Good morning and welcome to your Monday dose of Your Daily Meds.
Bonus Review: Consider a Rhesus (Rh) positive foetus being carried by a Rh negative mother in her first pregnancy. Would that foetus be affected by the mother’s antibodies against foetal red blood cells?
Answer: In short, probably not.
Given this is her first pregnancy, the mother will probably not have any Rhesus antibodies (Anti-D antibodies).
She could have developed these antibodies if she had been exposed to Rh positive blood in the past, such as in a previous pregnancy with an Rh positive foetus or an Rh positive blood transfusion.
So, by considering the use of Anti-D passive immunisation in the event of a sensitising event in a pregnant woman of this status; and avoiding Rh positive transfusions in women of child-bearing age, we can reduce the risk of blowing up foetal red blood cells…
Case:
A 34-year-old male is brought into the Emergency Department via ambulance after a high-speed motor vehicle accident.
On assessment:
* There is no eye opening
* Incomprehensible sounds are noted
* He pulls his hand away when you firmly squeeze his nailbed with a pen.
Which of the following correctly describes this man’s GCS score?
* GCS 7 – E 1; V 2; M 4
* GCS 7 – E 1; V 2; M 4
* GCS 7 – E 1; V 2; M 4
* GCS 7 – E 1; V 2; M 4
* GCS 7 – E 1; V 2; M 4
Have a think.
Scroll for the chat.
Paediatrics:
Which of the following is not considered in the calculation of an Apgar Score for a neonate?
* Heart rate
* Respiratory effort
* Muscle tone
* Temperature
* Reflex response
Have a think.
More scroll for more chat.
What the GCS?:
The Glasgow Coma Scale is used as a neurological scoring system and assesses the patient’s best eye response, best vocal response and best motor response.
It is scored out of 15, with the eye component scored out of 4, the verbal component out of 5 and the motor component out of 6.
In this case, there is no eye opening (E 1), there are incomprehensible sounds verbalised (V 2), and the patient withdraws from painful stimulus (M 4). This results in a total GCS of 7.
A GCS of 8 or less is often used as a marker for the need for intubation in the setting of an unprotected airway.
Remember, the minimum GCS is 3, not 0.
Toasters have a GCS of 3. As do logs.
The GCS marking criteria are shown below for reference:
APGARing:
The Apgar Score comprises the assessment of neonatal heart rate, respiratory effort, muscle tone, colour and reflex response; with each criterion scored from 0-2 with a maximum score of 10.
Not Temperature.
Consider the table below:
The score is based on the degree of cardiorespiratory and neurological depression present in the neonate and is measured at 1 and 5 (and sometimes 10) minutes after birth.
A normal Apgar score is between 7 to 10. Apgar score of 4 to 6 indicate moderate depression; and 0 to 3 indicates severe depression.
Bonus: Ok so what is the difference between a Hormone and a Vitamin?
Answer in tomorrow’s dose.
Closing:
Thank you for taking your Meds and we will see you tomorrow for your MANE dose. As always, please contact us with any questions, concerns, tips or suggestions. Have a great day!
Luke.
Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks.
Just credit us where credit is due.
