7. Sepsis Six in 60 Minutes: World Sepsis Day – September 13th
NEW SEPSIS PATHWAY
…for every hour you delay, the patient has a 33% increased risk of death!
6. Did you know about the RULE OF TENS for Fluid Resuscitation in Burns?
Burns Rule of TENS:
1. Estimate burn size (TBSA) to the nearest 10%.
2. Multiply %TBSA x 10 = Initial fluid rate in mL/hr (for adult patients weighing 40 kg to 80 kg).
3. For every 10 kg above 80 kg add 100 mL/hr to the rate.
5. New 2015 Resuscitation Guidelines Compedium
4. LFTs explained
LFTs = ‘hepatocellular’ or ‘cholestatic’ arrangement based on the pattern of elevation.
Hepatocellular pattern = transaminases > ALK
ALT is generally considered to be more specific to liver damage
Magnitude of aminotransferase elevation => guide initial diagnosis: mild (<5x), moderate (5-10x), or marked elevation (>10x)
Mild = NAFLD, Drug Induced Liver Injury, Alcohol-Induced Liver Injury
Severe = Acute Viral Hepatitis, Ischemic Injury, Acetaminophen Toxicity
3. The GCS is out-of-stock
Contrary to common belief, The Glasgow Coma Scale (GCS) is NEVER out-of-stock and the lowest score possible is 3.
An intubated patient still gets 1 point for verbal meaning they score 3T…there is nothing like a 2T score (at least not in human beings)
The phrase ‘GCS of 11’ is essentially meaningless, and it is important to break the figure down into its components, such as E3V3M5 = GCS 11.
The Scale was described in 1974 by Graham Teasdale and Bryan Jennett (Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2:81-4.) and is the most reference paper in medical literature
2. Nairobi Accident Hotspots
The most dangerous time to walk on Nairobi’s streets is on a Friday, around 7am, particularly along Mombasa Road.
1. Salter-Harris Fracture (remember the mnemonic SALTR)
Slipped (i.e., through growth plate and not involving bone) / Type I
Above growth plate (i.e., through metaphysis) / Type II (most common)
Lower growth plate (i.e., through epiphysis) / Type III
Through (i.e., through metaphysis growth plate and epiphysis) / Type IV
Rammed (i.e., Crush injury) / Type V (worst prognosis)
Intravenous magnesium sulfate given as a single dose of 1.2 g or 2 g over 15 to 30 minutes improves lung function and reduces the risk of hospital admission in adults with acute asthma exacerbations that have not resolved with current first line treatments.
Metered-dose inhalers with a spacer can perform at least as well as nebulisation in delivering beta-agonists in children with acute asthma. Salbutamol has systemic side effects – tremor and increased pulse rate were more common when using nebulisers.
Most DO NOT need a chest X-ray performed and a high WBC is common as a result both of stress as well as steroid use NOT A SIGN OF INFECTION so DON’T order labs or give antibiotics unless there are other features of infection.