HELLP Syndrome

hellp-syndrome-3-638

  • Any pregnant lady in late second or third trimester C/O malaise – Think HELLP (BP may be normal)
  • Treatment of HELLP syndrome is seizure prevention with MgSO4 and controlling BP
  • Getting OBGYN involved early is important to decide on the definitive treatment
  • HELLP by itself is not an indication for LSCS unless there are co-existing materal/fetal indications/distress

Cholangitis

Acute Cholangitis

  • Always think about cholangitis in any ill-appearing patient with RUQ pain or undifferentiated sepsis.
  • Charcot’s triad and Reynold’s pentad are not reliable. Absence of these clinical findings does not rule out cholangitis.  Use the total picture with clinical exam, labwork, and imaging studies.
  • Early antibiotics and consultation for biliary decompression are mainstays of therapy.

IV Iron for Anemia in the ED

Iron Sucrose (Venofer) Ferumoxytol (Feraheme)
Dose (Max) 300mg in 250mL NS 510mg in 17mL (add to 50ml NS)
Infusion Time 2 hrs 15-60 mins
Serious Hypersensitivity 0.6 per million <5 in 1000
Cost $120 $200

Patients with the following risk factors should receive slower infusions (e.g. Feraheme® [ferumoxytol] over 60 minutes or Venofer® [iron sucrose] 300mg over 2 hours)

  • Age > 65 yrs
  • Baseline systolic BP less than 100
  • Severe asthma or eczema
  • Severe respiratory or cardiac disease
  • Treatment with beta-blockers, ACE inhibitors or 3 or more anti-hypertensive medications
  • Nephrology patients

After IV Iron, and with ongoing oral supplementation, a patient’s hemoglobin will start to rise 3-7 days. You can expect a 1-2 point rise in the hemoglobin per day, and after 2-4 weeks the hemoglobin will have risen 20-30g/L. Ferrous sulfate 300mg contains 60mg of elemental iron and 1 tab can be taken each night on an empty stomach at least 2 hours after meals with Vitamin C 500mg. Patients should also avoid taking with calcium or magnesium supplements as these decrease absorption.

 

Neonatal Dermatology

The Benign Conditions

  • Erythema toxicum
  • Transient neonatal pustular melanosis
  • Mongolian spot
  • Cutis marmorata
  • Congenital nevomelanocytic nevi
  • Acrocyanosis
  • Haemangioma
  • Salmon patch/stork bite
  • Port wine stain
  • Neonatal acne
  • Milia
  • Epstein pearls
  • Miliaria

Rashes you shouldn’t ignore

  • Epidermolysis bullosa
  • Congenital syphillis
  • Congenital rubella
  • Herpes simplex
  • Neonatal varicella
  • Aplasia cutis congenita
  • Neonatal lupus erythematosus
  • Incontinentia pigmenti

 

Bell’s Palsy

Bell’s palsy (BP) is an idiopathic paralysis of the facial nerve and is the most common cause of lower motor neuron facial palsy. Treatment consists of prednisone 60-80 mg per day for one week. In addition, eye care in patients with BP must be a priority. The prognosis of BP is excellent, with 85% of patients regaining function within three weeks.

Constipation

Easing the strain: put your feet up for constipation

Top bowel tips

  • drink plenty of water
  • avoid caffeine
  • eat fibre
  • exercise
  • go when you feel the first urge
  • after breakfast, sit on the toilet for 15-20 minutes and wait for the ejection reflex- which does exactly what it says
  • take your time on the toilet
  • raise feet on a stool, lean forwards
  • don’t hold breath, ssss, grrrr, or moo
  • do a pelvic floor contraction when the bowel movement is done to encourage complete closing
  • congratulate yourself on releasing the poo hostage