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.
What is hyperemesis?
(From the RCOG 2016 Guideline)
- Distinguishes nausea and vomiting of pregnancy from hyperemesis gravidarum
- hyperemesis defined as
- >5% pre pregnancy weight loss
- electrolyte imbalance
how should it be treated?
- antiemetics in the community is first line treatment
- prochlorperazine, promethiazine and cyclizine are first line
- metoclopramide is second line due to the extra pyramidal effects
- ondansetron only when others have failed (less safety data)
- pyridoxine (vit B6) not recommended
Who should be admitted?
- indications for admission
- inability to keep down anti emetics
- ketonuria or weight loss (>5%) despite antiemetics
- comorbidity and vomiting (eg UTI…)
- steroids can be used (but not by us!)
- both ginger and acupressure are suggested as reasonable to try if patient wish to avoid drugs
- remember thiamine supplementaion
What are risk factors and signs of Pre-eclampsia?
- Risk factors for pre eclampsia
- prior pre-eclampsia
- multiple gestation
- history of high BP
- first pregnancy
- age <18, >40
- Symptoms of pre-eclampsia
- severe headache
- blurring or flashing vision
- pain below ribs
- swelling of face, hands or feet
How do you treat it?
- Treatment of hypertension and pre eclampsia
- admission for all!
- oral labetalol first line
- Severe pre-ecamplsia (various ways to define but involves BP>160)
- usual symptoms plus addition of possible clonus, pailloedema and signs of HELLP
- if seizing or imminent risk of eclampsia give magnesium
- loading dose 4g over 5 mins
- followed by infusion 1g/hour for 24hrs
- recurrent seizures treated with further 2g boluses over 5 mins
- resp depression (muscle weakness) and loss of deep tendon reflexes as signs of toxicity
- do not use standard antiepileptic drugs as an alternative to magnesium
- labetalol, hydralaizine or oral nifedipine are the antihypertensives to use
- remember the steroids for the bubba
- restrict fluids to 80ml/hr (risk of pulm oedema)
What is HELLP syndrome
Urinary tract infection in pregnancy
- unique in that recommendation is to treat asymptomatic bateriuria
- these asymptomatic UTIs have been associated with poor foetal outcomes
VTE in pregnancy