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Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
Gp presentation Pam and Chris Harnden
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Gp presentation Pam and Chris Harnden

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Demonstration of clear communication and collaborative, collegial working relationship between professionals.

Demonstration of clear communication and collaborative, collegial working relationship between professionals.

Published in: Health & Medicine
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  • 1. The case <ul><li>Miss R </li></ul><ul><li>24 yr old G3P1 </li></ul><ul><li>Previous elective C section for breech presentation </li></ul><ul><li>Rh neg </li></ul><ul><li>Minor complaints in pregnancy, spotting and RFM </li></ul><ul><li>Suffered abdominal burn following accident with full kettle of boiling water in second trimester. </li></ul><ul><li>Saw obstetrician given go ahead for VBAC </li></ul>06/07/09
  • 2. The reason for midwives 06/07/09
  • 3. <ul><li>At term seen c/o painful contractions 2:10 </li></ul><ul><li>Fully effaced 1cm dilated went home </li></ul><ul><li>4hrs later returned still same V/E- pethidine </li></ul><ul><li>2hrs later still unable to cope with contractions 2:10 </li></ul>06/07/09
  • 4. I knew we were heading for…. 06/07/09
  • 5. 06/07/09
  • 6. Miss R`s idea of natural childbirth 06/07/09
  • 7. Birth <ul><li>Became fully dilated </li></ul><ul><li>Pushed less than 1hour </li></ul><ul><li>Had normal birth in lithotomy </li></ul>06/07/09
  • 8. Postnatally <ul><li>Stayed 48hrs no problems breastfeeding </li></ul><ul><li>Seen daily for next 3 days c/o some thigh numbness. ? Effects epidural ?effects of lithotomy </li></ul><ul><li>Seen at 1wk no problems but no longer exclusively breastfeeding </li></ul>06/07/09
  • 9. <ul><li>Routine p/n visit at 2wks c/o “migraine” seen in A and E just came from GP given stronger painkillers </li></ul><ul><li>c/o some pressure at back of neck wanted to see the osteopath </li></ul>06/07/09
  • 10. WHEN YOU HEAR HOOFBEATS BEHIND YOU, DON`T EXPECT TO SEE A ZEBRA THE MEDICAL SCIENCE OF HOUSE, MD 06/07/09
  • 11. Chris + Pam Harnden 06/07/09
  • 12. Chris in work mode 06/07/09
  • 13. Chris before seeing ‘Miss R’ 06/07/09
  • 14. I want some medicines that work for my migraine doc. 06/07/09
  • 15. Miss R had no previous history of headaches 06/07/09
  • 16. Initial diagnosis post epidural headache 06/07/09
  • 17. Did this diagnosis make sense???? 06/07/09
  • 18. Conclusion reassess diagnosis <ul><li>Headache commenced 9 days post epidural </li></ul><ul><li>Headache persisted for at least 5 days (usually settle after 3 days) </li></ul><ul><li>Headache was not positional </li></ul>06/07/09
  • 19. How did the headache start? 06/07/09
  • 20. Does examination back up my concerns? 06/07/09
  • 21. ??papilloedema 06/07/09
  • 22. <ul><li>Admit hospital </li></ul><ul><li>??Intracerebral bleed or sub arrachnoid haemorrhage </li></ul>06/07/09

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