AMC EXAMS AUSTRALIA ,AUSTRALIAN MEDICAL EXAMS,MCQS,CLINICALS.

Complete miscarriage • No intrauterine gestational sac • No ovarian/fallopian mass • Products of conception passed • No evidence of POC in uterus • Endometrial thickness <15mm in longitudinal section Incomplete • No intrauterine gestational sac miscarriage • No ovarian/fallopian mass • POC passed • More POC seen in uterus Missed miscarriage • Intact intrauterine gestational sac • Fetal pole seen • No fetal heartbeat • CRL >6mm OR • Intact intrauterine gestational sac measuring >20mm • Fetal pole not seen

INITIAL MANAGEMENT When a woman describes bleeding in early pregnancy the treating doctor must first determine whether she has heavy bleeding and/or severe pain. Saturation of pads and/or passing clots larger than a 20 cent piece implies heavy bleeding. If either is present this scenario must betreated as a clinical emergency. The possibility of cervical shock should always be considered. A speculum examination should be performed, and any products of conception (POC) should be removed from the cervix . This is the only way to reverse shock associated with this condition. Basic life support principles apply. It is important to: • Ensure that the woman has a clear airway and adequate breathing before the speculum examination is performed. • Gain IV access with a cannula of at least 16G diameter and start IV crystalline fluids at a rate that maintains adequate blood pressure (>100/60) and pulse rate (<100 beats per minute). • As the IV is inserted, take blood for blood group typing

DIFFERENTIAL DIAGNOSIS OF VENOMOUS SNAKEBITE ■ non-venomous snakebite ■ bite or sting by other venomous creature (arthropod, including spider, octopus, jellyfish) ■ CVA ■ ascending neuropathy, eg Guillain-Barre syndrome ■ AMI ■ allergic reaction ■ hypoglycaemia/hyperglycaemia ■ drug overdose ■ closed head injury The combination of neurological disturbance and evidence of defibrination in a patient with an appropriate history is strongly suggestive of severe envenomation.

In managing the patient with suspected snakebite, it is necessary to establish whether significant envenomation has occurred and to attempt to identify the type of snake involved. A significant proportion of venomous snakebites don’t result in envenomation. The use of antivenom should be reserved for those cases with clinical or pathologic evidence of envenomation. 1.Snake venom Detection Kit 2.Clotting Studies 3.Creatinine Kinase-Indicating Myolysis 4.Urinalysis-Haemoglobin,Myoglobin 5.Renal Function-May be impaired secondary to Myoglobinuria or other mechanism.

Effects of Australian snake bite venom are usually species specific, but in general include: ■ neurotoxins ■ procoagulants ■ anti-coagulants ■ rhabdomyolysins ■ haemolysins (weak). Presentation Symptoms and signs of envenomation may include: ■ EARLY (within 30 minutes) - headache, nausea/vomiting, abdominal pain - coagulopathy ■ LATE (within several hours) - cranial nerve palsies (ptosis, ophthalmoplegia, dysarthria, dysphonia, dysphagia) - limb and truncal weakness - respiratory failure - haemorrhage ■ VERY LATE (delayed presentation, wrong/inadequate treatment) - prolonged paralysis - renal failure - uncontrollable haemorrhage Features suggestive of snakebite Identification of snakes is often unreliable: polyvalent antivenom should be used if the type of snake cannot be identified in all areas of Australia apart from Tasmania, where both tiger snake and copperhead bite may be successfully treated with tiger snake antivenom, and Victoria, where bites should be treated with combined ti