Month: October 2021
Evidence-Based Use of Therapeutics for Ambulatory Patients with COVID-19
Currently only a few treatments available help mildly ill patients – people who have COVID-19 who do not require admission to hospital. Drugs like azithromycin, bamlanivimab, colchicine, hydroxychloroquine, ivermectin, lopinavir-ritonavir, and vitamin D do not help patients with COVID-19, and may cause harm.
Dexamethasone, a steroid that can be given in pill form, may benefit patients who are at home but need supplemental oxygen, but does not help patients who are mildly ill who do not need supplemental oxygen.
Budesonide, a steroid that can be inhaled (from a “puffer”), has no effect on whether patients with mild COVID-19 get sicker, are hospitalized, or die. But there is weak evidence that inhaled budesonide 800 mcg twice daily for 14 days may make patients feel better a few days earlier, so doctors may consider prescribing it.
Dizziness…the good and the ugly…
The differential diagnosis of vertigo can be broken into peripheral and central causes. It is imperative the Emergency Physician consider central causes of vertigo.
Signs/ Symptoms Differentiating Peripheral and Central Vertigo
| Peripheral | Central | |
| Onset | Sudden or Insidious | Sudden |
| Severity of Vertigo | Intense Spinning | Ill-defined, may be severe or less intense |
| Prodromal Dizziness | Occurs in up to 25%, often single episode | Occurs in up to 25%, recurrent episodes suggest TIA’s |
| Intolerant of head movements/Dix-Hallpike Maneuver | Yes | Varies, but often intolerant |
| Associated Nausea/Diaphoresis | Frequent | Variable, but often frequent |
| Auditory Symptoms | Points to peripheral causes | May be present |
| Proportionality of Symptoms | Usually proportional | Often disproportionate |
| Headache/Neck Pain | Unusual | More likely |
| CNS signs/symptoms | Absent | Usually present |
| Head Impulse Test | Abnormal | Often normal |
| Nystagmus | Horizontal | Vertical/direction-changing |
| HINTS Testing | Negative | Abnormal in at least 1 out of 3 tests |
Guidelines on Case Management of COVID-19 in Kenya
These consolidated guidelines for the prevention, control and management COVID-19 in Kenya provide updated recommendations for comprehensive prevention and case management strategies in Kenya. They cover infection prevention and control measures including the use of vaccines. They also target the diagnosis and case management of COVID-19.
If only a condom was used initially…
Now the same condom will save this mother’s life from Postpartum Haemorrhage (PPH) (a leading cause of maternal mortality)