Paediatric Elbow Injuries

CRITOE gives us the order of ossification for the pediatric elbow – capitellum, radial head, internal epicondyle, trochlea, external epicondyle, and olecranon — typically occurring at year 1, 3, 5, 7, 9, and 11 – remember the order is the most important thing – all ossification centers should be accounted for.  Make sure one is not missing – or where one has been “created” traumatically.

 

Kenya’s emergency medical services needs major work

Access to emergency care can be improved by better delivery at health facilities and the creation of new policies at a national level. Specifically, Kenya needs to recognise emergency services as an integral component of the healthcare system.

 

Ectopic Pregnancy

  • Transvaginal ultrasound is the diagnostic tool of choice for tubal ectopic pregnancy.
  • Tubal ectopic pregnancies should be positively identified, if possible, by visualising an adnexal mass that moves separate to the ovary.
  • A serum beta-human chorionic gonadotrophin (β-hCG) level is useful for planning the management of an ultrasound visualised ectopic pregnancy.
  • Expectant management is an option for clinically stable women with an ultrasound diagnosis of ectopic pregnancy and a decreasing β-hCG level initially less than 1500 iu/l.
  • Systemic methotrexate may be offered to suitable women with a tubal ectopic pregnancy. It should never be given at the first visit, unless the diagnosis of ectopic pregnancy is absolutely clear and a viable intrauterine pregnancy has been excluded.
  • Surgical methods of management are associated with a high failure rate and should be reserved for those women suffering life-threatening bleeding.
  • Offer anti-D prophylaxis as per national protocol to all RhD-negative women who have surgical removal of an ectopic pregnancy, or where bleeding is repeated, heavy or associated with abdominal pain.