Child protection

Child protection is governed by law

children act(1989)-It describes 4 important concepts

1.The child's welfare is paramount
2.Parental responsibility
3.Children are best cared by both parents
4.Children are individual in their own right

Other important documents related to child protection:
A.Section 28 of the children act 2004
B.Lord Laming recommendations 2003


Child protection overrides confidentiality.Don't promise confidentiality when dealing with child protection.

Needs ensure effective inter agency communication.

Assessment framework
Parenting capacity
Child development needs
Family&social interaction

Child abuse is linked domestic violence-Antenatal routine enquiry into domestic abuse is helping to identify potential cases.

Child abuse is handled by MARAC-multi agency risk assessment conference

Child abuse is linked to substance abuse.


Managing disclosure
1-take allegation seriously
2-record accurately sign date
3-don't promise confidentiality
4-listen don't press for information
5-explain what you will do next
6-reassure the child or person


Types of abuse
1-physical abuse(non accidental injury)
2-neglect-difficult to set the limits
3-emotional abuse-difficult to set the limits long term implications difficult to prove witnessing domestic violence
4-sexual abuse


Role of the doctor

1.Examination of child
2.Record
3.Arrange treatment medical follow up
4.Prepare written report


Consent
1-medical emergency consent is not required
2-16 years and over can give own consent
3- Children under 16 years Fraser/Gillick competence
4-parental responsibility
5-may need PPO(police protection order)

more information on consent on children

Child over friendliness with strangers could be a sign emotional neglect.

Child abuse photograph taken by police officers because they need to be submitted in the court.


Any baby with unexplained bruises- skeletal survey is important

A powerpoint presentation on childabuse


My website

Cardiopulmonary resuscitation

Uploaded on authorSTREAM by ravimohanv



power presentation on basic life support



Emergency training in second life

UK resuscitation council

European council of Resuscitation



My Website

Fetal well being

Fetal Growth & Fetal well being are different aspects fetal evaluation.
Deficiencies in fetal well being could be associated with fetal growth restriction but it may also be present in fetal macrosomia(diabetes).


Fetal Growth is evaluated by
(I) clinical assessment of uterine size
(II)symphysiofundal height
(III)USS measurements of abdominal circumference


Fetal well being is evaluated by
(I)kick count chart
(II)CTG-non stress test
(III)Amniotic fluid index
(IV)biophysical profile
(V)umbilical artery doppler

Components of biophysical profile are.Each component is given a score of 2.
(I)Fetal movements
(II)Fetal respiratory movements
(III)Fetal tone
(IV)Amniotic Fluid index
(V)CTG-non stress test

Liquor assess chronic hypoxia other 4 parameters assess acute hypoxia

10/10 risk of fetal asphyxia in week 1<1000>2 weeks
3-abnormal venous Doppler
4-abnormal cardiograph/BPP

My Website

Genetics

Chromosomal findings in early miscarriage
40% normal 60% abnormal

Chromosomal abnormalities
1-number
2-structure


Downs syndrome-
1-trisomy 21
2-Robertsonian translocation
3-mosaicism

60% aborted
20%still birth

Robertsonian in Downs 96% denovo
21:21 trans location is 100% recurrence

Maternal age related to all trisomies

Autosomal recessive

Cystic fibrosis 1:2500 babies in U.K
Sex linked recessive
Duchenne Muscular dystropy free fetal DNA can be done to check the sex

Genetics

women's health news from national library of health

mnemoincs for MRCOG

Mnemonics in Obstetrics & Gynaecology

Breaking bad news-"SPIKES" protocol

      S-SETTING UP the Interview

      P-ASSESSING THE PATIENT'S PERCEPTION

      I-OBTAINING THE PATIENT'S INVITATION

      K-GIVING KNOWLEDGE AND INFORMATION TO THE PATIENT

      E-ADDRESSING THE PATIENT'S EMOTIONS WITH EMPATHIC RESPONSES

      S-STRATEGY AND SUMMARY

                article on breaking bad news

                another resource on breaking bad news

   Book:Mnemonics for Medical Students

Clinical Governance-"SPARE IT"

      S-staffing

      P-patient involvement

      A-audit

      R-research & risk management

      E-effectiveness

      I-information

      T-teaching/Training

 

HELLP syndrome-a complication of preeclampsia

 

      H-haemolysis

      EL-elevated liver enzymes

      LP-low platlets

 

HELPER-mnemonic for management of shoulder dystocia

      H-Help

      E-Evalute for an episiotomy (not necessarilyy done at this point)

      L-Legs (McRobert's- flexing the thighs up onto the maternal abdomen)

      P-Pressure (suprapubic)

      E-Enter (internal manoeurves- Wood Screw)

      R-Remove posterior arm

      R-Roll onto hands and knees

This is the recommended emergency drill from Advance Life Support Obstetrics (ALSO).

Interpretation of CTG     DRCM BRAVADO

      DR-Determine RISK

      C-Contractions

      M-Movements(fetal)/Meconium

      BR-Baseline rate

      A-Acceleration

      VA-Variability

      D-Deceleration

      O-Overall

Interpretation of CTG-another mnemonic-"DARTH VADER"

      D-Details(name,parity)

      A-Assess quality(rate of paper-in U.K 1cm/min)

      R-recorded fetal movements

      T-tocography

      H-Heart rate

      V-Variabilty

      A-Acceleration

      D-Deceleration

      E-Evaluation

      R-Response

                     source:

   

 

Causes of transient urinary incontinence-DIAPPERS

      Delirium

      Infection

      Atrophic vaginitis

      Pharmaceuticals

      Psychological problems

      Excess urine output

      Restricted mobility

      Stool impaction

Postpartum haemorrhage-4T

      T-Tone(atnonia)

      T-Tissue(retained placenta)

      T-Trauma

      T-Thrombin(coagulation disorders)

FORCEPS/VACUUM DELIVERY

      A - Address the patinet/Anaesthesia/Assistance( anaesthetist, colleague,paediatrician) 

      B- Bladder empty

      C- Cervix fully dilated/Contractions

      D- Determine position/Think and prepare for shoulder Dystocia

      E- Explain to the patient/ Exit plan if it fails, ready for cesarean section/check Equipment

      F - Fontanelle ( to check position )

      G - Gentle traction

      H- Handle elevated for forceps/Halt for vacuum ( no descent with 3 pulls, 3 times pop off )

      I - Incision/Episiotomy

      J- remove forceps when Jaw visible

Criteria for instrumental delivery- FORCEPS

      F-favourable head position(OA/OP)

      O-os fully dilated

      R-rutpture the membranes

      C-contractions

      E-fully engaged head

      P-adequate maternal pelvis

      S-Stirrups(Lithotomy)

Antepartum haemorrhage causes

      A-Abruption of placenta

      P-Placenta praevia(or vasa praevia)

      H-Haemorrhage from genital tract(ectropian/polyp/cervical cancer)

 

factors determining the outcome of labour

      P-Power of uterine contractions

      P-Passage/Pelvis

      P-Passenger(size & position of fetus)

 

Ectopic pregnancy risk factors-"ECTOPIC"

      E-Ectopic(past history)/Endometriosis

      C-Contraception-IUCD,POP

      T-Tubal surgery(sterilisation)

      O-other surgeries(laparotomy/appendicetomy)

      PID-pelvic inflammatory disease

      I-infertility treatment

      C-can't find-idiopathic

From:S.Yosuf & M.Choudry.Many more excellent mnemonics in:

Mnemonics for Medical Undergraduates

      

 

 

Oral contraceptive complications: warning signs ACHES:

   Abdominal pain

   Chest pain

   Headache (severe)

   Eye (blurred vision)

   Sharp leg pain

         more mnemonics

Apgar

A - appearance (color)

P - pulse (heart rate)

G - grimmace (reflex, irritability)

A - activity (muscle tone)

R - respiratory effort 

 

 

The five W's--post-operative fever

   Wind--pneumonia, atelectasis

   Water--urinary tract infection

   Wound--wound infections

   Wonderdrugs--especially anesthesia

   Walking--walking can help reduce deep vein thromboses and pulmonary embolus

         more mnemonics

 

 Postpartum collapse: causes  "HEPARINS"

      Hemorrhage

      Eclampsia

      Pulmonary embolism

      Amniotic fluid embolism

      Regional anaethetic complications

      Infarction (MI)

      Neurogenic shock

      Septic shock

more mnemonics

 

Domestic violence screening:"SAFE"

      S-Stress and safety

Do you feel safe in your relationship? What happens when you and your partner disagree? 

      A-Afraid or abused

Have you or your children ever been physically threatened or abused? Have you ever been forced to have sexual intercourse? 

      F-Friend or family awareness

Are your friends or family aware of what is happening? Would they support and help you? 

      E-Emergency escape plan

Are you in danger now, and would you like to go to a shelter or talk with someone? Do you have a place where you and your children could go in an emergency?

                               source

Mechanism of labour

                  "Don't Forget I Enjoy Really Expensive Equipment":

                                             Descent

                                             Flexion

                                             Interal rotation

                                             Extension

                                             Restitution

                                             External rotation

                                             Expulsion

                                                                                 source

 postnatal examination:"BUBBLES"

  B-Breast

  U-Uterus

  B-Bowel

  B-Bladder

  L-Lochia

  E-Episotomy

  S-Surgical site (for Cesarean section)

 causes of secondary amenorrhoea-"SOAP"

   S-Stress

   O-OCP

   A-Anorexia

   P-Pregnancy

more mnemonics contributed by excellent users:here

  Intrauterine infections:"TORCHS"

            T-Toxoplasmosis

            O-Other(parvo virus)

             R-Rubella

             C-cytomegalovirus

             H-Herpes

             S-syphilis

Jaundice at 24 hours of age-"RAGS"

         R-Rhesus incompatibility

         A-ABO incompatibility

         G-G6PD deficiency

         S-Spherocytosis

some more mnemonics

Chat with V. Ravimohan

Causes of increased alfa fetoprotein:

                "Increased Maternal Serum Alpha Feto Protein"

         Intestinal obstruction

         Multiple gestation

          Miscalculation of gestational age

          Myeloschisis

         Spina bifida cystica

         Anencephaly

         Abdominal wall defect

         Fetal death

         Placental abruption

                                 by Rinku Uberoi UNIBE

Female pelvis: shapes 

                  "GAP"

                         In order from most to least common:

                                 Gynecoid

                                 Android /Anthropoid

                                 Platypelloid

            Medical mnemonics for your PDA

 

Predisposing Conditions for Pulmonary Embolism: "TOM SCHREPFER"

         T--trauma

         O--obesity

         M--malignancy

         S--surgery

         C--cardiac disease

         H--hospitalization

         R--rest (bed-bound)

         E--estrogen, pregnancy, post-partum

         P--past hx

         F--fracture

         E--elderly

         R--road trip

                                 more

 

If you have any suggestions pls email me:

 

 

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