MyCpdZw - Protocols Details

ECTOPIC PREGNANCY

An ectopic pregnancy occurs when the fertilized egg attaches itself in a place other than inside the uterus. Almost all ectopic pregnancies occur in the fallopian tube and are thus sometimes called tubal pregnancies

Diagnosis

Consider any woman of reproductive age with abdominal pain, amenorrhea or abnormal vaginal

bleeding.

Most commonly in 5th – 8th week after LMP.

May present acutely, or (more commonly), sub-acutely with fluctuating abdominal discomfort with

dark, light PV bleeding & pelvic tenderness.

Beware: Bleeding can occur after pain in most are stable and walk into department, 20% have no

history of amenorrhea!

DO NOT perform vaginal examination.

Management

1. Early liaison with medical officer, esp. if unstable,

2. ABC’s Oxygen,

3. IV fluid resuscitation to maintain SBP >90mmHg,

4. FBC, Group & Hold,

5. Confirm pregnant with urinary,

6. Quantitative if diagnosis suspected, even with negative urinary test,

7. USS as directed by medical officer (Transvaginal if 1500-6500 U/Ml),

8. Rh. (Anti-D) immunoglobulin 250 IU IM (for singleton pregnancy <12/40), 625 IU IM (if

multiple pregnancy or gestational age >12/40 or unkown) to all Rheusu negative patients

who not received it within the last 6 weeks (e.g. for previous threatened miscarriages),

9. May require urgent laparoscopy/ laparotomy,

10. Conservative treatment is an option if:

· No acute systems,

· Falling that are <1000 U/ml initially &

· No blood seen in the Pouch of Douglas on USS.

Recent Protocols

COVID 19

COVID 19 is a disease caused by the most recently discovered coronavirus which is a large family of corona viruses causing illnesses. In humans it causes Respiratory infections for example Severe Acute Respiratory Disease (SARs) PRESENTATION Fever 77-98% Cough 46-82% Myalgia/Fatigue 11-52% Shortness of breath 3-31% Incubation period 14 days, most people develop symptoms between 5-6ays from exposure Stage1 (Early infection). Stage 2. Stage 3(Hyperinflation phase) Viral response---------------------------Pulmonary Phase----------------------Host Response *Anyone presenting with flu like symptoms should be assumed to be a COVID 19 case until proven otherwise*

WARFARIN OVERDOSE/ TOXICITY

Overdose of the oral anticoagulant warfarin (Coumadin), or drug interactions with warfarin, can lead to toxicity. Similarly, toxicity can result from exposure to superwarfarins, which are long-acting anticoagulants used in rodenticides. ... Warfarin is the most common oral anticoagulant in current use

SUICIDAL IDEATION

Suicidal ideation, also known as suicidal thoughts, is thinking about or having an unusual preoccupation with suicide.

SPINAL CORD INJURY

Emergency signs and symptoms of a spinal cord injury after an accident may include: Extreme back pain or pressure in your neck, head or back. Weakness, incoordination or paralysis in any part of your body. Numbness, tingling or loss of sensation in your hands, fingers, feet or toes. Loss of bladder or bowel control.