■ Women often don’t recognise
themselves as being depressed
– they hide their symptoms or
present as the baby having the
problem.
■ When symptoms (anxiety,
lowered mood, tearfulness,
fears of not being able to cope
or being a bad mother) are
recurrent, severe or continue for
more than two weeks, the diagnosis
of depression or anxiety
disorder must be considered.
■ In PND many anxieties arise
from the lack a balanced
perspective. Cognitive behavioural
therapy is well suited to
address these issues.
■ Maternal depression is associated
with poor developmental
outcomes for children with
implications for the child’s
education and the potential for
mental illness as adults.
■ Mothers’ groups can be
beneficial if they are specifically
for women with PND but general
mothers groups can alienate
women if they feel different to
the other “coping” mothers.
■ Early detection and treatment
of PND may lead to remission
of symptoms and improvement
for mother, child and family
members, but it does not
guarantee a good outcome.
For some women, mother-infant
or long-term therapy is needed
Monday 30 March 2009
Saturday 28 March 2009
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.
■ 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.
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.
Wednesday 25 March 2009
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
• 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.
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.
Monday 16 March 2009
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.
■ 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.
Snake Bites Australia How to investigate
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.
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.
Austrlian Snake Bites Overview
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 tiger/brown snake
antivenom
How to treat
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 tiger/brown snake
antivenom.
Important to remember
■ Correct diagnosis of snakebite
may be delayed because the
bite may not be dramatic or
painful, and snake venom
generally causes little local
pain or tissue destruction.
■ 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.
■ Children are more likely to
sustain multiple bites and may
be more quickly and severely
affected by snakebite than
adults because of their lower
body weight.
■ The combination of
neurological disturbance and
evidence of defibrination in a
patient with an appropriate
history is strongly suggestive of
Severe envenomation
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 tiger/brown snake
antivenom
How to treat
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 tiger/brown snake
antivenom.
Important to remember
■ Correct diagnosis of snakebite
may be delayed because the
bite may not be dramatic or
painful, and snake venom
generally causes little local
pain or tissue destruction.
■ 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.
■ Children are more likely to
sustain multiple bites and may
be more quickly and severely
affected by snakebite than
adults because of their lower
body weight.
■ The combination of
neurological disturbance and
evidence of defibrination in a
patient with an appropriate
history is strongly suggestive of
Severe envenomation
Saturday 14 February 2009
BRONCHOSCOPY
The therapeutic indications for bronchoscopy include:
removal of secretions and mucus plugs:
often used in ITU
pneumonic lobar collapse
allergic bronchopulmonary aspergillosis
removal of foreign bodies
stent insertion in benign airways disease:
for example in relapsing polychondritis
removal of secretions and mucus plugs:
often used in ITU
pneumonic lobar collapse
allergic bronchopulmonary aspergillosis
removal of foreign bodies
stent insertion in benign airways disease:
for example in relapsing polychondritis
BRONCHOSCOPY
Diagnostic role of flexible bronchoscopy
lung cancer:
the type and operability of lung tumours can be assessed
pneumonia:
good for identifying infecting organism
interstitial lung disease:
permits histoloy and analysis of bronchoalveolar lavage
causes of haemoptysis, cough and recurrent pneumonia
lung cancer:
the type and operability of lung tumours can be assessed
pneumonia:
good for identifying infecting organism
interstitial lung disease:
permits histoloy and analysis of bronchoalveolar lavage
causes of haemoptysis, cough and recurrent pneumonia
BROCHODILATORS
bronchodilators
Bronchodilation is a phenomenon of sympathetic stimulation. Thus drugs which attempt to achieve it include:
1.sympathomimetics
salbutamol } beta-2 adrenoceptor
terbutaline } agonists
fenoterol }
rimiterol }
salmeterol }
adrenaline
isoprenaline
2.antimuscarinics
Anticholinergics are drugs which antagonise cholinergic receptors.
3.xanthinesTypes of sympathomimetic include:
Xanthines are compounds which inhibit phosphodiesterase and thus are able to produce bronchodilatation.
theophylline
aminophylline
caffeine, theophylline and tannin
Bronchodilation is a phenomenon of sympathetic stimulation. Thus drugs which attempt to achieve it include:
1.sympathomimetics
salbutamol } beta-2 adrenoceptor
terbutaline } agonists
fenoterol }
rimiterol }
salmeterol }
adrenaline
isoprenaline
2.antimuscarinics
Anticholinergics are drugs which antagonise cholinergic receptors.
3.xanthinesTypes of sympathomimetic include:
Xanthines are compounds which inhibit phosphodiesterase and thus are able to produce bronchodilatation.
theophylline
aminophylline
caffeine, theophylline and tannin
Wednesday 11 February 2009
LONG TERM SIDE EFFECTS OF TREATMENT OF BREAST CANCER
Lymphoedema after axillary dissection and/or
radiotherapy. It can arise at any time, even many
years after treatment.
● Cardiovascular toxicity after radiotherapy, and
increased cardiovascular risk after premature
menopause. Treat with appropriate medical and
risk-reduction strategies.
● Congestive heart failure associated with anthracyclines
and trastuzumab. Monitor (mandatory with
trastuzumab) and manage medically if present.
● DVT, stroke (tamoxifen). Treat as usual if present.
● Hot flushes after premature menopause, tamoxifen
or aromatase inhibitors (less so). SSRIs, SNRIs and
gabapentin may be useful. Alternatives such as
black cohosh have also been suggested.
● Vaginal dryness and dyspareunia. Non-hormonal
moisturisers and lubricants; use local oestrogen
with caution as there may be systemic absorption.
● Loss of libido resulting from altered body image,
radiotherapy, chemotherapy, depression or
dyspareunia. Counselling may be helpful, as well as
appropriate medical treatment.
● Arthralgia and musculoskeletal symptoms, from
aromatase inhibitors and sometimes tamoxifen.
Conservative treatment such as paracetamol or
NSAIDs if needed.
● Depression and anxiety following the diagnosis,
loss of body image, concern about morbidity and
mortality, and the direct effects of some
treatment. Treat as usual, including supportive
counselling and antidepressants if needed.
● Fatigue, associated with the diagnosis and
treatment. Provide support, encourage activity,
and rule out psychiatric or biological causes
(depression, anaemia, hypothyroidism).
● Weight gain, which can occur with chemotherapy
and possibly with tamoxifen and aromatase
inhibitors. Manage as usual with diet and
exercise.
● Osteopenia or osteoporosis, associated with
treatment-induced menopause and aromatase
inhibitors. Monitor bone mineral density and treat
as usual, including bisphosphonates if needed.
NEJM 2007; 356:2505-13.
Drug class
Anthracycline
Alkylating agent
Anti-metabolite - Folic acid analogue
- Uracil analogue
- Taxane
Selective oestrogen receptor modulator
Nonsteroidal aromatase inhibitors
Steroidal aromatase inactivator
Luteinising hormone releasing hormone agonist
Monoclonal antibody
radiotherapy. It can arise at any time, even many
years after treatment.
● Cardiovascular toxicity after radiotherapy, and
increased cardiovascular risk after premature
menopause. Treat with appropriate medical and
risk-reduction strategies.
● Congestive heart failure associated with anthracyclines
and trastuzumab. Monitor (mandatory with
trastuzumab) and manage medically if present.
● DVT, stroke (tamoxifen). Treat as usual if present.
● Hot flushes after premature menopause, tamoxifen
or aromatase inhibitors (less so). SSRIs, SNRIs and
gabapentin may be useful. Alternatives such as
black cohosh have also been suggested.
● Vaginal dryness and dyspareunia. Non-hormonal
moisturisers and lubricants; use local oestrogen
with caution as there may be systemic absorption.
● Loss of libido resulting from altered body image,
radiotherapy, chemotherapy, depression or
dyspareunia. Counselling may be helpful, as well as
appropriate medical treatment.
● Arthralgia and musculoskeletal symptoms, from
aromatase inhibitors and sometimes tamoxifen.
Conservative treatment such as paracetamol or
NSAIDs if needed.
● Depression and anxiety following the diagnosis,
loss of body image, concern about morbidity and
mortality, and the direct effects of some
treatment. Treat as usual, including supportive
counselling and antidepressants if needed.
● Fatigue, associated with the diagnosis and
treatment. Provide support, encourage activity,
and rule out psychiatric or biological causes
(depression, anaemia, hypothyroidism).
● Weight gain, which can occur with chemotherapy
and possibly with tamoxifen and aromatase
inhibitors. Manage as usual with diet and
exercise.
● Osteopenia or osteoporosis, associated with
treatment-induced menopause and aromatase
inhibitors. Monitor bone mineral density and treat
as usual, including bisphosphonates if needed.
NEJM 2007; 356:2505-13.
Drug class
Anthracycline
Alkylating agent
Anti-metabolite - Folic acid analogue
- Uracil analogue
- Taxane
Selective oestrogen receptor modulator
Nonsteroidal aromatase inhibitors
Steroidal aromatase inactivator
Luteinising hormone releasing hormone agonist
Monoclonal antibody
RISK FACTORS FOR BREAST CANCER
Relative risk
Advanced age >10
Genes, family history, personal history
BRCA1/2 mutation 5-10
Breast cancer in first-degree relative 2
Previous atypical hyperplasia 4-5
Previous breast cancer >4
Breastfeeding for 12 months 0.96
One birth 0.93
Two births 0.84
Menstrual/reproductive history
Menarche before 11 years 3
Menopause after 54 years 2
First child after 30 1.2-1.4
First child after age 40 3
Current use of HRT 1.3-1.6
Current use of oral contraceptive 1.2
OtherLiving in a developed country (?oestrogen exposure) 5
High breast density on mammogram (?oestrogen exposure) >5
Abnormal exposure to ionising radiation 3
‘Lifestyle’
High socioeconomic status 2
High postmenopausal BMI 2
High premenopausal BMI <1
One alcoholic drink daily 1.07
Lancet 2005; 265: 1727-1741. Cancer 2004; 101:353-62.
Advanced age >10
Genes, family history, personal history
BRCA1/2 mutation 5-10
Breast cancer in first-degree relative 2
Previous atypical hyperplasia 4-5
Previous breast cancer >4
Breastfeeding for 12 months 0.96
One birth 0.93
Two births 0.84
Menstrual/reproductive history
Menarche before 11 years 3
Menopause after 54 years 2
First child after 30 1.2-1.4
First child after age 40 3
Current use of HRT 1.3-1.6
Current use of oral contraceptive 1.2
OtherLiving in a developed country (?oestrogen exposure) 5
High breast density on mammogram (?oestrogen exposure) >5
Abnormal exposure to ionising radiation 3
‘Lifestyle’
High socioeconomic status 2
High postmenopausal BMI 2
High premenopausal BMI <1
One alcoholic drink daily 1.07
Lancet 2005; 265: 1727-1741. Cancer 2004; 101:353-62.
Sunday 1 February 2009
THE MANAGEMENT OF VARIZELLA ZOSTER VIRUS EXPOSURE AND INFECTION IN PREGNANCY AND NEW BORN PERIOD
GOOD DAY
1.Zoster immunoglobulin (ZIG) should be offered to pregnant, varicella-seronegative women with significant exposure to varicella-zoster virus (VZV) (chickenpox) infection.
2.Oral aciclovir prophylaxis should be considered for susceptible pregnant women exposed to VZV who did not receive ZIG or have risk factors for severe disease.
3.Intravenous aciclovir should be given to pregnant women who develop complicated varicella at any stage of pregnancy.
4.Counselling on the risk of congenital varicella syndrome is recommended for pregnant women who develop chickenpox.
5.ZIG should be given to a baby whose mother develops chickenpox up to 7 days before delivery or up to 28 days after delivery.
6.Intravenous aciclovir should be given to babies presenting unwell with chickenpox, whether or not they received ZIG.
7.Breastfeeding of babies infected with or exposed to VZV is encouraged.
8.A mother with chickenpox or zoster does not need to be isolated from her own baby.
9.If siblings at home have chickenpox, a newborn baby should be given ZIG if its mother is seronegative.
10.The newborn baby does not need to be isolated from its siblings with chickenpox, whether or not the baby was given ZIG.
11.After significant nursery exposure to VZV, ZIG should be given to seronegative babies and to all babies born before 28 weeks' gestation.
1.Zoster immunoglobulin (ZIG) should be offered to pregnant, varicella-seronegative women with significant exposure to varicella-zoster virus (VZV) (chickenpox) infection.
2.Oral aciclovir prophylaxis should be considered for susceptible pregnant women exposed to VZV who did not receive ZIG or have risk factors for severe disease.
3.Intravenous aciclovir should be given to pregnant women who develop complicated varicella at any stage of pregnancy.
4.Counselling on the risk of congenital varicella syndrome is recommended for pregnant women who develop chickenpox.
5.ZIG should be given to a baby whose mother develops chickenpox up to 7 days before delivery or up to 28 days after delivery.
6.Intravenous aciclovir should be given to babies presenting unwell with chickenpox, whether or not they received ZIG.
7.Breastfeeding of babies infected with or exposed to VZV is encouraged.
8.A mother with chickenpox or zoster does not need to be isolated from her own baby.
9.If siblings at home have chickenpox, a newborn baby should be given ZIG if its mother is seronegative.
10.The newborn baby does not need to be isolated from its siblings with chickenpox, whether or not the baby was given ZIG.
11.After significant nursery exposure to VZV, ZIG should be given to seronegative babies and to all babies born before 28 weeks' gestation.
Saturday 31 January 2009
Asthma Management of Exacerbations
GOOD DAY !
ASTHMA
Managing exacerbations
SUMMARY OF PRACTICE POINTS
LEVEL OF EVIDENCE
Management of exacerbations in adults
A short (7-10 days) course of oral corticosteroids is the current standard treatment for adults with moderate-to-severe asthma exacerbations.
I
When administering a SABA via MDI during an exacerbation, use a spacer. [√]
In adults with acute exacerbations not considered severe enough for admission to hospital, high-dose ICS may be effective. II
Merely doubling the maintenance ICS dose is not effective in managing exacerbations. II
Management of exacerbations in children
A short (up to 5 days) course of oral corticosteroids (prednisolone 1 mg/kg up to 60 mg daily) is the current standard treatment for severe exacerbations. Closely monitor response to treatment. I
Children who are taking regular preventive medication should continue taking the same dose during an exacerbation. II
When administering a SABA via MDI during an exacerbation, use a spacer. III-1
Merely doubling the maintenance ICS dose is not effective in managing exacerbations in children. II
ASTHMA
Managing exacerbations
SUMMARY OF PRACTICE POINTS
LEVEL OF EVIDENCE
Management of exacerbations in adults
A short (7-10 days) course of oral corticosteroids is the current standard treatment for adults with moderate-to-severe asthma exacerbations.
I
When administering a SABA via MDI during an exacerbation, use a spacer. [√]
In adults with acute exacerbations not considered severe enough for admission to hospital, high-dose ICS may be effective. II
Merely doubling the maintenance ICS dose is not effective in managing exacerbations. II
Management of exacerbations in children
A short (up to 5 days) course of oral corticosteroids (prednisolone 1 mg/kg up to 60 mg daily) is the current standard treatment for severe exacerbations. Closely monitor response to treatment. I
Children who are taking regular preventive medication should continue taking the same dose during an exacerbation. II
When administering a SABA via MDI during an exacerbation, use a spacer. III-1
Merely doubling the maintenance ICS dose is not effective in managing exacerbations in children. II
ASTHMA KEY POINTS
GOOD DAY !
ACUTE ASTHMA
SUMMARY OF PRACTICE POINTS
LEVEL OF EVIDENCE
Managing acute asthma in adults
If the patient is acutely distressed, give oxygen and SABA immediately after taking a brief history and physical examination.
[√]
Assess response to treatment using spirometry, oxygen saturation, heart rate, respiratory rate and pulsus paradoxus status.
[√]
Wheeze is an unreliable indicator of the severity of an asthma attack and may be absent in severe asthma.
[√]
Ensure every patient receives adequate follow-up after an acute asthma episode, including review of medications, triggers and asthma action plan.
[√]
Managing acute asthma in children
If the patient is acutely distressed, give oxygen and SABA immediately after taking a brief history and physical examination.
[√]
Emergency management of acute asthma in a child is based on initial administration of salbutamol 4-6 puffs (< 6 years) or 8-12 puffs (≥6 years) via MDI.
I
Load the spacer with one puff at a time and give each puff separately.
III-1
If treatment with an oral corticosteroid (e.g. prednisolone 1 mg/kg up to 60 mg as a single daily dose) has been initiated for a moderate-to-severe acute episode, continue for up to 5 days.
ACUTE ASTHMA
SUMMARY OF PRACTICE POINTS
LEVEL OF EVIDENCE
Managing acute asthma in adults
If the patient is acutely distressed, give oxygen and SABA immediately after taking a brief history and physical examination.
[√]
Assess response to treatment using spirometry, oxygen saturation, heart rate, respiratory rate and pulsus paradoxus status.
[√]
Wheeze is an unreliable indicator of the severity of an asthma attack and may be absent in severe asthma.
[√]
Ensure every patient receives adequate follow-up after an acute asthma episode, including review of medications, triggers and asthma action plan.
[√]
Managing acute asthma in children
If the patient is acutely distressed, give oxygen and SABA immediately after taking a brief history and physical examination.
[√]
Emergency management of acute asthma in a child is based on initial administration of salbutamol 4-6 puffs (< 6 years) or 8-12 puffs (≥6 years) via MDI.
I
Load the spacer with one puff at a time and give each puff separately.
III-1
If treatment with an oral corticosteroid (e.g. prednisolone 1 mg/kg up to 60 mg as a single daily dose) has been initiated for a moderate-to-severe acute episode, continue for up to 5 days.
Friday 30 January 2009
Thursday 29 January 2009
MCQs
GOOD DAY !
Hi next to come is MCQ discussion............please mind that you needs to know what exactly is "ASKING".......this will help to select what is the answer.....!!!
Hi next to come is MCQ discussion............please mind that you needs to know what exactly is "ASKING".......this will help to select what is the answer.....!!!
Wednesday 28 January 2009
Sunday 25 January 2009
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