Minimum criteria for clinical diagnosis (one or more of the following minimum clinical criteria should be present) are as follows:
Bilateral lower abdominal (uterine) tenderness (sometimes radiating to the legs)
Cervical motion tenderness – Positive cervical motion tenderness is defined as increased discomfort from a normal pelvic examination, as stated by the patient. Of note, cervical motion tenderness is neither sensitive nor specific for gynaecologic pathology, is a sign of nonspecific peritoneal inflammation,
Bilateral adnexal tenderness (with or without a palpable mass)
One or more of the following additional criteria can be used to enhance the specificity of the minimum criteria and support a diagnosis of PID:
oral temperature >101° F (>38.3° C);
abnormal cervical or vaginal mucopurulent discharge;
presence of abundant numbers of WBC on saline microscopy of vaginal fluid;
elevated erythrocyte sedimentation rate;
elevated C-reactive protein; and
laboratory documentation of cervical infection with N. gonorrhoeae or C. trachomatis.
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)