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More session #available for physical #workshop in April 2025 😇;
▶️ Clinical Skills 🙌🏻 ; practice 17 procedures in just 1 day ✅
.
▶️ Blood taking, #branula insertion & blood culture 💉🩸workshop
.
▶️ #Episiotomy repair & basic #suturing workshop ✂️🪡
.
Let’s brush up our clinical skills 👋🏻 before HOship soon;
https://medicorp.onpay.my/order/form/clinicalskillsuturing_workshop
▶️ Clinical Skills 🙌🏻 ; practice 17 procedures in just 1 day ✅
.
▶️ Blood taking, #branula insertion & blood culture 💉🩸workshop
.
▶️ #Episiotomy repair & basic #suturing workshop ✂️🪡
.
Let’s brush up our clinical skills 👋🏻 before HOship soon;
https://medicorp.onpay.my/order/form/clinicalskillsuturing_workshop
1️⃣ Wells' score for deep vein thrombosis (DVT) [Online calculator (MD Calc)]
🔹Active cancer (treatment ongoing or within previous 6/12 or
palliative): 1 pt
🔹Paralysis, paresis or recent immobilization of lower extremities: 1 pt
🔹Recently bedridden more than 3/7 or major surgery within 4/52: 1 pt
🔹Localized tenderness along the distribution of the deep venous
system: 1 pt
🔹Entire leg swollen: 1 pt
🔹Calf swelling >3 cm than asymptomatic side (measured 10 cm below tibial tuberosity): 1 pt
🔹Pitting odema, greater in the symptomatic leg: 1 pt
🔹Collateral superficial veins (non-varicose): 1 pt
🔹Previously documented DVT: 1 pt
🔹Alternative diagnosis* to DVT as likely or more likely: MINUS 2 points
*Alternative Dx such as:
- Cellulitis
- Superficial phlebitis
- Post-thrombotic syndrome
- Chronic venous insufficiency
- Muscle strain/tear
- Dependent oedema in paralysed limb
- Oedema due to liver cirrhosis/CHF
- External venous obstruction (eg compression by tumour)
- Pseudoaneurysm
- Haematoma
🔹Active cancer (treatment ongoing or within previous 6/12 or
palliative): 1 pt
🔹Paralysis, paresis or recent immobilization of lower extremities: 1 pt
🔹Recently bedridden more than 3/7 or major surgery within 4/52: 1 pt
🔹Localized tenderness along the distribution of the deep venous
system: 1 pt
🔹Entire leg swollen: 1 pt
🔹Calf swelling >3 cm than asymptomatic side (measured 10 cm below tibial tuberosity): 1 pt
🔹Pitting odema, greater in the symptomatic leg: 1 pt
🔹Collateral superficial veins (non-varicose): 1 pt
🔹Previously documented DVT: 1 pt
🔹Alternative diagnosis* to DVT as likely or more likely: MINUS 2 points
*Alternative Dx such as:
- Cellulitis
- Superficial phlebitis
- Post-thrombotic syndrome
- Chronic venous insufficiency
- Muscle strain/tear
- Dependent oedema in paralysed limb
- Oedema due to liver cirrhosis/CHF
- External venous obstruction (eg compression by tumour)
- Pseudoaneurysm
- Haematoma
====== ====== ====== ======
2️⃣ Wells' score for pulmonary embolism (PE) [Online calculator (MD Calc)]
🔹Clinical signs & symptoms of DVT (minimum of leg swelling & pain with palpation of deep vein): 3 points
🔹An alternative diagnosis is less likely than PE: 1 point
🔹 Tachycardia > 100 beats/min: 1.5 point
🔹Immobilization or surgery in previous 4 weeks: 1.5 point
🔹Previous DVT/PE: 1.5 point
🔹Haemoptysis: 1 point
🔹Malignancy (on treatment, treated in the last 6 months or palliative): 1 point
⭐️ Clinical probability score: PE likely if ≥4 points, PE unlikely if ≤4 points
References:
1. CPG Prevention and Treatment of Venous Thrombosis 2013
#GIM@nota_perubatan
2️⃣ Wells' score for pulmonary embolism (PE) [Online calculator (MD Calc)]
🔹Clinical signs & symptoms of DVT (minimum of leg swelling & pain with palpation of deep vein): 3 points
🔹An alternative diagnosis is less likely than PE: 1 point
🔹 Tachycardia > 100 beats/min: 1.5 point
🔹Immobilization or surgery in previous 4 weeks: 1.5 point
🔹Previous DVT/PE: 1.5 point
🔹Haemoptysis: 1 point
🔹Malignancy (on treatment, treated in the last 6 months or palliative): 1 point
⭐️ Clinical probability score: PE likely if ≥4 points, PE unlikely if ≤4 points
References:
1. CPG Prevention and Treatment of Venous Thrombosis 2013
#GIM@nota_perubatan
Forwarded from Nota Perubatan
Algorithm for diagnosis of pulmonary embolism (PE) and deep vein thrombosis (DVT)
❓ What is the role of d-dimer in the diagnosis of DVT or PE?
- D-dimer has high negative predictive value, which helps to rule out DVT / PE.
- D-dimer is useful when Wells score suggests DVT / PE is unlikely. Negative Wells' score + negative D-dimer = low risk for DVT / PE = imaging is NOT required
- D-dimer is sensitive but not specific to thromboembolism. A positive d-dimer test is not helpful due to many causes of false positive d--dimer.
- If Wells' score suggests PE or DVT is likely, the next step would be imaging (CUS or CTPA), instead of sending blood for D-Dimer test in such cases.
❓ Tips when requesting USG doppler for lower limbs / CTPA:
- Always mention the relevant risk factors and Wells' score
- "Any d-dimer sent?" Answer: d-dimer was not sent because Wells' score is high
CUS: compression ultrasound
References:
1. CPG Prevention and Treatment of Venous Thrombosis 2013
2. Sarawak Handbook of Medical Emergencies 4th ED
Related post:
▶️ D-dimer
https://t.me/nota_perubatan/1126
#GIM@nota_perubatan
- D-dimer has high negative predictive value, which helps to rule out DVT / PE.
- D-dimer is useful when Wells score suggests DVT / PE is unlikely. Negative Wells' score + negative D-dimer = low risk for DVT / PE = imaging is NOT required
- D-dimer is sensitive but not specific to thromboembolism. A positive d-dimer test is not helpful due to many causes of false positive d--dimer.
- If Wells' score suggests PE or DVT is likely, the next step would be imaging (CUS or CTPA), instead of sending blood for D-Dimer test in such cases.
- Always mention the relevant risk factors and Wells' score
- "Any d-dimer sent?" Answer: d-dimer was not sent because Wells' score is high
CUS: compression ultrasound
References:
1. CPG Prevention and Treatment of Venous Thrombosis 2013
2. Sarawak Handbook of Medical Emergencies 4th ED
Related post:
▶️ D-dimer
https://t.me/nota_perubatan/1126
#GIM@nota_perubatan
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⬆️ Well's score for DVT & PE
Must know for HOs at surgical based dept, esp when you need to #request for;
✅ USG Doppler of lower limb TRO DVT
✅ Pulmonary CT angiogram TRO PE
.
All these notes - Credit to Channel Nota Perubatan
Must know for HOs at surgical based dept, esp when you need to #request for;
✅ USG Doppler of lower limb TRO DVT
✅ Pulmonary CT angiogram TRO PE
.
All these notes - Credit to Channel Nota Perubatan
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Venous Blood Taking ie venipuncture procedure 💉🩸
💉🩸 Let's practice both procedures,
Plus #sterile blood taking for Blood C&S (culture & sensitivity) sample at #Medicorp's;
✅ Clinical Skills Workshop
✅ Blood taking & branula insertion workshop
.
More sessions available in April, May & June 2025;
https://medicorp.onpay.my/order/form/clinicalskillsuturing_workshop
Plus #sterile blood taking for Blood C&S (culture & sensitivity) sample at #Medicorp's;
✅ Clinical Skills Workshop
✅ Blood taking & branula insertion workshop
.
More sessions available in April, May & June 2025;
https://medicorp.onpay.my/order/form/clinicalskillsuturing_workshop
Live from Clinical Skills Workshop today at Medicorp's Skills Lab 😍
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More #excellentHOs at Medicorp's blood taking, branula insertion & blood C+S #workshop today 🥰
Yes we had fun learning & practicing together ✅
Yes we had fun learning & practicing together ✅
#Eventful day at labour room,
But alhamdulillah tolerable sebab HO semua #function ✅
.
‼️ cord prolapse - pushed for EMLSCS
❗ Fetal distress, secondary #arrest - had to open up 2nd EMOT for EMLSCS 😅
❗cord round neck during SVD
.
‼️ Prolonged second stage due to poor maternal effort, delivered by #vacuum but baby not vigarous, attended stat by Paeds MO, alhamdulillah AS 6 at 1 mins, 9 at 5 mins
.
‼️ shoulder #stuck for 1 mins, delivered after suprapubic pressure & McRobert.
Baby 3.8kg, thank God good Apgar, Moro complete B/L 🤲
.
❗PPH due to uterine atony, EBL 1 litre, mother & baby well
.
Alhamdulillah all is well with good team work 💪
.
#HOnowadays #excellentHOs
#WardSimulation & yes, we simulated all these situations in less than 5 hours at Medicorp's Clinical Skills workshop today 🌟
But alhamdulillah tolerable sebab HO semua #function ✅
.
‼️ cord prolapse - pushed for EMLSCS
❗ Fetal distress, secondary #arrest - had to open up 2nd EMOT for EMLSCS 😅
❗cord round neck during SVD
.
‼️ Prolonged second stage due to poor maternal effort, delivered by #vacuum but baby not vigarous, attended stat by Paeds MO, alhamdulillah AS 6 at 1 mins, 9 at 5 mins
.
‼️ shoulder #stuck for 1 mins, delivered after suprapubic pressure & McRobert.
Baby 3.8kg, thank God good Apgar, Moro complete B/L 🤲
.
❗PPH due to uterine atony, EBL 1 litre, mother & baby well
.
Alhamdulillah all is well with good team work 💪
.
#HOnowadays #excellentHOs
#WardSimulation & yes, we simulated all these situations in less than 5 hours at Medicorp's Clinical Skills workshop today 🌟