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I struggled to find PEM resources for my CT3 year, despite the variety of excellent resources out there. I hope this website will help point you in the right direction. I'm not a PEM expert, but am following the guidance CEM have issued (in the form of a syllabus) to put together this page. This page is not endorsed by CEM, and any mistakes are mine.

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Showing posts with label hernia. Show all posts
Showing posts with label hernia. Show all posts

Friday, 8 May 2015

Paediatric Hernias

Epidemiology
Often present within 1st year of life.

Pathophysiology
Indirect - most hernias are indirect and extend through the internal and external rings. Often on the right hand side. 

Signs & Symptoms
- Asymptomatic bulge in the groin or scrotum - above the testicle
- May resolve when calm and supine
- Analgesia needed before reduction
- Gentle traction on the scrotum to help align the hernia sac with the external ring.
- While keeping gentle traction, squeeze distal to proximal 
- Apply pressure laterally with the index and thumb along each side of the hernia neck and inguinal canal.
- Imagine you are trying to stretch open the rings.
- Gently add more pressure distally and help reduce the hernia.
- This can take up to 40minutes

Incarceration or Strangulation
- Happens in 7 - 30% 
- Severe pain, bilious emesis, blood in stool, signs of peritonitis, redness and oedema on affected side of scrotum
- Don't attempt to manually reduce

References
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