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)

 

#WDR2016 World Day of Remembrance for Road Traffic Victims

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#WDR2016 Day 1 Checking PSV drivers at Kiambaa for Hypertension, Diabetes & Visual Acuity with @ntsa_kenya

#WDR2016 Day 2 Our teams and @ntsa_kenya at Juja Weighbridge for free Diabetes, Hypertension and Visual Acuity check up for PSV drivers

 

The World Day of Remembrance for Road Traffic Victims (WDR) is commemorated on the third Sunday of November each year – to remember the many millions killed and injured on the world’s roads, together with their families, friends and many others who are also affected. It is also a Day on which we thank the emergency services and reflect on the tremendous burden and cost of this daily continuing disaster to families, communities and countries, and on ways to halt it.

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Shut up during triage or end up on antihypertensives (learnt this from one of our nurses today)

BP Reading

10 Factors That Can Affect Blood Pressure Readings

  1. Blood Pressure Cuff is too Small
  2. Blood Pressure Cuff Used Over Clothing
  3. Not Resting 3-5 minutes
  4. Arm/Back/Feet Unsupported
  5. Emotional State
  6. Talking
  7. Smoking
  8. Alcohol/Caffeine
  9. Temperature
  10. Full bladder


 

BP 252/130…start IV Fluids…this won’t blow up the patient…

 

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The diagnosis of hypertensive emergency is made based upon the findings of hypertension in the setting of end-organ damage (usually heart, brain, or kidneys). What you really care about is the rate of increase rather than the actual BP number (there is no defining threshold).

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Think before pulling the trigger: HTN Emergency

Key Points in High BP management:

  1. Don’t get worried with numbers, treat only if the patient is symptomatic. Asymptomatic HTN goes home with good follow up/discharge instructions.
  2. High BP + end organ damage is HTN emergency, again don’t look at specific numbers to call it HTN emergency.
  3. Reduce MAP by 20-25% in the first hour with titratable IV meds (Exception dissection, eclampsia where you need to get down as quickly as possible)
  4. Most of them are fluid depleted and need IV fluids, which also prevents the sudden drop in pressures after commencing IV therapy.
  5. NTG drip is not the answer to everything!