Extra PACES notes Flashcards
what to do in lithium toxicity?
- stop lithium
- do urgent lithium level
- encourage fluids, stop diuretics, monitor electrolytes/drug interactions
- seek specialist advice
- refer to secondary care if severe symptoms
what to do if >3mmol/l?
osmotic or forced alkaline diuresis
what to tell people if taking lethium?
- carry lithium card
- regular blood tests
- don’t take OTC NSAID
- if dose missed, take as soon as possible
- if yday dose missed, do not double todays dose
what conditions require serial USS?
- SGA
- pre-existing HTN
- pre-existing diabetes
- epilepsy
- smoker/ drug misuse
- maternal age 40+
- previous still birth
what appointments do non-primips have?
8-10w 11-13+6w 16w 18-20+6w 28w 34w 36w 38w 41w
what extra visits do primips have?
25w
31w
40w
(routine care)
paeds HR ref range
<1: 110-160
1-2: 100-150
2-5: 95-140
5-12: 80-120
paeds RR ref ranges
<1: 30-40
1-2: 25-35
2-5: 25-30
5-12: 20-25
NICE red flag system
- pale/mottled/ashen
- does not wake/stay awake
- weak, high-pitched cry
- grunting, RR >60, mod/severe chest indrawing
- reduced skin turgor
- age <3 months, temp 38
- non-blancing rash
- bulging fontanelle
- neck stiffness
- focal neuro signs
when is BP checked in women with pre-existing HTN?
weekly BP checks if poorly controlled
every 2-4 weeks if well controlled
what is the BP monitoring post-partum in mothers with pre-exisiting HTN?
Day 1
Day 2
Once on day 3-5
F/U with GP at 2 weeks
pre-existing DM extra scans
foetal cardiac scan at 20w
serial growth scans
retinal and renal screening at booking, repeat at 28w
scans in gestational HTN
weekly FBC, LFTs, U&Es
US foetal surveillance every 2 weeks
pre-existing cardiac disease scans
- appointment every 2 weeks until 24w
- weekly thereafter
- extra foetal cardiac scan at 22w
measurements in OC
weekly LFTs
doppler/CTG every 2 weeks
what to do if think SGA?
- confirm with fetal biometry at 20w
- if confirmed, uterine artery doppler at 20-24 weeks
- if abnormal, serial growth scans
CVS definition
biopsy of trophoblast cells from developing placenta
adv: earlier
disadv: higher miscarriage rate (2%)
when to do OGTT if Hx of GDM?
at 16-18 weeks
when to do OGTT if RFs of GDM?
OGTT at 28 weeks
planned C-section over breech?
decreased perinatal mortality
decrease early neonatal mortality
long term health of breech baby not affected by delivery
surgical TOP
<14 w = vacuum aspiration
>14 w = dilatation and evacuation
medications to give in med/surgical TOP?
- prophylactic Abx (met and doxy)
- NSAIDs
- anti-D
F/U from TOP
2 week after = check complete/no infection
contraception (start hormonal on day of abortion)
abortion legal statement
- carried out in first 24 weeks if certain criteria are met
- any abortion carried out in hospital/licensed clinic
- 2 drs must agree that the abortion would cause less damage to womens physical/mental health than continuing
questions to ask in emergency contraception
- date of LMP
- what day of her cycle
- length of cycle
- date/time of any episodes of unprotected sex since LMP
- any meds that could interfere with EC
- abstein from sex until next period
indications for intrapartum GBS prophylaxis
- intrapartum fever, confirmed chorioaminitis
- prolonged ROM
- <37 weeks (preterm)
- previous infant with GBS
- maternal CBS colonisation
sepsis red flags in neonates that require sepsis Abx and sepsis screen
- intrapartum abs for sepsis (not GBS prophylaxis)
- resp distress >4 hours
- seizures
- mech ventilation needed in term baby
- signs of shock
how to manage LGA if detected at 24-36 weeks?
- offer OGTT
- if follows same path = reassure, arrange routine scan
- if acceleration of growth = USS for foetal biometery
if baby is SGA/IUGR, what investigations need to be done throughout pregnancy?
umbilical artery doppler serial measurements
USS biometry every 2 weeks
what causes a decreased AFP antenatally?
Down syndrome
Trisomy 18
maternal DM
triggers for lithium OD
dehydration
drugs (NSAIDs, ACEi, ARBs, diuretics, SSRIs)
how long to continue drug in OCD
12 months after remission
4 phases of cognitive therapy for OCD
relabel
reattribute
refocus
revalue
depression in elderly
- problem solving, increasing socialisation, day-time activities
- CBT, group therapy, family therapy, couple therapy
- Age UK
symptoms of LBD
fluctuating confusion
vivid visual hallucinations
parkinsonism
what drug to not prescribe in LBD?
antipsychotics
management of ASD
MDT
- psychosocial play based intervention
- applied behavioural analysis (improve speech behaviours)
- reduce impairment in communication (visual aids)
- reduce reinforcement of behaviour
investigations in LD
WAIS III or IQ
ABAS II
birth medical problems in people with Down Syndrome
congenital heart defects
duodenal atresia
Hirschprung’s
omphalocele (+ umbilical hernia)
Ix in ASD
- speak to child and nursery
- physical exam
- refer to developmental paediatrician/CAMHS
- autism assessment (ADI, ADOS)
- learning difficulties assessment
RFs for GOR in infants
preterm
cerebral palsy
following surgery for oesophageal atresia/diaphragmatic hernia
management in eczema
- prescribe generous amounts of emollients
- mild topical steroid (sparingly)
- use on inflamed areas until redness/itchiness subsides
(usually until 48 hours after the flare has been controlled) - consider non-sedating anti-histamine
eczema herpeticum
herpes simplex infection in pt with eczema
Tx: systemic acyclovir
differential diagnosis in early puberty
CAH
pituitary tumour
granulosa cell tumour
androgen secreting tumour
what to screen for in DS?
AVSD
duodenal atresia. Hirschprung
hypothyroidism
what extra investigation in DS
chromosomal karyoype analysis
if balanced translocation = risk of recurrence in future pregnancies
definition of cerebral palsy
movement disorder
caused by non-progressive lesion of motor cortex
due to insult that occurs around time of birth
burst therapy in asthma
10 puffs of salbutamol via MDI and spacer or nebs
repeat every 20-30 mins
30-40mg Prednisolone
assess response: HR, RR, oxygen sats, re-examine chest
if burst step fails
contact HDU, take a blood gas
- add ipratropium bromide to nebulised salbuatmol
- IV bolus mag sulfate
following that
IV Salbutamol or IV aminophylline
if someone is responding in ashtma, when do you discharge?
when stable on 4 hour treatment continue oral prednisolone for 3 days on discharge: review medication and inhaler technique provide personal asthma plan arrange F/U
questions to ask in ashtma history
- control
- when does she get symptoms
- difficulty sleeping?
- cough at night?
- any day time symptoms?
- every been admitted to the hospital?
- has your asthma every interfered with your usual activities
CIN I on smear
repeat in 6 months
many cases resolve on there own
if repeat if also dyskaryotic = colposcopy
sterilisation counselling
- serious operation and permanent
- risks associated
- take some time, book longer F/U in 2-3 weeks
- not 100% effective, other LARCs
- some people have regret
- failure rate 1/200
things to ask in prolapse
- bowel/bladder symptoms
- vaginal discharge
- sex
- obs history/ any birth complications
RFs for prolapse
activities
jobs that require heavy lifting
any constipation
smoking
examinations in prolapse
- general: BMI, nicotine staining
- abdo exam
- pelvic exam: bimanual, sims speculum, ask pt to cough
cervical screening - assess for any cervical symptoms
PV bleed PV discharge PCB, IMB Dyspareunia Sex, contraception
counselling in cervical screening
- screening test that is done so we can pick up any abnormal cell changes in your cervix early
- your test has shown that there are some abnormal cells
- we cannot be sure where theses cells are so we will need to send you to a colposcopy appointment
explaining colposcopy to a patient
- sit in a special chair, legs raised
- speculum (small plastic tube) inserted into vagina to look at cervix
- apply a dye to highlight any abnormalities
- use microscope to get better look
- if any abnormalities, can be removed during this time and examined by expert
low grade dyskryosis and -ve HPV
return to normal routine recall
what is red degeneration?
when fibroids outgrow their blood supply
mx: pain relied/fluids
(fibroids managed expectantly in pregnancy)
investigations in PCOS
BMI LH/FSH at day 3 Testosterone SHBG Prolactin Day 21 progesterone TVUSS
further investigatiins in infertility
semen analysis
tubal patency
lap/dye if suspect PIF/adhesions./endo
general advice in infertility
minimise alcohol
avoid smoking
regular intercourse
reduce weight
questions to ask in PE
SOB chest pain cough/wheeze/haemoptysis/fever clotting conditions liver condition
ddx of PE
physiological hyperventilation of pregnancy
pneumonia
asthma
HF
Ix in PE
Obs Exam Bloods ABG CXR Doppler CTPA
extra things in counselling in PE
teach women to self inject
LMWH/ warfarin not expressed in breast milk
post natal review at joint obs/haem clinic
thrombophillia testing once anticoag stoppped
ovarian cancer questions
bloating abdo pain bowel/bladder FLAWS check CA125
main management of Ovarian Ca
primary debulking surgery (total abdo hysterectomy + BSO)
peritoneal washings
chemo if stage 2-4
if fertility sparing needed in ovarian Ca
unilateral salpino-oophrectomy
survival in ovarian Ca
5 year survivial = 35%
if suspect stillbirth, what antenatal clinic investigations?
- abdo exam: if transverse lie = inc chance of dec foetal movements
- pinnard to listen to FHR
- speculum and swabs
- emergency antenatal USS
- placental doppler (look for reduced/ increased flow)
maternal causes of stillbirth
extremes of age infection drugs/alcohol/smoking thrombophilia IVF
placental/foetal causes of stillbirth
placental compromise/abruption
fetal chromosome abnormalities
infection
still birth counsellling
1/200 risk
no one’s fault
often do not know why
expectant management not recommended
medical: IOL with mifepristone and misoprostol - done ASAP to allow post mortem of foetus and placenta
surgical: ERPC (risk: infection, bleeds, perf, Ashmerman’s)
POI counselling
early menopause only treatment is HRT manage like menopause manage risk of osteoporosis (HRT best, next bisphosphonate) attend screening
vaccination discussion
no link between MMR vaccine and autism paper disproven, struck off many papers since then provided no link herd immunity reason we don't see many of these now recent outbreaks in UK stress importance of vaccination
measles symptoms and complications
most serious
fever, rash, cold symptoms
serious complications: pneumonia, encephalitis, SSPE (late brain damage)
mumps symptoms and complications
less contagious
usually mild
serious: pancreatitis, encephalitis, deafness, infertility
Rubella symptoms and complications
usually mild, fever, tiredness, joint pain
serious = encephalitis, thrombocytopaenia, congenital rubella
complications of eczema
- secondary infection
- growth retardation
- sleep disturbance
- psychosocial issue
short stature questions
food
bowel habits
MPH
redbook + development
definition of short stature
height < 2nd centile
normal variants of short stature
- constitutional delay
- familial short stature
- idiopathic short stature
investigations into short stature
- trend from growth charts (from last 6 months)
- MPH
- height-weight ratio (short/fat = organic)
- coeliac screen
- bone age
- TSH, GH stimulation
- karotyping
septic arthritis investigations
FBC, CRP/ESR, blood/joint culture
imagine: X-ray, USS, CT/MRI
Kocher criteria (septic arthritis vs transient synovitis)
- non weight bearing on affected side
- ESR >40
- fever > 38.5
- WCC >12,000
(All 4 = 99% chance of septic arthritis)
investigations of obesity
- dysmorphic features
- FBC< U&Es, LFTs
- cholesterol + TGs
- fasting glucose, OGTT
- BMI
management of obesity
MDT approach
primary care
diet and exercise
behavioural therapy (stimulates control, goal setting, problem solving)
ddx of infantile spasms
sandifer syndrome
benign myoclonus of infancy
GORD
breath holding spells
investigations of infantile spasms
full neuro
GI exam
FBC, LFTs, U&Es, glucose, blood/urine
brain imaging, EEG
triad of West Syndrome
infantile spasms
developmental delay
hysparrythmia on EEG
DMD signs
devlopmental motor delay calves FH? waddling gait Gower's sign CK
management of DMD
MDT, genetic counselling physio optimise bone health (Vit D, bisphosphates) help with mobility cardiac and resp surveillance support for inc weakness respite for family physio and airway clearnace
conversion disorder
internal conflict unconsciously converted into neurological symptoms
interpersonal therapy
concentrates on your relationship with other people
help rebuild supportive relationships that can meet your emotional needs
TCA toxicity
- anticholinergic = blocks Na reuptake
- sympatholytic = direct alpha-adrenergic blockade
- Na channel blockers = slow myocardial membrane depolarisation
Mx of TCA toxicity
IV Na bicarbonate
what is Turner’s?
genetic condition
missing all/part of 2nd chromosome
short term consequences of Turner’s
- heart problem = breathlessness
- kidney problems = UTI
- hearing/vision = ear infection
- dec bone density = joint/bone pain
long term consequences of Turner’s
HTN
DM
infertility
Mx of Turner’s
MDT
specialist paed endocrinologist
medical: GH for growth failure, oestrogen for induction of puberty
psych support
social: education for parents, prep for transition to living independently
bio management of self harm
Refer to A&E if significant harm and arrange them to be accompanied
Ensure any self harm wounds are address e.g. clean and steristripping
Ensure patient knows the damages of self harm
Treatment of any underlying MH conditions
Assess need for antidepressants
Alternative to cutting (Elastic bands, ice cubes)
If drawing of blood -
If really addicted ensure safe practises (first aid)
psych self harm
Treatment of any underlying mental health
Psychoeducation
Self help guides/ online resources to help tackle needs for self harm (Mediation, relaxation, exercise such as boxing to reduce stress)
Distraction techniques eg exercise, colouring
Samaritans - helpline/ other phone lines
Family therapy - mum/ dad?
CBT/ psychodynamic problem solving sessions
Art or exercise therapy
Social self harm
Education for family/ care plan
Inform social services to ensure children are well support - assessment of mum
Encourage talking to friends/ online support
Warn about the dangers of self harm communities/instagram etc
Involve mum - hide blades
Talk to school to ensure well supported
clozapine agranulocytosis
assess using traffic light system
amber: FBC twice weekly until blood count stabilises or increases
red:
red clozapine
Stop clozapine immediately & do not restart clozapine treatment
Can lead to sudden physical and mental withdrawal effects within 2-3 days
rebound psychosis, rapid detiororation in mental state
nausea , vomiting, diarrhoea, headache, restlessness, sweating, agitation (cholinergic rebound)
Check for signs of infection
Contact haematologist
Put patient in side room
FBC daily for up to 2 days until 2 consecutive non-red results
BP, Pulse, Temperature every 4 hours
Ensure patient’s consultant, care coordinator and clozapine clinic staff are aware - discuss individual care plan and medication review
ALL history aspects
- tired
- bruising
- SOB
- bone pain
- bowel/urinary symptoms
- recurrent infections
- FLAWS
ALL investigations
- full physical exam
- observations
- height and weight
- urine dipstick
- urgently call local paeds reg/send to A&E
- ? discuss with safeguarding lead
ALL counselling
We think there is something more serious going on
We’re concerned that the tiredness, shortness of breath and some of the signs I found could be the cause of something sinister.
The most important thing we want to rule out is leukaemia - this is cancer of the white cells in blood.
I know cancer is a scary word to be thinking out but it’s important we know if this is the case so we can treat ASAP
Our treatments for ALL are good and his prognosis is good (95% remission rate). His symptoms could be caused by something quite simple that will pass but it’s important we get to the bottom of this.
MDT members in ALL
GP, paediatrician, oncologist, clinical nurse specialist, play team, OT, physio, school
Mx of ALL
Conservative: Stay hydrated. Avoid contact with infected people.
Medical:
Induction chemotherapy, usually for around 3 years.
Prophylactic Abx.
Fluid therapy + allopurinol to reduce uric acid accumulation and protect renal function.
May need a blood/platelet transfusion to correct anaemia/thrombocytopenia.
Pain relief
Surgical: ?SCT
F/U
chickenpox counselling
Most children get this at some point.
Usually mild and clears up in a week, but can be dangerous for people with a poor immune system, or pregnant women.
Complications include skin infection, lung infection, but this is rare in children.
Chickenpox is usually treated at home. They will feel pretty miserable and uncomfortable, but treatment can help.
Paracetamol to relieve fever and discomfort, stay hydrated.
DON’T use anti-inflammatory painkillers like ibuprofen, can make them more ill
Camomile lotion or cooling gels to ease the itching
Stay away from school until all blisters scabbed.
symptoms of vulval cancer
- lump/ulcer on labia
- itching
- irritation
- soreness
- superficial dyspareunia
- bleeding
- FLAWS
differentials of vulval cancer
Lichen sclerosus Candida infection +/- vaginal discharge Vulval warts Scabies Other derm eye eczema, psoriasis, lichen simplex, contact dermatitis
VIN and types
Presence of atypical cells in vulvar epithelium
Usual type (most) - warty, basaloid SCC. Associated with HPV (esp 16), CIN smoking and chronic immunosuppression. Differentiated type VIN - rarer. Older women. Ulcer or plaque linked to keratinizing SCC
treatment for VIN
No treatment - monitor closely if low grade
Imiquimod - activates immune system to kill VIN
Laser treatment
Surgery: Wide local excision/ vuvlectomy
counselling for atrophic vaginitis
From the examinations and tests we have done the good news is that your cervix is completely normal
It looks as though you have vaginal atrophy.
This is something lots of women get after they have the menopause and is caused by reducing levels of one of your hormones called oestrogen.
It causes the vaginal walls to become a bit drier and thinner and sometimes they can bleed.
The treatment for this is generally an oestrogen cream which you put directly into your vagina and this helps to keep the vaginal tissue moist and healthy.
It’s also important to use lots of lubrication when you have sex so that the tissue doesn’t get irritated and sore.
important pregnancy questions
planned pregnancy?
IVF pregnancy?
results of the DS quadruple test
beta hCG = raised
AFP = low
inhibin A = raised
unconjugated estriol = low
antenatal screening shows increased risk of DS - counselling
I have had a look at your blood results and first I wanted to check if you knew what they were looking for?
They were looking at the risk of the baby having Down’s syndrome and some other conditions.
The test cannot say for sure whether the baby definitely has one of these syndromes but it gives us an idea if there is a high or low risk of this.
From the results it looks as though you have a higher chance of your baby having Down’s syndrome.
This means that there is a higher than 1 in 150 chance of Down’s syndrome. It is too early to say for definite either way.
options following this
So the options you have now are to leave it and wait until the birth or to have further screening which gives a much more accurate idea of whether the baby does have Down’s syndrome or not. As you are 16 weeks along now the appropriate test would be called amniocentesis. This is where we take a small sample of the amniotic fluid and test the cells inside.
how to manage a pregnant woman with asthma?
Monitor regularly
Same drug therapy for acute asthma
continuous foetal monitoring during severe acute asthma
Medication remains the same- no evidence that steroid affect foetus, prednisolone
Theophylines- check blood levels as protein binding decreases in pregnancy resulting in increased free drug levels.
Breastfeeding- encourage women to breastfeed, use asthma medications as normal during lactation
next steps in managing pregnant woman with cardiac disease
Referral to cardiac obstetrician team
Baseline ECG ordered and Echo if indicated
Baseline obs in Clinic and cardiac exam
Patient safety netting
complications to mother with heart disease in pregnancy
Arrhythmia Lethargy Congestive heart failure + oedema Cyanosis New/change in murmur Hypertension HF Stroke
complications to baby if mum has congenital heart disease
Baby: Cardiac abnormalities, neonatal morbidity, growth retardation, prematurity
epilepsy in pregnancy
Arrange an appointment with your neurologist to discuss medicines
Probable that they will switch you from sodium valproate as associated with a problems with development of the baby
As sodium valproate can lead to fetal malformations best to stay on the COCP until have switched to another medication
Unfortunately not much evidence or data on using any of the anti-epilepsy medications in pregnancy
HOWEVER, big risks to you and the fetus if you were to self discontinue any anti-epileptics so once on stable treatment recommended by neurologist, important to continue with this
Information about the UK Epilepsy and Pregnancy Register to join
Higher folic acid
obesity in pregnancy
- pre-pregnancy: higher folic acid, support to lose weight
- booking visit: assess VTE risk, ?aspirin need, OGTT booked, Vit D, refer to obs to discuss
- throughout pregnancy: monitor for pre-eclampsia, VTE
- labour and delivery: on consultant led obs unit, inform anaesthetics, consider early epidural
- following childbirth: mobilise early, continue thromboprophylaxis
SGA/IUGR RFs
- Smoking
- Alcohol
- Drugs
- Exercise
- Caffeine
- Diet
- Own/ partners bw
- Age
if increased risk of small baby, may be referred for..
- Reg USS from 26-28 weeks of pregnancy onwards (serial growth scans)
- uterine artery Doppler test at 20-24 weeks of pregnancy, depending on results may need serial assessment and another UAD from 26-28 weeks
if baby is small or not growing, may have following tests?
- Umbilical artery doppler – measure blood flow through umbilical cord
- CTG – tracings of baby’s heart
- Measure amount of amniotic fluid around baby
definition of SGA
Less than 10% for its gestation (if at term 2.7kg)
IUGR definition
Baby that have a failed to meet their growth potential and their growth in utero has been slowed
IUGR definition
Baby that have a failed to meet their growth potential and their growth in utero has been slowed
tell the difference between SGA and IUGR
Risk factors
Seeing if baby is growing continuously on the small growth curve
questions to ask in incontinence
prolapse UTI symptoms when is it worse FUNDHIPS what do you drink? caffeine? obs and deliveries any bowel problems how do you feel about it? FLAWS
management of incontinence
abdo exam vaginal exam urine dip MSU refer to urogynae for urodynamics
panic attack key question
any recent stressors
management of panic disorder
write to GP/ referral to liason/ CMHT for F/U
Panic disorder severity scale, HAD, GAD score
Bio: fluoxetine
Psych: CBT (help identify triggers) and self help (exercise, diet, meditiation)
Social: management of triggers
what to ask in all psych histories?
- RISK
- screen for all first rank symptoms (any abnormal thoughts, hallcuinations, feel like you are being controlled by anyone)
- pysch scoring system
- “I’d like to formally assess cognition”
MSE
Appearance: well kempt, appropriate for time/place/weather, fitting eye contact
Speech: normal rate, rhythm and volume, normal quantity
Emotion: subjectively (what they think) and objectively (what you think) low, affect, is mood congruent with affect
Thought: content (delusions/overvalued ideas, suicidal), form (speed), possession (insertion, withdrawal, broadcasting)
Perception: hallucinations
Cognition: orientated to time/place/person, would like to assess formally
Insight
RISK
what important feature to ask for ALL?
bone pain
ask in any pregnant lady past booking
bood type
epilepsy in pregnancy history
when diagnosed
when triggered
are you still getting check ups
what type of seizures
smear question
any smears
any abnormal results
questions to ask in labour
pain bleeding discharge rupture of membranes baby moving? screen for pre-eclampsia/chest pain
4 A’s of Alzheimers
aphasia (difficulty talking)
amnesia (memory loss)
apraxia (difficulty dressing)
agnosia (not recognising people)
key things to do in dementia history
screen for other dementias - LBD: mild parkinsonism, delusions, hallucinations, rigid muscles - Vascular: step wise, vascular RFs - Frontotemporal: younger, personality change collateral Donepizil refer to memory clinic inform DVLA
pseudo dementia
depression
need for continuous CTG in pregnancy
- pre-eclampsia
- on oxytocin
- chorioamnionitis
- IUGR
pre-op assessments
OP CHEC PBN Operative fitness: check cardio resp function Pills (drugs): anti-coags, OCP/HRT Consent History (MI, Asthma, HTN) Ease of intubation Prophylactic abx Bloods (FBC, U&E, G&S, clotting, glucose) NBM
neonatal resuscitation - first 30 seconds
assess tone, RR, HR (femoral and brachial), colour
neonatal resuscitation - first 60 seconds
if not breathing, open airway and do 5 inflation breathes
reassess and repeat until chest movement is seen
once chest movement is seen?
ventilate for 30 seconds
then chest compression and ventilate with rate of 3:1
Gross motor
6-8 weeks: raises head to 45 degrees in prone 6-8 months: sits without support 8-9 months: crawling 10 months: stands independently 12 months: walks unsteadily 15 months: walks steadily 2.5: runs and jumps
vision and fine motor development
6 weeks: fixes and follows 4 months: reaches for toys 4-6 months: palmar grasp 7 months: transfers toys 10 months: mature pincer grip 16-18 months: makes marks with crayons
brick building
tower of three: 18 months
tower of six: 2 years
bridge: 3 years
steps: 4 years
pencil skills
line: 2 years
circle: 3 years
cross: 3.5 years
square: 4 years
triangle: 5 years
hearing, speech, language development
newborn: startles to loud noises 3-4 months: vocalises alone 7 months: turns to soft sounds out of sight 10 months: dada, mamam 12 months: 2/3 words 18 months: 6-10 words 20-24 months: simple phrases 2.5-3 years: 3-4 word sentences, understands 2 joined commands
social, emotional, behavioral development
6 weeks: smiles 6-8 months: puts food in mouth 10-12 months: waves bye-bye 12 months: drinks from a cup with 2 hands 18 months: spoon to mouth 2 years: symbolic play, dry by day 3 years: parallel play
educational needs form
statement of special educational needs
who to refer FEP/schizophrenia patients to?
EIP
MOH protocol
A-E
MDT
call for senior help and alert midwife in chagre
2222 for MOH to alert haematology and lab
review drug chart, partogram, previous Hb
IV access, G&S, X match, coagulation screen
primary vs secondary PPH
primary = first 24 hours secondary = 24 hours - 12 weeks post partum
kawasaki management
IVIg + asprin
if fails, corticosteroids
NEC history
- systems review
- feeding
- WOB
- distended abdo
NEC Ix
ABCDE
FBC, CRP, coag, blood cultures, blood gas, U&Es, LFTs, AXR
explaining NEC to patient
tissues in gut become inflamed and start to die
can lead to a hole developing and can cause contents of his gut to leak into his tummy
very dangerous infection
treatment for NEC
ABC NBM IV Abx supportive care surgery if perforation laparotomy
