Tasty Morsels of EM 072 – #FRCEM Malaria

13 Jul

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

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)


2 Replies to “Tasty Morsels of EM 072 – #FRCEM Malaria

  1. 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 🙂

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