skeleton slides

Skeleton slides

objectives

• Present case of measles• Present mini-study of measles in TMC

Measles Outbreak

Information regarding measles outbreak. Check Anne’s posts, baka relevant. Highlight why we want to make a grandrounds presentation on measles.

CASE PRESENTATION

History

HPI• 2 year old male• CC: fever + rash• 2 days PTC – fever + cough + colds, no

consult blah..• 1 day PTC – still with fever, cough,

colds, poor appetite, consult, prescribed blah..

• Day of consult - …

• Fever• Rash• Coryza

Panel for noting salient features that will help in diagnosis of measles

Panel for your usual history and Pe

History

PMH• Fever• Rash• Coryza



History

ROS• Fever• Rash• Coryza



History

FH• Fever• Rash• Coryza



History

Vaccination Hx• (+) measles vaccine • Fever

• Rash• Coryza• (+) measles

vaccine



History

Birth History (if relevant)• Fever• Rash• Coryza



History

Developmental Hx• Fever• Rash• Coryza• (+) measles

vaccine



PE

• General: weak-looking• Vitals: HR, RR: 50s, BP, temp• Anthropometrics (z score etc)

• Fever• Rash• Coryza• (+) measles V• Weak-looking• Febrile• Tachypneic



PE

• General: weak-looking• Vitals: HR, RR: 50s, BP, temp• Anthropometrics (z score etc)

• Fever• Rash• Coryza• (+) measles V• Weak-looking• Febrile• Tachypneic• Crackles, bilateral• (+) maculo-papular

rash on face neck and upper chest



Contextual analysis

Salient features

FeverRashCoryza(+) measles VWeak-lookingFebrileTachypneicCrackles, bilateral(+) maculo-papular rash on face neck and upper chest

Salient features panel from hx and PE

Differentials

• Differential #1 : MEASLES•Fever•Coryza•(+) measles V•Weak-looking•Tachypneic•Crackles, bilateral•(+) maculo-papular rash on face neck and upper chest

Rule In Rule Out

Presents with: Fever rash coryza…..

Cannot be totally ruled out

Laboratory findings:CBC: high WBC with lymphocytic predominance

CXR: infiltrates (if with measles pneumonia)

PRESENTER: This will serve as our “theoretical discussion”.

NOTE: Since measles is a “simple” case and because this is not an sgd, we won’t have

separate slides as to the etiology, pathogenesis, clinical manifestation of

measles, diagnostics of measles. I.e. The presenter will hopefully discuss the clinical presentation (prodrome, even usu signs and symptoms), as he/she rules in

measles through our history and symptoms. PRESENTER: This will serve as our

“theoretical discussion”.

NOTE: The presenter can discuss the expected diagnostic management for

measles.

Differentials

• CBC results



PRESENTER: while these results are being shown, presenter will add theoretics. Such as why was this done, what are we looking for? what is expected in measles, is this the gold

standard?

Differentials

• CXR results



Film and official rdg


standard?

Differentials

• UA



Other labs done


standard?

Differentials

• Lab results



What other labs could have been done?

PRESENTER: Can talk about additional labs that could/should have been done (i.e.

measles serology). What results are expected?

Differentials

• Differential #2•Fever•Coryza•(+) measles V•Weak-looking•Tachypneic•Crackles, bilateral•(+) maculo-papular rash on face neck and upper chest

Rule In Rule Out

Presents with: Fever Tachypnea Crackles

Does not present with: rash blah…

Laboratory findings:CBC: high WBC with neutrophilic predominance

CXR: infiltrates

Expected lab findings May help in ruling in or out

PRESENTER: will comment that this does/does not coincide with previously

presented lab findings.

Differentials

• Differential #3•Fever•Coryza•(+) measles V•Weak-looking•Tachypneic•Crackles, bilateral•(+) maculo-papular rash on face neck and upper chest

Rule In Rule Out

Presents with: Fever Tachypnea Crackles

Does not present with: rash blah…

Laboratory findings:CBC: high WBC with neutrophilic predominance

CXR: infiltrates

Expected lab findings May help in ruling in or out

PRESENTER: will comment that this does/does not coincide with previously

presented lab findings.

Primary Working Impression

Measles(add other impresion: pneumonia? Dehydration? Blah)

PRESENTER: will highlight why we are choosing measles as our PWI. This will serve as our “theoretical discussion”. A

review of textbook -easles vs our patient’s measles.

But if we find important diagrams to help with this, we can add a few slides. Like

pictures of typical measles rash.

Management As intro to management we can present measles treatment protocol (of TMC or WHO or whatever) if ever

Management we can present ADMITTING ORDERS

ManagementProblem List Management

1. Fever Paracetamol, tepid sponge bath

2. Rash

3. Pneumonia Antibiotics used

4. Decreased oral fluid intake IVF

Summary slide of problem list with management.


1. Fever Paracetamol, tepid sponge bath

Important notes on progress of this problem during the course in the wards . How did it progress? How was it managed?

Fever range: _____Last day of fever


3. Pneumonia Antibiotics used

Day2 of hospitalization / day 4 of illness: Respiratory distress, intercostal retractions, oxygen saturation 80%Management: NSS nebulization salbutamol nebulization

Day3 of hospitalization / day 5 of illness: Still with intercostal restractions- CXR done Management: referal to pedia pulmo, antibiotics shifted from ceftriaxone to pip taz

Important notes on progress of this problem during the course in the wards . How did it progress? Show films and official rdg for subsequent cxrs. How was it managed?

PRESENTER: will comment on theoretics (such as why this drug is used, mechanism

of action, standard dosing.. Etc)

Management

• Discharge orders

“STUDY” PRESENTATION

Present statistics on TMC patients:How many measles cases were seen in the ER? How many were admitted? How does it differ from census of previous years (ask doc rica if we can have a copy of the census they reported nung last conference). Gender ratio? How many were vaccinated/not vaccinated? How does the presentation of measles in these cases differ from textbook-measles?

Contextual analysis

large-scale contextual analysis. Stakeholders: patients, health practitioners, govt, etc.

Measles in TMC

Info/statistics

Present statistics on TMC patients:How many measles cases were seen in the ER? How many were admitted? How does it differ from census of previous years (ask doc rica if we can have a copy of the census they reported nung last conference). Gender ratio? How many were vaccinated/not vaccinated? How does the presentation of measles in these cases differ from textbook-measles?

Measles in TMC

management

How is measles being managed in tmc (different ba from the typical management?). Ask dr. Aguirre if you can have a copy of the forms that she presented last conference. The TMC team made ata a “pathway” or protocol of how to manage measles.

Prevention

Present typical EPI protocol on measles. Any new vaccine protocols?

Public health

Present public health news. Aside from vaccination, how can spread be prevented? Handwashing? Masks? How can caregivers (lay and medical health practiioners) be prevented from acquiring the infection if they are taking care of the sick?

skeleton slides

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