choice in cervical spinal cord injury where manipulation of the neck is to be avoided. Its primary indication is for rapid awake intubations (e.g. decompensat-ing COAD) where sedation would be undesirable. Other indications for nasotracheal intubation include elective oral surgery or limited mouth opening (e.g. temporo-mandibular joint (TMJ) dysfunction). It is contra-indicated in severe facial trauma to avoid placement of the tube through the cribiform plate, which has happened Advantages of nasotracheal intubation are ease of communication for the patient (and potentially less need of sedation), easier mouth care, avoidance of occlusion of the tube by biting down (good in pediatrics or head injury). Disadvantages are that a...

Clinical Features

The spectrum of sinusitis has not been completely defined as it relates to clinical manifestations. However, there are two major types of infection which can usually be distinguished on clinical grounds acute, severe sinusitis, and mild, subacute sinusitis ( Iab eJJZ-,5).

Suggested Reading

Snow V, Mottur-Pilson C, Hickner JM et al. Principles of appropriate antibiotic use for acute sinusitis in adults. Ann Intern Med 2001 134 495-497. 6. Hickner JM, Bartlett JG, Besser RE et al. Principles of appropriate antibiotic use for acute sinusitis in adults background. Ann Intern Med 2001 134 498-505.

Chapter References

Kaliner MA, Osguthorpe JD, Fireman P, et al Sinusitis Bench to bedside current findings, future direction. Arch Otolaryngol Head Neck Surg 116 51, 1997. 13. Gwaltney JM Jr Sinusitis, in Mandell RG Jr, Bennett JE (eds) Principles and Practice of Infectious Diseases, 3rd ed. New York, Churchill Livingstone, 1990, pp 510-514. 15. Williams JW Jr, Simel DL Does this patient have sinusitis Diagnosing acute sinusitis by history and physical examination. JAMA 270 1242, 1993. 16. Williams JW, Simel DL, Roberts LR, et al Clinical evaluation of sinusitis. Ann Intern Med 117 705, 1992. 17. Diaz I, Bamberger DM Acute sinusitis seminars. RespirInfec 10(7) 14, 1995. 19. Gwaltney JM Jr State-of-the-art Acute community-acquired sinusitis. Clin Infect Dis 23 1209, 1996. 20. Williams JW, Holleman OR Jr, Samsa GP, et al Randomized controlled trial of 3 vs 10 days of trimethoprim sulfamethoxzole for acute maxillary sinusitis. JAMA 273(13) 1015, 1995. 21. Malm L Pharmacological background to...

Respiratory infections

These are divided into two anatomically separate categories. First, there are those of the upper respiratory tract, which extends from the nose to the vocal cords. These include the common cold (coryza), sinusitis, pharyngitis, laryngitis and epiglottitis. Secondly, there are infections of the lower respiratory tract. These may affect the large airways (bronchitis), the alveoli and parenchyma (pneumonia) or the pleura space, leading to an empyema. The source of infection is variable. Droplet inhalation is the most frequent although pathogens may be introduced to the lung by alternative routes, such as the aspiration of pharyngeal contents as seen in neurological conditions leading to bulbar palsy and defective swallowing, hematogenous spread as in miliary tuberculosis or staphylococcal septicemia, and direct extension from surrounding tissues. In patients with comorbid illness, impaired host responses or damaged respiratory tract, organisms normally regarded as nonvirulent can become...

Immune responses of the host

Clinically, the importance of the immune system is illustrated during its impaired function secondary to disease. Thus patients with generalized abnormalities of immunoglobulin production such as asplenic states, agammaglobulinemia, and myeloma are prone to recurrent bacterial sepsis. This particularly involves encapsulated microorganisms such as Streptococcus pneumoniae and some strains of Haemophilus influenzae, leading to repeated sinusitis, pneumonia and bronchiectasis. IgA deficiency may be asymptomatic although there can be an increase in upper and lower respiratory infections. Neutropenia increases the risk of many infections, especially those by gram-negative enteric baccilli (GNEB), such as Escherichia coli and Pseudomonas aeruginosa. An impaired T helper cell response, as associated with human immunodeficiency virus (HIV) infection, results in a greater frequency of opportunistic infections such as Pneumocystis carinii, a protozoan that colonizes normal lung. These patients...

Nutritional Support in the Postoperative Setting

Postoperative dysphagia can frequently be managed by alteration of the oral diet. Evaluation of swallowing by a speech pathologist will enable the selection of the appropriate diet. The patients that most often benefit from modification of the oral diet are those who have undergone procedures in the neck or in the thoracic cavity. Occasionally, these patients have severe dysphagia and cannot take any oral diet. Enteral feeding via tubes (inserted nasally or surgically) can be provided until the dysphagia resolves. In elective procedures on the esophagus or upper aerodigestive tract, a feeding tube is often placed at the index operation to facilitate postoperative feeding, when the preoperative nutritional assessment indicates a high risk of postoperative dysphagia. A surgically placed feeding tube can remain in place indefinitely a nasal feeding tube should not remain in place longer than a few weeks, due to the risk of nasal erosion and sinusitis.

Secondary Causes of Headache

SINUSITIS Infection of the sinuses may result facial pain or headache. Maxillary sinusitis, by far the commonest type, causes pain over the anterior aspect of the face, rather than headache. Involvement of other sinuses can cause headache frontal sinusitis over the forehead, ethmoid sinusitis behind and between the eyes, and sphenoid sinusitis a diffuse headache. The headache frequently varies with head position. Symptoms predictive of sinusitis include colored nasal discharge, maxillary toothache, and poor response to decongestants, while reliable signs include purulent nasal discharge and abnormal transillumination (not easy to do properly in the ED). Regardless of plain sinus x-ray findings, patients with four or more of the abovementioned features have a very high likelihood of sinusitis, while those with fewer than two features are very unlikely to have sinusitis.

Macromolecular Composition

Infection is transmitted via respiratory secretions. After a variable incubation period of up to 4 weeks the disease begins with growing hoarseness and aching throat, mild cough, and fever and does later develop into an atypical pneumonia. 12,13 In rare cases infection may also present as sinusitis or otitis media or lead to the aggravation of asthma. 14 In immunocompetent individuals the infection is usually self-limiting, but may be complicated by superinfections. In immunocompromised persons infection may take a more severe course. Reinfections do occur but are generally milder than primary infections. 13

Fusobacterium Infection And Immunity

The spectrum of infections in which Fusobacterium spp. play a pathogenic role include bacteremia, head and neck infections (such as chronic otitis media, sinusitis and mastoiditis, peritonsillar and retropharyngeal abscesses, Vincent's angina, gingival and dental infections), pulmonary infections (aspiration pneumonia, lung abscesses and empy ema), intracranial infections (meningitis and intracranial abscesses), gastrointestinal infections (peritonitis, hepatic and abdominal abscesses), osteomyelitis, urogenital (prostatic and female genital abscesses, amnionitis) as well as skin and soft tissue infections, especially around the oropharyngeal area.

Antibiotic resistance

The 1990s has become known as the era of multidrug resistance. Bacteria causing several kinds of human infectious diseases have become resistant to multiple antibiotics and the different types continue to increase. Infections challenge and impede the treatment of some patients in hospitals and the community. In hospitals, organisms found include Staphylococcus aureus, Escherichia coli, Pseudomonas, and Acinetobacter. In the community, multidrug-resistant bacteria causing acquired infections include pneumococci, gonococci, streptococci, E. coli, and Mycobacte-rium tuberculosis. There is ample evidence that the antibiotic-resistance problem is global, confronting many communities worldwide. Also, it is known that resistant organisms are spreading from one country to another. Resistant organisms are making it difficult to treat sinusitis, urinary tract infections, pneumonia, septicemias, and meningitis. Two disease-causing organisms enterococci in hospitals and Mycobacterium tuberculosis...

TABLE 1206 Differential Diagnosis of Asthma

INFECTION Fever and focal wheezing implicate infectious etiologies such as pneumonia or bronchiolitis. Nocturnal wheezing, nocturnal cough, and poor exercise tolerance may be clues of more chronic illness. Sinusitis can exacerbate asthma symptoms a history of nasal congestion and nocturnal cough or snoring should be treated with at least a 2-week course of antibiotics and nasal steroids. Recurrent attacks, failure to thrive, and a history of sinusitis and chronic ear infections should raise suspicion of cystic fibrosis as an etiology.

Orbital Cellulitis Postseptal Cellulitis

Orbital cellulitis is an orbital infection therefore it is deep to the orbital septum. This is a serious ocular infection that has the potential to be life-threatening. Staph. aureus is the most common pathogen however, H. influenzae flu should be considered in young children and mucormycosis in diabetics and immunocompromised patients. Polymicrobial infection is common. Orbital extension of paranasal sinus infection (especially ethmoid sinusitis) is the most frequent source. Orbital and sinus computed tomography (CT) scans should be performed in the ED. If the CT is negative, an enhanced CT should be performed looking for a subperiosteal abscess. Diagnostic clinical findings that help distinguish this infection from preseptal cellulitis include EOM motility impairment, pain, fever, and occasionally proptosis. Decreased visual acuity is a late finding. Cavernous sinus thrombosis can also occur. These patients require a full workup, admission, and intravenous antibiotics.

B cell deficiency diseases

The physiological importance of B cell function is revealed by diseases that result from selective B cell deficiencies and consequent lack of antibodies (agammaglobulinemia). Bruton's agammaglobulinemia (XLA) is an X-linked defect in B cell maturation in humans, with arrest at the Pre-B I stage and a resulting deficiency in all immunoglobulin classes. A corresponding B cell maturation defect, the Xid mutation, also occurs in CBA N mice. In male children with XLA, the maturation block results from deficiency of a B cell-specific protein tyrosine kinase, btk. With a profound lack of mature B cells but normal T cells, these children are particularly susceptible to infections by bacteria, mycoplasma, hepatitis virus and enteroviruses. They have recurrent middle ear infection, pneumonia, sinusitis and tonsillitis caused by Pneumococcus, Streptococcous and Hemophilus. Problems with infection begin several months after birth, when the pool of protective maternal antibody decreases. XLA...

Skin And Soft Tissue Infections

Sinusitis Definition This chapter discusses several of the more common skin and soft tissue infections of childhood, including conjunctivitis, impetigo, sinusitis, and cellulitis. Because of its particular severity, orbital periorbital cellulitis will be highlighted in a section separate from the general discussion of cellulitis however, the pathophysiology and clinical manifestations that are shared will not be repeated.

Anterior Nasal Packing

Nasal Sponges For Nose Bleeds Placement

Anterior packing alone is a relatively benign procedure. Complications associated with anterior nasal packing include dislodgement of the pack, persistent bleeding, sinusitis, septal necrosis, and, rarely, TSS. Any patient presenting after nasal packing with fever, rash, nausea, or vomiting, should be considered suspicious for TSS.

Human Rhinovirus Coat Protein

The human rhinovirus (HRV) belongs to the family of picornaviruses and is the main cause for common colds and a variety of other respiratory illnesses, including otitis media and sinusitis, and for exacerbations of asthma and reactive airways disease. These illnesses still lack effective antiviral treatment. The viral capsid is a promising and intensively studied target for drug development. This protein shell encapsulates a single, positive RNA strand and consists of 60 copies of four different viral proteins. HRV coat protein inhibitors act as capsid-binding antiviral agents that block the uncoating of the viral particles and or inhibit cell attachment (Hadfield et al., 1999). Their binding site is located within a hydrophobic pocket situated at the bottom of a depression, a so-called canyon, on the capsid surface. In the absence of an inhibitor, this pocket can be empty or occupied by a pocket factor, a lipid or fatty acid. Structural conservation in this region among the different...

Differential Diagnosis

The most important points to consider are those diagnoses arising as complications from sinusitis. These include any evidence of infectious extension from the sinus cavity, such as periorbital cellulitis, brain abscess, subdural empyema, meningitis, or cavernous sinus thrombosis. Such patients are febrile, extremely ill, may have unstable vital signs, can demonstrate altered mental status, meningismus, or focal neurologic findings. None of these symptoms are compatible with diagnosis of sinusitis. The history and physical should be structured such as to exclude these diagnoses. The differential diagnosis of patients with signs and symptoms of facial pain includes tension headache, migraines, and cluster headache. Headache syndromes can usually be excluded based upon limited and historical evidence of an infectious process. Cluster and migraine headache patients usually have a history of similar headache, and sinusitis is never preceded by aura or other prodromal neurologic symptoms....

Clinical Description

Cystic fibrosis is often considered the most common serious autosomal recessive disease in Caucasians of northern European ancestry. It is a multiorgan condition, characterized by abnormally viscous secretions from epithelial cells in various tissues, leading to duct obstruction and infections. The most prominent and potentially lethal site for these phenomena is the lung, but CF patients also may suffer from pancreatic exocrine insufficiency, intestinal obstruction (called meconium ileus in the perinatal period), diabetes, biliary cirrhosis, growth retardation and failure to thrive, dehydration because of excessive salt loss in sweat, and sinusitis. In addition, virtually all males with classical CF exhibit a congenital malformation, bilateral absence of the vas deferens (CBAVD), causing infertility.

Medical Infections In Surgical Patients

Nasotracheal intubation and to a lesser degree orotracheal intubation increase the risk of sinusitis. Lumbar puncture and both spinal and epidural anesthesia carry a small risk of meningitis. Instrumentation of the urinary tract increases the risk of cystitis and pyelonephritis. Patients with hemodialysis access or other implantable or temporary central venous access methods are at risk for bacterial endocarditis. Similarly, patients with preexisting valvular heart disease are at risk for seeding of the valves during invasive procedures. Patients receiving antibiotics, even those receiving only a prophylactic dose, are at risk for Clostridium difficile colitis. Patients receiving blood transfusions have a slight risk of hepatitis or HIV exposure, although transmission by transfusion continues to decrease with technological improvements.

Clinical presentation

Asthma may present acutely or as a chronic pulmonary disease. Symptoms of acute asthma include shortness of breath, chest tightness, wheezing and cough, often productive of clear or slightly colored sputum. When present, chest pain is usually musculoskeletal in origin. Audible wheezing may not be present in mild asthma, but may be elicited by forced expiratory maneuvers. Increased diurnal variations in pulmonary function are often associated with nocturnal exacerbations. Triggers for worsening asthma include cold air exposure, exercise, viral respiratory infections, sinusitis, gastroesophageal reflux, exposure to seasonal or perennial inhalant allergens, and exposure to inhaled irritants such as cigarette smoke. Seasonal variations in asthma severity often correlate with seasonal allergen exposure. Finally, a number of medications, including P adrenergic blockers and nonsteroidal anti-inflammatory agents, as well as sulfite preservatives, may exacerbate asthma in susceptible subjects....

TABLE 712 Causes of Gastroesophageal Reflux Disease

Less obvious presentations of GERD are also well recognized. Pulmonary symptoms, especially asthma exacerbations, and multiple ear nose throat symptoms are well described. GERD is present in many asthmatics, and in some can contribute to exacerbation by aspiration of minute amounts of gastric contents, with subsequent inflammation and bronchospasm, and by esophageal activation of reflex vagal tone, with consequent bronchospasm. Unfortunately, a reliable means for identifying asthmatic patients with GERD who will show an improvement in pulmonary symptoms with anti-reflux therapy has not been demonstrated in the literature.1718 GERD has been implicated in the etiology of dental erosion, vocal cord ulcers and granulomas, laryngitis with hoarseness, chronic sinusitis, and chronic cough. 1920

Table 142 Etiology of epistaxis

Local irritants Cocaine, nasal sprays, cigarette smoke, toxic gases Inflammatory Rhinitis, sinusitis, granulomatous disease Mass lesions Nasal sinus tumors, carotid artery aneurysm Medications Anti-platelet agents, NSAID's, warfarin, heparin Systemic disease Liver renal failure, DIC, thrombocytopenia

Clinical Evaluation and Management

Supratentorial lesions can be classified as either extracerebral or intracerebral. Extracerebral lesions include neoplasms, infections, and trauma-related injuries such as hematomas. Lesions such as neoplasms or abscesses impair consciousness via the mass effect that they exert. Headaches, seizures, motor sensory deficits, and cranial nerve dysfunction, rather than an altered state of consciousness, are usually the initial symptoms of neoplasms. Occassionally, a progressing frontal lobe lesion can produce behavioral changes prior to brain herniation. Subdural empyema, a process secondary to otorhinologic infection, meningitis, or intracerebral abscess, can present as an extracerebral lesion. Initial presentation includes subdued consciousness, sinusitis, headaches, focal skull tenderness, and fever. Further deterioration can lead to language dysfunction, hemiparesis, seizures, and eventual coma.

Focal reactions

In most local reactions, antigen is eliminated after a few hours or a few days, in particular by activated macrophages. When antigen cannot be eliminated, a local chronic inflammation may occur in the form of a granuloma. In that case, any new massive parenteral administration of antigen may provoke a violent focal reaction following interaction of antigen with locally accumulated sensitized lymphocytes this manifests as marked flare-up of the chronic inflammatory process. A historical example of focal reaction is the sudden aggravation of tuberculous lesions following intravenous injection of tuberculin, first attempted by Koch in the treatment of tuberculosis. Such reactions may still occasionally be observed after intradermal injection of too high a concentration of tuberculin. Similar focal reactions, for example in dental granulomas, sinusitis, etc., arc-frequently observed clinically. Flare-up reactions after new parenteral administration of antigen at the site of previous local...

Viral Diseases

Avian influenza virus does not cause a serious health problem, but infected ducks may become carriers and transmit the disease to chickens and turkeys. Ducks grown on range or semi-range are exposed to avian influenza through intermingling with wild waterfowl and other birds that may be carriers. Occasionally, mild sinusitis and sneezing may be observed in affected ducklings. Certain


Most commonly Staphylococcus aureus and Streptococcus pyogenes are the pathogens. Less often and usually associated with underlying chronic disease, immunosuppression, or infection at a particular site, for example periorbital cellulitis with sinusitis, pathogens can include Haemophilus influenzae, Pseudomonas aeruginosa, other Streptococci spp, gram-negative bacilli, Clostridia spp., and other anaerobes.3,4 In a data registry of hospitalized patients in Canada and the USA, 1562 bacterial isolates were identified over 1 year in a wide variety of patients with skin and soft-tissue infections S. aureus accounted for 42-6 of isolates, with 24 being MRSA, P. aeruginosa (11-3 ), Enterococcus spp. (8-1 ), Escherichia coli(7-2 ), Enterobacter spp. (5-2 ), and p-hemolytic streptococci (5-1 ).5 Essentially the same rank was seen in both countries with the exception of Enterococcus spp. which was third in the USA and seventh in Canada.5 If there is a concern with exposure to water, certain...

Preseptal cellulitis

This infection involves tissues anterior to the orbital septum and is sometimes preceded by trauma or sinusitis. Staphylococcus aureus, streptococci and Haemophilus influenzae are the common pathogens. Examination reveals eyelid erythema, swelling, warmth and tenderness, but there is neither proptosis nor restriction in ocular motility. Radiographs or CT scans may show signs of sinusitis or evidence of trauma. Systemic ampicillin combined with penicillinase-resistant antibiotics is the treatment of choice. Surgical treatment is indicated in unresponsive cases or for the treatment of associated sinusitis. While this condition in adults is relatively simple to treat, in infants and young children, this can constitute an emergency. The definition of the orbital septum in these cases is poor and it is not difficult for the infection to track through the septum into the tissues of the orbit. Since the orbit contains many vital structures, infection in this region can cause serious visual...

Prehospital Care

AIRWAY It is important to try to perform a complete neurologic assessment if possible before patients are intubated and sedated. The spine must be kept immobilized while the airway is managed. In general, this is accomplished using orotracheal intubation with in-line cervical stabilization (without distraction force) and cricoid pressure. Nasal intubation can be performed in patients while maintaining spine immobilization, though it is not our preferred method and presents considerable difficulties. Nasal intubation is generally a blind technique. Virtually all patients with potential cervical spine trauma require sedation before nasal intubation can be accomplished but if respirations become substantially depressed, nasotracheal intubation may not be possible. If patients are inadequately prepared they may resist intubation. Motion of an unstable fracture can worsen spinal injury. If patients are over-sedated, they may become hypoxic and lose the ability to protect the airway. Also,...

Plain Films

One of the most useful approaches is to assess symmetry. Consider the right and left sides as mirror images. Are there lucencies or shadows that are unilateral Are the sutures and sinuses symmetrical Look for bony integrity and subcutaneous air. While air fluid levels in the sinuses may occur with acute sinusitis, in the presence of trauma they are nearly pathognomonic for sinus fracture. Clouding of a sinus may be secondary to soft tissue swelling, or due to complete filling of the sinus with blood. When seen in the superior aspect of the maxillary sinus, a soft tissue density may represent herniation of orbital contents through the orbital floor

Dka In Pregnancy

Several physiologic changes in pregnant patients make them more prone to DKA. Maternal fasting serum glucoses are normally lower, which leads to relative insulin deficiency and an increase in baseline free fatty acid levels in the blood. Pregnant patients normally have increased levels of counterregulatory hormones. In addition, the chronic respiratory alkalosis seen in pregnancy leads to decreased bicarbonate levels due to a compensatory renal response resulting in a decrease in buffering capacity. Pregnant patients also have an increased incidence of vomiting and infections (e.g., urinary tract infections, sinusitis, otitis media), which are frequent precipitants of DKA. In addition, DKA is triggered at lower sugar levels in the pregnant population. 6 Maternal acidosis causes fetal acidosis and also decreases uterine blood flow and fetal oxygenation. Maternal hypokalemia can also lead to fetal dysrhythmias and death.

Infectious Disease

Bone infections, osteomyelitis, mostly bacterial infections, reach the bone by a penetrating injury such as a laceration or open fracture, by the bloodstream from a distant site, or by direct extension from an infection such as a soft tissue or dental abscess or a sinus infection. Mastoiditis has been found in Neanderthal, Nubian,

Down Syndrome

Recurrent upper respiratory infections, chronic sinusitis, and chronic middle ear effusions are seen in many young children with Down syndrome. These can be treated using standard protocols but should be referred to an otorhinolaryngologist or pulmonologist when they occur repeatedly. Sleep apnea and obstructive apnea are described but are not generally problems in the emergency setting.

Hyperbaric Oxygen

However, HBO is expensive and logistically cumbersome. It is contraindicated where closed air spaces in the body can cause damage due to expansion upon returning to normal atmospheric pressure, such as sinusitis, otitis media, asthma, and bullous pulmonary disease. Care should be taken with diabetic patients, as hy-poglycemia may be exacerbated by HBO.


Hydrocephalus is present in 70 to 90 percent of children with thoracic or lumbar level defects and in substantial numbers of those with sacral level defects. It is routinely treated with shunt placement early in life. Concerns regarding shunt function are common in patients presenting to the acute care setting. Signs and symptoms of shunt malfunction are lethargy, irritability, nausea, vomiting, visual problems, cognitive changes, neck pain, headache, swelling along the shunt path, or seizure.9 0 Not all symptoms need be present to indicate malfunction of the shunt. The symptomatology is nonspecific and can easily be due to a variety of other problems such as sepsis, urinary tract infection, otitis media, gastroenteritis, sinus infection, or viral syndromes. A number of children with massive constipation and a shunt may complain of similar symptomatology, which resolves when the fecal backup is relieved. Evaluation for shunt malfunction should proceed only after infectious and other...

Viral infections

An ulcerative dermatitis with vesicles, ulcers and crusts of the nasal planum and haired skin of the face. In some cases there may be multifocal areas of ulceration and a generalised distribution. There may be concurrent signs of conjunctivitis, keratitis, ocular discharge and repeated or persistent upper respiratory tract infection with sinusitis. The skin lesions may persist for weeks to months. There is no effective treatment and the condition may resolve spontaneously. Skin biopsy sections can reveal intranuclear inclusion bodies within the necrotic epidermis, with a mixed dermal infiltrate that may include numerous eosinophils, and this can lead to a misdiagnosis of EGC and allergy in some cases. Ultrastructural examination, polymerase chain reaction (PCR) and DNA sequencing (Hargis et ah, 1999) have confirmed the presence of FHV-1.

Sinus Headache

Sinus headache is an often cited complaint of many patients, although the acute headache due to actual sinusitis occurs less frequently than the rate quoted by the advertising media. Acute sinusitis presents with fever, pain triggered by pressure or direct percussion, and headache. Fever is the cardinal sign of this infective process. The pain associated with sinus diseases is a constant, dull ache. If the patient is suffering from acute sinusitis, the headache will typically increase in intensity as the day progresses. To confirm the diagnosis, sinus X-rays or sinus CT should be performed. Treatment consists of antimicrobial therapy and decongestants.

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