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Standard Treatment Guidelines and Essential Drugs List STANDARD TREATMENT GUIDELINES AND ESSENTIAL DRUGS LIST FOR THE MINISTRY OF HEALTH, TONGA- 2007. Standard Treatment Guidelines Tonga 2007 Standard Treatment Guidelines and Essential Drugs List: Ministry of Health. First Edition, 2007 Copyright © 2007, Ministry of Health, Tonga All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, scanned or transmitted in any form without the permission of the copyright owner. Ministry of Health PO Box 59 Nuku’alofa Tonga Phone: 676 23200 Fax: 676 24291 E-mail address: [email protected] Editors: Siale ‘Akau’ola & Siutaka Siua Cover design by: Owen Towle Formatted by: T. Nauna Paongo Printed by: Taulua Press STG 2 Ministry of Health Standard Treatment Guidelines Tonga 2007 TABLE OF CONTENTS 1. FOREWORD: 13 2. ABBREVIATIONS AND ACRONYMS: 14 3. ACKNOWLEDGEMENTS: 17 4. INTRODUCTION: 19 5. ACCIDENT AND EMERGENCY (A&E): 21 5.1. General Approach to A&E 21 5.2. Cardiac Arrest 26 5.3. Other Life Threatening Emergencies 30 5.4. Infectious Diseases 52 5.5. Severe Hypertension 58 5.6. Abdominal Pain 59 5.7. Surgical Problems 60 5.8. Red Eye 66 5.9. Dog Bite 67 6. CARDIOVASCULAR CONDITIONS. 68 6.1. Heart Failure 68 6.2. Myocardial Infarction 72 6.3. Cardiogenic Shock 77 6.4. Acute Coronary Syndrome (ACS) 79 6.5. Cardiac Arrythmias 80 6.6. Cardiac Arrest 87 6.7. Hypertension 89 6.8. Aortic Dissection 93 6.9. Bacterial Endocarditis 96 6.10. Infective Endocarditis Prophylaxis 97 7. CENTRAL NERVOUS SYSTEM (CNS) CONDITIONS 104 7.1 Headache 104 STG 3 Ministry of Health Standard Treatment Guidelines Tonga 2007 7.2 Seizures 107 7.3 Meningitis 108 7.4 Stroke 108 7.5 Involuntary Movement Disorders 110 7.6 Epilepsy 111 8 COMMON EAR, NOSE AND THROAT PROBLEMS. 113 8.1 Ear Disorders 114 8.2 Disorders Of The Nose And Paranasal Sinuses 122 8.3 Disorders Of The Pharynx, Larynx And Neck. 126 9 COMMON EYE CONDITIONS. 132 9.1 Acute Conditions: 132 9.2 Chronic Conditions 137 10 DENTAL AND ORAL CONDITIONS 140 10.1 Paediatric Problems 140 10.2 Infections 141 10.3 Protocol For Painful Tooth/Teeth 145 10.4 Antibiotic Prophylaxis 146 10.5 Bone Problems 146 10.6 Neurological Problems 147 10.7 Ulcers And Other Oral Conditions 148 11 ENDOCRINE CONDITIONS 150 11.1 Diabetes Mellitus: 150 11.2 Thyrotoxicosis 154 11.3 Hypothyroidism 155 11.4 Cushing’s Disease 155 12 FAMILY PLANNING AND CONTRACEPTIONS 157 12.1 The Use Of a Contraceptive Method 157 12.2 Natural Methods 157 STG 4 Ministry of Health Standard Treatment Guidelines Tonga 2007 12.3 Barrier Methods 158 12.4 Oral Contraceptives 158 12.5 Intrauterine Contraceptive Devices 160 12.6 Injectable Contraceptives 161 12.7 Post-coital Emergency Contraception 162 13 GASTRO-INTESTINAL CONDITIONS 163 13.1 Abdominal Pain/Dyspepsia/Heartburn/Indigestion 163 13.2 Haematemesis 164 13.3 Nausea And Vomiting 166 13.4 Acute Diarrhoea (<2 weeks duration) 168 13.5 Constipation 170 13.6 Jaundice 171 13.7 Ascites 172 13.8 Liver Failure 172 13.9 Acute Pancreatitis 174 13.10 Acute Hepatocellular Dysfunction (Hepatitis) 175 14 GYNAECOLOGY AND OBSTETRICS 177 14.1 Obstetrics Conditions 177 14.2 Gynaecology Conditions 187 15 IMMUNISATIONS 192 15.1 Vaccines Given To Children in Tonga 192 15.2 Tetanus Vaccine For Pregnant Women: 193 16 INFECTIONS (SELECTED) AND OTHER RELATED CONDITIONS 194 16.1 Cardiovascular System Infections 194 16.2 Central Nervous System Infections 194 16.3 Dengue Fever 197 16.4 Diabetic Foot Infection 199 16.5 Eye Infections 200 STG 5 Ministry of Health Standard Treatment Guidelines Tonga 2007 16.6 Gastrointestinal Infections 200 16.7 Genital Tract Infections 201 16.8 Leprosy 202 16.9 Malaria 203 16.10 Mycobacterial Infections (Tuberculosis) 204 16.11 Prophylactic Antibiotic Treatment 206 16.12 Respiratory Tract Infections 206 16.13 Skin, Muscle And Bone Infections 206 16.14 Staphylococcal Infections 206 16.15 Streptococcal Infections 207 16.16 Typhoid Fever 207 16.17 Urinary Tract Infections 208 16.18 Worms (Intestinal Helminthes) 210 17 MUSCULOSKELETAL CONDITIONS 211 17.1 Arthritis 211 17.2 Back Pain 215 17.3 Soft Tissue Rheumatism 216 17.4 Bone Diseases 217 18 NUTRITIONAL AND BLOOD CONDITIONS 218 18.1 Nutritional Disorders 218 18.2 Blood Conditions 223 19 PAEDIATRIC CONDITIONS 228 19.1 Common Emergency Conditions In Children. 228 19.2 Problems Of Neonates And Young Infants. 228 19.3. Cough Or Difficulty Breathing 234 19.4. Rheumatic Fever 243 19.5. Diarrhoea. 244 19.6. Common Surgical Problems. 244 20. PSYCHIATRIC CONDITIONS 245 STG 6 Ministry of Health Standard Treatment Guidelines Tonga 2007 20.2. Antidepressants 245 20.3. Antianxiety 246 21. RENAL AND URINARY TRACT CONDITIONS 247 21.1 Glomerulonephritis 247 21.2. Nephrotic Syndrome 247 21.3. Urinary Tract Infection 248 21.4. Calculi 248 21.5. Urinary Tract Obstruction 249 21.6. Benign Prostate Enlargement 250 21.7. Prostate Cancer 250 21.8. Renal Failure 251 21.9. Drugs And The Kidney 252 21.10. Renal Disease In The Elderly 253 22. RESPIRATORY CONDITIONS 255 22.1 Respiratory Failure 255 22.2. Obstructive Sleep Apnoea (OSA) 257 22.3. Chronic Obstructive Pulmonary Disease (COPD) 257 22.4. Oxygen Therapy 262 22.5. Asthma 265 22.6. Community Acquired Pneumonia (CAP) 274 22.7. Hospital Acquired Pneumonia (HAP) 281 22.8. Aspiration Pneumonia 282 22.9. Acute Pulmonary-Renal Syndrome 283 22.10. Pleural Effusion 284 22.11. Pneumothorax 286 23. SKIN CONDITIONS 290 23.1 Skin Infections 290 23.2 Other Skin Disorders ( Diaper Rash, Eczema, Urticaria, Psoriasis, Pemphigous, Vitiligo) 309 STG 7 Ministry of Health Standard Treatment Guidelines Tonga 2007 24 STI (SEXUALLY TRANSMITTED INFECTIONS) 319 24.1 Treatment Options For Common Causes Of Cervicitis And Vaginitis 319 24.2 Treatment Options For Common Causes of Urethritis 321 24.3 Treatment Options For Common Causes Of Genital Ulcer Disease 321 25 SURGICAL CONDITIONS (COMMON) 324 25.1 Surgical Problems In Neonates.: 326 25.2 Surgical Problems In Children 329 25.3 Principals Of Immediate Management Of Trauma 330 25.4 Common Fractures And Dislocations 330 25.5 Head Injury 334 25.6 Spinal Injury 335 25.7 Miscellaneous Surgical Problems (Trauma, burns, wound management, tetanus prophylaxis) 336 25.8 Surgical Antibiotic Prophylaxis 337 25.9 Breast Cancer 340 25.10 Palliative Care 340 26 ESSENTIAL DRUGS LIST 346 26.1 Anaesthetics 347 26.2 Analgesics 350 26.3 Antiallergics & Drugs used in anaphylaxis 352 26.4 Antidotes & Other Substances Used In Poisonings 352 26.5 Anticonvulsants/Antiepileptics 353 26.6 Anti-Infective Drugs 355 26.7 Anti-bacterial, Anti-viral, Anti-fungal And Anti-protozoal. 355 26.8 Antimigraine Drugs 360 26.9 Antineoplastic And Immunosuppressive Drugs 360 26.10 Antiparkinsonism Drugs 361 STG 8 Ministry of Health Standard Treatment Guidelines Tonga 2007 26.11 Antianaemia Drugs 361 26.12 Drugs Affecting Coagulation 362 26.13 Blood Products And Plasma Substitutes 362 26.14 Cardiovascular Drugs 363 26.15 Dermatological Drugs (topical) 366 26.16 Miscellaneous 368 26.17 Diuretics 370 26.18 Gastrointestinal Drugs 370 26.19 Hormones, Other endocrine Drugs And Contraceptives 373 26.20 Immunological Diagnostic Agents 376 26.21 Immunoglobulins And Vaccines 377 26.22 Muscle Relaxants (in anaesthesia) & Anticholinesterase 378 26.23 Ophthalmological Preparations 378 26.24 Oxytocics & Antioxytocics 379 26.25 Psychotherapeutic Drugs 380 26.26 Drugs Acting On The Respiratory Tract 382 26.27 Solutions Correcting Water, Electrolyte And Acid-Base Disturbances Oral 383 26.28 Vitamins And Minerals 385 27 INDEX 386 STG 9 Ministry of Health Standard Treatment Guidelines Tonga 2007 LIST OF TABLES Table 1 Triage Scale..................................................................21 Table 2 Asthma Severity Scale..................................................34 Table 3 Acute poisoning and their antdsotes .............................41 Table 4 Diazepam dosing rates..................................................45 Table 5 Signs and Symptoms of dehydration ............................46 Table 6 Mild dehydration ..........................................................47 Table 7 Moderate dehydration...................................................48 Table 8 Severe dehydration .......................................................48 Table 9 Common causes of food poisoning...............................53 Table 10 Abdominal Pain (Location of pain can help arrive at ...59 Table 11 Levels of hypertension..................................................89 Table 12 Step wise treatment of hypertension:............................91 Table 13 Antibacterial Recommendations for Dental, Oral, Respiratory Tract or Oesophageal Procedures............101 Table 14 Antibacterial Recommendations for Genitourinary Tract and Gastrointestinal Tract (excluding oesophageal) procedures ..................................................................102 Table 15 Types of headache ......................................................104 Table 16 Benign headaches .......................................................104 Table 17 Treatment of Benign Headaches:................................106 Table 18 Management of conjunctivitis ....................................133 Table 19 Signs and symptoms of Iritis ......................................134 Table 20 Prognostic Factors in Acute Pancreatitis ...................175 Table 21 Levels of severity of hypertension in pregnancy .......181 Table 22 Treatment of hypertension in pregnancy....................181 Table 23 Drug treatment of pain in labour................................184 Table 24 Vaccination of children in Tonga
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