Learning thread (ER medicine)

what are the Centor criteria for empirically treating for Strep throat?

speaking of strep throat, why is important to know if a pt who is presenting like an appy recently had strep throat?

Speaking of strep throat........how come nurses are not educating their patients to toss the toothbrush? I thought the nurse was to educate their patient. I have had a lady to come to the ER 5+ times for strep throat and when I was discharging her, I advised her to toss the toothbrush and go to the dollar store and buy the pack that has a few in a box for a dollar. I told her that after she used one toothbrush that day that she needed to toss it in the trash and the next day use a new one. Then after a few days she can get a more suitable toothbrush that she would like. She told me that no one has ever told her that. Well, I haven't seen her and it has been several weeks. Maybe I am a bit extreme with using a different toothbrush for a few days but strep throat is not a comfortable feeling and there are risks involved. I am a new ER nurse and I have found out that no one in my ER educates about tossing the toothbrush. So far, my advise has been very successful. No one that has followed my advised has had to return for reoccurring strep throat.

Hey, thanks for the toothbrush- tossing lesson! I always learn something new here.

As a student, this is a great thread to read too...thanks for starting it!

Quote:

What are the Centor criteria for empirically treating for Strep throat?

- I am not familiar with the Centor term but let me take a stab at the empirical treatment of strep; this makes for a great discussion. Here is a link and article that that I found:

https://www.medicinenet.com/strep_throat_diagnosis_and_treatment/views.htm

Sore Throat

Most sore throats (pharyngitis) are viral and will not respond to antibiotics. Bacterial causes of sore throat include group A streptococcus. The complications of strep throat include rheumatic fever, ear infections, mastoiditis, sinusitis, peritonsillar abscess, glomerulonephritis (a kidney disorder), and scarlet fever.

The medical challenges presented by a sore throat are not to treat the many that are viral, but to find the few that are strep throats and treat them promptly and effectively.

Diagnosis of Strep Throat

When a child has a sore throat, a rapid antigen test should be done for strep, according to Dr. Warren J. McIsaac and colleagues in Canada. If the rapid test is positive, the child (or adult) should be treated with an antibiotic. If the rapid test is negative, a throat culture may be done. (This takes more time, usually overnight.)

Treatment of Strep Throat

The cephalosporin antibiotics such as cephalexin (Keflex, Keftabs, Biocef) and cefadroxil (Duricef) are about three times more effective -- three times less likely to fail -- in eradicating strep than penicillin. This conclusion is based on a meta-analysis of 35 trials reported by Drs. Janet R. Casey and Michael E. Pichichero from the University of Rochester

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The Centor Score is a predictor measurement of the likelihood of a + strep diagnosis. Did I get that right?

Zen: increased anxiety between 3-5PM; could that be from the increased Catecholamenes?

Quote:

what are the Centor criteria for empirically treating for Strep throat?

The Centor Score is a predictor measurement of the likelihood of a + strep diagnosis. Did I get that right?

absolutely correct. specifically, the Centor criteria are:

1) hx of fever (usually > 101)

2) no cough

3) cervical chain adenophathy

4) exudative pharyngitis

I know one ER doc who will treat a pt presumptively as having Strep throat if they meet the criteria. Who hasn't seen rapid strep screens be negative only to have the culture turn out positive?

This is the same concept as using the Ottawa ankle rules to determine the necesity for ankle films. Speaking of the Ottowa ankle rules, what are they, specifically?

speaking of strep throat, why is important to know if a pt who is presenting like an appy recently had strep throat?

bump...

isn't anyone going to take a stab at this one?

Notice how I smoothed over that one! No, I do not know. And... I looked it up in the ENPC and could not find it (although it may be there). So...

(quote) why is important to know if a pt who is presenting like an appy recently had strep throat?

Oh and an FYI, please no bumping, it is not really allowed on the board (long story that is old). PM me if you you any Q's regarding that.

I have no idea about any of this but I am finding this thread very interesting. Keep them comming!