Acute Rhinosinusitis

  1. Sinusitis is a clinical diagnosis. Patients typically present with purulent nasal discharge and facial pain or other URI symptoms.
  2. The vast majority of patients with acute rhino sinusitis will be viral in nature and will not benefit from antibiotics
  3. Patients with prolonged symptoms, more than 7-10 days, without improvement or continued fevers past 2-3 days should be considered for antibiotic treatment as should those who are immunocompromised.

 

Paediatric “tube” sizes

You decided to intubate a child and wisely remembered that you should also follow with an NG/ OG after intubation to decompress the stomach.  In order to avoid the blank stare when asked “what size”?  Here’s a nice mnemonic about Pediatric “tube” sizes… easy as 1-2-3-4!!!  Please note ETT = endotracheal tube size.

  • 1 x ETT = (age/4) + 4 (formula for uncuffed tubes)
  • 2 x ETT = NG/ OG/ foley size
  • 3 x ETT = depth of ETT insertion
  • 4 x ETT = chest tube size (max, e.g. hemothorax)

So for example, a 4-year-old child would get intubated with a 5-0 ETT inserted to depth of 15 cm (3x ETT), a 10Fr NG/OG/foley (2x ETT), and a 20Fr chest tube (4x ETT).

Also, remember that you can use cuffed tubes in any child except neonates but the formula needs to be adjusted as follows: cuffed endotracheal tube ID (mm) = (age/4) + 3.5

Challenging Consultations

Practical top tips for managing challenging consultations:

  • Control your own emotions
  • Don’t get angry
  • Verbalise the difficulty
  • Validate your patient
  • Don’t be afraid of silence
  • Try to find some common ground
  • Know when to call it a day

As a doctor, if all has failed, take time to reflect on the consultation at a later point. Perhaps review the notes and discuss with colleagues. Be the type of doctor where calling it a day with an unhappy patient is a rare event and something that you feel is worth reflecting on.

The STEMI ECG Assessment

This ECG assessment is designed to evaluate your ability to use simply the 12-Lead ECG to make the diagnosis of a coronary artery occlusion. It uses a standardized list of 36 ECG’s from McCabe JM, et al. Physician Accuracy in Interpreting Potential ST-Segment Elevation Myocardial Infarction Electrocardiograms. J Am Heart Assoc. 2013;2:e000268.

WE are back!

We salute KMPDU and it’s leadership above for fighting for a better healthcare system in Kenya. As we embark on this journey, the Emergency Medicine Kenya Foundation is dedicated to supporting the cause through education and research that will promote better emergency care in Kenya.