How useful are physical examination manoeuvres for an adult patient with suspected meningitis?

meningitis

The Kernig, Brudzinski and Jolt Accentuation signs have limited utility in assessing patients with acute meningitis. The poor sensitivities mean that meningitis cannot be ruled out if the signs are not present (remember sn[out]). The relatively high specificities mean that your suspicion might increase if the signs are present (remember sp[in]) but unfortunately the associated low positive likelihood ratios show that no exam manoeuvre can reliably rule in the diagnosis. All three must be used with caution and in conjunction with other supporting laboratory and historical data.

 

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#POCUS Point of Care Ultrasound Initiative

 

ultrasound

Proficiency in basic Point of Care Ultrasound in Clinical Practice (#POCUS) is an essential skill for healthcare providers involved in the acute and routine care of adults and children.  Kenya has a limited number of radiologists and many healthcare facilities lack basic imaging modalities leading to delayed diagnoses and potentially increased morbidity and mortality. Point of Care Ultrasonography in the hands of a trained healthcare provider has been shown to augment the health care providers’ ability to assess and manage critically ill or injured patients and to increase the healthcare providers’ confidence in the diagnosis and initial management.

If you would like EMKF to consider donating a Portable Ultrasound Scanner to your facility, please click below.

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How Long Does a Cough From Respiratory Illness Last?

It is completely normal and expected to have a cough for 2 or even 3 WEEKS after onset of illness!!! It is also important to emphasize to your patients that they should ONLY seek care if they are having worsening symptoms or have alarm symptoms (i.e. High fever, bloody or rusty sputum, and/or worsening shortness of breath)

Were James Bond’s drinks shaken because of alcohol induced tremor?

After exclusion of days when Bond was unable to drink, his weekly alcohol consumption was 92 units a week, over four times the recommended amount. His maximum daily consumption was 49.8 units. He had only 12.5 alcohol free days out of 87.5 days on which he was able to drink.

Stroke…as simple as STR

 

You spend 3 hours in traffic everyday…this is how long a patient with an acute stroke has to get to an appropriate facility that could save them from a lifetime of disability.

Someone you know or you will probably have a stroke in your lifetime, early diagnosis and immediate referral could make all the difference.

Sometimes symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster.
The stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke.

A bystander can recognize a stroke by asking three simple questions :

S * Ask the individual to SMILE ..
T * = TALK. Ask the person to SPEAK A SIMPLE SENTENCE (Coherently) (eg ‘It is sunny out today’).
R * Ask him or her to RAISE BOTH ARMS .

If he or she has trouble with ANY ONE of these tasks, CALL AN AMBULANCE and get the patient to a STROKE APPROPRIATE FACILITY.

NOTE : Another ‘sign’ of a stroke is

  1. Ask the person to ‘stick’ out their tongue.
  2. If the tongue is ‘crooked’, if it goes to one side or the other that is also an indication of a stroke.

Remember these ‘3’ steps, STR . Read, Learn and Teach someone!

Evidence based strategies in Stroke Management

Most of the time there’s nothing much to do for the ischemic stroke patient but here’s some evidence based strategies that can potentially reduce the morbidity/mortality:

  1. Positioning: Elevation of the head of the bed (HOB) > 30 degrees
  2. Glucose control: 7.7-10 mmol/L (hyperglycemia associated with increased ICP and progression to hemorrhagic conversion)
  3. Blood pressure control: 15% reduction MAP over 24 hours if BP exceeds 220/120 (likely best accomplished with nicardipine infusion to avoid overcorrection)
  4. Adjunctive therapies: Prevent fever and hypercapnea
  5. Early physio and occupational therapy

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Lets delve into the Blood Culture!

Indications for blood culture (NOT COUGHS & COLDS)

  1. Clinical features of sepsis including tachycardia, tachypnea, increased or sub-normal temperature and change in sensorium, hypotension
  2. Suspicion of infective endocarditis
  3. Pyrexia of unknown origin
  4. Unexplained leucocytosis or leucopenia
  5. Systemic and localised infections including suspected meningitis, osteomyelitis, septic arthritis, acute untreated bacterial pneumonia or other possible bacterial infection