Top 10 Posts of 2016

 

10. All Shock Explained

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9. Priapism

Priapism

Non-ischemic (high-flow) Ischemic (low-flow)
Physical Exam Typically painless, not fully tumescent Painful, fully tumescent with corpus cavernosa rigidity without involvement of corpus spongiosum and glans penis
Aetiology High-flow priapism is extremely rare and most commonly associated with antecedent trauma including blunt trauma, or resulting from needle injury of the cavernosal artery. Low-flow priapism is caused by impaired relaxation and/or paralysis of cavernosal smooth muscle and in sickle-cell disease
Management NOT Emergency Emergency

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8. 2016 Guidelines

 

 

 


7. Sepsis Six in 60 Minutes: World Sepsis Day – September 13th

Sepsis

NEW SEPSIS PATHWAY

FLUIDS

ANTIBIOTICS

…for every hour you delay, the patient has a 33% increased risk of death!

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LACTATE


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

BLS

 

 

 

 


4. LFTs explained

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
    • Moderate = Alcoholic Hepatitis, Biliary Tract Disease
    • Severe = Acute Viral Hepatitis, Ischemic Injury, Acetaminophen Toxicity

 

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3. The GCS is out-of-stock

GCS

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

Accident Hotspots

The most dangerous time to walk on Nairobi’s streets is on a Friday, around 7am, particularly along  Mombasa Road.

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1. Salter-Harris Fracture (remember the mnemonic SALTR)

  1. Slipped (i.e., through growth plate and not involving bone) / Type I
  2. Above growth plate (i.e., through metaphysis) / Type II (most common)
  3. Lower growth plate (i.e., through epiphysis) / Type III
  4. Through (i.e., through metaphysis growth plate and epiphysis) / Type IV
  5. Rammed (i.e., Crush injury) / Type V (worst prognosis)

 

Magnesium Sulfate for Acute Asthma Exacerbation

acute-asthma

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.

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Coke Bottle named Asthma

Home made coca cola spacer

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.

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Mild to Moderate Acute Asthma Attack…

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.