5 Easy Steps to Patient Management

When a patient comes with a problem:

STEP 1: Assess
-See/inspect.
-Ask (what went wrong, what made him/her to seek medical support)
-History (brief, precise, to the point. No leading question. Take help from the attendant if the patient is minor, dumb, unconscious or psychologically unstable.)
-detect the major symptoms (from the clinical features. This helps to check & elicit the important signs)
-check the vitals: pulse, BP, respiratory rate, temperature.

STEP 2: Examine
>> Local.
>> Systemic.
>> Lab (blood, urine, stool, collections, pus, secretions etc) {consider the financial condition of patient.}
>> Imaging (x-ray, USG, scan, ECG etc) {consider the financial condition of patient.}

STEP 3: Manage
>>GENERAL:
-rest
-remove the factor that caused the disease.
-assurance
>>MEDICAL
-Analgesic (pain, acute inflammation etc)
-Antibiotic (systemic, local and topical: on the basis of lab finding.)
-Antihistamine (allergy, urticaria, mild hypersensitivity, hyper secretion.)
-Steroid (auto-immune, hypersensitivity, chronic inflammation, atrophy etc.)
-Fluid & electrolyte
-others.

Use of drugs is a bit complicated. Such as, there may be circulatory overload or insufficiency. What you going to do? In case of overload you can find edema, lung crepitations etc. You make the heart to beat slowly, use diuretic (if kidney & liver act normal) and monitor vitals, specially input and output. In case of insufficiency infuse fluid and electrolyte orally or I/V and monitor vitals, input, output. There is so much to write about this. But above mentioned are common.

STEP 4: Surgical Intervention
Only if the pathology is non-responsive to medical treatment or it is not treatable medically.

STEP 5: Follow Up & Re-assess
routine follow-up, re-assessment and re-evaluation is good for both, the patient & the doctor. It helps in better prognosis and necessary early intervention to the things that are going other than the normal track.





Md. Mukit Osman Chawdhury
Sunday, 11 July 2010
Chittagong

Rumors are killers

Seasonal Flu is a common phenomenon. Since ages people are being affected by seasonal flu and the best thing is it heals spontaneously.
The media says now-a-days, 25-90 people are being affected by H1N1 virus (responsible for Swine Flu). But, hey, can you remember of any one affected by this? Rather you can see that people are affected by normal seasonal flu.

What are the Sign and Symptoms????

1. Fever, in various degrees but persistent. Not below 100 degree.
2. Sore throat.
3. Pain all over the body.
4. Running nose.
5. Breathing problem is considered as the sign to differ from other types of flu. Though a person having asthma, may also present with breathing problem.

What to do???

1. Don't panic. Stay calm and quite and observe the situation.
2. This is somewhat hot, humid season going on. So better to stay indoor as long as you can. Because as long as you will be outside, you will be vulnerable to dehydration, electronic imbalance, sun stroke and infections.
3. Take enough rest, water, sleep and food.
4. Maintain personal hygiene.

What if you are affected by any type of Flu????

1. Stay home.
2. Take symptomatic treatment. i mean treatment for fever, running nose, sore throat and body ache.
3. Have adequate amount of food and water. Remember, if your body is weak, you can't resist even the simplest of infections.
4. Don't sneeze or cough over another person.
5. Consult any physician and don't go for any treatment via internet or any other media.

Stay fine and safe. Kill the rumors.

MEASLES: RESULTING IMPOTENCY IF IGNORED

Measles is an acute infection and highly communicable viral disease of childhood. The virus is mixo-virus group. The clinical feature is characterized by prodromal catarrhal symptoms; fever, koplik’s spots on the buccal mucosa and typical dusky-red blotchy rash.
The typical maculo-papular rash develops first at the back of the ears and at the junction of the forehead and hairline and then whole of the face; within a few hours the rash spreads rapidly to involve the skin of the rest of the body. At first the rash is discrete but later it may become confluent and patchy especially in the face and neck.

Epidemiological Determinants:

 Occurrence: It is endemic in most part of the world. The disease is universal.

 Agent: It is caused by an RNA para-myxovirus. It is only one serotype. The virus cannot live outside the human body for any length of time.

 Source of infection: The only source of infection is a case of measles carrier is not known to occur.

 Infective Material: Secretions of nose, throat and respiratory tract of a case of measles during the prodromal period and the early stages rash.

 Communicability: It is highly infectious during the prodromal period and at the time of eruption. Communicability declines rapidly after the appearance of the rash. The period of communicability is approximately 4 days before and 5 days after the appearance of the rash.

 Host factor: Attacks everyone in infancy or childhood. In developing country the environmental condition is poor so 6 months to 3 years of children are more susceptible. Now it is declined due to vaccination.

 Sex: Incidence is equal in both sexes.

 Immunity: No age group is immune if there was no previous immunity. One attack of measles generally confers lifelong immunity. Second attack is rare. Infants are protected by maternal antibodies up to 9 months of age.

 Nutrition: Measles tends to be very severe in the undernourished child. Mortality is very high in undernourished child then the well nourished child.

 Environmental factor: It may occur in any season. Epidemic of measles is in winter season and early spring in our country (January & April). It is common in less socio-economic condition.

 Transmission: It occurs directly from person to person mainly by droplet infection from 4 days before onset of rash until 5 days there thereafter. The portal of entry is the respiratory tract.

 Incubation period: 10-14 days.

 Clinical features: There are three stages in the natural history of measles. These are:
(1) Prodromal or Pre-eruptive stage:
o Begins 10 days after infection.
o Lasts until 14th day.
o Characterized by fever, coryza with sneezing with nasal discharge, cough redness of eyes, lacrimation and often photophobia.
o Vomiting and diarrhoea may be present.
o A day or two before the appearance of the rash, Kaplik’s spots appear on the buccal mucosa opposite the first and second upper molars. They are small, bluish-white spots on a red base, smaller than the head of a pin.

(2) Eruptive stage
o This stage is characterized by a typical, dusky-red, macular or maculo-papular rash which begins behind the ears and spreads rapidly in a few hours over the face and neck and extends down the body taking 2 to 3 days to progress to the lower extremities.

(3) Post-measles stage
o The child will remain weak for a few days and lose weight to a great extent.
o The child will become susceptible to suffer from other viral or bacterial infection.
o There may be growth retardation, diarrhoea, cancrum oris, pyogenic infections, candidosis, reactivation of pulmonary tuberculosis etc.



 Prevention:
By vaccination. (EPI)


Complications: Complications with measles are relatively common. Some complications are:
 Relatively mild and less serious diarrhea
 Pneumonia
 Encephalitis (sub-acute sclerosing panencephalitis)
 Corneal ulceration leading to corneal scarring.
Complications are usually more severe amongst adults who catch the virus.
The fatality rate from measles for otherwise healthy people in developed countries is low: approximately 1 death per thousand cases. In underdeveloped nations with high rates of malnutrition and poor healthcare, fatality rates of 10 percent are common. In immunocompromised patients, the fatality rate is approximately 30 %.
Vaccination can prevent this disease. So immunize your child against this as per schedule.