Over the past month or so, I’ve had several cases asking about diagnosis or treatment of keloid scars, so here’s a quick guide….
Jas, our new burns specialist helpfully put the following together to help us all assess burns properly.
Click to read.
As requested by MambweMasuka@virtualdoctors.org
Here is a photo of a spacer made from a bottle-500ml ideally. Please make one and keep it handy for when patients come with asthma attacks. 10 puffs through a spacer is equivalent to a nebuliser and is more effective if the patient is not too short of breath to manage it.
In the UK, all patients are encouraged to use a spacer with every dose of inhaler as it improves the drug delivery to the lungs (from 10% with no spacer to more than 30% with spacer)
- Assemble spacer (if necessary)
- Remove inhaler cap
- Hold inhaler upright and shake well
- Insert inhaler upright into spacer
- Put mouthpiece between teeth (without biting) and close lips to form good seal
- Breathe out gently, into the spacer
- Keep spacer horizontal and press down firmly on inhaler canister once
- Breathe in and out normally for 3 or 4 breaths
- Remove spacer from mouth
- Breathe out gently
- Remove inhaler from spacer
- If more than one dose is needed, repeat all steps starting from step 4
- Replace inhaler cap
I gather you all have paper copies in Zambia, but thought it may be useful on your phones too.
I am sure you will have local guidelines but these are the UK ones, with good information on other diagnoses to consider
pid-guidelines-2017-for-consultation click to view
A recent case sent to the volunteers involved an unconscious patient. A great acronym was given to help assess such a patient:
AEIOU TIPS is used to assess patients with an altered mental status (AMS) or an altered level of consciousness (ALOC).
There are some other useful tips on this website too.
Guidance on contraception changes frequently, and I find the attached UKMEC guidelines really helpful to assess the risk of each contraceptive.
My take home messages are
- start contraception as soon as possible to prevent pregnancies. Please don’t wait until the patient’s next menstruation (which was previous advice). None of the hormonal contraceptives will adversely affect a pregnancy but delaying starting contraception places a woman at risk of an unwanted pregnancy.
- any type of migraine is now a potential contraindication to COCP. Previously only migraine with aura was felt to be high risk.UKMEC
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.