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
From OHEM 4th p 660 and NICE 2016
What is Physiologic Jaundice?
- inability of the neonatal liver to deal with the normal rate of bilirubin production from red cell turn over
- of note breast milk jaundice is related to substance that inhibit gluconyl transferase
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High risk babies
- <38 weeks
- sibling who needed photorx
- intention for exclusive breast feeding
- jaundice in <24 hrs
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Jaundice in first 24 hrs
- this is rare and a red flag
- measure serum within 2 hrs of suspecting it (good luck there…)
- measure it every 6 hrs
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Jaundice in >24 hrss
- 6 hours to measure it following suspicion
- can use a non invasive device
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Factors increasing risk of kernicterus
- >340 in babies >37 weeks
- rapid rise
- clinical features of encephalopathy
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Spoiler
- look for chalky stools
- check conjgated bili (have they got bilairy atresia)
- FBC
- blood group and coombs (is this a haemolytic problem)
- ensure heel prick was alright (congenital hypothyroid)gestational age >37 and jaundice more than 14 days
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