plab 2
6-8 weeks
boy child
family history
projectile vomiting
no pain
content : milk
feeding test positive
pyloric stenosis
dd: head injury
intussusception
over feeding
inv : usg and abg
mgt : keyhole sx
20 month child , gp referral ( ask for gp letter )
complaints : vomiting , crying , red jelly stool , diarrhoea ( sometimes )
intussusception
explain with hands
dd: rule out causes of pain : hernia and torsion testis and head trauma
inx : usg + abg + Erect xray ( to rule out perfortion)
mgt :symtomatic : iv fluids and painkillers specific :enema by interventional radiologist
surgery
child
complaints : crying , poor feeding (dehydration) and fever
rapid breathing , grunting
chest xray : cracking , wheeze
risk factors : passive smoking , premature birth , lung condition , asthma and nursery
bronchiolits
dd : meningitis and uti
inv : blood + abg + expectoration culture and chest xray
mgt : caused by rsv , self limiting so only symtomatic mgt
admit , iv fluids , o2 , neb and paracetamol
watch out for red flags
sick floppy baby + fever
severe dehydration
check crt ( > 2 sec)
send for cbc , lft , rft , s. electrolytes and chest xray , abg , urine
treatment : admit , senior , o2 , fluids , abx if necessary
patient came with a h/o fits
take before , during and after fit history
any fever . cause of fever ( ear infection) , dehydration
febrile convulsions
ALWAYS ALWAYS CHECK BLOOD GLUCOSE TO RULEOUT HYPOGLYCEMIA
ix : urine dipstick and all blood tests
fever control: calpol , light dressing , fluids
< 5 mins : no need for him to come to hospital
> 5 mins : ambulance immediately
it is not the same as epilepsy ( abnormal electrical activity in the brain )
chances : 5 -15 % recurrence
h/o fall
indications of ct :
> 1 gcs < 14
<1 gcs < 15
3 episodes of vomiting
> 5 mins of LOC or amnesia
sezuires without h/o epilepsy
Non accidental injury suspision
doubt of open or deressed akull feacture or tense fontanelle
focal neurological deficit
dangerous mechanical injury
basal skull fracture ( racoon eye or battle door sign )
if no ct indication observe for 4 hours
if yes admit
ear infection , pulling the ear
acute otitis media
indication of giving abx:
pain > 4 days
b/l infection and age < 2 years
discharge from the ear
mgt: calpol for pain
child is screaming at night and is unaware if his condition the next morning
night terror
rule out : autism , epilepsy , asthma , abuse
difference between nightmare and night terror : in nightmare the child is fully aware after he/ she wakes up
mgt : reassure the mother
common in age gro 3-12
cuddling
donot disturb the child during episode
wake up the child 15 mins before the time of night terrors for 7 days
good sleep hygeine
avoid violent video games
talk to the child about stressors
in any surgery station
ICE , systemic review ,PMAFTOSA , DESA ( on any medications like warfarin , cocp , dm medication)
any additional problems after planning sx
Neck pain , back pain , jaw pain , dentures , filling , loose teeth , any facial fractures
ask for any advance directive
jahovas witness - no blood card
discuss the matter with the surgeons
any signed advance written document
refer to hospital leasion commity
draw and explain the procedure and complications
empty stomach for 6 hours
stop taking insulin on day before
post hemiarthroplasty
always r/o risk factors for clot : smoking , cocp , hormonal therapy, otc and travel history previous history of clot
anyway we put her on dalteparin ( started before sx to 28 days after sx )
occupational therapist : will install railing , electrical chair and change high toilet seat to low toilet seat
if she has no immediate relatives : social services
she wont be able to go up and down the stairs for atleast 3 months
return to work after 12 weeks
driving and sex 6 weeks
mobilize within 24 hrs with the help of clutches
ted stocking , intermittent pneumatic compression
herniorrhaphy
truss not recommended for young ppl as it weakens the abd wall
hip replacement assessment
criteria for knee replcement : severe pain in both knee which interfere with daily activities , pain at rest , BMI < 30
if BMI > 30 not fit for sx : DESA changes
enalapril
cough : side effect change it to arb
amlodipine : pedal edema
sick note : ankle sprain
provide letter
citizen advisary bureau ( whiplash also)
support with her child
follow up
cancer
mc milan specialist nurses trained to take care of cancer pts
ask for power of attorny
any advanced directive