Which Cough and cold remedies containing certain ingredients should no longer be used in children under 6 years as the balance of benefits and risk has not been shown to be favourable.
OTC cough and cold medicines containing the following active ingredients are affected by the advice: antitussives (dextromethorphan and pholcodine); expectorants (guaifenesin and ipecacuanha); nasal decongestants (ephedrine, oxymetazoline, phenylephrine, pseudoephedrine, and xylometazoline); and antihistamines (brompheniramine, chlorphenamine, diphenhydramine, doxylamine, promethazine, and triprolidine).
WWHAM
- W ho is it for?
- W hat are the symptoms?
- H ow long have you had the symptoms?
- A ctions already taken?
- M edication?
As Method
- A Age/appearance
- S Self or someone else
- M Medication
- E Extra medicines
- T Time persisting
- H History
- O Other symptoms
- D Danger symptoms
Encore
- E Explore
- N No medication
- C Care
- O Observe
- R Refer
- E Explain
SIT DOWN SIR
- S Site or location of a sign/symptom
- I Intensity or severity
- T Type or nature
- D Duration
- O Onset
- W With (other symptoms)
- N Annoyed or aggravated by
- S Spread or radiation
- I Incidence or frequency
- R Relieved by
Hypothetico-deductive reasoning
• Description: What is the problem?
• Observe: What might a I notice?
• Link to knowledge base: What knowledge do I need?
• Hypothesis: What do these cues tell me and how can I
explain this?
• Implement: What can I do about it?
• Evaluate: Did it work?
Process
- Presenting Complaint
- Consider three or more hypothesis
- Continue History Taking
- Consider the presence of red flags
- Refine the diagnosis
- Take action
- What is the common cause of hayfever?
Allergic rhinitis takes two different forms:
- Seasonal: Symptoms of seasonal allergic rhinitis can occur in spring, summer and early fall. They are usually caused by allergic sensitivity to airborne mold spores or to pollens from grass, trees and weeds.
- Perennial: People with perennial allergic rhinitis experience symptoms year-round. Dust mites, pet hair or mold generally cause it.
- What are the likely durations and frequencies of the coughs described?
Acute cough is defined as being of less than three weeks’ duration. A chronic cough lasts longer than 3 weeks.
- Does sputum (colour) give you any indications towards a potential diagnosis?
- Coughing up white or grey phlegm is often an indication of an upper respiratory tract infection or sinus congestion.
- A thick and dark yellow phlegm may be a sign of a viral or bacterial infection, sinus infection, or lower respiratory tract infection
- People who smoke tend to produce more brown phlegm, which often comes out combined with saliva in a grainy texture.
- Coughing up pink phlegm is an indicator of pulmonary oedema, also known as fluid in the lungs. It can also be a sign of bleeding when seen in small amounts, which show up as a stain or streak.
- Blood found in phlegm is known as haemoptysis. Coughing up a significant amount of blood could also be a sign of tuberculosis, pneumonia or cancer.
- What would you look out for when recommending NRT?
- Oral products can aggravate oesophagitis, and gastric and peptic ulcers, so should be used with caution by these patients.
- Inhalation products should be used with caution in patients with obstructive lung disease, chronic throat disease or disorders that cause bronchospasm.
- Patches can irritate the skin, so should be used with caution by patients with skin complaints and never applied to areas of skin that are broken, red or irritated. They can cause chest pain, sweating, myalgia, arthralgia, palpitations, cardiac arrhythmias and sleep disturbances (although removing patches at night may help).
- How would you counsel a patient interested in using and/or having been prescribed NRT patches?
Ask, Advise, Assess, Assist, and Arrange
