Dermatology

Skin care advice for patients with lymphoedema


■ Keep the skin supple using a non-perfumed moisturising cream such as sorbolene.
■ Avoid drying out your skin and consider using a soap-free alternative.
■ Clean any scratches, grazes or cuts immediately using an antiseptic solution,
use an antibacterial cream and cover the area with a clean, dry plaster.
■ Use an electric razor for shaving instead of a wet razor.
■ Avoid tattoos and body piercing.
■ Consider ways to protect the skin, such as wearing gloves while washing dishes,
gardening or handling pets.

Administration of Anti -D

At the first pregnancy consultation the mother's blood
group should be determined and blood taken for detection/
measurement of blood group antibodies. For
complete and incomplete miscarriages all Rh(D) negative
women who have not actively formed their own
anti-D should be given 250IU of anti-D.
There is insufficient evidence to suggest that a threatened
miscarriage before 12 weeks gestation necessitates
use of anti-D, but meta-analyses indicate that antenatal
administration of anti-D (for all indications
including miscarriage) can result in a 78% reduction
in allo-immunisation.

CLINICAL DEFINITION OF MISCARRIAGE-Australia

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

HOW TO TREAT MISCARRIAGE

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
and FBC, and arrange
cross-match of four units of
packed cells.
If analgesia is required, small
bolus doses of IV morphine
2mg titrated to pain at 5-
minute intervals gives quick
relief but should be accompanied
by metoclopramide 10mg
IV as an anti-emetic.
If shock cannot be controlled
despite adequate IV fluids
and removal of POC, the
woman must be prepared for
emergency D&C. Surgery
should not be delayed due to
haemodynamic instability; it
should be performed before
blood and fluid losses have
been replaced. Sometimes surgical
evacuation of the uterus
is needed to resolve shock.

Differential Diagnosis of snake bites ?

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.