Wednesday, 10 December 2008

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
3.Arrange treatment medical follow up
4.Prepare written report

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

Twitter Button from

Sunday, 7 December 2008

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

Bookmark and Share

Twitter Button from

Friday, 28 November 2008

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


Chromosomal findings in early miscarriage
40% normal 60% abnormal

Chromosomal abnormalities

Downs syndrome-
1-trisomy 21
2-Robertsonian translocation

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


Tuesday, 11 November 2008

women's health news from national library of health

Friday, 31 October 2008

mnemoincs for MRCOG

Mnemonics in Obstetrics & Gynaecology

Breaking bad news-"SPIKES" protocol

      S-SETTING UP the Interview






                article on breaking bad news

                another resource on breaking bad news

   Book:Mnemonics for Medical Students

Clinical Governance-"SPARE IT"


      P-patient involvement


      R-research & risk management





HELLP syndrome-a complication of preeclampsia



      EL-elevated liver enzymes

      LP-low platlets


HELPER-mnemonic for management of shoulder dystocia


      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



      BR-Baseline rate





Interpretation of CTG-another mnemonic-"DARTH VADER"


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

      R-recorded fetal movements


      H-Heart rate









Causes of transient urinary incontinence-DIAPPERS



      Atrophic vaginitis


      Psychological problems

      Excess urine output

      Restricted mobility

      Stool impaction

Postpartum haemorrhage-4T


      T-Tissue(retained placenta)


      T-Thrombin(coagulation disorders)


      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


      E-fully engaged head

      P-adequate maternal pelvis


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-Passenger(size & position of fetus)


Ectopic pregnancy risk factors-"ECTOPIC"

      E-Ectopic(past history)/Endometriosis


      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


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"



      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?


Mechanism of labour

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



                                             Interal rotation



                                             External rotation



 postnatal examination:"BUBBLES"







  S-Surgical site (for Cesarean section)

 causes of secondary amenorrhoea-"SOAP"





more mnemonics contributed by excellent users:here

  Intrauterine infections:"TORCHS"


            O-Other(parvo virus)





Jaundice at 24 hours of age-"RAGS"

         R-Rhesus incompatibility

         A-ABO incompatibility

         G-G6PD deficiency


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


         Spina bifida cystica


         Abdominal wall defect

         Fetal death

         Placental abruption

                                 by Rinku Uberoi UNIBE

Female pelvis: shapes 


                         In order from most to least common:


                                 Android /Anthropoid


            Medical mnemonics for your PDA


Predisposing Conditions for Pulmonary Embolism: "TOM SCHREPFER"





         C--cardiac disease


         R--rest (bed-bound)

         E--estrogen, pregnancy, post-partum

         P--past hx



         R--road trip



If you have any suggestions pls email



Custom Search