Pancreatitis Aguda

La pancreatitis aguda se caracteriza clínicamente por dolor abdominal acompañado de elevación de las enzimas pancreáticas en plasma y orina.

I. EPIDEMIOLOGIA
- Su incidencia parece haber aumentado en los últimos años.
- La edad de presentación se sitúa e torno a los 55 años siendo en un gran número de casos entre los 30-70 años; aunque puede aparecer a cualquier edad.
- En cuanto a presentación por sexo: la relación hombre / mujer , en función de la etiología; alcohol, litiasis biliar será de la mitad en España.
- Mortalidad del 5.1 al 17,3%

II. ETIOLOGIA:
- La etiología de alcohol y litiasis biliar se encuentra entre el 60-85 %
- Hay una presentación idiopática (no se explica la causa) ; aunque cada vez se relaciona más con etiología biliar.
-A continuación vamos a citar, una relación de causas de Pancreatitis Aguda:

• -  Colelitiasis
  
• -  Etilismo
  
• -  En el curso de un Postoperatorio de Cirugía abdominal /Bypass aortocoronario.
  
• -  CPRE
  
• -  Traumatismo abdominal cerrado
  
• -  Hipertrigliceridemia
  
• -  Déficit de CII apoproteina
  
• -  Hipercalcemia
  
• -  Insuficiencia renal
  
• -  Virus: Parotiditis Herpes virus Cosachkie, Echovirus.
  
• -  Ascaridiasis
  
• -  Mycoplasma
  
• -  Salmonella , Campylobacter yeyuni
  
• -  SIDA 
  
  • -  Fármacos (Azatiopirina, estrógenos, Diuréticos, Corticoides, Sulfonamidas.
    
  • -  LES, Vasculitis, Angeitis necrotizante
    
  • -  P. Trombocitopénica trombopática
    
  • -  Ulcera péptica penetrante
    
  • -  Obstrucción ampolla de Vater
    
  • -  Enteritis regional
    
  • -  Divertículo duodenal
    
  • -  Tumores pancreáticos.
    
  • -  Páncreas divisum
    
  • -  Veneno de Escorpión ( Tityus trinitatis)
    
    CLINICA
    Dolor abdominal (95-100%) de instauración súbita, que se intensifica rápidamente hasta alcanzar su pico de unos minutos a una hora, continuo, y se localiza en epigastrio, donde queda fijo o se irradia a uno o ambos hipocondrios, espalda, zona periumbilical y en cinturón.. A la exploración abdominal, el dolor a la palpación en epigastrio siempre aparece y con frecuencia se percibe sensación de ocupación o empastamiento a ese nivel o incluso una masa epigástrica en algunos casos, a veces con defensa pero sin claros signos de reacción peritoneal. Los ruidos intestinales son escasos o están ausentes.
    Ictericia (25-30%) ó rubicundez facial, relacionada esta última con la liberación de histamina y otras sustancias vasoactivas. En los casos graves, el compromiso hemodinámico es evidente, con hipotensión, taquicardia o incluso shock establecido Vómitos y náuseas están presentes 70-90% de los casos y suele haber detención del tránsito intestinal desde el comienzo del cuadro
    Distensión abdominal (60-70%) Febricula (70-85%) Hematemesis (5%) Hipotensión (20-40%)
    Cuadros confusionales (20-35%). El dolor suele no aparecer generalmente en los más graves, y el cuadro clínico se ve dominado por los vómitos, síntomas de manifestaciones sistémicas, shock o por la descompensación cetoacidótica, sin causa aparente, en un diabético. 
    
    
    
    En los casos graves también están presentes la Disnea (<10%) taquipnea, los signos de insuficiencia cardiaca, la confusión mental o la tetania, todo lo cual expresa el compromiso multisistémico. Las equimosis abdominales de localización periumbilical (signo de Cullen) (<5%) o en los flancos (signo de Gray-Turner) (<5%) son muy características, de la pancreatitis aguda así como manifestaciones tardías de la enfermedad, generalmente en extremidades inferiores, con aspecto similar al eritema nudoso o a la paniculitis supurada. (Necrosis grasa subcutánea (<1%) 
    

Fisiopatologia de la fiebre

En la antigua Grecia la fiebre era con- siderada un signo beneficioso durante una infección. Esta creencia tuvo sus orígenes en la doctrina Empedocleana que plantea- ba que la raíz de todo asunto estaba en "la tierra, el aire, el fuego y el agua". Estos conceptos fueron replicados por otros, in- cluidos los de Hipócrates, quien se refirió a los cuatro "humores": sangre, flema, bi- lis amarilla y bilis negra. Ellos considera- ban que la enfermedad se presentaba cuan- do uno de estos humores eran producidos en exceso, y en respuesta a este desbalance, el cuerpo desarrollaba una fiebre que "co- cinaba" el exceso del humor y finalmente se alejaba del cuerpo.

Los criterios de Hipócrates y Galeno coincidían al considerar ambos el papel be- neficioso de la fiebre y el uso de ésta como terapia.1,2 En el siglo XVII y aún en la década de los 60 del propio siglo se man- tuvo esta idea.
La primera de las teorías revisadas acerca de la fiebre en el siglo XX comien- za con la cita de Tomas Sydenham,3 cono- cido médico inglés que expresó: "La fie- bre es el motor que la naturaleza brinda al mundo para la conquista de sus enemigos".
Este concepto beneficioso de la fiebre se mantuvo sin cuestionamientos alrede- dor de 2 000 años, y se realizaron impor- tantes trabajos científicos que señalaron a la fiebre como un mecanismo de valor en la sobrevivencia del huésped infectado.4

Luego de los experimentos de Claude Bernard, eminente fisiólogo francés, quien demostró que los animales morían cuan- do su temperatura corporal normal exce- día de 5 - 6 °C,5 y con la introducción del termómetro en la práctica médica, comen- zó a considerarse la fiebre como un signo no ya tan beneficioso.

AGENTESINDUCTORES Y SUSTANCIAS NEUROQUÍMICAS

La reacción febril suele presentarse como resultado de la exposición del cuer- po a microorganismos infectantes, comple- jos inmunitarios u otras causas de infla- mación.

Esta reacción (fig. 1) se inicia por los efectos de agentes inductores externos7 (bacterias, polen, polvos, vacunas, cuer- pos nitrados de fenol, proteínas o produc- tos de desintegración de éstas) o por toxi- nas polisacáridas producidas por bacterias.8 Estos agentes inductores estimulan la pro- ducción de pirógenos endógenos, ya se trate de mediadores solubles o citoquinas, por células de la línea monocito-macrofágica, linfocitos o células neoplásicas,9 infecta- das por virus y otras.10,11 Entre las cito- quinas circulantes con acción pirogénica se encuentran la interleuquina 1 α y ß (IL1), la interleuquina 6 (IL ), el factor de necrosis tumoral α y ß (FNT), el interferón a y ß (INF) y la proteína α 1 inflamatoria del macrófago (PIM).11-13 No obstante, debe- mos señalar que el aumento de la tempe- ratura no se debe sólo a los efectos farmacológicos de estos mediadores.

Entre los efectos de la interleuquina 1 y la de otros pirógenos endógenos se ci- tan:

Aumento de la quimiotaxis.
Aumento de la actividad oxidativa (metabólica). Aumentodelaliberacióndelactoferrina en neutrófilos lo cual produce una dis- minución del hierro sérico, inhibiendo así el incremento de muchos mi- croorganismos.
Estimulación de la proliferación de linfocitos ß y producción de anticuerpos. Estimulación de la activación de linfocitos T. Aumentodelaproliferacióndelinfocitos T auxiliadores.
Aumento de la capacidad citotóxica de los linfocitos T.
Las observaciones in vitro sugieren que la fiebre desempeña una importante fun- ción en la potenciación de la respuesta in- mune.
Las citoquinas circulantes probable- mente no penetran en el cerebro, pero interactúan con elementos sensoriales en el órgano vascular de la lámina terminal (OVLT) y otras regiones cercanas al cere- bro, donde promueven la síntesis de prostaglandinas E2 a través de la estimulación de la cicloxigenasa. 

15 consejos para los estudiantes de medicina

No me ha ido mal estos cuatro años pero creo que podría haberme ido mejor si hubiese actuado de forma diferente en algunos momentos. Espero que estos consejos te sean de utilidad, los he escrito con la mayor honestidad y sinceridad posible.

1. No estudies en base a lo que tus compañeros digan que han estudiado

¿Cuántas veces habré escuchado el famoso “ni me lo he mirado” o el “vengo a probar suerte” justo antes de un examen? Luego todo son notables, excelentes y matrículas de honor caídas del cielo. Estudia en base a tu propio criterio, no te dejes influenciar por nadie en concreto.

2. No presumas de estudiar medicina

¿Tienes algún motivo para hacerlo que no sea el de satisfacer tu ego? Hay una diferencia fundamental entre orgullo y ego. El ego es inestable, necesita de la aprobación externa y lo único que conseguirás con él es parecer un gusano. El orgullo, en cambio, nace de dentro, representa tus valores, tus ideales, tus méritos, y lo construyes día a día. Debes estar orgulloso de estudiar lo que siempre has querido pero no por ello necesitas satisfacer tu ego predicándolo a los cuatro vientos, o como hacen algunos, dejándolo caer como quien no quiere la cosa.

3. No necesitas ir a clase ni para aprobar ni para sacar nota

Tantea el terreno los primeros días, cada profesor es un mundo: algunos se ciñen a lo que dan en clase a la hora del examen, otros prefieren inventarse el temario con la excusa de que deberíamos estudiar de los libros. A los primeros es más útil escucharlos que a los segundos.

4. Ve a clase todos los días

Sí, el punto anterior no contradice este. Yo he estado un cuatrimestre entero y parte del siguiente sin ir a ninguna clase. Decía que estudiaría durante esas horas pero me engañaba a mí mismo. Lo único que hacía era perder el tiempo: me iba al gimnasio, me recorría todas las montañas del Baix Camp en bici, miraba temporadas enteras de Juego de Tronos y Breaking Bad, me pasaba por la facultad a saludar a la gente… Y luego, los jueves y sábados, fiesta. Todo acabó cuando un día me miré al espejo y me pregunté: ¿de dónde cojones ha salido este ni-ni? Hasta que no llegan los exámenes se vive muy bien como estudiante pero si no asistes a clase y desconectas puedes no volver a conectar nunca más y empezar a naufragar.

5. Si quieres sacar matrículas, ponte a estudiar antes de lo que lo hacemos la mayoría

No tiene más misterio. Déjate de teoría extrañas y de capacidades innatas porque al final esto no son más que excusas baratas. Aquí no hay ni listos ni tontos, aquí hay vagos y perezosos o constantes y dedicados.

6. Sé honrado, pero no ignorante

Si no te sabes una respuesta y puedes copiártela de alguien que intuyas que sí la sabe, copia. En esta vida no solo se vive de buenas intenciones. Ahora bien, no te ganes la fama de copión. Todos hemos echado un ojo al examen de al lado alguna vez, pero hasta un cierto límite. Personalmente, no me importa que se copien de mí, pero aborrezco que abusen o me pregunten directamente (y menos si no he terminado el examen).

7. Preséntate a todos y cada uno de los exámenes

Jamás he entendido como hay gente que no se presenta a un examen porque “lo lleva mal”. Es duro estar haciendo un examen y no saber qué responder, lo entiendo, pero es fundamental que asistas, conozcas como pregunta el profesor y memorices las preguntas para que en la recuperación vayas con pies de plomo. Y te lo digo: no serías el primero que diciendo eso ha aprobado porque al final resulta que sí que lo llevaba bien o porque, aludiendo al punto anterior, ha echado un ojo al de al lado.

8. No siempre dando se recibe, pero si te piden da

Me refiero a apuntes, exámenes, resúmenes, etc. Nunca sabes en qué momento irás apurado y te hará falta una ayuda extra. Hoy por ti, mañana por mí, esa es la clave del éxito. Yo posiblemente hubiese suspendido Fisiología en segundo de no haber sido por los esquemas de mi amiga Ana, que resumían el temario entero en una hoja DINA2. ¡Gracias Ana!

9. No te martirices por sacar un aprobado (o incluso un notable)

Los estudiantes de medicina estábamos acostumbrados a sacar excelentes en bachillerato, pero la facultad es otro mundo. Puedes estudiar mucho y suspender o estudiar poco y aprobar. No pasa nada. Al menos en mi facultad tenemos más de 60 asignaturas a lo largo de toda la carrera (y creo que me quedo corto con ese número). Tranquilo que por un 5 no vas a manchar tu expediente si tanto te preocupa.

10. Coge con pinzas lo que te digan los amigos de cursos superiores.

Te voy a poner un ejemplo personal. En mi año, en el examen de psicología los alumnos se dividieron en dos clases. Los que entraron primero lo hicieron en una clase separados por varias filas y controlados por una profesora con mala leche. A los que entramos más tarde, por el contrario, nos tocó la lotería. El profesor no había reservado más aulas y tuvimos la suerte de hacer el examen pegados los unos a los otros. Si lo analizo objetivamente era un examen difícil, 10 preguntas escritas de un temario larguísimo, pero hice el examen, literalmente, al lado de mi compañero de piso. Y si le añadimos que el profesor era un bonachón, el resultado es hacer un examen como si estuviésemos en un bar de tapas, comentando las preguntas en voz alta y riéndonos de la situación en medio del examen. Cabe decir que no me ha vuelto a pasar, fue algo excepcional que siempre que lo recuerdo me entra la risa. Pero esto me condiciona pues a pensar que la asignatura de Psicología “fue fácil”, al menos para mí. Dudo que los compañeros de la otra clase pensasen lo mismo.

11. Hatters gonna hate

En España los deportes nacionales son el marujeo y la crítica ajena; creo que no me equivocaría si dijese que en tu facultad también. Siempre que hagas algo nuevo o diferente vas a ser criticado, pero no por ello dejes de hacerlo. Aunque traigo buenas noticias: también hay gente estupenda que te apoya y cree en lo que haces, enfócate en ellos. Aplica esto a todos los terrenos de tu vida universitaria y te irá bien.

12. La medicina debería ocupar un lugar importante en tu vida

No todo en esta vida es medicina pero debes recordar que has entrado en esta carrera para ser médico, no pierdas el norte. No sé tú pero la matrícula en Cataluña no es barata, y eso que mi universidad es pública. Así que céntrate y deja todos tus rollos mentales para después de los exámenes, que tiempo habrá.

13. La competitividad siempre estará presente

En algunas facultades es más descarada, en otras hay que leerla entre líneas. Pero repito: siempre estará ahí. Puede que te digan sutilmente “ya te pasaré los apuntes” y te quedes esperándolos toda la vida. Puede que cuando salgan las notas comparen la suya con la tuya. O que simplemente se autocritiquen por no haber llegado al excelente. Actitudes que rozan lo ridículo si se piensa en los valores que un médico supuestamente debe tener.

14. No digas a todo el mundo lo que has sacado en un examen

Si te preguntan di solamente si te ha ido bien o mal. Comenta tus notas con tu familia y, si quieres, con los amigos más cercanos, pero no las prediques a diestro y siniestro. No entres en el juego de la competitividad porque el principal afectado serás tú.

15. Empatiza con tus compañeros, no solo con los pacientes

Con esto me refiero a celebrar los buenos resultados académicos cuando un compañero ha suspendido o no le ha ido como él querría. Cada uno libre de hacer lo que quiera y seguramente haya opiniones encontradas en este apartado, pero yo, por respeto y educación, en este caso no celebro mis notas. O al menos no manifiesto externamente mi extrema alegría delante de dicha persona. Más que nada porque a mí no me gustaría que me lo hiciesen. Lo que más odiamos cuando sufrimos una derrota en cualquier ámbito es que nos restrieguen las victorias ajenas, ya sea directa o indirectamente.

Y resopla… Resopla tantas veces como necesites

Tendrás momentos buenos, pero también momentos malos, muy malos. Serán esos días en los que la carrera se convertirá en un tubo por el que habrá que pasar, y además, bastante estrecho: asignaturas inútiles, profesores obstinados, ley de Murphie en todas partes… Pero recuerda esto siempre: 15 consejos para los nuevos estudiantes de medicina.

En qué piensa un estudiante de medicina

Hola médicos! hoy hablaremos sobre el tema "En qué piensa un estudiante de medicina" (en realidad solo es una modificación de la divertida viñeta "En qué piensan los hombres"). Saludos!!

Te invitamos a compartir!!!

16 reglas para ser un buen Estudiante de Medicina

Los 16 mandamientos que todo alumno de medicina y futuro doctor debería tener en cuenta y NO olvidar

1. Aprende a hacer frente a la incertidumbre.
2. Duda de lo que te enseñaron, sobre todo si parece inconsistente o incoherente.
3. Demuestra lo que sabes con humildad. Al fin y al cabo, alguien lo supo antes que tú
4. Sé tú mismo todo el tiempo.
5. Disfruta.
6. Trata de practicar la medicina con la misma ética y los principios en que creías que cuando entraste en la facultad.
7. Que nunca te asuste admitir tu ignorancia.
8. La medicina no es sólo el trabajo clínico, también se ocupa de las relaciones, el trabajo en equipo, sistemas, habilidades de comunicación, investigación, publicaciones, y la evaluación crítica.
9. Trata a tus pacientes con el mismo cuidado y respeto que lo harías si fueran tus amigos del alma o tu familia.
10. Más allá de la familia no hay un lazo más estrecho que entre médico y paciente.
11. No creas todo lo que lees en los periódicos y las revistas médicas.
12. El objetivo es saber cómo aprender, cómo conseguir información médica relevante, y la forma de evaluar críticamente la información
13. Las primeras 10 veces que hagas algo -presentarte a un paciente, poner un catéter intravenoso, coser una laceración- será difícil, así que a pasa por esas 10 veces lo más rápido posible.
14. A pesar de que no deberías tener miedo a decir "no sé" cuando sea apropiado, tampoco hay que tener miedo a estar equivocado.
15. Valora cada rotación durante tu formación, incluso si no tienes intención de continuar con la especialidad, debido a que estás haciendo cosas y compartiendo experiencias que son únicas.
16. Cuando tienes un mal día, ya que estás cansado, estresado, quemado por el trabajo, y no te valoran lo suficiente, no olvides que las cosas son mucho peores para la persona en el extremo frío del estetoscopio. El día puede ser malo, pero tú no tienes cáncer de páncreas.

Te invitamos a compartir!!!

20 Useful Sites for Medical Students In 2015

Whether you are a graduate, an undergraduate or a continuing student, the web is one resource material that you can’t do without, and there is a plethora of dedicated student websites available. This piece will attempt to highlight 20 of the most useful websites that medical students can use to make their life easier.

Medical Resource Websites

Part of med student school life involves intensive research work. Webmasters are well aware of the concept and that is why they have designed specific search engines that are fully dedicated to providing medical students with all the resource materials they need. Some of the popular med search engines include:

• Omni Medical Search – this search engine is dedicated to gathering information from some of the top medical professional web sites. The information that is provided by the search engine is basically from peer level sources. If you are also looking for some of the hard to find medical resources, this search engine has the perfect answer for you.
• MedNet – the metasearch engine is dedicated to providing med students with all the information relating to journals, associations and new sources among others.
• Hardin MD – as a University of Lowa sponsored website, Hardin MD provides users with the option of searching for general health topics and disease based on their alphabetical order. Users can also get access to a number of online articles and photos related to their disease search.
• Healthline – the search engine allows the user to conduct searches on some of the best health sites available on the internet. Ultimately, it helps to reduce the time spent on the internet researching.

Student Reference Sites

The websites listed here can be used as a wonderful source of reference material for med students who wish to conduct additional research.

• MedicalStudent – this website provides users with a plethora of free online medical textbooks together with helpful links that are well equipped with relevant information in as far as the field of medicine is concerned.
• MedicalMatrix – quite similar to MedicalStudent as it offers both paid and free links to online textbooks, CME and medical journals. The only difference is that MedicalMatrix is a lot more thorough, as it offers specific links based on speciality.
• FreeBookCenter – this dedicated website does not only provide free e-books for med students, it also includes books related to Computer Science, Networking and Web Technology.
• Student Book World – this website compares the prices of books that are available so that the users can have the option of making their own decision before purchasing a book. Their catalogue contains a number of med related books.
• NCBI Bookshelf – in as much as the National Centre for Biotechnology Information was developed as a source of molecular biology information, their library is expanding from just dealing with biomedical books to including books related to general medicine.
• The Merck Manuals – these manuals are a series of healthcare related books that can be used by doctors for diagnosis and therapy-based disorders. The best thing about The Merck Manuals is that it is available for free online.

Student Life and Advice

Most of the websites that are found in this category are dedicated to providing advice to students and helping them out with their college or university life. They include:

• Bright Knowledge – students are provided with essential guides to their careers, education and their general student life. All this is done in a bid to shape their future. The team at Bright Knowledge are dedicated to ensuring that students are offered with all the help they need to work out whatever it is they want to achieve in future.
• My Math Done – math has always given students a hard time and here students can find all the help they need with their homework problems. They also have a nice blog on multiple educational topics & great infographics.
• National Debtline – we all know that money management is a skill that needs to be polished over time. For thus reasons, National Debtline – a free, confidential and debt advice service – is dedicated to helping students with constructive advice that will help them deal with their debt.
• My Money Steps – this is also another dedicated website that provides free online services in advising students about their debts. They are normally available around the clock throughout the week to provide their customers with independent and confidential advice.

Student Money

The websites covered here are dedicated to equipping students with essential money management tips.

• Student Bank Accounts – this website is committed to providing students with a comparison platform where students can make comparison of the top student bank accounts. The fact that university students are required to have a bank account means that banks are always on the look out and ready to pounce. With this site it becomes much easier to select a bank account of your choice.
• Buying Brain – a dedicated blog that provides students with essential advice on saving money. Students can learn about the various ways of enhancing their savings while in school to form a good basis for their future.

Student Jobs

At the end of it all, students are looking for employment opportunities in esteemed firms. These websites are designed to assist them with essential tips on how to market themselves:

• Interview Questions and Answers – fresh graduates normally have a hard time with interviews. This website is basically designed to equip the students with all the essential tips that will give them confidence as they approach an interview panel.
• My Resume Online – a dedicated website that offers students with all the information on the latest job hunting strategies and other essential techniques. You can expect to learn a lot more about the latest trends in resume writing and also get an opportunity to learn about the different ways of using social media.

Student Accommodation

You can get all the information you’ll need regarding your accommodation from the following websites:

• Move’m – a website committed to reviewing and advising students on matters related to their accommodation needs.
• Rate My Roof – here, students themselves are given the liberty of reading, rating and reviewing their student housing.

Each of the aforementioned websites is unique in their own ways and can be used to benefit students differently. Use them to your greater advantage.

Food choices influenced by memory

You have a choice between two foods: a chocolate bar or a piece of cake. What influences your decision? The desire to be healthy? The need for a sugar boost? According to a new study, your choice may be influenced by your memory of a particular food. A stronger memory association with an apple, for example, may encourage you to opt for the apple, even if the cake is the more attractive choice.

The study also reveals that the influence of memories in food choice is driven by an increase in communication between two brain regions - the hippocampus and the ventromedial prefrontal cortex.

Study leader Dr. Sebastian Gluth and colleagues, from the University of Basel in Switzerland, publish their findings in the journal Neuron.

According to the researchers, many everyday decisions we make - such as "Where shall we go for dinner?" - are guided by information retrieved from our memories. However, the neurological processes underlying such decisions were unclear. Dr. Gluth and colleagues set out to gain a better understanding of these processes.

The team enrolled 60 young participants to their study and showed them 48 snacks - including chocolate bars, pretzels and chips - on a computer screen. Each snack was allocated to a specific location on the screen, and the participants were asked to rate each snack in order of preference.

Next, the participants underwent functional magnetic resonance imaging (fMRI), during which they were repeatedly asked to choose between two snacks. However, 30 participants were only shown the location of the snack, meaning they had to recall the snack linked to each location. The other 30 participants were shown the snacks directly on the screen. 

Participants were more likely to choose snacks they could remember

From their experiment, the researchers found that participants opted for the snacks they were better able to recall the location of. What is more, subjects chose they snacks they could recall better even if they had rated them lower in preference previously.

The food choices of the 30 participants who were shown the snacks directly on the screen during fMRI correlated with their previous preference ratings.

From the fMRI scans, the team was able to assess the brain activity of participants during their memory-based food choices. This enabled them to create a mathematical model showing how memories influence the decision-making process.

From this, they identified an increase in communication between the hippocampus - the brain region involved in memory - and the ventromedial prefrontal cortex - the decision-making brain region - as participants made their food choices.

Paracetamol

When can I take paracetamol?

You can take paracetamol for:

• mild to moderate pain, for example backache, headache, migraine, muscle strains, period pain, toothache and aches and pains due to colds and flu
• fever (high temperature)
• osteoarthritis and other painful, non-inflammatory conditions.

The dose of paracetamol for adults is:

• one or two 500mg tablets every four to six hours
• up to a maximum of 8 tablets in 24 hours.

Alternatively:one or two 665mg tablets every eight hours

• up to a maximum of six tablets in 24 hours.

It’s dangerous to take more than eight 500mg tablets in 24 hours as you may damage your liver, which may be irreversible and fatal.

Can paracetamol be given to children?

Paracetamol may be given to children from one month of age for pain and fever. Follow the dose instructions with the pack and seek medical advice if symptoms are severe or get worse.

The routine use of paracetamol before, or at the time of, immunisation is no longer recommended due to the use of better vaccines with fewer side effects. Discuss the use of paracetamol with your doctor or pharmacist if you are concerned about immunisation side effects like pain and fever.

If your child has a temperature higher than 38.5°C and this is making them uncomfortable, paracetamol can be given to help ease any discomfort. Seek medical advice if the fever does not get better.

A doctor may advise regular paracetamol for infants younger than one month old, but don’t give regular paracetamol to an infant as young as this unless advised to by a doctor.

How does paracetamol work?

Paracetamol has been in common use for over 50 years but the way it works to reduce pain and fever is not fully known. Paracetamol begins to ease pain and lower a high temperature about 30 minutes after a dose is taken. It usually lasts for about four to six hours.

When should I not take paracetamol?

Don’t take paracetamol if you:

• have an allergy to paracetamol
• are taking other paracetamol containing medicines, such as codeine combinations, migraine preparations and some cough and cold remedies, because of the risk of overdosing with paracetamol
• have already taken eight 500mg tablets within a 24 hour period.

Check with your doctor or a pharmacist before taking paracetamol if you have:

• liver problems
• kidney problems.

Can I take paracetamol with my other medicines?

Don’t take paracetamol if you are also taking other paracetamol containing medicines, such as codeine combinations, migraine preparations and some cough and cold remedies, because of the risk of overdosing on paracetamol which may damage your liver and can be fatal.

Paracetamol taken for a few days for pain or fever doesn’t interact with many other medicines.

It’s okay to take paracetamol if you are on antibiotics.

If you want to check that paracetamol is safe to take with your other medicines, ask your doctor or a pharmacist, or read the information leaflet that comes with your medicine.

Warfarin

Paracetamol is the recommended painkiller for people taking warfarin.

Long-term use of paracetamol may increase the effect of warfarin, which can increase the risk of bleeding. However, this is unlikely to happen with occasional doses of paracetamol.

Can I take paracetamol if I’m pregnant?

Paracetamol is considered the first choice of painkiller if you are pregnant as it has been taken my large numbers of pregnant women without any adverse effect on the mother or baby.

However, if you take paracetamol when pregnant, make sure you take it for the shortest possible time.

Can I take paracetamol if I’m breastfeeding?

Paracetamol is the first choice of painkiller if you are breastfeeding.

It appears in breast milk in very small amounts which are unlikely to harm your baby.

If you take paracetamol when breastfeeding, make sure you take it for the shortest possible time.

What are the possible side effects of paracetamol?

People react differently to medicines. Just because a side effect is listed it doesn’t mean you will get the side effect.

Side effects from paracetamol are rare but include:

• rash
• blood disorders
• liver and kidney damage (when taken at higher than recommended doses).

Will paracetamol affect my driving?

Paracetamol is unlikely to affect your driving.

Is it okay to drink alcohol when I’m taking paracetamol?

Drinking a small amount of alcohol is unlikely to be harmful if you are taking paracetamol.

Are there any foods I should avoid?

There are no known interactions with food.

20 Tips to Help Prevent Medical Errors

Patient Fact Sheet

Medical errors can occur anywhere in the health care system: In hospitals, clinics, surgery centers, doctors' offices, nursing homes, pharmacies, and patients' homes. Errors can involve medicines, surgery, diagnosis, equipment, or lab reports. These tips tell what you can do to get safer care.

One in seven Medicare patients in hospitals experience a medical error. But medical errors can occur anywhere in the health care system: In hospitals, clinics, surgery centers, doctors' offices, nursing homes, pharmacies, and patients' homes. Errors can involve medicines, surgery, diagnosis, equipment, or lab reports. They can happen during even the most routine tasks, such as when a hospital patient on a salt-free diet is given a high-salt meal.

Most errors result from problems created by today's complex health care system. But errors also happen when doctors* and patients have problems communicating. These tips tell what you can do to get safer care.

What You Can Do to Stay Safe

The best way you can help to prevent errors is to be an active member of your health care team. That means taking part in every decision about your health care. Research shows that patients who are more involved with their care tend to get better results.

1.     Make sure that all of your doctors know about every medicine you are taking.

This includes prescription and over-the-counter medicines and dietary supplements, such as vitamins and herbs.

2.     Bring all of your medicines and supplements to your doctor visits.

"Brown bagging" your medicines can help you and your doctor talk about them and find out if there are any problems. It can also help your doctor keep your records up to date and help you get better quality care.

3.     Make sure your doctor knows about any allergies and adverse reactions you have had to medicines.

This can help you to avoid getting a medicine that could harm you.

4.     When your doctor writes a prescription for you, make sure you can read it.

If you cannot read your doctor's handwriting, your pharmacist might not be able to either.

5.     Ask for information about your medicines in terms you can understand—both when your medicines are prescribed and when you get them:

o    What is the medicine for?

o    How am I supposed to take it and for how long?

o    What side effects are likely? What do I do if they occur?

o    Is this medicine safe to take with other medicines or dietary supplements I am taking?

o    What food, drink, or activities should I avoid while taking this medicine?

6.     When you pick up your medicine from the pharmacy, ask: Is this the medicine that my doctor prescribed?

7.     If you have any questions about the directions on your medicine labels, ask.

Medicine labels can be hard to understand. For example, ask if "four times daily" means taking a dose every 6 hours around the clock or just during regular waking hours.

8.     Ask your pharmacist for the best device to measure your liquid medicine.

For example, many people use household teaspoons, which often do not hold a true teaspoon of liquid. Special devices, like marked syringes, help people measure the right dose.

9.     Ask for written information about the side effects your medicine could cause.

If you know what might happen, you will be better prepared if it does or if something unexpected happens.

Hospital Stays

10.  If you are in a hospital, consider asking all health care workers who will touch you whether they have washed their hands.

Handwashing can prevent the spread of infections in hospitals.

11.  When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will follow at home.

This includes learning about your new medicines, making sure you know when to schedule follow-up appointments, and finding out when you can get back to your regular activities.

It is important to know whether or not you should keep taking the medicines you were taking before your hospital stay. Getting clear instructions may help prevent an unexpected return trip to the hospital.

Surgery

11.  If you are having surgery, make sure that you, your doctor, and your surgeon all agree on exactly what will be done.

Having surgery at the wrong site (for example, operating on the left knee instead of the right) is rare. But even once is too often. The good news is that wrong-site surgery is 100 percent preventable. Surgeons are expected to sign their initials directly on the site to be operated on before the surgery.

12.  If you have a choice, choose a hospital where many patients have had the procedure or surgery you need.

Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their condition.

Other Steps

14.  Speak up if you have questions or concerns.

You have a right to question anyone who is involved with your care.

15.  Make sure that someone, such as your primary care doctor, coordinates your care.

This is especially important if you have many health problems or are in the hospital.

16.  Make sure that all your doctors have your important health information.

Do not assume that everyone has all the information they need.

17.  Ask a family member or friend to go to appointments with you.

Even if you do not need help now, you might need it later.

18.  Know that "more" is not always better.

It is a good idea to find out why a test or treatment is needed and how it can help you. You could be better off without it.

19.  If you have a test, do not assume that no news is good news.

Ask how and when you will get the results.

20.  Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources.

For example, treatment options based on the latest scientific evidence are available from the Effective Health Care Web site. Ask your doctor if your treatment is based on the latest evidence.

Easy way to REMEMBER 12 Cranial Nerves (examination and mnemonic)

The cranial nerves are 12 pairs of nerves that can be seen on the ventral (bottom) surface of the brain. Some of these nerves bring information from the sense organs to the brain; other cranial nerves control muscles; other cranial nerves are connected to glands or internal organs such as the heart and lungs. 

Can't remember the names of the cranial nerves? 

Here is a handy-dandy mnemonic for you:

• On Old Olympus Towering Top A Famous Vocal German Viewed Some Hops.

The bold letters stand for:

olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, spinal accessory, hypoglossal.

Test Your Cranial Nerves

Now that you know the names and functions of the cranial nerves, let's test them. These tests will help you understand how the cranial nerves work. These tests are not meant to be a "clinical examination" of the cranial nerves.

You will need to get a partner to help...both of you can serve as the experimenter (tester) and the subject. Record your observations of what your partner does and says.

Olfactory Nerve (I)

Gather some items with distinctive smells (for example, cloves, lemon, chocolate or coffee). Have your partner smell the items one at a time with each nostril. Have your partner record what the item is and the strength of the odor. Now you be the one who smells the items...have your partner use different smells for you.

Optic Nerve (II)

Make an eye chart (a "Snellen Chart") like the one on the right. It doesn't have to be perfect. Have your partner try to read the lines at various distances away from the chart.

Oculomotor Nerve (III), Trochlear Nerve (IV) and Abducens Nerve (VI)

These three nerves control eye movement and pupil diameter. Hold up a finger in front of your partner. Tell your partner to hold his or her head still and to follow your finger, then move your finger up and down, right and left. Do your partner's eyes follow your fingers?

Check the pupillary response (oculomotor nerve): look at the diameter of your partner's eyes in dim light and also in bright light. Check for differences in the sizes of the right and left pupils.

Trigeminal Nerve (V)

The trigeminal nerve has both sensory and motor functions. To test the motor part of the nerve, tell your partner to close his or her jaws as if he or she was biting down on a piece of gum.

To test the sensory part of the trigeminal nerve, lightly touch various parts of your partner's face with piece of cotton or a blunt object. Be careful not to touch your partner's eyes. Although much of the mouth and teeth are innervated by the trigeminal nerve, don't put anything into your subject's mouth.

Facial Nerve (VII)

The motor part of the facial nerve can be tested by asking your partner to smile or frown or make funny faces. The sensory part of the facial nerve is responsible for taste on the front part of the tongue. You could try a few drops of sweet or salty water on this part of the tongue and see if your partner can taste it.

Vestibulocochlear Nerve (VIII)

Although the vestibulocochlear nerve is responsible for hearing and balance, we will only test the hearing portion of the nerve here. Have your partner close his or her eyes and determine the distance at which he or she can hear the ticking of a clock or stopwatch.

Glossopharyngeal Nerve (IX) and Vagus Nerve (X)

Have your partner drink some water and observe the swallowing reflex. Also the glossopharyngeal nerve is responsible for taste on the back part of the tongue. You could try a few drops of salty (or sugar) water on this part of the tongue and see if your partner can taste it.

Spinal Accessory Nerve (XI)

To test the strength of the muscles used in head movement, put you hands on the sides of your partner's head. Tell your partner to move his or her head from side to side. Apply only light pressure when the head is moved.

Hypoglossal Nerve (XII)

Have your partner stick out his or her tongue and move it side to side.