New content quiz May 2015

The indicator strip is purple when the ETCO2 is < 4mmHg; tan when  4-140 mmHg; and yellow when 15-38mmHg. The colour changes between inspiration and expiration however a persistent yellow colour on opening indicates a spoiled product. (Link)

The differential diagnosis of EBV infection most commonly includes:  Streptococcal pharyngitis, Cytomegalovirus, Human herpesvirus 6, Herpes simplex virus type 1, Adenovirus, HIV, Toxoplasmosis, Leukaemia and Lymphoma. Kawasaki’s disease  would be the least likely differential. (Link)

In 2011, 241 laboratory confirmed cases of IMD  showed a significant decline since 2004 of Serogroup C Meningococcal infections with serogroup B comprising 78% of bacterial isolates. (Link)

The rash usually starts as erythematous macular or urticarial lesions that  progress to blanching papules, then becomes palpable purpure. It is usually symmetrical and involves the extensor surfaces of limbs (mainly lower) and buttocks. (Link)

The diagnosis requires the presence of  fever of at least five days duration and four of the following:  changes in extremities (e.g. erythema, oedema, desquamation); bilateral conjunctivitis ; polymorphous rash; cervical lymphadenopathy; changes in lips and oral cavity (e.g. pharyngeal oedema, dry/fissured or swollen lips, strawberry tongue). Fever and less than four of the above features is sufficient to establish the diagnosis when echocardiography shows coronary artery disease and when other diseases with similar clinical features are excluded.  Arthritis, urethritis and hepatitis may occur but are not required for diagnosis. (Link)

National patient identity standards require at least three approved patient identifiers (UR number, Date of Birth, Name and Surname): on registration or admission; when care, therapy or other services are provided; whenever clinical handover, patient transfer or discharge documentation is generated. (Link)

The usual sequence of events should be to: inform the patient of the incident; provide immediate medical attention; manage any complications; arrange appropriate disposition and ongoing care; notify staff providing ongoing care of the circumstances; manage staff members; document events, management and notifications; complete any appropriate safety system notifications. (Link)

It is important in this situation not to say you would like to withdraw care, rather change the emphasis to providing symptomatic and comforting care. It is also important not to say that there is nothing you can do – symptomatic and comforting care is an active process. (Link)

A Bankart lesion is an avulsion of anterior glenoid labrum and tear of the anterior capsule which gives a rounded appearance to the anterior glenoid margin. It has a strong association with recurrent dislocations and surgical repair is usually required if present. (Link)

The Hill-Sachs deformity is a compression fracture of the humeral head causing a   deformity of the posterolateral articular surface of humerus secondary to abrasion by the glenoid margin. It is best seen on the AP film in internal rotation and often appears as a hyperdense area of bone adjacent to the articular surface. (Link)

The zero position of the shoulder is when it is abducted 165 degrees, flexed 45 degrees with the elbow supinated. With scapular fixation (placing downward pressure over the trapezius) the zero position is achieved at approximately 100-110 degrees of abduction. In the zero position, the humerus, scapula and the cone of rotator muscles are all in the same axis so a single force along the axis of humerus can overcome all other forces acting to prevent relocation. Most methods used when the arm is abducted aim to achieve this position. (Link)

Patient safety incident is an event that could have resulted, or did result, in unnecessary harm to a patient. Reportable circumstance is a situation where there was significant potential for harm, but no incident occurred. Near miss is an incident which did not reach the patient (e.g. prescribing error detected prior to administration). No harm incident is an event reached a patient but no discernible harm resulted. Adverse event is an incident that results in harm to a patient. Harm is an impairment of structure or function of the body and/or any deleterious effect. Adverse drug reaction is an unexpected harm arising from a justified treatment. Adverse effect is a known effect that is not what is primarily intended and related to a medicine’s pharmacological properties. Preventable is considered as avoidable in the particular set of circumstances. Mitigating factor is an action or circumstance that prevents or moderates the progression of an incident towards harming a patient when the mechanism by which damage may occur is already in train, but has not yet led to the maximum possible harm. Resilience is the degree to which a system continuously prevents, detects, mitigates or ameliorates hazards or incidents.(Link)