I’ve noted a few cases of acute asthma on the VDr system and thought this guideline may be helpful. I realise you may not have the ability to monitor oxygen saturations or even peak flows, but assessing the patient especially their general state, plus respiratory rate and pulse can give a lot of vital information.
Ventolin is best given through a spacer. These can be made by cutting a hole in a coke (or other plastic) bottle and getting patient to breath normally through one end with the inhaler inserted into the hole. I can post a photo if that doesn’t make sense (let me know). Oral salbutamol isn’t any good during an attack.
This is a personal topic since I have recently developed this skin condition, hence my knowledge about it (and sympathy to patients with skin conditions) has increased.
It most frequently occurs following a streptococcal throat infection (in my case) or after medications such as NSAIDS (ibuprofen) or B Blockers. This explanation is from Dermnet (a very good site for dermatology you can access through your mobiles):
Guttate psoriasis is psoriasis that is characterised by multiple small scaly plaques that tend to affect most of the body. ‘Gutta’ is Latin for drop; guttate psoriasis looks like a shower of red, scaly tear drops that have fallen down on the body. Lesions are usually concentrated around the trunk and upper arms and thighs. Face, ears and scalp are also commonly affected but the lesions may be very faint and quickly disappear in these areas. Occasionally there may be only a few scattered lesions in total.
The diagnosis of guttate psoriasis is made by the combination of history, clinical appearance of the rash, and evidence for preceding infection. It tends to affect children and young adults and has a good chance of spontaneously clearing completely.
Treatment options include: using emollients, steroid creams, coal tar or phototherapy.
On the drug list I note that aqueous lotion is available-this would be good as an emollient (although we have recently moved away from this in the UK due to some skin sensitivity to it). Patient should both wash with it, like a shower gel, and moisturise as much as possible.
Coal tar can also be applied but can be smelly, so moisturise after application. Steroids of any strength can be used but in my case it is too difficult to apply as I am completely covered in small spots.
I have been referred to hospital for phototherapy which is essentially UV exposure. Sun also works (but beware of sunburn), but isn’t so available in the UK even in summer!
Fingers crossed it works, as I’m very itchy
As a GP I have only ever used tranexamic acid to reduce/stop blood flow in women with heavy periods. So, I was really interested in a recent study in the Lancet which looked at its use for Postpartum Haemorrhage, a major cause of maternal deaths (100,000 deaths per year).
This international trial found that tranexamic acid (1g intravenously) decreased the risk of death from Postpartum Haemorrhage by about a third if given within 3 hours. The World Health Organization said it would update its recommendations for treating postpartum haemorrhage treatment.
Of course the next step is to get iv tranexamic acid available for women who need it the most — women in the poor, remote areas of the world, where maternal mortality is the highest.
I note it isn’t available on the Zambia Essential drug list and hope that this study will alter its availability worldwide.