Posted by FaDhLi on Wednesday, January 26, 2011
A lumbar puncture should not be performed in a patient with suspected meningococcemia when certain conditions are present. This is intended to minimize the risk for cerebral herniation or other adverse effect when there may be little additional information obtained from the CSF studies.
Contraindications to lumbar puncture:
(1) confident clinical diagnosis of meningococcal disease, with typical hemorrhagic rash
(2) drowsiness or impaired consciousness
Glasgow coma scale <>
deteriorating Glasgow coma scores
signs of raised intracranial pressure
(3) focal neurologic signs
(4) signs of raised intracranial pressure, including marked instability in blood pressure and heart rate
(5) evidence of septic shock, with signs of poor perfusion
(6) infection at the planned lumbar puncture site
(7) moderate to severe bleeding disorder
Additional notes:
(1) A normal CT scan does not exclude a raised intracranial pressure.
(2) If lumbar puncture is not performed and the patient has not improved within 24 hours despite therapy, then reassess the need for lumbar puncture.
Posted by FaDhLi on Wednesday, January 26, 2011
Premature infants are smaller and less developed than full term infants of the same postnatal age.
If the gestational age at birth is used to correct the postnatal age, then the development of the premature infant can be more meaningfully compared to normal infants.
corrected age in weeks
= (age in weeks since birth) - [40 - (weeks of gestation at birth)]
The age correction should be done for the first year.
Afterwards the correction has little if any benefit, and the chronological age can be used.
Posted by FaDhLi on Thursday, November 04, 2010
DEFINITION FEVER
elevation of body temperature that exceeds the normal daily variation and occurs in conjunction with an increase in the hypothalamic set point—for example, from 37C to 39C (shift of the set point from “normothermic” to febrile levels)
CHILLS
a sensation of coldness
RIGORS
exaggerated shivering
how all of these related?
fever comes with abnormally high body temperature, but why the patient can has chills and rigors (or shivering)?
read more below
Posted by medik-ukm on Wednesday, November 03, 2010
heart rate
respiratory rate
blood pressure
temperature
pain score
i'm not very sure whether pain score is still the vital sign, but in 2008, KKM add in the 5th vital sign which is PAIN SCORE.
Posted by medik-ukm on Tuesday, October 19, 2010
[5 x (height in centimetre)] - 400
however, in exam, please mentioned that you will compare the result with PEF chart.
thanks to hanim
Posted by medik-ukm on Saturday, October 16, 2010
Medical students MUST know how to instruct patient on the technique of using Peak Expiratory Flow.
I dont know whether it can come out in exam, but i'm sure you will have to instruct the patient some other day, maybe when you become a houseman.
Sorry if there are any mistakes in the information below.
ONE
Your mouth must be empty.
For best results, you should stand.
If you are unable to stand, sit-up straight.
TWO
Set the peak flow meter to zero at the bottom of the meter.
THREE
Hold in your hand with your thumb and forefinger on the grips and the mouthpiece facing toward you.
Younger children may opt to hold the device with both thumbs underneath and fingers on the grips.
Avoid blocking the vent holes as much as possible and do not allow fingers to interfere with the Peak Indicator.
FOUR
Take as deep a breath as possible filling your lungs completely with air.
FIVE
Place your mouth on the mouthpiece, past your teeth and form a tight seal with your lips.
Place your tongue below the mouthpiece.
Make sure your tongue is not blocking the opening at any time.
SIX
Blow, or exhale, the air out into the meter as strongly (HARD!) and quickly (FAST!) as you can in a single blow.
This will cause the indicator to move and indicate your peak flow.
Do not spit or cough into the device. If this occurs, repeat this step again.
SEVEN
Reset peak indicator.
(some people say do not reset because the device will automatically point to only the best reading effort)
EIGHT
Repeat the whole test another two times more for a total of three maneuvers.
NINE
Once you have completed three maneuvers, record your best effort
(DO NOT TAKE THE AVERAGE!)
TEN
You have to know what is normal reading for you.
There is normogram based on age, height and weight. (find out yourself)
There is also a PEF chart. (find out yourself)
Is there any formula for the normogram? i cant find it~
Posted by medik-ukm on Saturday, October 16, 2010
Posted by medik-ukm on Thursday, October 14, 2010
Abdominal Pain or Tenderness
Persistent Vomiting
Clinical Fluid Accumulation (pleural effusion/ascites)
Mucosal Bleed
Restlessness or Lethargy
Tender Enlarged Liver
Increase in HCT concurrent with rapid decrease in platelet
Posted by medik-ukm on Monday, October 11, 2010
Stage 1slight reticular (slight granular) decrease in transparency of the lung, no certain difference to normal findings.
Stage 2Soft decrease in transparency with an aerobronchogram, which overlaps the heart (= always a sign of an alveolar lung reaction!)
Stage 3like stage 2, but with gradual stronger decrease in transparency, as well as a blurry diaphragm and heart.
Stage 4White lung: practically homogenic lung opacity
Synopsis of the changes in Stages I - IV.source :
http://www.kinderradiologie-online.de/radiology/20021110223558.shtml#a1
Posted by medik-ukm on Monday, October 11, 2010
The parameters assessed by inspection or auscultation of the upper and lower chest and nares on a scale of 0, 1 or 2 using this system are :
Chest movement
Synchronized vs. minimal lag or sinking of the upper chest as the abdomen rises. In the most extreme instances, a seesaw-like movement of the chest and abdomen is observed and would be given a score of 2.
Intercostal retractions
Retraction between the ribs is rated as none, minimal or marked.
Xiphoid retractions
Similarly retraction below the xiphoid process are rated as none, minimal or marked.
Nasal flaring
There should be no nasal flaring. Minimal flaring is scored 1 and marked flaring is scored 2.
Expiratory grunting
Grunting that is audible with a stethoscope is scored 1, and grunting that is audible without using a stethoscope is scored 2.
As you can see on the slide, the higher the score, the more severe the respiratory distress.
Posted by medik-ukm on Monday, October 11, 2010
Explaining what a febrile seizure is.
A seizure occurring in association with fever in children between 3 months and 6 years of age, in whom there is no evidence of intracranial pathology or metabolic derangement
A febrile convulsion is not epilepsy. No regular medication is needed.
Children suffer no pain or discomfort during a fit.
Children usually have fewer febrile seizures as they get older and most seizures stop completely by the age of six.
Reassured with prognosis
Population risk of febrile seizure is 2.7% to 3.1%
Risk of recurrence of febrile seizure after first seizure is 27% to 32%
Risk of epilepsy after simple febrile seizures 1.5% to 2.4%
No evidence that any child has ever died as a result of simple febrile seizure
No evidence of permanent neurological deficits following febrile seizure
Children who have febrile convulsions normally grow up healthy and do not have any permanent damage from seizures.
Control the fever if their child has a febrile illness
Take of clothing and tepid sponging
Antipyretic e.g. syrup or suppository Paracetamol 15mg/kg 6 hourly. It is indicated for patient’s comfort, but has not been shown to reduce the recurrence rate rate of febrile seizure. carefully check the label for the correct dose
What to do to if their child has a further febrile seizure
Do not panic. Remain calm.
Note the time of onset of the fit and how long it lasted
Ensure the child is safe by placing them on the floor and removing any objects that he could hit against.
Loosen the child’s clothing especially around the neck
Place the child in recovery position (left lateral with head lower than the body)
Wipe any vomitus or secretion from the mouth
Do not insert any object into the mouth
Do not give any fluid or drugs orally
Stay near the child until the seizure is over and comfort the child as he is recovering
Ambulance should be called if :
seizure has lasted 5-10 or more minutes and shows no signs of stopping
parents are very worried and anxious
source : wardround in Hospital Slim River
Read more »
Posted by medik-ukm on Saturday, June 19, 2010
Tetralogy of Fallot is treated surgically. A temporary operation may be done at first if the baby is small or if there are other problems. Complete repair comes later. Sometimes the first operation is complete repair. Placement of a BLALOCK-TAUSSIG SHUNT (BTS) is a 'closed-heart' procedure performed as a first stage to correct TOF. Placement of a shunt is usually a temporary measure designed to alleviate symptoms until such time that the patients is in better condition to undergo complete repair.
BTS (An incision is made on the side of the chest under the arm, extending up towards the scapula).
The significant problem in TOF is REDUCED blood flow into the lungs. This results in reduced oxygen delivery to the body.
The operations designed to increase blood flow into the lungs are called SYSTEMIC-PULMONARY SHUNTS. These are connections between aorta or one of its branches (the "systemic" arteries / subclavian artery) and the pulmonary artery. The principle underlying these shunts is that a portion of blood flow from the arteries will ne directed across the shunt into the pulmonary artery and its branches. This has 2 effects :
- First, by increasing the total lung blood flow, the amount of oxygen available for distribution to the rest of the body is increased.
- Second, the increasing amount of blood flowing into the pulmonary artery and its branches stimulates them to grow in size. The narrow portions may become wider. So, later, when an operation for total correction is performed, there is little or no obstruction to lung blood flow.
Patient who have had completely repair of this condition in infancy may present with particular problems.
Repair of the right ventricular outflow obstruction and enlargement of the pulmonary valve annulus may leave severe pulmonary regurgitation which may lead eventually to exertional dyspnoea.
The surgery itself has, until recently, required a right ventriculotomy (cutting into the right ventricle). this leave a scar that can be associated with cardiac rhythm abnormalities in later life. patients may present with palpitations or syncope.
Signs may include:
- a median sternotomy scar,
- a long diastolic murmur of pulmonary regurgitation and signs of right ventricular enlargement (parasternal impulse)
- and later of tricuspid regurgitation (big v waves in the neck and a pulsatile liver).
Thanks to Dr Ngiu for asking us about BTS and how to know the patients had done the operation for TOF, any signs?
Sources :
Talley O'Connor Clinical Examination
A111218
