ALPHA Medical Centre, Prospect Highway (2026)

24/05/2019

*24 MAY*
*WORLD SCHIZOPHRENIA DAY*

⚡ *Addressing misconceptions* ⚡

🔺 BLACK MAGIC CAN CAUSE SCHIZOPHRENIA

*Schizophrenia is caused by chemical imbalances in brain. It's an illness just like others*

🔺SCHIZOPHRENIA MEANS COMPLETE MADNESS.

*Not at all. Schizophrenia means loss of touch from reality. This can be in one specific area of person's functioning, which means other areas can be relatively normal.*
*This is how most of Schizophrenia starts but if not treated early it progresses to involve all areas of brain functioning*

🔺SCHIZOPHRENIA ALWAYS NEEDS LIFE LONG TREATMENT.

*If treatment given early and completely we can stop medications in 20-30% of the cases roughly.*

🔺SCHIZOPHRENIA PATIENTS ARE BURDEN TO FAMILY.

*With the introduction of new medications most of them can function independently and at least 30-40% can earn their livelihood. (of course it depends on prognostic factors)*

🔺EVERY SCHIZOPHRENIA PATIENT NEEDS SHOCK TREATMENT THAT IS VERY PAINFUL.

*Not everyone needs ECTs (shock treatment). It's a painless and safe procedure that gives quick improvement*

🔺IF THERE IS NO CURE WHAT'S THE USE OF TREATING SCHIZOPHRENIA..??

*Schizophrenia is a chronic disorder like Diabetes mellitus, Hypertension n others. Illness can be controlled not cured in moderate to severe cases.*

*Even with this control patient can have a very good lifestyle that can be worse if not treated.*

🔺FAMILY HAS TO SUFFER BECAUSE OF SCHIZOPHRENIA

*To some extent this is true. Hence to reduce the burden of illness family has to*
♦ *Accept the illness*
♦ *Start treatment early*
♦ *Give regular treatment till advised without experimentation*
♦ *Follow stress management skills for themselves.*

07/03/2018

RHESUS FACTOR INCOMPATIBILITY A LEADING CAUSE OF MISCARRIAGE!
(MUST READ)

Rhesus Factor is an antigen that exists on the surface of red blood cells in most people (about 85% of humans). It is also referred to as Rh Factor. People who have the Rh have “positive” (+) blood types, such as A+, O+ or B+ are said to be rhesus Factor positive, while those who have the Rh “negative” (-) blood types, such as A–, O– or AB– are said to be rhesus factor negative . The “+” and “-” in front of the blood group is the Rhesus factor. Generally, we have A+, A–, B+, B–, AB+, AB–, O+ and O–. Rhesus factor is genetic in nature. It is inherited from the parents, emphatically the father.

How does Rhesus Factor cause miscarriage?

If a Rh– woman is impregnated by a man with Rh–, there wouldn’t be any problem. However, if a Rh– woman is impregnated by a man with Rh+, there would be a problem if the baby inherits Rh+ from the father . We have here what is medically called Rhesus Factor Incompatibility. The baby would obviously be Rh+. During child birth, once the baby’s Rh+ comes in contact with the woman Rh- during delivery, the antibodies are immediately activated by the woman’s body’s immune system.

The activated antibodies would see the new Rh+ as foreign body or a threat and consequently they would be at alert to attack and get rid of the foreign body. Unfortunately as such, after this particular child birth, the woman would keep having miscarriages because the activated antibodies would see subsequent Rh+ pregnancies as foreign bodies and would keep fighting and taking them off.

Women with Rh activated antibodies are said to be Rh sensitized and once these antibodies are activated , they can never be deactivated until the woman dies. Rh induced antibodies are activated in a Rh- woman by child birth, abortion, miscarriage and ectopic pregnancy.

If a Rh– woman commits an abortion for a Rh+ man and the antibodies are activated in her system, the woman might end up childless throughout her life except if she later marries another man with with the same Rh–. The possibility of a Rh– woman finding a Rh– man is slim as about 85% of human beings are Rh+. This is a warning to our young girls who commits abortions all in the name of boyfriend-girlfriend relationships.

If you’re a woman with Rh– and your fiance is Rh+, and you haven’t committed abortion for him and you don’t want to leave him, then, you need to take note of the following:

In order to prevent the activation of the antibodies, doctors would give women in this category an injection called Rhogam during and after pregnancy to prevent spontaneous abortion due to Rhesus factor incompatibility. The injection is normally administered 28 weeks into pregnancy, 72 hours after delivery, after ectopic pregnancy, miscarriage or abortion. If the injection is not administered and the antibodies are activated, they would never be deactivated again!

In many African cultures up till today, women who are so unfortunate to find themselves having serial spontaneous abortions due to Rhesus factor incompatibility are considered witches by some of their people. Some of the women would accuse their in-laws of being behind their predicament.

So, if you’re a woman with Rh– , you need to be very careful. It might be difficult for you to get a husband with a Rh– because about 85% of human beings are Rh+. So, in order not to find yourself in the aforementioned problem, put all that have been said at the back of your mind and go for genetic counselling. If you have a daughter or a sister with Rh–, counsel them on Rhesus Factor Incompatibility and the dangers lying therein.

It should also be noted that a Rh– person(man or woman) cannot receive blood donation from a Rh+ person even if they have the same blood group. The consequence of such blood transfusion is fatal. It would lead to death as the blood would clot. This is due to the incompatibility in their Rhesus factor.

Know your Blood group and Rhesus factor today!

Share, Mention or tag a friend so that he/she can also be informed.

22/02/2018

Bronchiolitis is the term used to describe acute inflammation of the bronchioles. It can occur at any age but is usually seen in the relatively narrow immature bronchioles of infants and is mostly caused by a viral infection.
Air entering through the mouth or nostrils passes down the trachea (windpipe) and through the two bronchi to the right and left lung. The two bronchi further divide into smaller tubes called bronchioles. These consist of muscular, fibrous and elastic tissue and get progressively smaller as they spread further into the lungs. They finally become a single layer of epithelial cells called terminal bronchioles.
Viruses inhaled by infants can travel down into the bronchioles and infect the epithelial cells. Infection provokes an inflammatory response with the release of active chemicals called cytokines and the influx of white blood cells. Destruction of the virus infected epithelial cells by the immune response
causes an increase in goblet cells which excrete excessive mucus. Response to viral infection ultimately results in the accumulation of mucus, fluid and cell debris which blocks the narrow bronchioles, preventing air from reaching the alveoli and causing breathing difficulties and oxygen starvation.
Infants are affected most often because of their small airways, high closing volumes, and insufficient collateral ventilation. In most infants, recovery begins with regeneration of bronchiolar epithelium after 3-4 days; however, cilia do not appear for as long as 2 weeks. Mucus plugs are predominantly removed by macrophages.

The majority of cases of bronchiolitis in infants and young children are caused by respiratory syncytial virus (RSV). RSV is a single stranded, capsulated RNA virus that belongs to the family of paramyxoviruses, which also includes viruses such as mumps, measles and the newly discovered Hendra and Nipha viruses.

Signs & Symptoms
Initially, children will usually present with symptoms of an upper respiratory tract infection such as mild rhinorrhoea (runny nose), cough, and low grade fever. Fever >39°C is unusual and should prompt a thorough examination and further investigations to exclude other possible causes.
If infection spreads to the lower respiratory tract (40% of infants and young children) it may cause a more severe infection with rapid heart beat, rapid shallow breathing, paroxysmal cough, cyanosis (blue tinge to skin and mucus membranes due to lack of oxygen), apnoea, (short periods without breathing) and dyspnoea (shortness of breath. Other signs of breathing difficulties include subcostal and intercostal retractions (inward movement of muscles between and below the ribs), diminished breath sounds and nasal flaring.
Other common findings include wheezing, inspiratory crackles, pharyngitis, conjunctivitis, vomiting, irritability and poor feeding.
The liver and spleen may be palpable due to hyperinflation of the lungs.

Conditions with Similar Symptoms
Bronchiolitis obliterans-organizing pneumonia (BOOP)
Congenital heart disease
Congenital structural airway anomaly
Altitude sickness
Aspiration pneumonia
Asthma
Pneumonia
Croup
Paediatric apnoea
Paediatric foreign body ingestion
Sepsis
Pertussis
Gastroesophageal reflux
Cystic fibrosis
Kartagener's syndrome
Tracheomalacia/bronchomalacia
Pneumothorax

Investigations
Scope of investigations depends on severity of illness.
Blood for FBC, ESR, CRP, electrolytes, BUN, creatinine and blood gasses if indicated.
Nasopharyngeal aspirate for virus culture and antigen detection (PCR).
Blood and urine culture if indicated.
Pulse oximetry and chest radiograph if indicated.

Treatment
Most cases of bronchiolitis are relatively mild self resolving illnesses that can be managed at home with attention to fluid intake, nutrition and temperature. Children with significant breathing difficulties or other signs of severe illness should be admitted to hospital.
There is no effective antimicrobial therapy currently available for the viruses that cause bronchiolitis. Treatment is mainly supportive with appropriate management of oxygenation and hydration.
Humidified oxygen may be administered if necessary to maintain transcutaneous oxygen saturation higher than 92%. The use of high-flow nasal cannulas may reduce intubation rates in infants with bronchiolitis.
Infants with bronchiolitis may be mildly dehydrated because of decreased fluid intake and increased fluid losses from fever and tachypnea, therefore it is important to maintain adequate hydration. Parenteral therapy may be necessary in children who are unable to take fluids by mouth or who have a respiratory rate higher than 70 breaths/min. Patients with apneic episodes should have access to IV hydration
Infants with bronchiolitis and recurrent apnoea or severe breathing difficulties may require mechanical ventilation Continuous positive airway pressure (CPAP) and intermittent mandatory ventilation (IMV) with positive end-expiratory pressure (PEEP) have been successfully used to treat these infants.
Negative-pressure ventilation has been used successfully in infants with bronchiolitis, with a reduced need for endotracheal intubation and shortened lengths of stay.
Infants with progressive hypoxemia that does not respond to conventional ventilation may respond to high-frequency ventilation or extracorporeal membrane oxygenation (ECMO).

Prevention
There is no effective vaccination available for RSV or the other viruses that commonly cause bronchiolitis, however, palivizumab, a monoclonal antibody may be used in selected children to provide passive immunity to RSV. It has been shown to reduce RSV-related hospitalisation and intensive care admissions significantly. Palivizumab is recommended for the protection of children at high risk of severe RSV disease, including;
* Children under 2 years with chronic lung disease, who have required at least 28 days' supplemental oxygen from birth or who are receiving home oxygen.
* Infants less than 6 months old with a left-to-right shunt, haemodynamically significant congenital heart disease or pulmonary hypertension.
* Children under 2 years with severe congenital immunodeficiency.
The first dose should be administered before the start of the RSV season.

Patient Management
Although most children make a full recovery from bronchiolitis, there is an association between bronchiolitis and subsequent reactive airways disease.
Parents should ensure that children receive appropriate follow up.

01/12/2017

TUBERCULOSIS

Tuberculosis is the term used to describe infection with a bacterium called Mycobacterium tuberculosis. This organism is spread by aerosols generated when an infected individual coughs.
Droplets expelled by the cough may contain hundreds of organism which have the potential to infect others who share the same air space. Inhaled organisms are deposited in the lungs where they are ingested by defensive cells of the immune system called macrophages. The infected cells transport the organisms through the lymphatic system to adjacent lymph nodes.

Infection with Mycobacterium tuberculosis may have a number of different outcomes, depending on the macrophages initial response to the organism.

Elimination of the organism. The organism is destroyed by the macrophages and the immune system, and the individual remains asymptomatic

Dormant Infection. The macrophages fail to destroy the organism but prevent replication. Potentially infective mycobateria persist in lymph nodes

Primary tuberculosis. The macrophages fail to destroy or contain the organism and it spreads to infect lung tissue and adjacent lymph nodes. It may also spread through the lymphatics or bloodstream to infect meninges (covering of brain and spinal cord), bones, genitourinary system or gastrointestinal tract. Infection of the lymph nodes in the neck (scrofula) is a well recognised complication of primary TB.

Reactivation tuberculosis. Organisms that are dormant within lymph node macrophages are reactivated to cause infection. This can happen many years after a primary infection and is usually the result of a failed or compromised immune system.

Mycobacterium tuberculosis is a slow growing organism that generally causes chronic infections with the formation of granulomas (nodular deposits of inflammatory material). Over a period of time these granulomas may have calcium deposited in them (calcified) and these calcified deposits may show up in later radiographs as the only evidence of a previous infection.

The recent emergence of multi-drug resistant strains of M tuberculosis (MDR-TB) is a cause for considerable concern and has resulted in the re-emergence of this organism as a potential health problem in a number of western countries.

SIGNS & SYMPTOMS
Pulmonary tuberculosis is a respiratory disease that usually presents with low grade fever, weight loss, night sweats and cough. Patients may also have chest pain and haemoptysis (coughing up blood).

Conditions with Similar Symptoms

Sarcoidosis

Bronchopulmonary aspergillosis

Bronchiectasis

Lung abscess

CEAA

Nocardiosis

Histoplasmosis

Carcinoma
Actinomycosis

Atypical mycobacterial infection

INVESTIGATIONS
Three early morning sputum samples for culture and antigen detection

Chest radiograph.

Mantoux test or Quantiferon test may be helpful in some cases.

HIV testing is advisable for patients diagnosed with TB.

TREATMENT
Treatment is normally commenced with four antimicrobials, rifampicin, isoniazid, ethambutol and pyrazinamide, especially in those areas where antimicrobial resistance is common. If the mycobacterium is cultured and antibiotic sensitivities are available, the drug regimen can be adjusted accordingly. For sensitive organisms, ethambutol can be discontinued, and after two months pyrazinamide is also discontinued. Isoniazid and rifampicin are continued for a further four months. Resistant organisms or those which fail to respond to initial therapy may require treatment for up to eighteen months.

Antibiotics

Isoniazid

Adult

300mg PO qd (+/-pyroxidine)

Child 10mg/kg/d PO not to exceed 300mg/d

Rifampicin

Adult

600mgPO qd

Child

10-20mg/kg PO qd not to exceed 600mg/d

Pyrazinamide

Adult

75kg 2.5gPO qd

Child

15-30mg/kg/d PO not to exceed 2g/d

Ethambutol

Adult

15-25mg/kg PO qd

Patient Management
Patients who smoke should cease. Avoid unnecessary contact with others to prevent spread.
Ensure that all antimicrobials are taken for the period of time specified.
Maintain good diet.

with your friends if you care

25/06/2017

ASTHMA

Asthma is a major noncommunicable disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person.

Symptoms may occur several times in a day or week in affected individuals, and for some people become worse during physical activity or at night. During an asthma attack, the lining of the bronchial tubes swell, causing the airways to narrow and reducing the flow of air into and out of the lungs.

Recurrent asthma symptoms frequently cause sleeplessness, daytime fatigue, reduced activity levels and school and work absenteeism. Asthma has a relatively low fatality rate compared to other chronic diseases.

Asthma is under-diagnosed and under-treated. It creates substantial burden to individuals and families and often restricts individuals’ activities for a lifetime.

The causes
The fundamental causes of asthma are not completely understood. The strongest risk factors for developing asthma are a combination of genetic predisposition with environmental exposure to inhaled substances and particles that may provoke allergic reactions or irritate the airways, such as:

indoor allergens (for example, house dust mites in bedding, carpets and stuffed furniture, pollution and pet dander)
outdoor allergens (such as pollens and moulds)
to***co smoke
chemical irritants in the workplace
air pollution.

Other triggers can include cold air, extreme emotional arousal such as anger or fear, and physical exercise. Even certain medications can trigger asthma: aspirin and other non-steroid anti-inflammatory drugs, and beta-blockers (which are used to treat high blood pressure, heart conditions and migraine).

Urbanization has been associated with an increase in asthma. But the exact nature of this relationship is unclear.

Reducing the asthma burden
Although asthma cannot be cured, appropriate management can control the disease and enable people to enjoy a good quality of life. Short-term medications are used to relieve symptoms. Medications such as long-term inhaled steroids are needed to control the progression of severe asthma.

People with persistent symptoms must take long-term medication daily to control the underlying inflammation and prevent symptoms and exacerbations. Inadequate access to medicines is one of the important reasons for the poor control of asthma in many settings.

Medication is not the only way to control asthma. It is also important to avoid asthma triggers - stimuli that irritate and inflame the airways. With medical support, each asthma patient must learn what triggers he or she should avoid.

Although asthma does not kill on the scale of chronic obstructive pulmonary disease (COPD) or other chronic diseases, failure to use appropriate medications or to adhere to treatment can lead to death.

25/06/2017

TETANUS INFECTION

Tetanus, or lockjaw, is a bacterial infection that is characterized by painful muscle spasms, serious complications, and can lead to eventual death. Tetanus is not transmitted from person-to-person. A person usually becomes infected with tetanus when dirt enters a wound or cut.

Tetanus germs are likely to grow in deep puncture wounds caused by dirty nails, knives, tools, wood splinters, and animal bites. The disease is caused by a potent neurotoxin that is produced by the bacteria in the absence of oxygen.

Symptoms

Signs and symptoms of tetanus appear anytime from a few days to several weeks after tetanus bacteria enter your body through a wound. The average incubation period is seven to 10 days.

Common signs and symptoms of tetanus include:

●Spasms and stiffness in your jaw muscles (trismus)
●Stiffness of your neck muscles
●Difficulty swallowing
●Stiffness of your abdominal muscles
●Painful body spasms lasting for several minutes, typically triggered by minor occurrences, such as a draft, loud noise, physical touch or light
●Fever
●Sweating
●Elevated blood pressure
●Rapid heart rate

The following increase your likelihood of getting tetanus:

●Failure to get vaccinated or to keep up to date with booster shots against tetanus
●An injury that lets tetanus spores into the wound
●A foreign body, such as a nail or splinter
●Tetanus cases have developed from the following:
Puncture wounds — including from splinters, body piercings, tattoos, injection drugs
●Gunshot wounds,Compound fractures,Burns,Surgicalwounds,Animal or insect bites,
Infected foot ulcers,Dental infections
●Infected umbilical stumps in newborns born of inadequately immunized mothers
The disease is particularly common and serious in newborn babies. This is called neonatal tetanus and most infants die who get the disease. Neonatal tetanus is particularly common in rural areas where most deliveries are at home without adequate sterile procedures.

People who recover from tetanus do not have natural immunity and can be infected again and therefore need to be immunized.

14/06/2017

For those who get up at night from sleep to urinate or early morning
Each individual must take note of the three and half minutes rule. Why is it important? This will greatly reduce the number of sudden deaths. Often this occurs, a person who still look healthy, has died in the night. Often we hear stories of people, "yesterday I was chatting with him, why did he suddenly die?"
The reason is that waking up at night to go to the bathroom is often done in a rush. Immediately we stand, the brain lacks blood flow.
In the middle of the night when you are awakened by the urge to urinate for example, ECG pattern can change. Because getting up suddenly, the brain will be anaemic and causes heart failure due to lack of blood.
We are advised to do this
1. When waking from sleep, lie in bed for the first 30 seconds
2. Sit in bed for the next thirty seconds
3. Lower your legs, sitting on the edge of the bed for the last half-minute.
After three and half minutes, you will not have ischemic brain and heart will not fail, reducing the possibility of a fall and sudden death. It can occur regardless of age; young or old.

Share with family, friends & loved ones.

*Have a beautiful evening*

28/02/2017

DENTAL CARIES(Tooth Decay)
Sugar-dependent infectious disease resulting in cavities or holes in the teeth.
Cause
Poor oral hygiene results in bacteria accumulation in a plaque on the tooth surface. Acid is produced as a by-product of the metabolism of dietary carbohydrate by the plaque bacteria. This causes demineralization of the tooth surface. The weakened tooth structure disintegrates, resulting in a cavity in the tooth.
Clinical features
Localized toothache
Cavitations in the teeth
Tooth sensitivity to hot and cold stimuli Susceptible sites are those areas where plaque accumulation can occur unhindered, e.g. pits and fissures of the posterior teeth, interproximal surfaces, and teeth in malocclusion
Differential diagnosis
Dental abscess
Referred pain from ENT infections, commonly sinusitis
Management
Paracetamol 1gm every 6 hours
Or Ibuprofen 400 mg
Refer to a dental specialist for fillings or extraction
Prevention
Dietary advice: Advise the patient to avoid sugary foods and soft drinks and have adequate fresh fruit and vegetables in their diet
Reduction in the availability of a microbial substrate by regular brushing, preferably after every meal
Tooth strengthening and protection of teeth by rinsing with fluoride rinses and applying sealants to susceptible
sites
Omedicine
Health is Wealth

25/02/2017

What is PEP?
Who should consider taking PEP?
What should I do if I think I was recently exposed to HIV?
When should PEP be taken?
How long is PEP taken for?
What HIV medicines are used for PEP?
Does PEP work?
Does PEP cause side effects?
How can I learn more about PEP?
1. PEP stands for “post-exposure prophylaxis.” The word “prophylaxis” means to prevent or protect from an infection or disease. PEP involves taking antiretroviral (ARV) medicines very soon after a possible exposure to HIV to prevent becoming infected with HIV.
2. There are 2 types of PEP: oPEP and nPEP. oPEP stands for “occupational post-exposure prophylaxis.” It’s when a health care worker takes PEP because of a possible on-the-job exposure to HIV, such as during a needlestick injury.
The other type of PEP is called nPEP, and it stands for “non-occupational post-exposure prophylaxis.” It’s when someone takes PEP because of a possible HIV exposure that happened outside of the person’s work, such as during s*x or injection drug use.
3. PEP might be prescribed for you if you are HIV negative or don’t know your HIV status, and in the last 72 hours you:
a. Think you were exposed to HIV during your work, for example from a needlestick injury
b. Think you were exposed to HIV during s*x
Shared needles or drug preparation equipment (“works”)
c. Were s*xually assaulted
Your health care provider will help to determine whether you should receive PEP.
4. PEP is intended for emergency situations. It is not meant for regular use by people who may be exposed to HIV frequently. Another HIV prevention method, called pre-exposure prophylaxis or PrEP, is when people at high risk for HIV take an ARV medicine daily to prevent getting HIV.
If you think you were exposed to HIV, immediately contact your health care provider or go to an emergency room, urgent care clinic, or local HIV clinic right away. You will have an HIV test and other tests done. Your health care provider or emergency room doctor will help to decide whether you should receive PEP.
5. PEP should be started as soon as possible to be effective and always within 72 hours (3 days) after a possible exposure to HIV. Research has shown that PEP has little or no effect in preventing HIV infection if it’s started later than 72 hours after an exposure to HIV.
6. PEP involves taking 3 or more ARV medicines each day for 28 days. You will need to return to your health care provider at certain times while taking PEP and after you finish taking PEP for HIV testing and other tests.
The Centers for Disease Control and Prevention (CDC) provides information on recommended ARV medicines for PEP. CDC also provides PEP recommendations for specific groups of people, including children, pregnant women, and people with kidney problems. The most recent PEP recommendations can be found on CDC’s PEP Guidelines webpage . Your health care provider or emergency room doctor will determine which medicines you should take as part of PEP.
7. PEP is effective in preventing HIV infection when it’s taken correctly, but it’s not 100% effective. The sooner you start PEP after a possible HIV exposure, the better. While taking PEP, it’s important to keep using condoms with s*x partners and to continue safe drug injection practices. Read this fact sheet from CDC for information on how to use condoms correctly .
8. The ARV medicines in PEP may cause side effects. The side effects can be treated and aren’t life threatening. Talk to your health care provider if you have any side effect that bothers you or that does not go away.
9. PEP medicines may also interact with other medicines that people are taking (known as a
drug interaction ). Because of potential drug interactions, it’s important to tell your health care provider about any other medicines that you take.
Credits: aidsInfo.

24/02/2017

ACUTE EPIGLOTTITIS.
Note.
Important cause of stridor in a child. Do not examine airway without senior anaesthetic support if diagnosis considered.
Acute epiglottitis is a paediatric medical emergency you must know about
Increasingly rare due to the use of Hib vaccination
Aetiology
Haemophilus influenzae infection
Clinical
The classical signs are the 1-6 year old with a severely sore throat.
Infant is unable to speak or swallow in distress usually
Fever, flushed and generalised infection.
The symptoms have come on in a matter of hours.
Silent, drooling and unable to swallow saliva with a fever of over 38.5 C
Soft and quiet stridor
Investigations
(Bloods not done until airway secure)
↑ WCC ↑ CRP
Mild ↑ Creatinine if dehydrated
Management
Quickly start 15 l/min humidified Oxygen and call for help.
Do not examine throat, Do not cannulate but summon anaesthetic help to manage airway.
Child is at risk of respiratory arrest
Call a senior anaesthetist, pediatrician and ENT surgeon immediately.
Child may require a surgical airway and if formal intubation is not possible then tracheostomy is performed.
Once antibiotics are commenced the condition usually improves rapidly
Prevent with Hib vaccination for Haemophilus influenzae type b infection.

14/12/2016

ECLAMPSIA
Occurrence of fits after 20 weeks of pregnancy
in a mother with no previous fits.
Clinical features
1. Patient may or may not have had previous
clinical features of severe pre-eclampsia
2. Patient develops headache, blurring of
vision, and sees aura (flickering lights before
her eyes)
3. Fits like an epileptic
4. BP raised >140/90
5. Oedema of legs and sometimes face and
body
6. Unconsciousness if condition not treated
Differential diagnosis
Other causes of fits, e.g. cerebral malaria,
meningitis, epilepsy, poisoning
Investigations
1. Blood for Hb, Malaria parasites
2. Urea, electrolytes
3. Clotting time
4. Fibrinogen levels
Management
1. Aims at stopping convulsions and then
delivering the baby.
First aid
1. Protect the airway by placing the patient on
her left side
2. Prevent patient from hurting herself, e.g.
stop her from biting the tongue by using a
padded spatula or airway
3. When there are convulsions
Start anticonvulsants with a loading dose of
magnesium sulphate injection 50%
Dilute 4g (8mL) to 20mL total volume with
water for injection
Give as slow IV bolus over 10-15 minutes
Check respiration rate and patellar reflexes
4. If there are further convulsions
Repeat the dose of magnesium sulphate as
above
Note
Magnesium sulphate is the first line
recommended anticonvulsant in management
of this condition.
However, if the drug is not available,
use diazepam 10mg slow IV over 2 minutes as
an alternative
If these are satisfactory
Continue loading dose with magnesium
sulphate.
1. Use 10g (20mL of 50% solution)
2. Mix with 1mL of lignocaine injection 2%
3. Give 10.5mL of this mixture IM into each
buttock
Monitor BP, pulse, and respiration half hourly;
pass indwelling Foley’s catheter for
continuous bladder drainage
Monitor fluid balance
Only if the following are noted
Patient passed 100mL urine or more over last
4 hours
Respiratory rate is >16 per minute
Patellar reflexes are present
Give maintenance dose of magnesium
sulphate 5g (10mL of 50% solution) deep IM
every 4 hours
Continue until 24 hours after convulsions
have stopped
If BP is >110mm diastolic or >170mm systolic
Give hydralazine 10mg IV bolus
According to response, repeat hydralazine
dose every 15 minutes until diastolic BP down
to 100mm
Alternative if hydralazine not available:
Nifedipine 20mg sublingually every 12 hours
for 1-2 doses until delivery
Monitor BP every 15 minutes until stable
Deliver the baby within 6-12 hours by the
quickest method once BP is controlled
Note
Antidote for magnesium sulphate
Give calcium gluconate 1-2g slow IV and
repeat prn until rate increases if there is
respiratory distress (rate
Prevention
Regular attendance for antenatal care

Monday	08:30 - 18:00
Tuesday	08:30 - 18:00
Wednesday	08:30 - 18:00
Thursday	08:30 - 18:00
Friday	08:30 - 18:00
Saturday	08:30 - 13:00
Sunday	09:00 - 13:00

ALPHA Medical Centre

24/05/2019

07/03/2018

22/02/2018

01/12/2017

25/06/2017

25/06/2017

14/06/2017

28/02/2017

25/02/2017

24/02/2017

14/12/2016

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