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·π«∑“ß‡«™ªØ‘∫—µ‘„π‚§√ß°“√À≈—°ª√–°—π ÿ¢¿“æ∂â«πÀπâ“

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π«ª. 09-016-01

«—π/‡¥◊Õπ/ªï

01/06/2545

Àπâ“∑’Ë

1/11

‰¢â‡©’¬∫æ≈—π„π‡¥Á°‡≈Á°


‡√◊ËÕß ‰¢â‡©’¬∫æ≈—π„π‡¥Á°‡≈Á°

Àπâ“

§”π‘¬“¡ 2

°“√«—¥Õÿ≥À¿Ÿ¡‘ 2

“‡Àµÿ 4

·π«∑“ß°“√«‘π‘®©—¬ 4

·π«∑“ß°“√√—°…“ 5

°“√¥Ÿ·≈√—°…“∑—Ë«‰ª 6

°“√„Àâ¬“≈¥‰¢â 6

°“√√—°…“Õ◊ËπÊ 8

- °“√„Àâ “√πÈ”∑¥·∑π 8

- °“√ªÑÕß°—π·≈–√—°…“°“√™—°®“°‰¢â 8

‡¥Á°Õ“¬ÿ 0<3 ‡¥◊Õπ 9

‡¥Á°Õ“¬ÿ 3 ‡¥◊Õπ - 3 ªï 11

°“√ª√–‡¡‘π§«“¡√ÿπ·√ß 11

°“√µ‘¥‡™◊ÈÕ·Õ∫·Ωß (Occult infection) 12

°“√µ√«®∑“ßÀâÕßªØ‘∫—µ‘°“√ 13

°“√√—°…“ 14

‡Õ° “√Õâ“ßÕ‘ß 17

√“¬™◊ËÕ§≥–∑”ß“π 18

µ“√“ß∑’Ë 1 ¢π“¥¬“ acetaminophen ∑’Ë„™â„π‡¥Á° 7

·ºπ¿Ÿ¡‘∑’Ë 1 ·π«∑“ß°“√¥Ÿ·≈√—°…“‰¢â‡©’¬∫æ≈—π„π‡¥Á°Õ“¬ÿ 0<3 ‡¥◊Õπ 15

·ºπ¿Ÿ¡‘∑’Ë 2 ·π«∑“ß°“√¥Ÿ·≈√—°…“‰¢â‡©’¬∫æ≈—π„π‡¥Á°Õ“¬ÿ 3 ‡¥◊Õπ - 3 ªï 16

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π«ª. 09-016-01


01/06/2545

Àπâ“∑’Ë

2/11

‰¢â‡©’¬∫æ≈—π„π‡¥Á°‡≈Á°

§”π‘¬“¡

Õÿ≥À¿Ÿ¡‘√à“ß°“¬¡“µ√∞“π : Õÿ≥À¿Ÿ¡‘∑’Ë«—¥∑“ßª“°

‰¢â : Õÿ≥À¿Ÿ¡‘√à“ß°“¬ «—¥∑“ßª“° Ÿß°«à“ 37.0 Ì´

Õÿ≥À¿Ÿ¡‘ ∑“ßª“° ∑“ß°âπ ∑“ß√—°·√â

‰¢âµË” 37.5 - 38.4 o ´ 38.0 - 38.9 o ´ 37.0 - 37.9 o ´

‰¢âª“π°≈“ß 38.5 - 39.4 o ´ 39.0 - 39.9 o ´ 38.0 - 38.9 o ´

‰¢â Ÿß > 39.5 o ´ > 40 o ´ > 39 o ´

·π«∑“ß‡«™ªØ‘∫—µ‘π’È ‡ªìπ‡§√◊ËÕß¡◊Õ àß‡ √‘¡§ÿ≥¿“æ¢Õß°“√∫√‘°“√¥â“π ÿ¢¿“æ∑’Ë‡À¡“– ¡°—∫

∑√—æ¬“°√·≈–‡ß◊ËÕπ‰¢ —ß§¡‰∑¬ ‚¥¬À«—ßº≈„π°“√ √â“ß‡ √‘¡·≈–·°â‰¢ªí≠À“ ÿ¢¿“æ¢Õß§π‰∑¬

Õ¬à“ß¡’ª√– ‘∑∏‘¿“æ·≈–§ÿâ¡§à“ ¢âÕ·π–π”µà“ßÊ „π·π«∑“ß‡«™ªØ‘∫—µ‘π’È‰¡à„™à¢âÕ∫—ß§—∫¢Õß°“√ªØ‘∫—µ‘ ºŸâ„™â

“¡“√∂ªØ‘∫—µ‘·µ°µà“ß‰ª®“°¢âÕ·π–π”π’È‰¥â „π°√≥’∑’Ë ∂“π°“√≥å·µ°µà“ßÕÕ°‰ª À√◊Õ¡’‡Àµÿº≈∑’Ë ¡§«√

‚¥¬„™â«‘®“√≥≠“≥∑’Ë‡ªìπ∑’Ë¬Õ¡√—∫„π —ß§¡

‰¢â‡©’¬∫æ≈—π : ‰¢â ‰¡à‡°‘π 7 «—π

Õÿ≥À¿Ÿ¡‘∑“ß∑«“√Àπ—° : Ÿß°«à“∑“ßª“° 0.5 o ´

Ÿß°«à“∑“ßº‘«Àπ—ßÀ√◊Õ√—°·√â 1 o ´

∑“√° : ‡¥Á°Õ“¬ÿ < 12 ‡¥◊Õπ ∑“√°··√°‡°‘¥ : ‡¥Á° Õ“¬ÿ < 30 «—π

¿“«–‰¢â‡©’¬∫æ≈—π„π‡¥Á°‡≈Á° : „π∑’Ëπ’ÈÀ¡“¬∂÷ß ¿“«–‰¢â„π‡¥Á°Õ“¬ÿ‰¡à‡°‘π 3 ªï ∑’Ë‡°‘¥¢÷Èπ¡“‰¡à‡°‘π

7 «—π ·≈– ‰¡à¡’Õ“°“√·≈–Õ“°“√· ¥ß∑’Ë∫Õ°∂÷ßµ”·Àπàßµ‘¥‡™◊ÈÕ À√◊Õ “‡Àµÿ¢Õß‰¢â

∑’Ë™—¥‡®π

°“√«—¥Õÿ≥À¿Ÿ¡‘√à“ß°“¬

«‘∏’∑’Ë¥’∑’Ë ÿ¥ ”À√—∫∑“√° §◊Õ °“√«—¥∑“ß∑«“√Àπ—° ¥â«¬‡∑Õ√å‚¡¡‘‡µÕ√å™π‘¥·°â«∫√√®ÿª√Õ∑

À√◊Õ™π‘¥· ¥ßµ—«‡≈¢ (digital)

°“√«—¥Õÿ≥À¿Ÿ¡‘∑“ßÀŸ¥â«¬‡§√◊ËÕß«—¥Õÿ≥À¿Ÿ¡‘‡¬◊ËÕ·°â«ÀŸ (tympanic thermometer) ∂â“„™â ∂Ÿ°µâÕßµ“¡

∑’Ë√–∫ÿ‚¥¬∫√‘…—∑ºŸâº≈‘µ®–√«¥‡√Á« ‡™◊ËÕ∂◊Õ‰¥â ·≈– –¥«° ·µà∂â“„™âº‘¥‡∑§π‘§ ‡™àπ ‡¥Á°¡’¢’ÈÀŸ¡“° ®–‰¥â§à“∑’Ëº‘¥

‡™◊ËÕ∂◊Õ‰¡à‰¥â √«¡∑—Èß¡’√“§“·æß ®÷ß‰¡à·π–π”„Àâ„™â

§«“¡ Ÿß¢Õß‰¢â„π∑“√° ‰¡à∫Õ°§«“¡√ÿπ·√ß¢Õß‚√§∑’Ë‡ªìπ “‡Àµÿ¢Õß‰¢â „π∑”πÕß°≈—∫°—π

∑“√°∑’Ë¡’Õÿ≥À¿Ÿ¡‘√à“ß°“¬µË”°«à“ª°µ‘ (<36 o ´ ) Õ“®¡’°“√µ‘¥‡™◊ÈÕ∑’Ë√ÿπ·√ß‰¥â

“‡Àµÿ

‡¥Á°∑’Ë¡’‰¢â ‚¥¬‰¡à¡’Õ“°“√º‘¥ª°µ‘Õ◊Ëπ

“‡Àµÿ à«π„À≠à‡ªìπ°“√µ‘¥‡™◊ÈÕ‰«√— ´÷ËßÀ“¬‡Õß‰¥â

à«ππâÕ¬‡°‘¥®“°

- °“√µ‘¥‡™◊ÈÕ·∫§∑’‡√’¬„π°√–· ‡≈◊Õ¥·Õ∫·Ωß (occult bacteremia) ÷ËßÀ“°‰¡à‰¥â√—∫

°“√√—°…“Õ“®¥”‡π‘πµàÕ‰ª‡ªìπ°“√µ‘¥‡™◊ÈÕ∑’ËÕ«—¬«– ”§—≠ ‡™àπ meningitis ‰¥â

- °“√µ‘¥‡™◊ÈÕ·∫§∑’‡√’¬∑’Ë∑“ß‡¥‘πªí “«–

- ‡¬◊ËÕ·°â«ÀŸÕ—°‡ ∫

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π«ª. 09-016-01


01/06/2545

Àπâ“∑’Ë

3/11

‰¢â‡©’¬∫æ≈—π„π‡¥Á°‡≈Á°

·π«∑“ß°“√«‘π‘®©—¬

‡¥Á°µâÕß‰¥â√—∫°“√ª√–‡¡‘π®“°·æ∑¬å‚¥¬≈–‡Õ’¬¥√Õ∫§Õ∫ ‡¡◊ËÕ

- ∑“√°∑’Ë¡’‰¢â > 38.5 o ´

- ‡¥Á°∑’Ë¡’‰¢â √à«¡°—∫ Àπâ“·¥ß µ—«·¥ß ‡Àß◊ËÕÕÕ° ´÷¡ °√– —∫°√– à“¬ À“¬„®‡√Á« ™—°

√âÕß‰Àâ‰¡àÀ¬ÿ¥ ‡∫◊ËÕÕ“À“√

“‡Àµÿ :

°“√µ‘¥‡™◊ÈÕ·∫§∑’‡√’¬À√◊Õ‰«√— ‡ªìπ “‡Àµÿ∑’Ë∫àÕ¬∑’Ë ÿ¥

“‡ÀµÿÕ◊Ëπ Ê ∑’Ëæ∫‰¥âπâÕ¬ ‰¥â·°à

- °“√‰¥â√—∫ “√æ‘…À√◊Õ¬“∫“ß°≈ÿà¡ ‰¥â·°à phenothiazine ·≈– anticholinergic

- Õ“°“√‰¢â®“°§«“¡√âÕπ ‡™àπ Õ¬Ÿà„π∑’Ë¡’Õÿ≥À¿Ÿ¡‘√âÕπ®—¥ À√◊Õ «¡‡ ◊ÈÕºâ“Àπ“‡°‘π‰ª

- °“√∑’Ë√–∫∫ª√– “∑ à«π°≈“ß‰¥â√—∫°“√°√–∑∫°√–‡∑◊ÕπÀ√◊Õ¡’æ¬“∏‘ ¿“æ

¢âÕ¡Ÿ≈∑’Ë™à«¬„π°“√«‘π‘®©—¬ ‰¥â·°à

1. ‡«≈“∑’Ë‡√‘Ë¡¡’‰¢â

2. ≈—°…≥–¢Õß‰¢â

3. Õ“°“√·≈–Õ“°“√· ¥ßÕ◊Ëπ Ê ∑’Ë¡’√à«¡¥â«¬ ‡™àπ ‰Õ πÈ”¡Ÿ° µ“·©– Õ“‡®’¬π ∑âÕß‡ ’¬ °“√¥÷ß„∫ÀŸ

(Õ“®· ¥ß∂÷ßÀŸ™—Èπ°≈“ßÕ—°‡ ∫ )

4. ª√–«—µ‘°“√§≈Õ¥ ª√–«—µ‘ ÿ¢¿“æ √«¡∂÷ß∫—π∑÷°°“√„Àâ«—§´’π

5. ª√–«—µ‘‡°’Ë¬«°—∫ ¿“æ·«¥≈âÕ¡„π∫â“π °“√‡≈’È¬ß¥Ÿ ·≈–°“√„ÀâÕ“À“√ °“√ —¡º— ‚√§µ‘¥‡™◊ÈÕ

6. °“√µ√«®√à“ß°“¬‚¥¬≈–‡Õ’¬¥ ¥Ÿ ’¢Õßº‘«Àπ—ß —ß‡°µ≈—°…≥–°“√À“¬„®·≈–√–¥—∫§«“¡√Ÿâ µ‘

§≈”™’æ®√ ¥Ÿ capillary refill ¥Ÿ§«“¡µ÷ß¢Õßº‘«Àπ—ß (skin turgor )

7. °“√µ√«®ÀŸ ‡æ◊ËÕ¥Ÿ«à“¡’ÀŸ™—Èπ°≈“ßÕ—°‡ ∫À√◊Õ‰¡à

°“√µ√«®∑“ßÀâÕßªØ‘∫—µ‘°“√

Õ“®®”‡ªìπµâÕßµ√«®∑“ßÀâÕßªØ‘∫—µ‘°“√ À“°°“√µ√«®√à“ß°“¬¬—ß‰¡à “¡“√∂«‘π‘®©—¬ “‡Àµÿ¢Õß ‰¢â‰¥â

‚¥¬‡©æ“–Õ¬à“ß¬‘Ëß„π‡¥Á°∑“√°∑’Ë¡’‰¢âª“π°≈“ß·≈–‰¢â Ÿß∑’Ëµ√«®À“µ”·Àπàßµ‘¥‡™◊ÈÕ‰¡àæ∫

·π«∑“ß°“√√—°…“

‡¥Á°‡≈Á°∑’Ë¡’‰¢â§«√‰¥â√—∫°“√µ√«®«‘π‘®©—¬·≈–¥Ÿ·≈√—°…“‚¥¬‡√Á« ‡æ√“–¿“«–‰¢â‡ÕßÕ“®¡’º≈‡ ’¬

µàÕ‡¥Á°‰¥â

1. °“√¥Ÿ·≈√—°…“∑—Ë«‰ª

¢—Èπ·√°§◊Õ°“√∑”„Àâ∑“√°√Ÿâ ÷° ∫“¬µ—«¢÷Èπ

§«√∂Õ¥‡ ◊ÈÕÕÕ°∫â“ß ∂â“‡¥Á°∑’Ë„ à‡ ◊ÈÕºâ“Àπ“‡°‘π‰ª ‡æ◊ËÕ„Àâº‘«Àπ—ß√–∫“¬§«“¡√âÕπÕÕ°®“°

√à“ß°“¬

°“√‡™Á¥µ—«‡ªìπ«‘∏’∑’Ë∑”„Àâ‰¢â≈¥≈ßÕ¬à“ß¡’ª√– ‘∑∏‘¿“æ

- ‡™Á¥µ—«¥â«¬πÈ”∏√√¡¥“ ‰¡à§«√‡™Á¥µ—«¥â«¬πÈ”‡¬Áπ À√◊Õ·Õ≈°ÕŒÕ≈å

- ‡™Á¥¥â«¬ºâ“™ÿ∫πÈ”„Àâ∑—Ë«∑—Èßµ—« ‚¥¬‡©æ“–∫√‘‡«≥¢âÕæ—∫ ‰¥â·°à §Õ √—°·√â

¢“Àπ’∫ ´÷Ëß¡’‡ âπ‡≈◊Õ¥„À≠àºà“π ∑”„Àâ√–∫“¬§«“¡√âÕπ‰¥â¥’

- ‡Õ“ºâ“™ÿ∫πÈ”„À¡à ‡¡◊ËÕºâ“¥Ÿ¥´—∫§«“¡√âÕπ®“°√à“ß°“¬®πºâ“‡ªï¬°π—Èπ√âÕπ

2. °“√„Àâ¬“≈¥‰¢â (µ“√“ß∑’Ë1)

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π«ª. 09-016-01


01/06/2545

Àπâ“∑’Ë

4/11

‰¢â‡©’¬∫æ≈—π„π‡¥Á°‡≈Á°

∂â“¡’‰¢âµË” Õ“®‰¡àµâÕß„Àâ¬“≈¥‰¢â

·µà∂â“‰¢â Ÿß‡°‘π 39.5 o ´ §«√„Àâ¬“≈¥‰¢â„π∑ÿ°Õ“¬ÿ §«√ —°ª√–«—µ‘°“√°‘π¬“≈¥‰¢â¡“°àÕπ

‡æ◊ËÕªÑÕß°—π°“√„Àâ´È”·≈–¬“‡°‘π¢π“¥

¬“∑’Ë§«√„™â≈¥‰¢â§◊Õ acetaminophen

¬“≈¥‰¢â∑’Ë¡’°“√„™â ‰¥â·°à

2.1. Acetaminophen

- ‡ªìπ¬“≈¥‰¢â∑’Ë‡À¡“– ¡∑’Ë ÿ¥ „Àâ„π¢π“¥ 10-15 ¡°./°°. „Àâ È”‰¥âÀ≈—ß 4-6 ™¡.

‰¡à‡°‘π 5 §√—Èß„π 24 ™¡.

- ¬“π’È‰¡à§àÕ¬¡’º≈¢â“ß‡§’¬ß‡¡◊ËÕ„Àâ„π¢π“¥ª°µ‘

- º≈¢â“ß‡§’¬ß ”§—≠ §◊Õæ‘…µàÕµ—∫ ÷Ëß®–‡°‘¥¢÷Èπ‡¡◊ËÕ„™â¬“¡“°‡°‘π‰ª®π√–¥—∫¬“ Ÿß

∂÷ß√–¥—∫∑’Ë‡ªìπæ‘… À√◊Õ‡¡◊ËÕ„Àâæ√âÕ¡°—∫¬“Õ◊ËπÊ ∑’Ë¡’æ‘…µàÕµ—∫ ‡™àπ barbiturates,

carbamazepine, INH, rifampin, sulfapyrazone.

2.2. Aspirin

- ¡’ƒ∑∏‘Ï≈¥‰¢âÕ¬à“ß¡’ª√– ‘∑∏‘¿“æ‡™àπ‡¥’¬«°—∫ acetaminophen ·µà‰¡à§«√„™â‡ªìπ

¬“≈¥‰¢â ‡æ√“–¡’¢âÕ‡ ’¬À≈“¬Õ¬à“ß

- ¡’§«“¡ —¡æ—π∏å°—∫°“√‡°‘¥ Reyeûs syndrome ‡¡◊ËÕ„Àâ·°àºŸâªÉ«¬∑’Ë¡’°“√µ‘¥‡™◊ÈÕ

‰«√— ‚¥¬‡©æ“–Õ¬à“ß¬‘ËßÕ’ ÿ°Õ’„

- ∑”„Àâ gastritis ·≈–≈¥ platelet adhesion ∑”„Àâ‡≈◊Õ¥À¬ÿ¥¬“° ‚¥¬‡©æ“–‡¡◊ËÕ

‡ªìπ‰¢â‡≈◊Õ¥ÕÕ°

µ“√“ß∑’Ë 1 ¢π“¥¬“ acetaminophen ∑’Ë„™â„π‡¥Á°

Dosage Form ¢π“¥¬“ ¢π“¥°“√„™â

µàÕ °°./«—π 10¡°/°°/§√—Èß Àà“ß°—π >4 ™¡

Õ“¬ÿ ¡°.

- Tablet 350, 500 ¡°. - 10 ¡°/°°/§√—Èß 0-3 ‡¥◊Õπ 40

- Syrup 120 ¡°./5¡≈ - 0.3-0.4 ¡≈/°°/§√—Èß 4-11 ‡¥◊Õπ 40

- Concentrated syrup: - 0.1 ¡≈/°°/§√—Èß 1 - < 2 ªï 120

100 ¡°/¡≈. 2-3 ªï 160

4-5 ªï 240

6-8 ªï 320

9 -10 ªï 400

11 ªï 480

12-14 ªï 640

> 14 ªï 650

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π«ª. 09-016-01


01/06/2545

Àπâ“∑’Ë

5/11

‰¢â‡©’¬∫æ≈—π„π‡¥Á°‡≈Á°

2.3 Ibuprofen

- ¡’√–¬–°“√ÕÕ°ƒ∑∏‘Ïπ“π°«à“ acetaminophen ·≈– aspirin

- µâÕß°‘πæ√âÕ¡Õ“À“√À√◊Õπ¡‡æ◊ËÕ≈¥º≈¢â“ß‡§’¬ßµàÕ∑“ß‡¥‘πÕ“À“√ ‰¥â·°à ª«¥∑âÕß

§≈◊Ëπ‰ â ª«¥¡«π„π∑âÕß À√◊Õ ‡≈◊Õ¥ÕÕ°„π°√–‡æ“–®“°°“√‡°‘¥·º≈

- ‰¡à¡’√“¬ß“π«à“‡°’Ë¬«¢âÕß°—∫ Reyeûs syndrome ·µà¡’√“¬ß“π«à“¡’æ‘…µàÕ‰µ

- §«√À≈’°‡≈’Ë¬ß°“√„™â‚¥¬‡©æ“–„π‡¥Á°‡≈Á°

3. °“√√—°…“Õ◊Ëπ Ê ‰¥â·°à

3.1 °“√„Àâ “√πÈ”∑¥·∑π „π‡¥Á°∑’Ë¡’‰¢â §«√„Àâ‡¥Á°¥◊Ë¡πÈ”‡æ’¬ßæÕ

3.2 °“√ªÑÕß°—π·≈–√—°…“°“√™—°®“°‰¢â

‡¥Á°∑’Ë¡’‰¢â§«√‰¥â√—∫°“√¥Ÿ·≈„°≈â™‘¥ ≈¥‰¢â‚¥¬°“√‡™Á¥µ—«À√◊Õ„Àâ¬“‡¡◊ËÕ¡’‰¢â Ÿß

√–«—ßÕ“°“√™—°®“°‰¢â ( febrile seizure ) ´÷Ëßæ∫‰¥â„π‡¥Á°Õ“¬ÿ 6 ‡¥◊Õπ ∂÷ß 5 ªï

„π‡¥Á°Õ“¬ÿ 30 «—π - 5 ªï √—°…“Õ“°“√™—°„π¢≥–π—Èπ¥â«¬

- diazepam 0.2-0.5 ¡°./°°./§√—Èß (‰¡à‡°‘π 5 ¡°./§√—Èß) ∑“ß‡ âπ‡≈◊Õ¥¥”

(IV) „Àâ´È”∑ÿ° 15-30 π“∑’ (‡¥Á°Õ“¬ÿ > 5 ªï „Àâ 5-10 ¡°./§√—Èß)

- ∂â“·∑ß‡ âπ‡≈◊Õ¥‰¡à‰¥â„Àâ diazepam «π‡¢â“∑“ß∑«“√Àπ—° ‚¥¬‰¡àµâÕß

‡®◊Õ®“ß‰¥â ‚¥¬„™â¢π“¥ 0.5 ¡°./°°./§√—Èß „ à„π insulin syringe ¢π“¥

1 ¡≈. „ à∑“ß∑«“√Àπ—°≈÷° 3-4 ´¡. ®–‰¥â¢π“¥¬“∑’Ë∂÷ß√–¥—∫„π 10-15

π“∑’ ·≈–¡’ƒ∑∏‘Ïπ“π 4 ™¡.

‡¥Á°∑’Ë™—°‡¡◊ËÕ¡’‰¢â µâÕß§‘¥∂÷ß “‡Àµÿ®“°°“√µ‘¥‡™◊ÈÕ¢Õß√–∫∫ª√– “∑ à«π°≈“ß

‡ ¡Õ ‚¥¬‡©æ“–Õ¬à“ß¬‘Ëß‡¡◊ËÕ‡ªìπ‡¥Á°Õ“¬ÿπâÕ¬°«à“ 6 ‡¥◊Õπ À√◊Õ‡¥Á°∑’Ë‰¡à‡§¬¡’

ª√–«—µ‘™—°®“°‰¢â À√◊Õ‰¡à¡’§«“¡º‘¥ª√°µ‘∑“ß ¡Õß¡“°àÕπ

‡¥Á°Õ“¬ÿ 0-<3 ‡¥◊Õπ

1. À≈—°°“√∑—Ë«‰ª ª√–°Õ∫¥â«¬ :

„Àâ°“√√—°…“µ“¡ “‡Àµÿ´÷Ëß à«π„À≠à‡°‘¥®“°°“√µ‘¥‡™◊ÈÕ

·°â‰¢·≈–ªÑÕß°—π¿“«– dehydration ·≈–¿“«–™—° ·≈–

¥Ÿ·≈„Àâ‡¥Á°‰¥â√—∫§«“¡ ∫“¬ ‡™àπ ‡™Á¥µ—« „Àâ¬“≈¥‰¢â

2. ‡¥Á°Õ“¬ÿ 0-<3 ‡¥◊Õπ∑’Ë¡’‰¢â > 38.5o ´

§«√√—∫‰«â„π‚√ßæ¬“∫“≈‡æ◊ËÕª√–‡¡‘π·≈– —ß‡°µÕ“°“√ µ≈Õ¥®πµ√«®∑“ßÀâÕßªØ‘∫—µ‘°“√

Õ¬à“ß≈–‡Õ’¬¥ ‰¥â·°à CBC, UA, blood culture ·≈–Õ“®∑” urine culture ¥â«¬ ∂â“ ß —¬ UTI ‚¥¬‡©æ“–

Õ¬à“ß¬‘Ëß∂â“®–„Àâ¬“ªØ‘™’«π–

§«√µ√«®≈–‡Õ’¬¥‡™àππ’È ‰¡à«à“®–√—°…“·∫∫§π‰¢âπÕ° À√◊Õ√—∫‰«â„π‚√ßæ¬“∫“≈

à«π°“√∑” chest X-ray π—Èπ §«√∑”„π√“¬∑’Ë¡’Õ“°“√· ¥ß§«“¡º‘¥ª°µ‘¢Õß√–∫∫∑“ß‡¥‘π

À“¬„® ‡™àπ ‰Õ À“¬„®‡√Á«º‘¥ª°µ‘ øíß‡ ’¬ßªÕ¥‰¥â¬‘π‡ ’¬ßº‘¥ª°µ‘ ‡ªìπµâπ

3. √–À«à“ß√Õº≈‡æ“–‡™◊ÈÕ

°≈ÿà¡ low-risk Õ“®®– —ß‡°µÕ“°“√°àÕπ‰¥â

à«π°≈ÿà¡ high-risk §«√„Àâ¬“ªØ‘™’«π–‰ª°àÕπ‡≈¬ ¬“ªØ‘™’«π–∑’Ë„Àâ‡ªìπ empiric §◊Õ

ampicillin √à«¡°—∫ gentamicin

Administrator


√À— ‡Õ° “√

π«ª. 09-016-01


01/06/2545

Àπâ“∑’Ë

6/11

‰¢â‡©’¬∫æ≈—π„π‡¥Á°‡≈Á°

4. °√≥’∑’Ë‡¥Á°´÷¡ À√◊Õ¡’°√–À¡àÕ¡‚ªÉß À√◊Õ¡’ abnormal neurological sign §«√æ‘®“√≥“‡®“–

À≈—ß ∂â“º≈µ√«®πÈ”‰¢ —πÀ≈—ß‡¢â“‰¥â°—∫ bacterial meningitis §«√„Àâ¬“ªØ‘™’«π– ¥—ßπ’È

Cefotaxime 200 ¡°./°°./«—π À√◊Õ Ceftriaxone 100 ¡°./°°./«—π

5. °“√√—°…“·∫∫§π‰¢âπÕ°

Õ“®æ‘®“√≥“„π°√≥’∑’Ë

- ‡¥Á°¥Ÿ¥’ (nontoxic) ·≈–

- µ√«®√à“ß°“¬‰¡àæ∫µ”·Àπàß∑’Ë ß —¬«à“¡’°“√µ‘¥‡™◊ÈÕ ·≈–

- ‰¢â‰¡à Ÿß°«à“ 38.5o ´

- º≈°“√µ√«® CBC ·≈– urine ‰¡à¡’≈—°…≥–∑’Ë™’È·π–«à“‡ªìπ bacterial infection

- ºŸâª°§√Õß‡¢â“„® “¡“√∂æ“‡¥Á°¡“µ‘¥µ“¡Õ“°“√‰¥â

°“√µ√«®·≈–√—°…“

- àß CBC, UA (æ‘®“√≥“ àß bacterial culture µ“¡§«“¡‡À¡“– ¡)

- æ‘®“√≥“°“√„Àâ¬“ªØ‘™’«π–µ“¡ “‡Àµÿ∑’Ë§‘¥∂÷ß ‡™àπ

Viral infection, dengue infection : ‰¡à„Àâ¬“ªØ‘™’«π–

Bacterial upper respiratory tract infection ‡™àπ otitis media : „Àâ

amoxycillin À√◊Õ co-amoxiclav

Urinary tract infection : gentamicin 3-5 ¡°./°°./«—π IM «—π≈–§√—Èß

À√◊Õ oral co-trimoxazole 6 ¡°./°°./«—π ( àß urine culture °àÕπ‡√‘Ë¡¬“)

Occult bacteremia : ceftriaxone 50 ¡°./°°./§√—Èß IM «—π≈–§√—Èß ( àß

blood culture °àÕπ‡√‘Ë¡¬“)

- Õ∏‘∫“¬„ÀâºŸâ¥Ÿ·≈‡¥Á°∑√“∫∂÷ß

‘Ëß∑’Ë·æ∑¬å§‘¥·≈–∑’Ë∑” „π°“√«“ß·ºπ°“√¥Ÿ·≈√—°…“‡¥Á°

°“√¥Ÿ·≈‡¥Á°∑’Ë∫â“π ·≈–

Õ“°“√∑’ËµâÕßæ“‡¥Á°¡“æ∫·æ∑¬å°àÕπ«—ππ—¥

°“√π—¥°≈—∫¡“¥ŸÕ“°“√Õ’°§√—Èß æ√âÕ¡∑—Èßøíßº≈°“√‡æ“–‡™◊ÈÕ„π 1-2 «—π µàÕ¡“

- ∂â“º≈°“√‡æ“–‡™◊ÈÕ„π‡≈◊Õ¥°≈—∫¡“„Àâº≈∫«° §«√®–√—∫‰«â„π‚√ßæ¬“∫“≈ ·≈–

„Àâ ¬“ªØ‘™’«π–∑“ß‡ âπ‡≈◊Õ¥∑’Ë‡À¡“– ¡µ“¡º≈§«“¡‰«¢Õß‡™◊ÈÕ∑’Ë‰¥â

6. °√≥’∑’Ë√—∫‰«â„π‚√ßæ¬“∫“≈ ·≈–„Àâ¬“ªØ‘™’«π–‰ª°àÕπ

∂â“º≈°“√‡æ“–‡™◊ÈÕ®“°‡≈◊Õ¥°≈—∫¡“æ∫«à“‡ªìπ true bacteremia °Á„Àâ°“√√—°…“‰ªµ“¡‡™◊ÈÕ∑’Ë

æ∫π—Èπ

∂â“°“√‡æ“–‡™◊ÈÕ„π‡≈◊Õ¥‰¥âº≈≈∫·µà„Àâ¬“·≈â«Õ“°“√¥’¢÷Èπ ·π–π”„Àâ¬“µâ“π®ÿ≈™’æµàÕ®π§√∫

10 «—π À√◊Õ®π¡’Õ“°“√ª°µ‘ 5 «—π ‡π◊ËÕß®“°°“√∑’Ëº≈‡æ“–‡™◊ÈÕ„π‡≈◊Õ¥‡ªìπ≈∫‰¡à “¡“√∂ exclude occult

bacteremia ‰¥â

‡¥Á°Õ“¬ÿ 3 ‡¥◊Õπ-3 ªï

°“√ª√–‡¡‘π§«“¡√ÿπ·√ß

1. „Àâ¥Ÿ∑—Èß ‘Ëß∑’Ë«—¥‰¥â·≈–«—¥‰¡à‰¥â ‰¥â·°à°“√¥Ÿ≈—°…≥–°“√√âÕß ªØ‘°‘√‘¬“¢Õß∫‘¥“¡“√¥“ §«“¡µ◊Ëπ

µ—«¢Õß‡¥Á° ’ ¿“«–°“√¢“¥πÈ” °“√µÕ∫ πÕßµàÕ ‘Ëß‡√â“

Administrator


√À— ‡Õ° “√

π«ª. 09-016-01


01/06/2545

Àπâ“∑’Ë

7/11

‰¢â‡©’¬∫æ≈—π„π‡¥Á°‡≈Á°

2. ‡¥Á°∑’Ë¥ŸÕ“°“√¬‘ËßªÉ«¬¡“°‚Õ°“ ∑’Ë®–‡°‘¥®“°°“√µ‘¥‡™◊ÈÕ·∫§∑’‡√’¬√ÿπ·√ß®–¬‘Ëß Ÿß

∂â“‡¥Á°¥Ÿ ∫“¬ ( Well appearing ) ‚Õ°“ µ‘¥‡™◊ÈÕ·∫§∑’‡√’¬√ÿπ·√ß√âÕ¬≈– 3

¥ŸªÉ«¬ ( Ill appearing ) ‚Õ°“ µ‘¥‡™◊ÈÕ·∫§∑’‡√’¬√ÿπ·√ß√âÕ¬≈– 26

¥ŸÕ“°“√Àπ—° ( Toxic ) ‚Õ°“ µ‘¥‡™◊ÈÕ·∫§∑’‡√’¬√ÿπ·√ß√âÕ¬≈– 92

3. °“√µÕ∫ πÕßµàÕ¬“≈¥‰¢â‰¡à‰¥â‡ªìπ ‘Ëß∫Õ°§«“¡√ÿπ·√ß¢Õß‚√§

°“√µ‘¥‡™◊ÈÕ·Õ∫·Ωß (Occult infection)

ºŸâªÉ«¬∑’Ëµ√«®‰¡àæ∫ “‡Àµÿ¢Õß‰¢â Õ“®¡’°“√µ‘¥‡™◊ÈÕ·Õ∫·Ωß (occult infection) µàÕ‰ªπ’È

1. Urinary tract infection

„π°“√ª√–‡¡‘πºŸâªÉ«¬‡¥Á°∑“√°∑’Ë¡“¥â«¬‰¢â ∑’Ë°“√ —°ª√–«—µ‘·≈–µ√«®√à“ß°“¬‰¡à “¡“√∂∫Õ°·À≈àß

¢Õß°“√µ‘¥‡™◊ÈÕ‰¥â (fever of uncertain source) §«√‡°Á∫ªí “«– ‡æ◊ËÕµ√«®·≈–‡æ“–‡™◊ÈÕ∑—Èß„π‡¥Á°‡≈Á°·≈–

‡¥Á°‚µ

2. Pneumonia

Pneumonia à«π„À≠à¡—°· ¥ßÕ“°“√™—¥‡®π ·µà„π‡¥Á°‡≈Á°Õ“®¥Ÿ¬“°

‡¥Á°∑’Ë‡ªìπªÕ¥Õ—°‡ ∫®“°·∫§∑’‡√’¬¡—°¡’‰¢â Ÿß°«à“ 39 Ì´ ·≈– WBC Ÿß°«à“ 20,000 ‡´≈≈å/

¡≈.

„π‡¥Á°Õ“¬ÿµË”°«à“ 2 ªï “‡Àµÿ¢ÕßªÕ¥∫«¡∑’Ëæ∫¡“°∑’Ë ÿ¥ §◊Õ°“√µ‘¥‡™◊ÈÕ‰«√—

3. Bacterial gastroenteritis

°“√µ‘¥‡™◊ÈÕ„π√–∫∫∑“ß‡¥‘πÕ“À“√ ¡—°¡’Õ“°“√∑âÕß‡¥‘π·≈–Õ“‡®’¬π√à«¡¥â«¬

4. Meningitis

Bacterial meningitis „π‡¥Á°‡≈Á° Õ“°“√Õ“®‰¡à™—¥ ·µà‡¥Á°¡—°¥ŸªÉ«¬

°“√µ√«®√à“ß°“¬„π‡¥Á°‡≈Á° ∑’Ë∑”„Àâ ß —¬ bacterial meningitis ‰¥â·°à ÷¡ °√–À¡àÕ¡ Àπâ“‚ªÉß

(„π√“¬∑’Ë°√–À¡àÕ¡¬—ß‰¡àªî¥) Õ“‡®’¬π §Õ·¢Áß ™—°

°“√µ√«®«à“°√–À¡àÕ¡Àπâ“‚ªÉßÀ√◊Õ‰¡à §«√µ√«®„π∑à“π—Ëß ·≈–‡¥Á°‰¡à√âÕß ∂â“‡ªìπ¡“°®–‰¡à¡’

pulsation ∑’Ë°√–À¡àÕ¡Àπâ“

À“° ß —¬ °“√µ√«®πÈ”‰¢ —πÀ≈—ß®–™à«¬„Àâ«‘π‘®©—¬‰¥â

5. Occult bacteremia

æ∫‰¥âπâÕ¬ ‡¥Á°Õ“¬ÿµË”°«à“ 3 ªï ∑’Ë¡’‰¢â ¡’‚Õ°“ ¡’·∫§∑’‡√’¬„π°√–· ‡≈◊Õ¥πâÕ¬°«à“√âÕ¬≈–

3 ∑—Èßπ’È¢÷Èπ°—∫Õ“¬ÿ¢Õß‡¥Á°·≈–§«“¡ Ÿß¢Õß‰¢â

„π°√≥’∑’Ë‡¥Á°‡≈Á°¡’‰¢â Ÿß >38.5 Ì ‚¥¬∑’Ë‰¡à¡’Õ“°“√· ¥ß‡©æ“–∑’Ë ‡¡◊ËÕ‰¥â≈¥‰¢â·≈â«¬—ß´÷¡À√◊Õ

√âÕß°«πº‘¥ª°µ‘§àÕπ¢â“ß¡“° ·≈–¬—ß‰¡à “¡“√∂«‘π‘®©—¬‡ªìπ‚√§Õ◊Ëπ

- æ‘®“√≥“ àß blood culture

- „Àâ¬“ªØ‘™’«π–

- Occult bacteremia ª√–¡“≥√âÕ¬≈– 80 ‡°‘¥„π‡¥Á°Õ“¬ÿ‰¡à‡°‘π 24 ‡¥◊Õπ ·≈–

“‡Àµÿ‡°◊Õ∫∑—ÈßÀ¡¥ §◊Õ Streptococcus pneumoniae, Haemophilus influenzae

·≈– non-typhoidal Salmonella

°“√µ√«®∑“ßÀâÕßªØ‘∫—µ‘°“√

‡¥Á°∑’Ë¡’‰¢â·≈–¥Ÿ‰¡àªÉ«¬

- ‡ªìπ„π°≈ÿà¡∑’Ë¡’§«“¡‡ ’Ë¬ßµË” ‰¡à®”‡ªìπµâÕßµ√«®∑“ßÀâÕßªØ‘∫—µ‘°“√∑—π∑’

Administrator


√À— ‡Õ° “√

π«ª. 09-016-01


01/06/2545

Àπâ“∑’Ë

8/11

‰¢â‡©’¬∫æ≈—π„π‡¥Á°‡≈Á°

- “¡“√∂„Àâ°“√¥Ÿ·≈√—°…“∑’Ë∫â“π‰¥â À“°ºŸâª°§√Õß‡¢â“„®·≈– —ß‡°µÕ“°“√‡Õß‰¥â ·≈–æ“‡¥Á°

¡“µ√«®‡æ◊ËÕµ‘¥µ“¡Õ“°“√„π«—πµàÕ Ê ‰ªµ“¡§«“¡‡À¡“– ¡

∂â“‡¥Á°¥ŸªÉ«¬ ·≈–·æ∑¬å‰¡à·πà„®„π§«“¡‡ ’Ë¬ß

- §«√ àßµ√«®∑“ßÀâÕßªØ‘∫—µ‘°“√ ‚¥¬µ√«® CBC, UA, urine culture,

- ∂â“ WBC >15,000 -20,000 ‡´≈≈å/ ¡≈. §«“¡‡ ’Ë¬ßµàÕ bacteremia ª√–¡“≥ √âÕ¬≈– 3-4

- ∂â“ WBC >20,000 / ‡´≈≈å/ ¡≈. §«“¡‡ ’Ë¬ßµàÕ bacteremia ª√–¡“≥√âÕ¬≈– 8-10

- Absolute neutrophil count (ANC) ¡’§«“¡‰«·≈–§«“¡®”‡æ“– Ÿß°«à“ WBC À√◊Õ

absolute band count „π°“√§âπÀ“ bacteremia ANC > 10,000 / ‡´≈≈å/ ¡≈. ¡’§«“¡‡ ’Ë¬ß

¢Õß bacteremia ‡ªìπ√âÕ¬≈– 8-10

√âÕ¬≈– 6-10 ¢Õß‡¥Á°∑’Ë¡’·∫§∑’‡√’¬„π°√–· ‡≈◊Õ¥ ®–‡°‘¥°“√µ‘¥‡™◊ÈÕ√ÿπ·√ß

∂â“‡¥Á°¥ŸªÉ«¬ „Àâ∑” blood culture ‚¥¬‡©æ“–Õ¬à“ß¬‘Ëß ‡¡◊ËÕæ‘®“√≥“«à“®”‡ªìπµâÕß„Àâ¬“µâ“π®ÿ≈™’æ

„Àâ∑” blood culture °àÕπ‡ ¡Õ

°“√µ√«®Õ◊Ëπ ‡™àπ °“√∂à“¬¿“æ√—ß ’ªÕ¥ ‡æ“–‡™◊ÈÕÕÿ®®“√– À√◊Õ µ√«®πÈ”‰¢ —πÀ≈—ßπ—Èπ ‰¡à®”‡ªìπ

µâÕß∑”∑ÿ°√“¬ ‡≈◊Õ°∑”µ“¡§«“¡‡À¡“– ¡ ‡¡◊ËÕ ß —¬«à“®–¡’ª«¥∫«¡ µ‘¥‡™◊ÈÕ∑“ß‡¥‘πÕ“À“√ À√◊Õ‡¬◊ËÕÀÿâ¡ ¡Õß

Õ—°‡ ∫ µ“¡≈”¥—∫

°“√√—°…“

‡¥Á°∑’Ë¥Ÿ‰¡àªÉ«¬ ¡’§«“¡‡ ’Ë¬ßµË” “¡“√∂¡“µ√«®´È”‰¥â‰¡à¬“°π—° “¡“√∂„Àâ —ß‡°µÕ“°“√∑’Ë∫â“π‰¥â

‚¥¬‰¡àµâÕß„Àâ¬“µâ“π®ÿ≈™’æ

‡¥Á°∑’Ë¡’§«“¡‡ ’Ë¬ß Ÿß„π°“√‡°‘¥ occult bacteremia ®“°°“√ —°ª√–«—µ‘·≈–°“√µ√«®√à“ß°“¬

§«√ àß CBC, blood culture, UA, urine Gram-stain, urine culture Õ“®„Àâ¬“µâ“π®ÿ≈™’æ‚¥¬‰¡àµâÕß√Õ º≈°“√‡æ“–

‡™◊ÈÕ ‚¥¬‡©æ“–∂â“ WBC >15,000 ‡´≈≈å/¡≈.À√◊Õ absolute neutrophil > 10,000 ‡´≈≈å/¡≈.

¢âÕ¡Ÿ≈¢Õßµà“ßª√–‡∑»·≈–ª√–‡∑»‰∑¬ · ¥ß«à“‡™◊ÈÕ∑’Ëæ∫‡ªìπ “‡Àµÿ¢Õß occult bacteremia

„π‡¥Á° à«π„À≠à §◊Õ S.pneumoniae ·≈– H.influenzae ®÷ß·π–π”„Àâ „Àâ amoxicillin À√◊Õ„Àâ ceftriaxone

„π°√≥’∑’Ë‡¥Á°‡§¬‰¥â√—∫¬“ªØ‘™’«π–„π 3 ‡¥◊Õπ°àÕπ À√◊Õ ‰¥â√—∫°“√¥Ÿ·≈„π ∂“π√—∫‡≈’È¬ß‡¥Á° ÷Ëß∑”„Àâ¡’§«“¡‡ ’Ë¬ß

Ÿß¢÷ÈπµàÕ°“√µ‘¥‡™◊ÈÕ¥◊ÈÕ¬“

∂â“„Àâ¬“ªØ‘™’«π–·≈â«‡¥Á°¥’¢÷Èπ ·π–π”„Àâ„Àâ¬“ªØ‘™’«π–®π§√∫√–¬–‡«≈“ ∂÷ß·¡â°“√‡æ“–‡™◊ÈÕ®–

‰¡à¢÷Èπ À“°º≈‡æ“–‡™◊ÈÕ„π‡≈◊Õ¥„Àâº≈∫«° °“√ª√–‡¡‘πºŸâªÉ«¬„À¡à«à“°“√µ‘¥‡™◊ÈÕ‡©æ“–∑’ËÕ¬ŸàÀ√◊Õ‰¡à ‡™àπ

meningitis, pneumonia

Administrator


√À— ‡Õ° “√

π«ª. 09-016-01


01/06/2545

Àπâ“∑’Ë

9/11

‰¢â‡©’¬∫æ≈—π„π‡¥Á°‡≈Á°

·ºπ¿Ÿ¡‘∑’Ë 1 ·π«∑“ß°“√¥Ÿ·≈√—°…“‰¢â‡©’¬∫æ≈—π„π‡¥Á°Õ“¬ÿ 0 - 3 ‡¥◊Õπ

Administrator


√À— ‡Õ° “√

π«ª. 09-016-01


01/06/2545

Àπâ“∑’Ë

10/11

‰¢â‡©’¬∫æ≈—π„π‡¥Á°‡≈Á°

·ºπ¿Ÿ¡‘∑’Ë 2 ·π«∑“ß°“√¥Ÿ·≈√—°…“‰¢â‡©’¬∫æ≈—π„π‡¥Á°Õ“¬ÿ 3 ‡¥◊Õπ - 3 ªï

Administrator


√À— ‡Õ° “√

π«ª. 09-016-01


01/06/2545

Àπâ“∑’Ë

11/11

‰¢â‡©’¬∫æ≈—π„π‡¥Á°‡≈Á°

‡Õ° “√Õâ“ßÕ‘ß

1. Finkelstein JA, Christiannsen CL, Platt R. Fever in pediatric primary care : occurrence,

management and outcomes. Pediatrics 2000;105:260-6.

2. °¡≈«‘™ ‡≈“ª√– æ«—≤π“ ª√–‡¡‘π°“√„™â Rochester criteria „π°“√®”·π°ºŸâªÉ«¬‡¥Á°‰¢â Ÿß‡©’¬∫

æ≈—π∑’Ë¡’§«“¡‡ ’Ë¬ßµË”µàÕ°“√µ‘¥‡™◊ÈÕ·∫§∑’‡√’¬√ÿπ·√ß ß¢≈“π§√‘π∑√å‡«™ “√.

3. Silpapojakul K, Chupuppakarn S, Yuthasompob S, et al. Scrub and murine typhus in children with

obscure fever in the tropics. Pediatr Infect Dis J 1991;10:200-3.

4. Washington LJ, Holder MS, Kirksey OW, Palm DE. Fever in infants. Clinician Reviews 1999;

9:51-53, 57-58, 63-64, 66-68.

5. Childrenûs Hospital Medical Center(Cincinnati, OH). Evidence based clinical protocol

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