Nota Perubatan

Category: Internal Medicine

  • Atrial Fibrillation (AF)

    ECG Features

    • Absence of P wave
    • Irregularly irregular R-R interval
    • Narrow QRS complex

  • Iron Deficiency Anaemia (IDA)

    Introduction

    • IDA accounts for 75% non-physiologic anaemia in pregnancy [1]

    Definition of Iron Deficiency

    • Iron replete: Ferritin >100 ng/mL PLUS TSAT >20%
    • Low iron stores: Ferritin 30 – 100 ng/mL PLUS TSAT >20%
    • Iron sequestration (functional iron deficiency): Ferritin >100 ng/mL PLUS TSAT <20%
    • Absolute iron deficiency:
      • Ferritin <30 ng/mL, OR
      • Ferritin <100 ng/mL PLUS TSAT <20%

    References

    1. Horowitz KM, Ingardia CJ, Borgida AF. Anemia in pregnancy. Clin Lab Med. 2013 Jun;33(2):281-91. doi: 10.1016/j.cll.2013.03.016. Epub 2013 Apr 19. PMID: 23702118. [PubMed]

  • Pain as the 5th Vital Sign & Acute Pain Management

    Scales for Pain

    Visual analogue scale (VAS):

    Documentation e.g. VAS 3, VAS – 7

    Modified WHO Analgesic ladder for acute pain management

    Further reading: CPG Pain as the 5th vital sign (3rd edition)

  • Pulmonary Embolism

    ECG Features

    S1Q3T3

  • Hypertension

    Q&A

  • Tension Pneumothorax

    Miscellaneous

    Tracheal deviation is a late sign in tension pneumothorax. Don’t wait for tracheal deviation to diagnose tension pneumothorax.

  • Delirium

    Definition

    Clinical syndrome characterized by disturbed cognitive function, perception or consciousness, that has an acute onset and fluctuating course

    Types

    (i) Hyperactive: agitated, restless, distressed
    (ii) Hypoactive: drowsy, lethargy, unengaged, inattentive
    (iii) Mixed: alternates between hyperactive and hypoactive states

    Predisposing factors

    Remember ‘PINCH ME‘

    • Pain
    • Infection / cognitive impairment / intracranial problem
    • Nutrition
    • Constipation / urinary retention
    • Hydration / Hypoxia

    • Medication
    • Environment / Electrolyte imbalance / Extra device or restrain

    Symptoms

    • Confusion
    • Hallucination
    • Delusion
    • Changes in sleeping habits
    • Changes in personality
    • Changes in mood
    • Agitated
    • Quiet and withdrawn
    • Inattention

    Screening tool for delirium

    • CAM score
    • 4AT delirium assessment tool

    Management

    • Manage underlying medical illness
    • Treat the predisposing factors e.g. pain, constipation
    • Supportive care e.g. daily orientation, availability of caregiver / objects that are familiar to patient, help patient to mobilise
    • Prevent hospital acquired complications e.g. pressure sores, DVT

    The most important thing is to PREVENT delirium

    How to reduce risk of delirium?

    • Avoid pain
    • Avoid constipation
    • Bring glasses / hearing aids / dentures that patient usually used at home
    • Orient the patient throughout the day
    • Encourage patient to move / have physical activity
    • Bring familiar objects from home / familiar caregiver
    • Avoid sedatives
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