Code of ICD Frequent colds. ORZ - a group of diseases with general symptoms and a similar treatment principle
Acute respiratory viral infections (ARVI) - a group of acute infectious diseases caused by viruses and characterized by the defeat of various respiratory tract departments. ARVI is the most common acute infectious pathology. In most cases, ARVI have a similar clinical picture that makes up of symptoms of general intoxication and respiratory syndrome. Principles of diagnosis, treatment and prevention of distribution infection Common for all ORVIs (with the exception of influenza, which has distinctive features of epidemiology and prophylaxis).
Anamnesis. Intelligence for contact with ORVI patients. An indication of the so-called "cold factor" or episode of hypothermia to the development of basic symptoms of the disease. To date, there is no satisfactory pathogenetic substantiation of this phenomenon, although the relationship between the fact of supercooling and the development of ARVI is no doubt. Perhaps the effects of cold contributes to microbiocenosis disorders (activation of conditionally pathogenic bacterial microflora of the upper respiratory tract, reactivation of latent and chronic viral infection etc.).
Acute Respiratory Virus Infections: Symptoms, Symptoms
Clinical picture
Syndrome of general intoxication: astheno - vegetative disorders (headache, weakness, anorexia, less often vomiting) and an increase in temperature. The duration of the syndrome of general intoxication during ARVI most often does not exceed 5 days. The preserving more than 5-7 days of fever is often associated with the addition of secondary bacterial complications (pneumonia, otitis, sinusitis).
Catarial syndrome: Hyperemia of zea tissues, rhinitis, hyperemia Eye conjunctive and eyelids, including with conjunctivitis phenomena (pharyingsonunctival fever with adenovirus infection), catarrhal tonsillitis (overlap sorens, which is typically only for adenovirus infection).
Respiratory syndrome. Laryngitis. Rough "barking" cough. Hoarseness, witness voices (dysphony). It is possible to develop the obstruction of the upper respiratory tract (croup or stenosis laryngotrachitis): shortness of breath, mainly inspiratory; The severity of the patient's condition in such cases is determined by the severity of respiratory failure. Tracheitis. A frequent "adsady" cough, often accompanied by pains for the sternum. Tracheitis (laryngotracheitis) is characteristic of the two most common orvi - flu and paragrippa. Typical tracheitis, accompanied by general intoxication syndrome, makes it possible to diagnose flu with a high degree of accuracy. Moderate intoxication in combination with laryngotracy in the non-epidemic influenza period is usually associated with paragripping infection. Bronchitis. Dry cough or wet. Auscultative: Hard breath, dry or wet scattered wheezes. It is possible to develop the obstruction of the lower respiratory tract (obstructive bronchitis, bronchiolitis): expiratory shortness of breath, tachipne, noisy, whistling breathing, auscultative - dry whistling and wet solubular wheezes, with percussion - a box shade of sound. The severity of the patient's condition is determined by the severity of respiratory failure.
Limphoproliferative syndrome is characterized by a moderate increase in lymph nodes (cervical, paratraheal, bronchial, rarely - other groups), liver and spleen. Characterized for adenoviral infection.
Hemorrhagic (thrombohemorrhagic) syndrome is mainly due to the damage to the vascular wall and is manifested by increased bleeding (bleeding from mucous membranes), hemorrhagic (phetechial) rash on the skin. Developed only with flu.
Infections Acute Respiratory Virals: Diagnostics
Laboratory research
Virological research. Immunofluorescence method - detection of viral ag in the epithelium of the nasal mucosa using specific at. Detection of serum AT to AG pathogen: serological studies using special diagnosticums in various reactions (RPGA, Ring, ELFA, etc.). Diagnostic value is the fact of increasing the Tutors of AT 4 times.
Complications
Bacterial pneumonia. Purulent otitis, sinusitis. Activation of chronic foci of bacterial infections.Acute Respiratory Virus Infections: Treatment Methods
Treatment
Etiotropic therapy is designed for influenza (Rimantadine, Omeltamivir, anti-hygospose immunoglobulin) and RSV - infection (Ribarin). Antibacterial therapy is shown in the development of bacterial complications (pneumonia, otitis, sinusitis, lymphadenitis). The antibiotic is chosen taking into account the sensitivity of the selected microflora. Symptomatic therapy. Paracetamol and ibuprofen are used to relieve hyperthermic syndrome. With the difficulty of nasal breathing (ritin), vesseloring drugs are prescribed (xylometazoline, napazoline). In the bronchial obstruction syndrome, bronchology preparations (aminoophyllin and b - adrenomimetics) are shown.Prevention
The term of insulation of the patient with flu and other ARVI - 7 days. In case of diseases in children's teams, the contacts are established for 7 days. Contact children of older age for the prevention of influenza is possible the purpose of Rimantadina in 25 mg 2 p / day for 2 to 3 days. In the premises, daily wet cleaning and ventilation 2-3 p / day are needed. During the flu epidemic or when an outbreak of ARVI in a children's institution with a prophylactic goal, IPHN is injected in 5 drops of 3 p / day. Active influenza immunization is carried out inactivated or alive vaccines that are manufactured annually from virus strains recommended by WHO. All vaccines provide short-term type-specific immunity, which requires annual vaccination.MKB-10 . J00 Acute Naphorgitis [Rubber]. J02 Acute pharyngitis. J03 Acute tonsillit [Angina]. J06 sharp infection Upper respiratory tract of multiple and unspecified localization. J10 Influenza, caused by identified influenza virus. J11 Flu, the virus is not identified. J12 Viral pneumonia, not classified in other categories. J20 Acute bronchitis. J21 acute bronchiolitis. J22 Acute respiratory infection of the lower respiratory tract uncomfortable.
For the treatment of ARVI, pathogenetic (antiviral) and symptomatic therapy are carried out. During intoxication, the patient must comply with the bedding, stick to the dairy diet. The use of fluid is prevented by drying the affected mucous membranes of the respiratory tract, helps to reduce the viscosity of sputum and contributes to the speedy removal of toxins.
Amiquin, Arbidol and Amizon are recognized in the most efficient drugs.
Amicizon stimulates interferon products, has an antipyretic effect, relieves inflammatory manifestations. The appointment of amizon is possible from the 6th age. Amaxin, stimulating the production of interferon all types, has a wide spectrum of antiviral action, contributes to the activation of immunity. A direct antiviral action has the arbidol, which can be prescribed from 2 years old.
The so-called group of immunomodulator groups contribute to the activation of immunity. In order to increase the level of lysozyme and interferon, nasal drops of human interferon or referon are prescribed. Children of preschool age are prescribed rectal Viferon Suppositories, which is produced in 4 dosages. Viferon 1 and 2 are used for children, suposory with a larger dosage (Viferon 3 and 4) - in adults. Lizozyme, which is a factor in the defense of Nardu with interferon, is contained in a lesobactic preparation, the use of which is already possible from 6 yedy age.
Hyperthermic syndrome at ARVI requires a relief when the mark is reached above 38.5s. However, if the history was noted fibrils convulsions, even a subfibril temperature should be reduced.
Antipyretic drugs should be used very carefully. Uncontrolled self-treatment with NSAIDs is fraught with the development of complications. For example, the appointment of aspirin in children is not recommended at all due to the risk of developing the syndrome, dangerous by the high level of mortality. The drugs of the analgin can coagulate blood-forming sprouts up to the development of agranulocytosis. Therefore, it is better to use nimesulide derivatives - Naz, Nimille and others. Paracetamol preparations can be used from 3-hover age, one-time dose up to 15 mg / kg, and daily - up to 60 mg / kg. Paracetamol overdose is fraught with the lesion of the liver, so it is necessary to monitor the daily dose of paracetamol in all used preparations.
Development Rubbly makes nasal breathing. Preparations that improve nose respiration by narrowing vessels are called decongestants. Forms of reception of decongestants are different - these are sprays, aerosols or drugs for oral administration. Nasal decontantages are not recommended to take more than 5 days, since with a longer reception they can strengthen the runny nose. Widespread applications found drugs Nafazolin, oxymetomazone, phenylephrine and the composition of nasal sprays may include essential oils (preparations Pinosol, Equazoline and others).
For children and adults, the use of moisturizing the mucous membrane of the nose seawater is shown. Release already ready-made sterile solutions - Aqua Maurice, Hümer. The trace elements included in its composition contribute to the improvement of nasal respiration.
Dry or productive cough with ORVI is an indication for the use of musolithic preparations. To this end, they are used as phytopreparations (aim, licorice, thyme, ivy, alta, oregano, and) and synthetic flourities (ADC, ambroxol, bromgexin and).
In the soreness in the throat, it is often necessary to rinse with a solution of furaticiline in dilution of 1: 5000.
Acute respiratory diseases (ORZ) - a group of diseases characterized by the defeat of various departments of the respiratory tract, a short incubation period, short fever and intoxication. Acute respiratory diseases include both ARVI and diseases caused by bacteria.
Synonyms
Acute respiratory infections, ORVI, cold
Code of the ICD-10
J06.9 Acute infection of the upper respiratory tract uncomfortable.
J02.0 streptococcal pharyngitis.
J20 Acute bronchitis.
O99.5 respiratory diseases complicating pregnancy, childbirth and postpartum period.
EPIDEMIOLOGY
ORZ - widespread diseases, they constitute about 90% of all infectious pathology. During pregnancy, ORZ is observed in 2-9% of patients. The source of infection is a sick person. Infection occurs with airborne droplets. Diseases often occur in the form of epidemics. In moderate latitudes, the peak of morbidity occurs from the end of December to the beginning of March. The disease is easily distributed in various institutions, places of increased accumulation of people.
Preventive Pregnancy Pregnancy
General measures of prevention include the maximum restriction of communication with outsiders, unfamiliar people during the increased morbidity, reception of vitamins. Among the specific prevention measures, vaccinations (flupes) are of particular importance. Reception of various antiviral drugs (Amantadine, Rimantadine, Olemetamivir, Acyclovir, Ribavirin). It should be noted that at present, from the point of view of evidence-based medicine, the effectiveness of such antiviral tools, asin, tetrabrometrahydroxidiphenyl, interferon-a2 in the form of nasal applications is not confirmed.
ORZ classification
ORZ is classified for etiological attribute. These include both viral infections and diseases caused by bacteria. Influenza, paragripp, adenoviral, respiratory and sycitial, rinoviral and repurring infections are greatest importance.
Etiology (reasons) ac
The pathogens include various types of viruses, less often bacterial infection. Among viruses, rhinoviruses, coronairuses, adenoviruses, influenza virus and paragrippa are most common. Among bacterial pathogens are the greatest value of streptococci. Mycoplasma, chlamydia, gonococci are also celebrated.
PATHOGENESIS
The gate of infection - the mucous membranes of the respiratory tract. The pathogen, falling into the upper respiratory tract, penetrates the cylindrical cylindrical epithelium, where its active reproduction occurs, which leads to damage to cells and the inflammatory response. With severe forms of disease (flu), all departments of airways can be involved right up to the Alvetol with the development of complications in the form of acute bronchitis, sinusitis, otitis, pneumonia.
Pathogenesis of complications of gestation
The acute infectious process in the first trimester of pregnancy has a direct toxic effect on the fruit until his death. In some cases, there is infection of the placenta with the development of further placental insufficiency, the formation of the SIR and the intrauterine infectious pathology of the fetus.
Clinical picture (symptoms) ARZ during pregnancy
The incubation period lasts from several hours to two days. The disease has a sharp start: an increase in temperature to 38-40 ° C, chills, pronounced general intoxication (headache, weakness, pain in the muscles of the hands, legs, lower back, pain in the eyes, photophobia, adamina). Circle, nausea, vomiting may occur. The fever lasts 3-5 days, the decrease in temperature occurs critically, with an abundant sweating. Later there may be more or less long subfebristitet. When inspection, there is hyperemia of the face, neck, zea, the injection of spool vessels, sweating, bradycardia. Language is covered. When studying blood, leukopenia and neutropenia are detected. In the fevering period, protein, red blood cells, cylinders may appear in the urine. Catarial influenza syndrome is expressed by pharyngitis, rhinitis, laryngitis, especially characteristic of tracheitis. When rinovius, adenovirus infection, the incubation period lasts longer and may continue the week or more. Incication is expressed moderately. Temperature of the body may remain normal or subfebrile. Leading syndrome - catarrhal; It is manifested in the form of rhinitis, conjunctivitis, pharyngitis, laryngitis with the advent of dry cough.
Complications of gestation
The formation of developmental defects are noted (when infected in the first trimester of pregnancy - from 1 to 10%), the threat of abortion of pregnancy in 25-50% of cases, intrauterine infection of the fetus, placental insufficiency with the formation of a delay of intrauterine development and chronic fetal hypoxia. Possible detachment of the placenta in 3.2% of cases.
ARZ diagnosis during pregnancy
ANAMNESIS
When collecting anamnesis, it is paid to possible contacts with patients, exposure to frequent colds.
Physical examination
Physical examination is of particular importance in the diagnosis of OSZ complications. Attentive auscultation makes timely suspection and diagnose the development of acute bronchitis, pneumonia.
LABORATORY RESEARCH
During the period of epidemic outbreaks, the diagnosis does not represent difficulties, while sporadic cases of the disease (flu, adenovirus infection) require laboratory confirmation. Investigation of smears from the zea and nose using the ELISA. The serological method (retrospective) allows you to determine the increase in the Tutor AT to the virus in dynamics in 5-7 days. Clinical blood test (leukopenia or leukocytosis with moderate roded shift, soe may be normal). For timely diagnosis of complications, the determination is shown at a period of 17-20 weeks of pregnancy of AFP, B-HCH. Study in the blood of the hormones of the fetoplacentar complex (estrilla, pl, progesterone, cortisol) is carried out on from 24 and 32 weeks.
Instrumental research
In the case of suspicion of the development of OSZ complications (sinusitis, pneumonia) to clarify the diagnosis on life indications, an x-ray study is possible.
Differential diagnosis
Differential diagnosis is carried out between different types of OSZ (influenza, adenoviral, respiratory and sycitial infection), sharp bronchitis and other acute infections (measles, rubella, scaryttern).
Indications for consultation of other specialists
It is shown in severe the course of the disease with pronounced signs of intoxication, with the development of complications in the form of bronchitis, sinusitis, pneumonia, otita, etc.
An example of the formulation of diagnosis
Pregnancy 33 weeks. ORVI. The threat of premature births.
Treatment of ORZ (cold, influenza) in pregnant women
Prevention and forecasting of the complications of gestation
Includes timely treatment of the infectious process.
Features of treating complications of gestation
Treatment of complications of gestation in trimesters
I trimester: symptomatic treatment of ARVI. In the future, careful observation of the development of pregnancy, the formation and growth of the fetus. When developing complications of ARVI (pneumonia, Otitis, sinusitis) use pathogenetic antibacterial, anti-inflammatory and immunostimulating therapy. In the influenza, the interruption of pregnancy is carried out due to a high (10%) risk of developmental anomalies.
II and III trimesters: therapy using interferonov (other antiviral drugs are prohibited during pregnancy). In a bacterial infection, antibiotics are used, taking into account the possible harmful effect on the fruit. If necessary, treat the threat of pregnancy interruption, placental insufficiency according to generally accepted schemes. In the detection of signs of intrauterine infection, an immunoglobulin of a person is intravenously administered in a day three times, followed by the purpose of interferon (interferon-A2) in the form of rectal candles of 500 thousand meters a day every day for 10 days, then 10 candles 500 Through thousand meters a day twice a week.
Treatment of complications in childbirth and postpartum period
In childbirth, careful anesthesia is shown to prevent generic anomalies and bleeding.
Prevention of fetal hypoxia, treatment of native anomalies is carried out by generally accepted methods. In the postpartum period in the first day, the parental should be assigned uterotonic drugs, conduct preventive antibiotic therapy
Evaluation of the effectiveness of treatment
They are carried out according to the results of the blood test on the hormones of the fetoplacentar complex, ultrasound and CTG data.
Selection of the term and method of the delivery
Rhodework in the acute period is associated with a high risk of native anomalies, bleeding, as well as postpartum purulent-septic complications. In connection with this, along with antiviral and antibacterial therapy, during this period, treatment is carried out to improve the function of the fetoplacementary complex and pregnancy prolongation. Rhodeworgation should be carried out after subscribing signs of acute infectious process. Preferably consider the delivery to the natural generic paths.
Information for the patient
When IVI, the patient is infected for 5-7 days from the beginning of the disease. In the event of an ARVI, a physician consultation is required due to the high risk of complications of both pregnant and the fetus.
Modern methods of treatment of ARVI, ORZ, rhinitis, noodopharyngitisStandards of treatment of ARVI, ORZ, rhinitis, noodopharyngitis
The protocols of treatment of ARVI, ORZ, rhinitis, noodopharyngitis
ORVI, ORZ, rhinitis, Noodopharyngitis
Profile: therapeutic
Stage: Polyclinic (outpatient).
Purpose of the stage: reduce the severity of symptoms; Prevent the development of purulent and ungunny complications in a bacterial infection, minimizing the frequency of development of side effects of treatment.
Duration of treatment:
ORVI - on average 6 - 8 days.
ORZ - 3 - 5 days.
Rinith - 5 - 7 days.
Naphorgitis - 5 - 7 days (depending on the shape, gravity and complications).
ICD codes:
J10 flu caused by identified influenza virus
J11 influenza, virus is not identified
J06 Acute infections of the upper respiratory tract of multiple and unspecified localization
J00 Acute Naphorgitis (Rubber)
J06.8 Other acute infections of the upper respiratory tract of multiple localization J04 Acute laryngitis and tracheitis.
Definition:
ARVI - Infectious diseases of the upper respiratory tract caused by viruses are characterized by inflammation of the mucous membrane, which can spread from the nasal cavity to the lower parties of the respiratory system, with the exception of the alveol. In addition to general ailments, local symptoms characteristic of various syndromes occur: pain in the throat (pharyngitis), a runny nose (typical cold), a nasal congestion, a sense of pressure and pain in the face (sinusitis), cough (bronchitis). The causative agents of these diseases include viruses of more than 200 species (including 100 varieties of rhinoviruses) and bacteria of several species.
Orz- acute respiratory disease.
Rhinitis - Inflammation of the mucous membrane of the nose.
Acute rhinitis is an acute catarrhal inflammation of the mucous membrane of the nose, accompanied by sneezing, tearing and abundant secretion of water mucus, usually caused by the virus.
Allergic rhinitis - rhinitis associated with hay fever (pollinosis). Atrophic rhinitis is chronic rhinitis with the thinning of the mucous membrane of the nose, often accompanied by the formation of crusts and ill-smelling discharges.
Caseous rhinitis is chronic rhinitis, characterized by filling the cavities of the nose of bad smelling, similar to cheese, substance.
Eosinophilic non-allergic rhinitis - nasal mucosa hyperplasia with an increased eosinophil content, not bound by contact with a specific allergen.
Hypertrophic rhinitis - chronic rhinitis with mucous membrane hypertrophy. Film rhinitis is chronic inflammation of the nasal mucosa, accompanied by the formation of fibrinic crusts.
Purulent rhinitis - chronic rhinitis with abundant purulent separated.
Vasomotor rhinitis is swelling the nasal mucosa without infection or allergies.
NazoFaringitis- Inflammation of the mucous membrane of the region of the Hoang region and the upper pharynx. An unpleasant sensation in the nasopharynk (burning, tingling, dryness), head in the back of the head, hindered nasal breathing, bellows, the accumulation of the mucous membrane is discharged, which sometimes acquires a blood stitch and is difficult to leave the nasopharynx.
In adults, nucleargite occurs without increasing body temperature.
It is divided into acute, chronic and nonspecific napodargites (with diphtheria, meningitis).
Research on diphtheria stick and staphylococci (strokes from zea and nose) are needed.
Classification:
ARVI
1. On etiology more often than other pathogens adenoviruses, respiratory - sycitial
viruses, rhinoviruses, coronaviruses, flu virus, paragrippa.
2. According to the peculiarities of the lesions of organs and complications (otitis, laryngitis, pneumonia, meningitis, etc.).
3. By severity of the patient's condition.
ARZ is divided into two groups: viral and bacterial-mixed etiology.
1 group - ORVI.
2 Group - Bacterial and secondary viral-bacterial inflammation of the upper respiratory tract.
Risk factors:
Supercooling, smoking, contact with patients, the presence of witnessed in the nearest environment (at work, at home) The flu epidemic and other viruses, preferably autumn-winter seasonality, adverse living conditions (recurrence, antisanitation, etc.) The impact of adverse weather correlators, dust, Gas, pollen of various plants, stagnant hyperemia of the mucous membrane of the nasal cavity during alcoholism, chronic heart disease, vessels, kidneys.
For ORZ:
1. Differences of chronic infection foci (tonsillitis, rinofaring, bronchitis).
2. Walled factors (cooling, drafts, industrial shoes, clothing).
For vasomotor rhinitis: a changed reactivity of the body, functional shifts in the endocrine, CNS and the vegetative nervous system.
Diagnostic criteria:
Signs of acute infectious damage are predominantly upper and, to a lesser extent, the lower respiratory tract in the absence of a sealing syndrome of pulmonary parenchyma and leukocytosis in peripheral blood.
Flu:
- characteristic epidanamnez;
-oled sudden start;
- Processing of the signs of a generalized infectious process (high fever, pronounced intoxication) with a relatively lower severity of the catarrhal syndrome;
- Complaints for pronounced headaches, especially in the frontal-temporal area, abnormal arcs, retroorbital pains, intense muscular pain in the back, limbs, sweating;
- Catarial syndrome preferential signs of rhinitis, tracheitis (nasal congestion, passing), "viral zev";
-Fast evolution of catarrhal syndrome from the virus phase (blockade of nasal respiration, dry cough, hyperemia and small grain of the ocehole mucous membrane) to viralobacterial.
Paragripp:
- incubation is more often 2-4 days;
- seasonality - the end of winter, the beginning of the spring;
- the beginning of the disease can be gradual;
- the flow of sluggish, in adults is not important with a relatively greater circumstancy of the disease;
- the temperature reaction more often does not exceed 38 ° C
- the manifestations of intoxication are weakly expressed;
- Catarial syndrome arises early. Characterized by hoarseness of voice, stubborn dry cough.
Respiratory infection:
- establishment of group morbidity in groups, family foci;
- Incubation 2-4 days;
- seasonality predominantly winter-spring;
- the beginning of the disease is acute;
- leading symptom complex - intensive rhinitis;
- Sometimes the signs of laryngotracy are developing (voices, unproductive cough);
- the temperature response is not constant, intoxication is expressed moderately;
"The study is more likely, the duration of the disease is 1-3 days.
Adenovirus infection:
- establishment of group morbidity, epidemic focus;
- incubation 5-8 days
- preferential season - summer - autumn period;
- the possibility of infection not only by air - drip, but also by the fecal-oral way;
- the beginning of the disease is acute;
- Characterized by the combination of exudative inflammation of the mucous membranes of the rotogling, trachea;
- the main symptom complex - the pharyingokonuctivinal fever;
- the manifestations of intoxication are more often moderate,
- Characteristic of the bright hyperemia of the language with the development of acute tonsillitis
- the possibility of diarrhea (in young children), increasing the spleen, less often liver;
- Current more often, can be delayed up to 7-10 days.
Respiratory - Syncitial infection:
- refer to high-flowangiomic ARVI; establishment of group morbidity, epidemic foci;
- the duration of incubation is 3-6 days;
- seasonality of the cold season;
- in adults proceeds easily, with a gradual start, low-heated manifestations of intoxication, subfebrile temperature, non-terrified signs of tracheobronchitis;
- characterized by a stubborn cough, first dry, then productive, often parole;
- pronounced manifestations of respiratory failure
- often complicated by viral-bacterial pneumonia.
Rinovirus infection:
- establishment of group morbidity;
- incubation of 1-3 days;
- seasonality - autumn-winter;
- Start sharp, sudden;
- Lightweight
- temperature reaction;
- The leading manifestation with abundant serous, in the further mucous membrane detachable.
Characteristic: sore throat, runny nose, nasal congestion, feeling of pressure and pain in the face of the face, cough.
In the case of acute viral rhinitis, there is ailments, fatigue; sneezing; A slight increase in temperature and less frequently - headache, hoarseness.
During the first night, mucous membranes from the nose are noted, then purulent.
List of major diagnostic activities:
1. Collecting anamnesis (characteristic epidanamneus, contact with patients, etc.)
2. An objective examination (inspection data).
Tactics of treatment:
Treatment of patients with light and moderate severity is carried out at home. Patients are isolated at home. Careful faces should enjoy gauze masks.
Non-drug treatment facilities are to use various thermal procedures: steam inhalations, hot foot and shared baths, warming up in a bath and sauna, warm shutting and abundant hot drink - tea, hot milk with soda and
honey, warm fruit juices.
Medical treatment is most effective as a prophylactic agent, antiviral drugs during the fever prescribed remantadine 0.3 g in 1st \\ day, 0.2 g per 2nd and 0.1 g in the following days, interferon alpha 2 A, beta 1 , alpha 2 in the form of powders for inhalation and instillation in nasal moves, oxoline ointment 0.25% in nasal moves and eyelids 3-4 times a day, with a temperature: prescribe the most secure paracetamol 500 mg 2-3 times a day to 4 For days, acetylsalicylic acid - 500mg 2-3 times a day to 3 days.
Abundant warm drink.
Treatment of adult antibiotics with non-specific infection of the upper respiratory tract does not speed up recovery and is not recommended.
With acute viral ritin, the rest is shown.
Paracetamol is prescribed, 0.5-1 g inside every 4-6 hours, but not more than 4 days, or aspirin, 0.325-1 g inside every 4-6 hours, but not more than 4 g / day.
With a thrust dry cough, a mixture of cough ambroxol is prescribed by 0.03g 333 mg / 5 ml syrup, 3 mg / 5 ml. In the first 2-3 days 10 ml 3 times a day, then 5 ml 3 times a day.
With throat pain - rinse with diluted lemon juice, antiseptic solutions, herbs champs in warm form.
Askorbinic acid is prescribed, 2 g / day inside in powders or tablets.
In atrophically, the frequent washing of the nasal cavity is recommended by saline, drops with vitamin A for injection into the nasal cavity; 3 times a day in severe cases of retinol acetate 1-2 dragee in 2 days, vitamin A is prescribed inside courses for 1 month 2-3 times a year, the possibility of antibacterial therapy on the basis of bacteriological surveys should be taken into account.
List of basic medicines:
Antiviral drugs
1. Rimantadine 0.3-0.2 -0.1 g Table
2. Oxoline ointment, 0.25%.
Nonarcotic analgesics and nonsteroidal anti-inflammatory drugs
3. Paracetamol 200 mg, 500 mg, Table.
4. Acetylsalicylic acid 100 mg, 250 mg, 325 mg, 500 mg, table.
Mulitatic drugs
5. Ambroxol 30 mg, Table.
Vitamins
6. Ascorbic acid 50 mg, 100 mg, 500 mg, table.
7. Retinol acetate 114 mg, dragee.
With complications (pneumonia):
1. Amoxicillin 500 mg, Table, oral suspension 250 mg / 5 ml
2. Amoxicillin - clavulanic acid 625 mg, table.
Translation criteria for the next stage of treatment:
Transfer to the stationary stage of treatment with hyperstoxic form of the ARVI, the presence of complications, the ineffectiveness of the treatment conducted, a burdened by a premorbid background, accompanying chronic diseases.
Approved
Union of Pediatricians of Russia
Clinical recommendations
Acute respiratory viral
iNFECTION (ARVI) in children
МКБ 10:
J00 / J02.9 / j04.0 / j04.1 / j04.2 / j06.0 / j06.9
Year of approval (revision frequency):
2016 (
revision every 3 years)
ID:
URL:
Professional associations:
Union of Pediatricians of Russia
Agreed
Scientific Council of the Ministry
Health of the Russian Federation
__ __________201_
2
Table of contents
Keywords................................................ .................................................. ...................... 3.
List of abbreviations ................................................ .................................................. ................ 4 1. Brief information ............................... .................................................. .............................. 6 1.1 Definition ................. .................................................. ................................................. 6. 1.2 etiology and pathogenesis .............................................. .................................................. ..... 6 1.3 Epidemiology .......................................... .................................................. .................... 6 1.4 coding on the ICD-10 ....................... .................................................. ............................ 7 1.5
Classification................................................. .................................................. ................. 7 1.6 Examples of diagnoses ............................. .................................................. .......................... 7 2.
Diagnostics................................................. .................................................. ....................... 8 2.1 Complaints, anamnesis ...................... .................................................. ..................................... 8 2.2 Physical examination ......... .................................................. .................................. 9 2.3 Lab diagnostics ............ .................................................. ................................ 9 2.4
Instrumental diagnostics .................................................. .................................... 10 3. Treatment .......... .................................................. .................................................. .................. 11 3.1 Conservative treatment ............................ .................................................. ................. 11 3.2 Surgical treatment ................................... .................................................. .................. 16 4. Rehabilitation ............................ .................................................. ......................................... 16 5. Prevention and dispensary observation .. .................................................. .................. 16 6. Additional information affecting the course of the course of the disease .................... . 18 6.1 Complications .............................................. .................................................. ................... 18 6.2 Maintenance children ............................................................. .................................................. ............. 18 6.3.
Outcomes and forecast ............................................... .................................................. ......... nineteen
Criteria for assessing the quality of medical care ............................................... ................... twenty
Bibliography................................................ .................................................. ............... 21.
Appendix A1. Composition of the working group ................................................. ............................ 25.
Appendix A2. Methodology for the development of clinical recommendations .......................... 26
Appendix A3. Related Documents ................................................ ............................. 28.
Appendix B. Algorithms of patient maintenance .............................................. ....................... 29
Appendix B. Information for patients ............................................ .......................... thirty
Appendix G. Decoding Notes ............................................. ........................... 33.
3
Keywords
acute infection of the upper respiratory tract uncomfortable;
acute respiratory infection;
acute infections of the upper respiratory tract of multiple and unspecified localization;
acute laryngitis and tracheitis;
acute laryngitis;
acute laryngotracheit;
acute laryngoparingitis;
acute nationopharygitis (runny nose);
acute tracheitis;
acute pharyngitis uncomfortable;
acute pharyngitis.
4
List of abbreviations
Il -interleukin
ORVI -acute respiratory viral infection
5
Terms and Definitions
The concept of "acute respiratory viral infection (ARVI)" - summarizes the following nosological forms: acute nationopharygitis, acute pharyngitis, acute laryngitis, acute tracheitis, acute laryngoparing, acute infection of the upper respiratory tract uncomfortable. New and narrow-proof professional terms in these clinical guidelines are not used.
6
1. Brief information
1.1
Definition
Acute respiratory viral infection (ORVI) - acute, in most cases, self-limiting respiratory tract infection, manifested by catarrhal inflammation of the upper respiratory tract and flowing with fever, rhinar, sneezing, cough, sore throat, violation of the overall state of different severity.
1.2
Etiology and pathogenesis
The causative agents of diseases of the respiratory tract are viruses.
The spread of viruses occurs most often by self-intoulation on the mucous membrane of the nose or the conjunctival from the hands contaminated during contact with the patient
Another path is the air-droplege - when inhaling the aerosol particles containing the virus, or when larger droplets on the mucous membranes in close contact with the patient.
Incubation period of most viral diseases - from 2 to 7 days.
Selection of viruses in patients maximally on the 3rd day after infection, dramatically decreases to the 5th day; Non-intensive selection of the virus can be maintained up to 2 weeks.
Viral infections are characterized by the development of catarrhal inflammation.
ORVI symptoms are the result not so much damaging influence of the virus, how much reaction system of congenital immunity. The affected epithelium cells are isolated cytokines, incl. Interleukin 8 (Il 8), the amount of which correlates both with the degree of attracting phagocytes to the submucosal layer and epithelium and the severity of symptoms. An increase in nasal secretion is associated with an increase in vessel permeability, the number of leukocytes in it can increase repeatedly, changing its color with transparent on white and yellow or greenish, i.e. Change the change in the color of the nasal mucus with a sign of bacterial infection is unfounded.
Installation that, in any viral infection, a bacterial flora is activated (the so-called "viral-bacterial etiology
Ori "on the basis of, for example, the presence of the patient leukocytosis) is not confirmed by the practice. Bacterial complications of ARVI arise relatively rarely.
1.3
Epidemiology
7
ARVI - the most common person infection: children under the age of 5 are transferred, on average, 6-8 Episodes of ARVI per year, in children's preschool institutions, the incidence of 1-2 months is especially high, 10-15% higher than Inorganized children, however, in school the latter are more often sick. The incidence of acute infections of the upper respiratory tract can differ significantly in different years. The incidence is highest in the period from September to April, the peak of morbidity falls on February-March. The recession of the incidence of acute infections of the upper respiratory tract is consistently registered in the summer months, when it is reduced by 3-5 times. According to the Ministry of Health of Russia and Rospotrebnadzor in 2015, it amounted to 20.6 thousand cases of diseases per 100 thousand people (against 19,5 thousand on
100 thousand population in 2014). The absolute number of diseases with acute infections of the upper respiratory tract in the Russian Federation amounted to 30.1 million cases in 2015.
Among children from 0 to 14 years, the incidence of sharp infections of the upper respiratory tract in 2014. amounted to 81.3 thousand. per 100 thousand or 19559.8 thousand registered cases.
1.4
Coding on the ICD-10
Acute Natural Facre (J00) (J00)
Acute pharyngitis (j02)
J02.9 -
A sharp pharyngitis is uncomfortable
Acute laryngitis and tracheitis (j04)
J04.0 -
Acute laryngit
J04.1 -
Acute tracheitis
J04.2 -
Acute laryngotrachiteitis
Acute infections of the upper respiratory tract multiple and
uncomfortable Localization (J06)
J06.0 -
Acute laryngoparing
J06.9 -
Acute infection of the upper respiratory tract uncomplicated
1.5
Classification
The division of ARVI (Naphorgitis, Farrygita, Laringhotragte without stenosis of larynx) by severity is not advisable.
1
.6 examples of diagnoses
Acute nationopharygitis, acute conjunctivitis.
Acute laryngitis.
If the etiological role of the viral agent is confirmed, the clarification is made to the diagnosis.
8
As a diagnosis, the term "ORVI" should be avoided using the terms
«
acute Noodopharyngitis"Or" acute laryngit ", or" acute pharyngitis ", since Larygitis (cd), tonsillitis, bronchitis, bronchiolitis, which should also be indicated in the diagnosis, also cause pathogens. Details These syndromes are considered separately
(See clinical recommendations for children with acute tonsillitis, acute bronchitis and stenzing laryngotracy).
2. Diagnostics
2.1
Complaints, anamnesis
Patient or parents (legal representatives) may complain about
arising rhinitis and / or cough and / or hyperemia conjunctiva (catarrhal
conjunctivitis) in combination with phenomena of rhinitis, pharyngitis.
The disease usually begins acutely, often accompanied by increasing
temperatures of the body to subfebrile numbers (37.5 ° C-38.0 ° C). Febrile fever
more peculiar to influenza, adenoviral infection, enterovirus infections.
Increased temperature in 82% of patients decreases on the 2-3rd day of the disease; more
for a long time (up to 5-7 days), the febrile is kept in flu and adenoviral infection.
Rising the level of fever during the disease, symptoms of bacterial
intoxication in the child must be alarmed with respect to joining
bacterial infection. Re-climbing temperature after short
improvements often happens when developing acute average otitis on the background
long runny nose.
For NazoFaringitis, the complaints are characterized by nasal congestion, allocations from
nasal moves, unpleasant sensations in the nasopharynx: burning, tingling, dryness,
often cluster of the mucous membrane discharge, which in children, staining along the rear wall
things, can cause a productive cough.
When spreading inflammation on the mucous membrane of auditory pipes
(
eustheitim) appears skulling, noise and pain in the ears, it may decrease the ear.
Age features of the course of Naphorgitis: in infants - fever,
separated from nasal moves, sometimes anxiety, difficulties in feeding and
fall asleep. Elder children typical manifestations are symptoms of rhinitis (peak
on the 3rd day, duration up to 6-7 days), in 1/3-1 / 2 patients - sneezing and / or cough (peak in 1-
y day, average duration - 6-8 days), less often - headache (20% in 1st and 15% - until the 4th
day).
Symptom, allowing to diagnose laryngitis, is instilling
9
vote. At the same time there is no difficulty breathing, other signs of stained stenosis.
With pharyngitis, hyperemia and the ethomation of the rear wall of the pharynx, its
the graininess caused by hyperplasia of lymphoid follicles. On the back wall of the throat
there may be a noticeable small amount of mucus (catarrhal pharyngitis),
faringitis is also characterized by an unproductive, often obsessive cough. This
the symptom causes the extreme concern of parents, delivers unpleasant feelings.
child because the cough can be very frequent. Such cough is not amenable
treatment
armored carriers
mukolithics
inhalation
glucocorticosteroids.
Larygitis, laryngotracy is characterized by a rough cough, witness voice. For
trachey cough can be obsessive, frequent, exhausting the patient. Unlike
from the cereal syndrome (obstructive laryngotracy), the phenomena of the stenosis of the larynx
notes, there is no respiratory failure.
On average, ORVI symptoms can last up to 10-14 days.
2.2 Physical examination
The general inspection involves assessing the general condition, physical development.
child, counting the frequency of breathing, heart cuts, inspection of the upper
respiratory tract and zea, inspection, palpation and peracutia of the chest,
auscultation of the lungs, palpation of the abdomen.
2.3
Laboratory diagnostics
Survey of the patient with ORVI intends to identify bacterial foci, not
determined by clinical methods.
Routine virological and / or bacteriological examination of all patients is not recommended, since This does not affect the choice of treatment, the exception is an express test for influenza in highly fevering children and an express test for Streptococcus in suspected acute streptococcal tonsillitis.
Clinical urine analysis (incl. Using test strips in outpatient conditions) It is recommended to carry out all fevering children without catarrhal phenomena.
(
Comments: 5-10% of breast and early children with urinary infection
the paths also have a viral co-infection with clinical signs of ARVI.
However, the study of urine in children with noodopalitis or laryngitis without
10
fever is carried out only if there are complaints or special recommendations in connection
with the accompanying pathology of the urinary system.
Clinical analysis of blood is recommended for conducting common symptoms in children with fever.
Comments: Increasing the level of markers of bacterial inflammation is
the reason for finding a bacterial focus, first of all, "dumb" pneumonia,
acute medium otitis, urinary tract infection. Repeated
clinical blood tests and urine are needed only in case of detection
deviations from the norm during the primary examination or the appearance of new
symptoms requiring diagnostic search. If symptoms are viral
infections were stopped, the child stopped fevering and has a good
well-being
repeated
study
clinical
analysis
blood
it is impractical.
Features of laboratory indicators for some virus infections
Leukopenia characteristic of flu and enterovirus infections usually
none with other ORVI.
For PC-viral infection, lymphocytic leukocytosis is characteristic, which
may exceed 15 x 10
9
/ l.
When adenovirus infection, leukocytosis can reach the level of 15-20 x ∙ 10
9
/ L.
and even higher, with neutropylis more than 10 x 10 are possible
9
/
l, raising
the level of C-jet protein is above 30 mg / l.
Determining the level of C - reactive protein is recommended for eliminating severe bacterial infection in children with febrile fever
(temperature rise above 38ºС), especially in the absence of visible focus of infection.
(
Comments:Increased above 30-40 mg / l more characteristic of
bacterial infections (probability above 85%).
2.4
Instrumental diagnostics
Recommended to all patients with ORVI symptoms to spend the opposite.
(
Power recommendation 2; The level of reliability of evidence is C).
Comments: The otoscopy should be part of the routine pediatric
examination of each patient, along with auscultation, percussion, etc.
11
Radiography of the chest organs is not recommended for each child with SMI symptoms
(
Power recommendation 1; The level of reliability of evidence is C).
Comments:
Indications for the radiography of the chest organs are:
-
the emergence of physical symptoms of pneumonia (see PKR on pneumonia
children)
-
reduced Spo.
2
less than 95% with smooth air
-
the presence of pronounced symptoms of bacterial intoxication: the child is sluggish and
salt, unavailable eye contact, sharply expressed anxiety, refusal
from drink, hyperesthesia
-
high level of markers of bacterial inflammation: promotion in general
leukocyte blood analysis of more than 15 x 10
9
/ l in combination with neutropilose more than 10 x
10
9
/ l, the level of C-jet protein is above 30 mg / l in the absence of a focus
bacterial infection.
It should be remembered that the detection of light enhancement on the radiograph
bronchomicious drawing, expansion of the shadow of the roots of the lungs, increase
airiness is not enough to establish the diagnosis of pneumonia and not
are an indication for antibacterial therapy.
Radiography of the incomplete sinuses are not recommended for patients with acute Natural Farnish in the first 10-12 days of the disease.
(Power of recommendation 2; The level of reliability of evidence is C).
Comments: conducting radiography of the incomplete sinuses in the early term
diseases often identifies inflammation of the apparel sinus due to the virus
the nose that is spontaneously resolved for 2 weeks.
3.
Treatment
3.1
Conservative treatment
ORVI - the most frequent cause of the use of various drugs and
procedures, most often unnecessary, with an unproved action, often causing
side effects. Therefore, it is very important to clarify the parents benign
the nature of the disease and report what the estimated duration of available
symptoms, as well as convince them of the adequacy of minimal interventions.
Etiotropic therapy is recommended for influenza A (including H1N1) and in the first 24-48 hours of the disease. Neuraminidase inhibitors are effective:
Oseltamivir ( aTH code: J05AH02) from age 1 year 4 mg / kg / day, 5 days or
12
Zanyvir ( aTH code: J05AH01) Children from 5 years in 2 inhalations (only 10 mg) 2 times a day, 5 days.
(
Power recommendation 1; The level of reliability of evidence is a).
Comments: to achieve optimal effect, treatment must be
started when the first symptoms of the disease appeared. Patients with bronchial
asthma in the treatment of zanamivir must have as an agent
aid short-range bronchodulators. To other viruses, not
containing neuraminidases, these drugs do not act. Evidence
the base of the antiviral efficiency of other drugs in children
it remains extremely limited.
Antiviral drugs with immunotropic effects do not have a significant clinical effect, their appointment is inappropriate.
(
Power recommendation 2; The level of reliability of evidence -a).
Comment: These drugs develop a minor effect.
Perhaps appointment no later than the 1st day of the Day of Interferon Alpha
well, VK
(ATH code:
L03AB05),
however, there is no reliable evidence of its effectiveness.
Comments: ORVI is sometimes recommended interferonogens, but follows
remember that children over 7 years old when applying the fever
reduces less than 1 day, i.e. their use with most ORVI with
a short febrile period is not justified. Research results
efficiency of using immunomodulators during respiratory
infections, as a rule, show a minor effect. Preparations
recommended for the treatment of more severe infections, for example, viral
hepatitis, with ORVI not used. For the treatment of ARVI in children not
recommended homeopathic remedies, since their effectiveness is not
proved.
It is not recommended to use antibiotics for the treatment of uncomplicated ARVI and influenza, incl. If the disease is accompanied in the first 10-14 days of disease with rhinosinusitis, conjunctivitis, laryngitis, crop, bronchitis, broncho-prestructive syndrome.
(Power of recommendation 1; level of reliability of evidence - a).
Comments:Antibacterial therapy in the case of uncomplicated viral
infections not only does not prevent bacterial superinfection, but
contribute to its development due to the suppression of a normal pneumatic flora,
"Restraining aggression" staphylococci and intestinal flora. Antibiotics
13
can be shown to children with chronic pathology affecting
bronchopulmonary system (for example, fibrosis), immunodeficiency in which
there is a risk of exacerbation of the bacterial process; The choice of antibiotics they usually
predefined in advance the character of the flora.
It is recommended to conduct symptomatic (supportive) therapy .
Adequate hydration contributes to the discharge of secrets and facilitates their destruction.
(Power of recommendation 2; The level of reliability of evidence is C).
It is recommended to carry out elimination therapy, because
effective and safe. Introduction to the nose of physiological solution 2-3 times a day ensures the removal of mucus and restoring the work of the fiscal epithelium.
(Power of recommendation 2; The level of reliability of evidence is C).
Comments:Introduce the saline solution better in the position lying on
back with back back head for irrigation of nasopharynx and adenoid or adenoids. W.
small children with abundant separated effectively aspiration of nose mucus
special manual suction followed by the introduction of physiological
solid. Position in the crib with raised head end contributes
disintegration of the mucus from the nose. Senior children are justified spray with salt
isotonic solution.
It is recommended to assign vasoconstricting drops in the nose (decongestants) with a short rate of no more than 5 days. These drugs do not shorten the duration of a cold, but can facilitate the symptoms of the nasal congestion, as well as restore the function of the hearing pipe. In children, 0-6 years old are used phenylephrine ( aTH code:
R01ab01
) 0.125%, oxymetazoline ( aTH code: r01ab07) 0,01-0.025%, xylomezoline
aTH code: r01ab06) 0.05% (from 2 years), in older - more concentrated solutions.
(Power of recommendation 2; The level of reliability of evidence is C).
Comments:
Using
systemic
preparations
containing
decongestants (for example, pseudoephedrine) is extremely not desirable, medicinal
the means of this group are allowed only from age 12 years.
To reduce the temperature of the television factory child, it is recommended to be disclosed, wrapped with water T ° 25-30 ° C.
(Power of recommendation 2; The level of reliability of evidence is C).
In order to reduce body temperature in children, it is recommended to use only
14 two preparations - paracetamol w, vk
aTH code: N02BE01) up to 60 mg / kg / day or ibuprofen w, vk
aTH code: M01AE01) up to 30 mg / kg / day.
Power of recommendation 1 (level of reliability of evidence - a)
Comments:Antipyretic drugs in healthy children ≥3 months
justified at temperatures above 39 - 39.5 ° C. With a less pronounced fever
(38-
38.5 ° C) Funds that reduce the temperature are shown to children up to 3 months,
patients with chronic pathology, as well as with temperatures associated with temperature
discomfort. Regular (coursework) receiving antipyretic unwanted,
repeated dose is administered only after a new temperature increase.
Paracetamol and ibuprofen can be used inside or in the form of rectal
suppositories, there is also paracetamol for intravenous administration.
Alternation of these two antipytics or the use of combined
preparations have no significant advantages over monotherapy one of
these medicines.
It must be remembered that the most important problem for fever - on time
recognize bacterial infection. Thus, the diagnosis of severe
bacterial infection is much more important than fighting fever. Application
antipyretic
together
from
antibiotics
fraught
maskirovka
ineffectiveness of the latter.
In children with an antipyretic purpose, it is not recommended to use acetylsalicylic acid and nimesulide.
(Power of recommendation 1; The level of reliability of evidence is C).
The use of metamizole in children due to the high risk of agranulocytosis is not recommended.
Comment: In many countries of the world, metamizole is prohibited for use already
more than 50 years ago.
(
Power recommendation 1; The level of reliability of evidence is C).
The nasal toilet is recommended as the most efficient cough relief method.
Because with Na Napargitis, the cough is most often due to the irritation of the larynx by flowing secret.
(Power of recommendation 1; The level of reliability of evidence - b).
It is recommended to warm drinking or, after 6 years, using lollipops or pastilips, containing antiseptics to eliminate cough with pharyngitis, which is associated with the "throat" due to the inflammation of the mucous membrane of the pharynx or dryness when the mouth is breathing.
15
(
Power recommendation 2; The level of reliability of evidence is C).
Anti-tech, expectorant, mucolyts, including numerous proprietary drugs with various plant means, are not recommended for use in ORVI due to inefficiency, which has been proven in randomized studies.
(
Power of recommendations 2 The level of reliability of evidence is C).
Comments: With a dry obsessive cough in a child with pharyngitis or
laringhotrachite sometimes it is possible to achieve a good clinical effect when
using butamirate, but the evidence base for use
there is no antifreeze.
Inhalation steam and aerosol are not recommended for use, because did not show the effect in randomized studies, and not recommended
World Health Organization (WHO) for the treatment of ARVI.
(
POWER OF RECOMMENDATION 2 The level of reliability of evidence - b).
Antihistamine preparations of the first-generation, possessing an atropine-like action, are not recommended for use in children: they have an adverse therapeutic profile, have pronounced sedative and anticholinergic side effects, violate cognitive functions
(Concentration of attention, memory and ability to learn). In randomized studies, drugs of this group have not shown efficiency in reducing the symptoms of rhinitis.
(Power of recommendation 2; The level of reliability of evidence is C).
It is not recommended to all children with ARVI to prescribe ascorbic acid (vitamin
C) Since this does not affect the course of the disease.
Must be hospitalized in the hospital:
- Children under 3 months with febrile fever due to the high risk of developing severe bacterial infection.
- Children of any age with any of the following symptoms (main dangerous signs): inability to drink / suck the chest; drowsiness or absence of consciousness; breathing frequency is less than 30 per minute or apnea; symptoms of respiratory distress; Central cyanosis; phenomena of heart failure; Heavy dehydration.
- children with complex febrile convulsions (duration of more than 15 minutes and / or repeated more than once every 24 hours) are hospitalized for the whole
16 Fever period.
- Children with febrile fever and suspicion of severe bacterial infection (but may be hypothermia!), having the following accompanying symptoms: lethargy, drowsiness; Failure to eat and drink; hemorrhagic rash on the skin; vomiting.
- children with respiratory failure phenomena having any of the following symptoms: melting breathing, inflating the wings of the nose with breathing, the milestones (head moving, synchronized with breath); The frequency of respiratory movements in a child up to 2 months\u003e 60 per minute, in a child aged 2-11 months\u003e 50 per minute, in a child older than 1 year\u003e 40 per minute; retraction of the bottom of the chest when breathing; Blood saturation with oxygen The average duration of finding in the hospital may amount to 5-10 days depending on the nosological form of complication and severity of the state.
Hospitalization of children with noodamagitis, laryngitis, tracheobronchit
concomitant hazardous signs are inexpedient.
Febrile fever in the absence of other pathological symptoms in children over 3 months is not an indication for hospitalization in the hospital.
Children with simple febrile convulsions (up to 15 minutes, once during the day), completed by the time of appeal to the hospital, do not need hospitalization, but the child should be examined by a doctor to eliminate neuroinfection and other causes of convulsion.
3.2
Surgery
Not required
4. Rehabilitation
Not required
5.
Prevention and dispensary observation
Preventive measures that prevent the spread of viruses are of paramount importance: careful washing of hands after contact with the patient.
Recommended O.
washing masks, o
washing surfaces surrounded by the patient
in medical institutions - compliance with the sanitary and epidemic regime, the corresponding processing of phonenadoscopes, otoscopes, the use of disposable
17 towels; O.
in children's institutions - fast insulation of diseased children, compliance with the regimening mode.
The prevention of most viral infections remains nonspecific, since there are no vaccines against all respiratory viruses.
At the same time, the annual vaccination against the age of 6 months is recommended, which reduces the incidence.
(Power of recommendation 2; the level of reliability of evidence - b).
Comments:It has been proven that the vaccination of children from influenza and pneumococcal
infections reduces the risk of developing acute average otitis in children, i.e.
reduces the likelihood of complicated ARVI flow. When
contact a child with patients with influenza, as prevention possible
the use of neuraminidase inhibitors (oseltamivir, zanamivir) in
recommended age dosage.
In the first year of life from risk groups (prematurity, bronchopulmonary dysplasia palivizumab, The drug is introduced intramuscularly at a dose of 15 mg / kg monthly 1 time per month from November to March.
(Power of recommendation 1; level of reliability of evidence - a).
In children with hemodynamically significant congenital defects of the headwall prevention of PC virus infection in the autumn-winter season, passive immunization is recommended palivizumab, The drug is injected intramuscularly at a dose
15 mg / kg monthly 1 time per month from November to March.
(Power of recommendation 2; level of reliability of evidence - a)
Comment: see the CR to provide medical care for children with bronchopulmonary
dysplasia, cr of the immunoprophylaxis of respiratory syncytial viral
infections in children.
Children over 6 months with recurrent ENV organs and respiratory tract infections are recommended for the use of systemic bacterial lysates (ATH code
J07AX; ATH code L03A; ATH Code L03AX) These drugs are likely to reduce the incidence of respiratory infections, although their evidence base is not large.
(Power of recommendation 2; level of reliability of evidence - c)
It is not recommended to use immunomodulators to prevent
18 sharp respiratory viral infections, because Reliable evidence of reducing respiratory incidence under the influence of various immunomodulators - no.
The preventive effectiveness of plant preparations and vitamin C, homeopathic preparations is also not proven.
(
Power recommendation 1; The level of reliability of evidence - b)
6.
Additional information affecting the course and outcome of the disease
6.1 Complications
ORVI complications are observed infrequently and associated with accession.
bacterial infection.
There is a risk of developing acute average otitis against the background of the flow
naphorgitis, especially in young children, usually on the 2nd and 5th day
diseases. Its frequency can reach 20 - 40%, but not all
an purulent otitis occurs, requiring the appointment of antibacterial therapy
.
Preservation of nasal congestion longer than 10-14 days, deterioration
after the first week of the disease, the appearance of pain in the area of \u200b\u200bthe face may indicate
development of bacterial sinusitis.
On the background of flu frequency of viral and bacterial (most often
conducted Streptococcus Pneumoniae) Pneumonia can reach 12%
sick virus infection of children.
Bacteremia complicates the course of ARVI on average in 1% of cases under RS
viral infection and 6.5% of cases in enterovirus infections.
In addition, respiratory infection can be trigger
exacerbations of chronic diseases, most often bronchial asthma and infection
urinary tract.
6.2
Keeping children
Child at ARVI is usually observed in an outpatient clinical conditions
doctor pediatrician.
Common or semi-passing mode with a rapid transition to the overall after
reduced temperature. Re-inspection is necessary when saving the temperature
more than 3 days or deterioration.
Inpatient treatment (hospitalization) is required when developing complications and
long-term febrile fever.
19
6.3
Outcomes and forecast
As indicated above, ORVI, in the absence of bacterial complications, vehicles,
although they can leave for 1-2 weeks such symptoms as separated from the nasal
moves, cough. The view that repeated ARVIs are especially frequent are
manifestation or lead to the development of "secondary immunodeficiency" is unfounded.
20
Criteria for assessing the quality of medical care
Table 1.
Organizational and technical conditions for the provision of medical care.
Type of medical care
Specialized medical care
Terms of rendering
medical care
Stationary / day hospital
Form of rendering
medical care
Emergency
Table 2.
Criteria for the quality of medical care
No. p / p
Quality criteria
Power recommendation
The level of reliability of evidence
1.
Completed (clinical) blood test launched no later than 24 hours from the moment of entering the hospital
2
C.
2.
Complete urine analysis (with increasing body temperature above 38
⁰С)
1
C.
3.
The study of the level of C-reactive protein in the blood is performed (with an increase in body temperature above 38.0 s)
2
C.
4.
Eliminate therapy (washing the nasal cavity by physiological solution or sterile seawater solution) (in the absence of medical contraindications)
2
C.
5.
Treatment of local decongestants
(vesseloring drops in the nose) short rate from 48 to 72 hours (in the absence of medical contraindications)
2
C.
21
Bibliography
1.
Van Den Broek M.F., Gudden C., Kluijfhout W.P., Stam-Slob M.C., Aarts M.C., Kaper
N.M., Van der Heijden G.J. No Evidence for DistingUishing Bacterial from Viral Acute Rhinosinusitis Using Symptom Duration And Purulent Rhinorrhea: A Systematic Review of the Evidence Base.
Otolaryngol Head Neck Surg. 2014 Apr; 150 (4): 533-7. DOI:
10.1177 / 0194599814522595. EPUB 2014 Feb 10.
2.
Hay AD, Heron J, Ness A, Alspac Study Team. The Prevalence of Symptoms and Consultations in Pre-School Children In The Avon Longitudinal Study Of Parents and Children
(ALSPAC): A Prospective Cohort Study. Family Practice 2005; 22: 367-374.
3.
FENDRICK A.M., MONTO A.S., NIGHTENGALE B., Sarnes M. The Economic Burden of Non-Influenza-Related Viral Respiratory Tract Infection in the United States. Arch Intern Med. 2003 Feb.
24; 163(4):487-94.
4.
The Union of Pediatricians of Russia, the International Mother and Child Health Fund.
Scientific and practical program "Acute respiratory diseases in children. Treatment and prevention. " M., 2002
5.
Health care in Russia. 2015: Stat.SB. / Rosstat. - M., 2015. - 174 p.
6.
http://rospotrebnadzor.ru/activities/statistical- materials / statictic_details.php? element_id \u003d 5525 7.
Tastenko V.K. Diseases of respiratory organs in children. M. Pediatrician. 2012 8.
Pappas de, Hendley Jo, Hayden FG, WinTher B. Symptom Profile of Common Colds in School-Aged Children. PEDIATR INFECT DIS J 2008; 27: 8.
9.
Thompson M., COHEN H. D, VODICKA T.A ET AL. Duration of Symptoms of Respiratory Tract Infections in Children: Systematic Review BMJ 2013; 347 DOI: http://dx.doi.org/10.1136/bmj.f7027.
10.
Wald E.R., AppleGate K.E., Bordley C., Darrow D.H., Glode M.P. et al. American.
Academy of Pediatrics. CLINICAL PRACTICE GUIDELINE FOR THE DIAGNOSIS AND MANAGEMENT OF ACUTE BACTERIAL SINUSITIS IN CHILDREN AGED 1 TO 18 YEARS. Pediatrics. 2013 jul; 132 (1): E262-80.
11.
Smith M.J. Evidence for the Diagnosis and Treatment of Acute Uncomplicated Sinusitis in Children: A Systematic Review. Pediatrics. 2013 jul; 132 (1): E284-96.
12.
JEFFERSON T, JONES MA, DOSHI P, ET AL. Neuraminidase inhibitors for preventing and treating influenza in Healthy Adults and Children. Cochrane Database Syst Rev. 2014;
4: CD008965.
13.
World Health Organization Department of Communicable Disease Surveillance and
RESPONSE. Who Guidelines on The Use Of Vaccines and Antivirals During Influenza Pandemics.
2004.
22 http://www.who.int/csr/resources/publications/influenza/who_cds_csr_rmd_2004_8/en/
Accessed February 18, 2015.
14.
A.A. Baranov (ed.) Guide on outpatient clinical pediatrics. M.
Gootar media. 2nd ed. 2009.
15.
Schaad U.B. OM-85 BV, An Immunostimulant in Pediatric Recurrent Respiratory Tract Infections: A Systematic Review. World J PediaTr. 2010 Feb; 6 (1): 5-12. DOI: 10.1007 / S12519-
010-0001-x. EPUB 2010 Feb 9.
16.
Mathie RT, Frye J, Fisher P. Homeopathic Oscillococcinum® for Preventing And Treating Influenza and Influenza-Like Illness. Cochrane Database Syst Rev. 2015 jan 28; 1: CD001957. DOI:
10.1002 / 14651858.cd001957.pub6.
17.
Kenely T, Arroll B. Antibiotics for the Common Cold and Acute Purulent Rhinitis.
Cochrane Database Syst Rev 2013; 6: CD000247 18.
Baranov A.A., Stachinsky L.S. (Ed.) The use of antibiotics in children in outpatient practice. Practical recommendations, 2007 KMP 2007; 9 (3): 200-210.
19.
Harris A.M., Hicks L.A., Qaseem A. ApproPriate AntiBiotic Use for Acute Respiratory
Tract Infection In Adults: Advice for High-Value Care from The American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016; 164 (6): 425-34
(ISSN: 1539-3704)
20.
King D1, Mitchell B, Williams CP, Spurling GK. SALINE NASAL IRRIGATION FOR ACUTE UPPER RESPIRATORY TRACT INFECTIONS Cochrane Database Syst Rev. 2015 APR 20; 4: CD006821. DOI:
10.1002 / 14651858.cd006821.pub3.
21.
Wong T1, Stang As, Ganshorn H, Hartling L, Maconochie IK, Thomsen Am, Johnson
DW. Cochrane in Context: Combined and Alternating Paracetamol and Ibuprofen Therapy for Febrile Children. Evid Based Child Health. 2014 SEP; 9 (3): 730-2. DOI: 10.1002 / EBCH.1979.
22.
Smith SM, Schroeder K, Fahey T. Over-The-Counter (OTC) Medications for Acute Cough in Children and Adults in Ambulatory Settings. Cochrane Database Syst Rev 2012; 8: CD001831.
23.
Chalumeau M., Duijvestijn Y.c. ACETYLCYSTEINE AND CARBOCYSTEINE FOR ACUTE UPPER AND LOWER RESPIRIC PATIENTS IN PAEDIATRIC PATIENTS WITHOUT CHRONIC BRONCHO-PULMONARY DISEASE. Cochrane Database Syst Rev. 2013 May 31; 5: CD003124. DOI:
10.1002 / 14651858.cd003124.pub4.
24.
Singh M, Singh M. Heated, Humidified Air for the Common Cold. Cochrane Database Syst.
Rev 2013; 6: CD001728.
25.
Little P, Moore M, Kelly J, et al. Ibuprofen, ParaceTamol, and Steam for Patients in Primary Care: Pragmatic Randomised Factorial Trial. BMJ 2013;
347: F6041.
23 26.
DE SUTTER A.I., SARASWAT A., VAN DRIEL M.L. Antihistamines for the Common Cold.
Cochrane Database Syst Rev. 2015 NOV 29; 11: CD009345. DOI:
10.1002 / 14651858.cd009345.pub2.
27.
Hemilä H, Chalker E. Vitamin C For Preventing and Treating The Common Cold. Cochrane.
Database Syst Rev 2013; 1: CD000980 28.
Providing inpatient assistance to children. Guidance on the treatment of the most common diseases in children: Pocket directory. - 2nd ed. - M.: World Health Organization, 2013. - 452 p.
29.
Prutsky G.J., DomecQ J.P., Elraiyah T., Wang Z., Grohskopf L.A., Prokop L.J., Montori
V.M., MURAD M.H. Influenza Vaccines Licensed in the United States in Healthy Children: A Systematic Review and Network Meta-Analysis (Protocol). SYST REV. 2012 DEC 29; 1: 65. DOI:
10.1186/2046-4053-1-65.
30.
Fortanier A.c. et al. Pneumococcal Conjugate Vaccines for Preventing Otitis Media.
Cochrane Database Syst Rev. 2014 Apr 2; 4: CD001480.
31.
Norhayati M.N. et al. Influenza Vaccines for preventing Acute Otitis Media in Infants and Children. Cochrane Database Syst Rev. 2015 Mar 24; 3: CD010089.
32.
Committee On Infectious Diseases and Bronchiolitis Guidelines Committee: Updated
Guidance for Palivizumab Prophylaxis Among Infants and Young Children at Increased Risk Of
Hospitalization for Respiratory Syncytial Virus Infection. Pediatrics 2014 Vol. 134 No. 2 August.
1, 2014 pp. E620-E638.
33.
Ralston S.L., Lieberthal A.S., Meissner H.c., Alverson B.K., Baley J.E., Gadomski A.M.,
Johnson D.W., Light M.J., Maraqa N.F., Mendonca E.A., Phalan K.J., Zorc J.J., Stanko-Lopp D.,
Brown M.A., Nathanson I., Rosenblum E., Sayles S. 3RD, Hernandez-Cancio s.; American.
Academy of Pediatrics. Clinical Practice Guideline: The Diagnosis, Management, and
Prevention of Bronchiolitis Pediatrics Vol. 134 No. 5 November 1, 2014 E1474-E1502.
34.
Baranov A.A., Ivanov D.O. et al. Palivizumab: Four seasons in Russia. Bulletin
Russian Academy of Medical Sciences. 2014: 7-8; 54-68 35.
Kearney S.C., Dziekiewicz M., FELESZKO W. Immunoregulatory and Immunostimulatory Responses of Bacterial Lysates In Respiratory Infection and Asthma. Ann Allergy Asthma.
Immunol. 2015 May; 114 (5): 364-9. DOI: 10.1016 / J.anaII.2015.02.008. EPUB 2015 MAR 6.
36.
Lissiman E, Bhasale Al, Cohen M. Garlic for the Common Cold. Cochrane Database Syst.
Rev 2009; CD006206.
37.
Linde K, Barrett B, Wölkart K, et al. Echinacea for Preventing and Treating The Common Cold. Cochrane Database Syst Rev 2006; CD000530.
38.
Jiang L., Deng L., Wu T. Chinese Medicinal Herbs for Influenza. Cochrane Database Syst.
24
Rev. 2013 Mar 28; 3: CD004559. DOI: 10.1002 / 14651858.cd004559.pub4.
39.
SteinsBekk A., Bentzen N., Fønnebø V., Lewith G. Self Treatment With One Of Three Self Selected, Ultramolecular Homeopathic Medicines for The Prevention of Upper Respiratory Tract Infections in Children. A Double-Blind Randomized Placebo Controlled Trial. Br j Clin Pharmacol.
2005 APR; 59 (4): 447-55.
25
Appendix A1. Composition of the Working Group
Baranov A.A. Acad. Russian Academy of Sciences, Professor, Ph.D., Chairman of the Executive Committee of Russian Fatiatricians;
Lobzin Yu. V., Acad. RAS, Professor, D.M., President of the Euro-Asian Society for Infectious Diseases, Deputy Chairman of the National Scientific Society of Infectious
Namazova-Baranova L.S. Acad. RAS, Professor, D.M., Deputy
Chairman of the Executive Committee of the Union of Pediatricians of Russia;
Tastenko V.K. D.M., Professor, Honored Science Worker, Expert
World Health Organization, Member of Russian Pediatrics Union;
Uskov A.N. D.M., Professor
Kulichenko T.V. D.M., Professor RAS, Expert of the World Organization
Health care, member of Russian pediatricians;
Bakradze MD DM N., Member of the Union of Pediatricians of Russia;
Vishneva E.A.
Selimzyanova L.R. K.M.N., Member of the Union of Pediatricians of Russia;
Polyakova A.S. K.M.N., Member of the Union of Pediatricians of Russia;
Artyomova I.V. M.N.S., Member of the Russian Pediatrician Union.
The authors confirm the lack of financial support / conflict
interests that need to be promulgated.
26
Appendix A2. Clinical Recommendation Development Methodology
Target auditorium of data of clinical recommendations:
1.
Pediatrician doctors;
2.
Doctors of general medical practice (family doctors);
3.
Students of medical universities;
4.
Students in the ordainture and internship.
Table 1.
Scheme for assessing the level of recommendations
Power
reliability
recommendations
Relation to the risk and benefits
Methodological quality of existing evidence
Explanations for the application of recommendations
1A.
Strong
recommendation,
based
on the
evidence
high Quality
Reliable consistent evidence based on well-performed
RCCs or irrefutable evidence presented in any other form.
Further research is unlikely to change our confidence in assessing the ratio of benefit and risk.
A strong recommendation that can be used in most cases at a predominant number of patients without any changes and exceptions.
1V.
Strong
recommendation,
based
on the
evidence
moderate quality
Benefit clearly prevails over risks and costs, or vice versa
Evidence based on the results of rocks made with some restrictions (contradictory results, methodological errors, indirect or random, etc.) or other good bases.
Further research
(If they are held), they will probably have an impact on our confidence in assessing the benefit and risk ratio and can change it.
Strong recommendation, the use of which is possible in most cases
1C.
Strong
recommendation,
based
on the
evidence
low quality
The benefits are likely to prevail over possible risks and costs, or vice versa
Evidence based on observational studies, unsystematic clinical experience, results
RCCs made with significant disadvantages.
Relative about a strong recommendation that can be changed in obtaining evidence of higher quality
2A.
Weak
recommendation,
based
on the
evidence
high Quality
The benefits are comparable with possible risks and costs
Reliable evidence based on well-performed
RCCs or confirmed by other irrefutable data.
Further research is unlikely to change our confidence in assessing the ratio of benefit and risk.
Weak recommendation.
The choice of best tactics will depend on the clinical situation.
(Circumstances), patient or social preferences.
2V.
Benefit
Proof of,
Weak
27
Weak
recommendation,
based
on the
evidence
moderate quality
it is comparable to risks and complications, but there is uncertainty in this assessment. Based on the results of RCA, made with significant limitations (contradictory results, methodological defects, indirect or random), or strong evidence presented in any other form.
Further research
(If they are held), most likely will have an impact on our confidence in assessing the benefit and risk ratio and can change it. recommendation.
Alternatives to the naya tactic in certain situations may appear for some patients the best choice.
2s
Weak
recommendation,
based
on the
evidence
low quality
Ambiguity in assessing the ratio of benefits, risks and complications; The benefits can be comparable with possible risks and complications.
Evidence based on observational studies, unsystematic clinical experience or RCCs with significant disadvantages.
Any estimate of the effect is regarded as uncertain.
Very weak recommendation; Alternative approaches can be used equally.
* In the table, the digital value corresponds to the strength of the recommendations, the letter - corresponds to the level of evidence.
Actualization of these clinical recommendations will be held at least
than once every three years. Decision on the update will be accepted on
the basis of the proposals presented by medical professional
non-profit organizations, taking into account the results of a comprehensive assessment
drugs, medical devices, as well as clinical results
approbation.
28
Appendix A3. Related documents
Medical care procedures:
1.
Order of the Ministry of Health and Social Development of the Russian Federation of April 16
2012 N 366n "On approval of the procedure for providing pediatric assistance";
2.
Order of the Ministry of Health and Social Development of the Russian Federation from
05.05.2012 N 521n "On approval of the procedure for providing medical care for children with infectious diseases"
Criteria for assessing the quality of medical care:Order of the Ministry of Health of Russia 520n from
July 15, 2016 "On approval of the criteria for assessing the quality of medical care"
Medical Help Standards:
1.
Order of the Ministry of Health of the Russian Federation of 9/11/12 No. 798n Standard of specialized medical care for children with acute respiratory diseases of moderate severity
2.
Order of the Ministry of Health of the Russian Federation of 24.12.12
№1450N Standard of specialized medical care for children with acute respiratory diseases of severe severity
3.
Order of the Ministry of Health of the Russian Federation of December 28, 12
No. 1654N Standard of primary health care for children with acute Noodopharyngitis, Larygitis, Trachey and acute infections of the upper respiratory tract of easy severity
29
Appendix B. Patient Leading Algorithms
NOT
YES
NOT
YES
NOT
YES
Diagnostics (p.4)
Outpatient treatment
Consultation of a specialist
Treatment in hospital
There are indications for hospitalization
(p.10)?
Prevention of re-infection (p.8)
Correction of therapy
Patient with SMI Symptoms
Is the diagnosis confirmed?
Therapy is effective?
30
Appendix B. Information for patients
ARVI (Acute respiratory viral infection) is the most common disease in children.
Cause of the disease - Diverse viruses. The disease is more often evolving in autumn, in winter and early spring.
As infected with an ARVI infection: Most often, by hitting a nasal mucous membrane or conjunctiva from hand contaminated with patients
(for example, through a handshake) or with infected with virus surfaces (rinovirus is preserved for them to day).
Another way is air-drip - when inhaling the particles of saliva, released during sneezing, cough or close contact with the patient.
The period from infection before the start of the disease: in most cases - from 2 to 7 days.
Selection of viruses in patients (infinity for others) maximum on the 3rd day after infection, dramatically decreases to the 5th day; Non-intensive selection of the virus can be maintained up to 2 weeks.
Signs of ARVI: The most frequent manifestation of ARVI in children is nasal congestion, as well as discharge from the nose: transparent and / or white and / or yellow and / or green (the appearance of seals from a yellow or green nose - is not a sign of attaching a bacterial infection!). Increasing the temperature more often lasts no more than 3 days, then the body temperature is reduced. In some infections (flu and adenovirus infection), the temperature above 38ºC is saved longer (up to 5-7 days).
When ORVI can also be: throat, cough, eye redness, sneezing.
Surveys:in most cases, additional examinations of the child with
ORVI is not required
Treatment:ORVI, in most cases, is benign, it is allowed for 10 days and does not always require the appointment of medicines.
Decrease in temperature:the fevering child should be revealed, wipe the water T °
25-
30 ° С. In order to reduce the temperature in children, it is permissible to use only 2 preparations - paracetamol or ibuprofen. Antipyretic Preparations in healthy children ≥3 months are justified at temperatures above 39 - 39.5 ° C. With a less pronounced fever (38-38.5 ° C), the means that reduces the temperature, is shown to children up to 3 months, patients with chronic pathology, as well as with a discomfort associated with temperature. Regular (coursework) reception of antipyretic unwanted, re-
31 Dose are administered only after a new temperature increase.
The alternation of these two drugs or their use in combination does not lead to
strengthening the antipyretic effect.
In children with an antipyretic purpose, acetylsalicylic acid and
nimesulide. Extremely unwanted use of metamizole In children due to the high risk of developing agranulocytosis. In many countries of the world, metamizole is prohibited for use for more than 50 years ago.
Antibiotics - Do not act on viruses (the main cause of ARVI). The question of the appointment of antibiotics is considered when suspected bacterial infection .
Antibiotics should appoint a doctor. The uncontrolled antibiotics can contribute to the development of microbes-resistant and cause complications.
How to prevent the development of ARVI:
The fallen child should be left at home (not to drive to a kindergarten or school).
The measures preventing the spread of viruses are of paramount importance: careful washing of hands after contact with the patient.
It is also important to wear masks, washing surfaces surrounded by a patient, compliance with the ventilation mode.
The annual flu vaccination from the age of 6 months reduces the risk of this infection.
It also has also been proven that the vaccination of children from influenza and pneumococcal infection reduces the likelihood of developing acute average otitis in children and complicated ARVI flow.
Reliable evidence of reducing respiratory morbidity under the influence of different immunomodulators - no. The preventive effectiveness of plant preparations and vitamin C, homeopathic preparations is also not proven.
Contact your specialist if:
- Baby for a long time refuses to drink
- You see changes in behavior: irritability, unusual drowsiness with a decrease in reaction to contact attempts with child
- The child has difficulty breathing, noisy breathing, breathing, the increase in intercostal intervals, jugular pits (place located in front between the neck and chest)
- in a child convulsions against the background of elevated temperature
- Child nonsense against the background of elevated temperature
- Increased body temperature (more than 38.4-38.5ºC) persists more than 3 days
- nasal congestion is preserved without improvement more than 10-14 days, especially if you see the "second wave" of increasing body temperature and / or deterioration
32 baby
- the child has pain in the ear and / or selection from the ear
- The child has a cough, lasting more than 10-14 days without improve
33
Appendix G. Decoding Notes
…
j.
–
the drug, which is included in the list of vital and most important medicines for medical applications for 2016
…
vC
–
the drug included in the list of drugs for medical use, including drugs for medical applications, appointed by solving medical commissions of medical organizations
(Order of the Government of the Russian Federation of December 26, 2015 N 2724-P)
Document Outline
- Keywords
- 2TSPs abbreviations
- 1. Brief information
- 2TU1.1 Definition
- 2TU1.2 etiology and pathogenesis
- 2TU1.3 Epidemiology
- 1.4 Coding on the ICD-10
- 1.5 Classification
- 2T12TU.6 Examples of diagnoses
- 2. Diagnostics
- U2.1 Complaints, Anamnesis
- 2.2 Physical examination
- U2.3 Laboratory diagnostics
- U2.4 Instrumental diagnostics
- 3. Treatment
- U3.1 Conservative Treatment
- U3.2 Surgical treatment
- 4. Rehabilitation
- 5. Prevention and dispensary observation
- 6. Additional information affecting the course and outcome of the disease
- 6.1 Complications
- U6.2 Knowing children
- U6.3 Exodes and Forecast
- Criteria for assessing the quality of medical care
- Bibliography
- Appendix A1. Composition of the Working Group
file -\u003e Working program for normal physiology naturally scientific cycle for specialty 32. 05. 01 "Medical and prophylactic matter"