I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.
You can find more things on the FRCEM on this site here.
Describe some typical features
- fever
- jaundice (from haemolysis)
- anemia
- low platelets (once had a lab tech tell me they’d never seen falciparum with a platelet over 100 which i thought was a useful pearl)
- splenomegaly
- Vivax is Indian subcontinent mainly
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What are the UK treatment recommendations?
From the 2016 UK Guidelines
- Three quarters diagnosed in UK is falciparum
- remember repeat films needed to exclude the diagnosis
- Admit most with falciparum for 24 hrs due to risk of deterioration
- For uncomplicated malaria in adults
- arteseminin combo is 1st line
- quinine or malarone 2nd choice
- For severe (includes >2% parasites) malaria in adults
- IV artesunate
- IV quinine 2nd choice (needs monitoring for low sugar)
- For kids don’t forget broad spectrum antibiotics to cover for potential other infections
- Haemolysis occurs in approximately 10-15% patients following intravenous artesunate treatment (usually within a couple of weeks)
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P.vivax might be traditionally prevalent in India only but I caught mine in Africa or on a plane/airport (Brussels?).
Remember: pathogens and disease don’t read textbooks 🙂
Maybe they have passports though…