Palliative Care

Last week I posted information on recognition and emergency management of the acutely sick patient. It is just as important to be able to identify those patients in whom no cure is possible or who are nearing the end of their life. Cardiorespiratory disease or stroke, for example, can lead to significant terminal morbidity; as can end stage kidney disease, HIV and cancer. In these patients comfort and symptom control are vital. I attach an excerpt from a WHO publication about management of common problems in palliative care. It is helpful because it also makes suggestions about how families can help their loved ones when they are cared for at home. I have included some links to other related documents that I think may be useful.


Atrial fibrillation extras

As discussed in the podcast, here is the stroke risk calculator and an ECG example

CHADS2 Scoring Scheme

Condition Points
C Congestive heart failure 1
H Hypertension 1
A Age > 75 years 1
D Diabetes Mellitus 1
S2 Prior Strokeor TIA 2

Annual Stroke Risk with Respect to CHADS 2 Score (1)

CHADS2 Score Stroke Risk % 95% confidence interval
0 1.9 1.2-3.0
1 2.8 2.0-3.8
2 4.0 3.1-5.1
3 5.9 4.6-7.3
4 8.5 6.3-11.1
5 12.5 8.2-17.5
6 18.2 10.5-27.4

AF rapid ventricular response




Hello everyone, My full names are Chongo Ng’ona Kabungo, a clinical officer general based at Matua rural health centre, in Siavonga, southern part of Zambia.
I have a very brief testimony to give about the virtual doctors, though brief, I feel it’s important I go ahead a write it.
About March earlier this year, my late aunt, alive then got very ill. We had tried to take her to a number of clinics and hospitals, but nothing satisfactory was been done. So i decided to create a case for her on the virtual doctors application. Some options where given on the possible solutions to our patient. She later past on with non hodgkin’s lymphoma and other seconding factors. My testimony is the doctor on virtual doctors advised to do some scans, others for cancer, though we did it late,it was a worth while call.
So the virtual doctors to me is more of a learning and exploration tool on how I can manage the patients that I see and in the long run would help reduce on the cases of referring to the district hospital as the management of some case would have been discussed and known the management to heart.
Thank you for your time, best regards ????