Pediatric minor emergencies in OPD practice 1
Summary
TLDRIn this medical presentation, Dr. Nancer discusses pediatric emergencies, focusing on case scenarios including foreign body aspiration, seizures, and excessive crying in infants. He emphasizes the importance of recognizing life-threatening conditions and the systematic approach to diagnosis, including the use of X-rays and observation. The talk also covers the dangers of button battery ingestion and the proper management of suspected poisoning, advising against routine stomach wash and highlighting the need for careful assessment and referral.
Takeaways
- 🕒 The speaker emphasizes the importance of timely response in pediatric emergencies and outlines a structured approach to manage such cases efficiently.
- 🏥 In cases of foreign body aspiration in children, immediate referral to a hospital or an x-ray facility is crucial for diagnosis and management.
- 🚫 The speaker advises against performing first aid measures like back slaps or Heimlich maneuver if the child is already coughing, as it could be dangerous.
- 🔍 For suspected foreign body ingestion, a detailed examination and x-ray, if available, are recommended to assess the situation before deciding on further action.
- 🔋 The dangers of ingested button batteries are highlighted, including the potential for severe tissue damage due to electrical circuits, necessitating immediate referral.
- 🤔 The differentiation between various types of seizures and mimics is discussed, with an emphasis on the importance of recognizing red and green flags for appropriate diagnosis.
- 👶 For children presenting with excessive crying, a systematic approach to rule out serious underlying conditions is advised before considering benign causes.
- 🧪 The role of stomach wash and activated charcoal in managing poison ingestions is questioned, with recommendations to avoid their routine use without proper expertise.
- 🦠 The potential dangers of household chemicals and the importance of identifying corrosive substances in cases of ingestion are underscored.
- 🐍 Identification of snake and scorpion bites is crucial, as their clinical presentations and management differ significantly from other types of bites or stings.
- 🏃♂️ The need for prompt and appropriate referral in cases of suspected toxic ingestion or envenomation is stressed, with attention to the initial management and safe transportation of the patient.
Q & A
What is the main topic of the presentation?
-The main topic of the presentation is minor pediatric emergencies, focusing on case scenarios that can be managed in office pediatrics.
What is the first case scenario discussed in the presentation?
-The first case scenario is about an 18-month-old girl who is brought in with complaints of choking on a plastic toy, showing signs of coughing, irritability, and respiratory distress.
What is the recommended initial response to a child suspected of ingesting a foreign object?
-The recommended initial response includes arranging immediate referral to a nearby hospital, considering an X-ray to confirm ingestion, and trying first aid measures if necessary, while reassuring the parents.
Why should first aid measures like the Heimlich maneuver be used cautiously in a child who is already coughing?
-First aid measures like the Heimlich maneuver should be used cautiously because they imitate a cough and increase thoracic pressure to push out a foreign body. If the child is already coughing, it indicates the airway is not completely obstructed, and further attempts could be counterproductive and potentially dangerous.
What are the signs of a laryngeal foreign body in a child?
-Signs of a laryngeal foreign body include the absence of cough and voice due to complete obstruction of the larynx, which is a life-threatening situation requiring immediate attention.
What is the danger associated with button batteries if ingested by a child?
-Button batteries are dangerous because they can cause extensive tissue damage through electrical circuits, potentially leading to burns and serious injury, and in severe cases, even death.
What is the recommended approach for differentiating between a seizure and other paroxysmal events in children?
-The recommended approach includes evaluating the child for red and green flags, observing the child's response to tactile stimulation, and considering the presence of a triggering event. If there is doubt, an EEG or video recording can be useful for further analysis.
How should a physician respond to a child with excessive crying and no apparent cause?
-The physician should follow a systematic approach, starting with ruling out life-threatening conditions, then common benign conditions, and finally observing the child if no cause is found to ensure the symptoms either disappear or another diagnosis becomes apparent.
What are some common household items that can be dangerous if ingested by a child?
-Common dangerous household items include cleaning agents, toilet cleaners, hand sanitizers, mosquito repellents, and certain types of oils. These can cause corrosive damage or systemic toxicity if ingested.
What is the general advice regarding the use of stomach wash and activated charcoal in cases of suspected household chemical ingestion by a child?
-The general advice is to avoid routine use of stomach wash and activated charcoal in such cases, as their benefits have not been proven, and they can have dangerous consequences. Proper training and expertise are required if they are to be used at all.
How can a physician identify a scorpion sting in a child?
-A physician can identify a scorpion sting by looking for signs of an autonomic storm, such as hypertension, profuse sweating, and salivation. The absence of cardiac toxicity in the first few hours can help differentiate it from other causes of shock.
What is the recommended procedure when referring a child with a suspected snakebite?
-When referring a child with a suspected snakebite, it is important to give the first dose of antivenom and ensure that the airway is secure before transfer, as the progression of symptoms can be rapid and life-threatening.
Outlines
🚨 Pediatric Emergencies: Foreign Body Aspiration
The speaker begins by addressing the topic of pediatric emergencies, specifically focusing on foreign body aspiration. An 18-month-old girl is presented as the first case, who is coughing and irritable after playing with a plastic toy. The speaker discusses various responses to such a situation, including immediate referral to a hospital, performing an X-ray, and attempting first aid measures. The emphasis is on recognizing complete airway obstruction as the most dangerous scenario, characterized by the absence of cough and voice. The speaker advises against performing first aid if the child is still coughing, as it could worsen the situation, and suggests observing the child for signs of distress or respiratory issues, potentially referring them for further examination if necessary.
🔋 The Dangers of Button Battery Ingestion
The second paragraph delves into a case of a two-year-old child with Down syndrome who presented with excessive salivation due to the ingestion of what was initially thought to be a coin, but was later identified as a button battery. The speaker highlights the severe risks associated with button battery ingestion, including extensive tissue damage from electrical circuits. The summary includes guidance on how to handle such batteries safely and the importance of immediate referral to a facility where the battery can be removed, as well as the signs to look for in an X-ray to identify a button battery.
🤔 Differentiating Seizures from Other Episodes
The third paragraph discusses the challenge of distinguishing between seizures and other episodes in children, such as breath-holding spells or syncope. The speaker outlines 'green flag' signs that suggest a less serious condition, such as movements that can be stopped by touch or specific triggers for the episode. 'Red flag' signs indicating a more serious condition are also detailed, including loss of consciousness, developmental delay, or neurological injury. The importance of a detailed history and, if necessary, an electroencephalogram (EEG) to differentiate between conditions is emphasized.
👶 Excessive Crying in Infants: A Systematic Approach
In the fourth paragraph, the speaker addresses the common scenario of excessive crying in infants and the challenge of identifying serious underlying conditions. A systematic approach is advocated, starting with ruling out life-threatening conditions, then moving to common benign conditions if the child appears well. The speaker advises a thorough physical examination and observation if no serious condition is found, highlighting the importance of not relying on a long list of differential diagnoses but rather a step-by-step evaluation.
🏠 Household Poisoning: Management and Referral
The fifth paragraph focuses on the management of potential household poisoning in children, discussing the inappropriateness of routine stomach washes and the limited role of activated charcoal. The speaker advises caution with certain household items that have caused severe morbidity and mortality, such as hydrocarbons and certain oils, and stresses the importance of referring children who have ingested suspicious substances for proper evaluation and management.
🐍 Venomous Bites and Stings: Identification and Referral
The final paragraph discusses the evaluation of children who have sustained unknown bites or stings, focusing on the differentiation between snake bites, scorpion stings, and other insect bites. The speaker outlines the signs to look for in each case and the importance of timely referral, especially if there are signs of neurotoxicity or an autonomic storm. The summary includes advice on the initial management of these cases and the importance of securing the airway before transfer if neurological symptoms are present.
Mindmap
Keywords
💡Pediatric Emergencies
💡Foreign Body Aspiration
💡Laryngeal Obstruction
💡Bronchial Foreign Body
💡First Aid Measures
💡Button Battery Ingestion
💡Seizures
💡Green Flags and Red Flags
💡Excessive Crying
💡Household Poisoning
💡Unknown Bite
Highlights
Introduction to the topic of pediatric emergencies, specifically focusing on foreign body aspiration and other minor emergencies.
Case discussion approach to manage pediatric emergencies in an office setting, starting with an 18-month-old girl with a plastic toy aspiration.
Differentiating between various responses to foreign body aspiration, including immediate referral, X-ray, and first aid measures.
The danger of complete airway obstruction due to laryngeal foreign body and the signs to look for in such cases.
Explanation of why first aid measures like the Heimlich maneuver can be counterproductive in a coughing child.
Management of bronchial foreign body which is an emergency but not a dire one, allowing for safer hospital referral.
Importance of detailed examination and observation in cases where X-ray and respiratory assessments are normal.
Case of a two-year-old with a button battery aspiration, emphasizing the dangers of button batteries causing extensive tissue damage.
The mechanism of tissue damage caused by button batteries through electrical circuits rather than chemical leaks.
Urgent referral for cases involving button battery ingestion due to the high risk of severe complications.
Differentiating between seizures and other nonepileptic events such as breath-holding spells or syncope.
Use of green and red flag signs to assess the nature of a child's event, such as tactile stimulation responsiveness.
The significance of a detailed history and examination in cases of alleged poisoning, especially with household chemicals.
Advice against routine stomach wash and activated charcoal administration in cases of suspected poisoning.
Importance of recognizing and referring corrosive substance ingestion due to potential severe internal damage.
Differentiating between various types of insect bites, with emphasis on the need for observation and referral in cases of unknown bites.
Identification of signs of scorpion sting, including hypertension and parasympathetic symptoms, and the importance of avoiding certain treatments in the initial stages.
The necessity of securing the airway and administering atropine in cases of severe neurotoxicity due to insect bites before referring the patient.
Transcripts
yeah the screen is visible correct yeah
thank you
uh thanks milo for that uh introduction
and i thank the organizers for giving me
this opportunity
since we're running late we'll start
with the topic straight away uh i've
been asked to talk on
a minor pediatric copies emergencies uh
of course sitting in a testicular center
i may not be the kind of person to see
we'll talk about this but we do see a
few of these minor
emergencies around furniture you come to
us so with that experience i will try to
do justice to the topic in the next 20
minutes
what we're going to do is uh just case
me discussion on four of the case
scenarios which is
uh uh we'll try to see how they can be
managed in the office pediatrics
so the first case is uh 18 month old
girl who was brought with the
complaints of talking on a plastic toy
which she was playing around 30 minutes
back
on arrival she is coughing repeatedly
and is irritable and that's respite
distress
parents are worried and wants you to do
something immediately in your clinic
so what would be our response so there
are multiple things we can do
we can arrange to refer the child
immediately to the nearby hospital
if you have an x-ray facility somewhere
in nearby you can send up for an x-ray
and see if
really she has ingested anything and
then we can try
some first aid measures we have been
taught have like spine over or
back slabs are just you know in uh
during our training we can of course
reassure and come the parents actually
might have coughed it out there
and nothing to worry so from all these
options uh
for most of the time when i asked my
residents or other people they always go
for this
see because all them feel that child is
gonna come with their acute event and we
should do something
and you know we should do some past
eight which is so let us see what we
should do
uh why this choose uh you know
uh try again uh option c sometimes can
be dangerous
so uh what is most dangerous in a child
who's coming to you with a
foreign body aspiration is a complete
airway obstruction so that happens only
if there is a laryngeal
obstruction of the larynx and subloading
[Music]
they can die immediately so that is the
most life-threatening thing which you're
worried about
so how does the laryngeal foreign body
present
see first most of the features would be
that they'll have no cough no voice
because larynx is obstructed completely
so they don't they won't be able to make
any noise there will not be coffee
and some the universal talking sign even
though they're described in others and
uh
sometimes this can happen that the story
mode is actually passed in the larynx
and in the login one of the smaller
airways either the right bronchus or the
left bronchus
and when you lose some first aid
measures like hemolytics or just
the thrust this body foreign body can
get destroyed and go back
up into the larynx and especially
vegetable foreign enter the airways
because they absorb
water and when they go back even though
they're small enough to possibly have a
larynx before now they may begin off and
then get stuck completely and put this
complete obstruction so it can be
counterproductive
and most of these first aid measures
what we do hemolytics maneuver or just
thrust they are just
imitating a cough they just the
mechanism of how they act is they
increase their throstic pressure and
push their body out so that's what we do
when we cough
so they're just an imitation cops so
when the child is actually coughing you
should not try any any
more imitations and just wait for the
child to handle it in this cell it is
dangerous even if you tell a strider
that means some sound is probably being
produced that means not completely
obstructed
the these frustrated measures are used
only when the airway is completely
obstructed so in the shell we just need
to
watch for uh what's going to happen okay
so is there a bronchial foreign body
that is not an emergency
of course it's an emergency but it's not
a dire emergency where we need to do
something
immediately the foreign one of the bronx
even if it is one of the main bronchus
the other side the lung is completely
able to work and it will save the child
and we can wait for even uh you know 24
hours or 48 hours so
it's not absolute emergency we can
safely refer the child to a hospital
where they can do
a long scope in a controlled situation
so we need to refer to a child if you
have the clinic hi like this comes i'm
going to refer the child
so you first of all examine the child in
great detail
degrees bilateral carefully look for it
any respiratory stress or any noisy
breathing
and if you have a facility like an x-ray
any abnormal just x-ray look at the
two lungs field and if they look
symmetric or not it can be a collapse
either impression might asymmetry
those things indicate that there is some
area obstruction either complete or
partial if
all these things are normal then most
probably even though there's a talking
episode most likely there's nothing
serious
and you can even observe the child he in
our common practice is if the child is
hyped or distressed that bilateral error
is symmetrical and good and x-ray is
normal and then they'll be usually
observed
we don't want to check those copies in a
hospital so
unless the parents are very worried so
this is another similar case which was
given shown to us by process thank you
sir many years back and just borrowing
from this case so this is a two-year-old
down syndrome child who bought the
complaints of
ruling of saliva since one day so
suspecting that
child may have followed something they
took an x-ray and there was a round
metallic
object looking like a coin so it was
reported very easily with the help of
the surgeon
but still even after that child
continued to worsen so i interrupted an
air leak as you can see here
there is some number of suppliers
emphysema
when we look at they looked at the
metallic thing clearly they found that
actually it was not a
coin actually it was a button but this
button battery is very dangerous
with a shallow ridge in between so that
can be sometimes seen in the next right
sometimes that will be also we can see a
slight uh slanting
slop from the one side to the other side
okay so these are signs
if we see like this and carefully you
may be able to pick up a
button but it's very very important
because button batteries can be very
very dangerous you know what it's
dangerous
primarily because police extensive
tissue damage not because of chemical
leak that's what i used to think
many years back but the way they put the
damage is through electrical
uh circuit so this is the diagram which
is the internet about how to handle a
button batteries
by one of the companies like button
batteries they say you should test the
battery like this
you should only hold it like along the
edges that is because
this battery battery one side is
positive charge i will say negative
charge and if you hold like this
the circuit can be completed through
your hand and it can get slowly get
discharged
so this guy this is this happens when
you just a button by challenges the
button battery and is lying in some uh
tight cavity like nose air firings or
isopagus the
mucosa along with the secretions the
mucus acts like a very good conducting
gel
and the circuit is completed battery
short circuited and even if the battery
is walled
enough current to burn the microscope so
it basically cauterizes the microbes on
the surrounding tissues
when we had seen i had seen actually two
children who have massive hematomas
following a butter battery injection
there they even iota was eroded
and we lost them so if a child comes to
you with a button battery injection it's
an
immediate uh it's a very uh acute
emergency tell us we refer to a place
where it can be taken out
as early as possible there are
circumstances if you find the batteries
reach the stomach then this nature of
perfection and damage is very less
because this
is so circuiting unlikely to happen so
and if the battery is less than
15 millimeter usually it passes out
safely but
button battery is always a very
dangerous thing well now for the next
case
uh this is a two-year-old developer in
the normal girl body completes the first
episode of abnormal moments one hour
back
there appears to be normal and
interacting with scene with you so you
don't know that i have a seizure or not
so how do you distribute the future
means there are a lot of different ios
comes in and you may have rotated them
differently especially multiple episodes
are there
so there are some green flag signs for
social media and some red black science
procedures this is uh taken from one of
the
rubio attitudes so the movement is
supposed to be tactile stimulation
suppose any moment which you can
stop by your own touching the initially
then that is a solution you make
and tissue mimics are usually triggered
by specific event location or emotion
for example
a breath holding spell whether you know
a painful stimulus a child gets upset
or standing for a long time in an
assembly line so this is if there will
be a triggering event
and the moments or the staring of
against or whatever you describe the
same mimic
usually stops you can uh with the
distraction that means
actually has not lost lost consciousness
you can distract the child
but for uh but if it is a seizure then
most of these movements are
non-repressible and they seizure the
triggering event usually
suppose mother says that that usually
when they get up from sleep or around
that time
you know they're coming out of people it
happens that that is highly serious of
seizures that is a very
short lot of short for
you just to sleep being around the sleep
and waking from sleep is that
time and serious can be saturated and
loss of consciousness during an event
any step of loss of
consciousness any
there is some drowsiness or fatigue for
the lasting for half an hour to one hour
highly seriously
then of course any possibility of
developmental delay regression or
neurological injury
so taken along none of these red flags
or green flags are actually reliable but
if technology falls supposedly a lot of
uh
green flags and hardly any red flag a
lot of red flags and hardly any
uh green flag then we can say
differentiate decision or resistance
because there is a lot of the big list
of sister and social media we are not
going to go through all of that
common confusions just as an example i
have taken withholding spell for infants
if you
be careful taking history of pathology
spell the thynotic episode the
holding during expiration and the
typical age group you will find that
mother description involves a lot of uh
green flags and hardly any red flags
less than 10 15 percent of them can have
any tanks and laws of consciousness or
convolutions
if that is there of course there can be
a confusion in that case we may have to
do
further investigations which we will
discuss later for example syncope an
older child this is similar it's a
common thing which you can confuse with
even yesterday one of my pietrick icu
sisters about her
daughter who is around nine ten years
what has incorporated by standing in
church but somebody else said her
advised
mri for her and she was coming and
asking me what to do
so uh so sometimes in cinco you can have
some oral like symptoms which may
confuse you for
like a temple of epilepsy the kind of
occasional jerking of limbs
some urinary incontinence can be rarely
be there but if you ask you stick very
carefully you find that these moments
in syncope at all any moments are they
usually they are not there they are
actually high amplitude to
twitching lasting only a few seconds
like a jerk and unlikely
with a rhythmic you know and lasts for a
longer time and multiple
moments and the fall when the small from
sync up is more gradual as compared to
an electronic seizure
if they don't hardly ever injure
themselves seriously when there's a
syncope
and usually there will be no fecal
incontinence or any tongue bite and
usual trigger factors are quite
you know typical long standing standing
like an assembly line or a church
exercise heat etc okay so
uh the most important thing is again uh
evaluating the child for uh
taking a detailed history for the red
and
green flags and if there is a doubt the
next thing to do is not a
imaging but to do an easy if a video is
if you available is very useful because
the host style has a but that uh mimic
during
eg then we can actually look at the easy
signatures yeah and of course this will
be already discussed if the decision of
what to do
i will skip that now come to case four
so case four is a five month old
boy who came with excessively crying for
one day he did not have fever
uh was feeding well it was occasionally
consolable but he was uncooperative for
examination as most of the children are
and was absurd after giving uh some
uh phenomena or something ready but that
last only for one hour he was quite
early for one hour and again he started
crying so mother wasn't willing to go
home
we need to figure it out so this is a
common scenario a child with interesting
crime
so the issues which faces this can a
normal well-appearing infant person with
acute excessive crying as a soil symptom
can have a serious underlying disease
and if so then what test or
lab investigation or this can help us
find this thing
so the important thing here is there is
no even though there is a
big list of things see i've taken it
from some book
there is a three slides full of courses
for insurance and crime so
there's no way we can always rule all
this out so this loaded list
uh evaluation will not help so the maybe
a better thing to do is
do a systematic approach with step one
you wrote any life threatening
conditions
then once you once you reasonably ruled
out life-changing situation condition
which can present like this then you can
go for common bettering conditions
even after that you're confused then it
may be better to observe the child till
uh either the symptoms completely
disappear or something else comes up and
you're able to diagnose this what we
usually follow
i mean i usually follow so step one is
like you know serious things so what are
serious things we already have
discussion on
how to pick up a you know evidence of
comments at a shock okay look for
certain signs like you know
the change in metal status block cft or
no difference in central and vertical
pulse you can subtle science first
comments are a shock
if that is there of course then you're
dealing with a serious situation if that
is not that look at temperature
instabilities especially fever is there
then look for you know all infections
which are not very obvious like for
example a common example is a urinary
tract infection so look for that
big world cup some of the children then
make sure you take an spo2 because some
of the children especially with the
neuromuscular disease they might not
have
you know obvious distress so no
respiratory
or you know retractions so i guess pure
so hypoxia without much distress
then suspect a neuromuscular disease but
whenever any check spo to suppose
something you find that actually the
spirit is low and then you look
carefully child has some distress
actually then
actually you may be dealing with a
cardiac or a permanent disease so sport
is useful for screening
and look at the heart rate the heart
rate is precisely very high more than
200 to 20
and not coming down at all even with you
know some coming medications but you are
trying then
think of an arrhythmia and of course
anybody's committing
to think of a surgical thing retraction
it is
in the next talk and look at of course
look at the folder and always bulging
font and decision irritability and
operating of course suspect
uh infections infection or trauma i
simply
in your rash history of rash anywhere uh
recently or even the mother for the
infant
think of herpes incorporates then people
resign look at the pupils
any drummer people to signs any
hypertension tachycardia
these are an nga symptom these are signs
of some toxic injections either it is
you know
uh or a scope instinct once we get a
childhood stop instinct who mothers not
notice scorpion so there are highly
irritable cry
there are all kinds of autonomic
disturbances
so toxins and metabolic causes things
can be cut off
if all these things are ruled out then
most people are dealing with something
benign conditions are these no even
nasal condition you are a throat stomach
at disparing that is insect bites
foreign bodies in the air nose
bearings coronal abrasions anal fissure
post humanization of course drugs some
drugs and especially similar biomedical
drugs given for common
call uh digital 20k so these are the
common things so just have a
head to toe carefully completely strip
the child and examine complete uh
thorough examination you'll be able to
find it uh so
basically there are physical examination
the key and if either nothing is found
just also said
it especially since you're going out
most of the dangerous conditions so case
5 is a two-year-old child what is the
allergies
for cleaner uh one hour back foot home
for example
appears conscious interacting with
stable rifles this is a common thing
our household is maybe a dangerous place
for small uh tortoise and infants
so many chemicals are there they're
getting just so many things starting
from fourth cleaner to
toilet cleaner nowadays a lot of you
know hand sanitizers are there
uh cinemas already mentioned about
mosquito repellents and all that so
this is a very common thing and they
present to you they look all right you
so what to do
so first question is should we do a
stomach wash if you look at the evidence
uh literature
there are strong recommendations for
example this is a positive paper from
clinical toxicology from both
american and the european toxicology
groups okay so
they definitely say that this should be
it should not be performed routinely
and if at all for the treatment of
poison patients in the rare
circumstances it is used it should be
performed
performed by individuals with the proper
training and expertise so in this
prayerful clique
in an office practice better to avoid
this because sometimes they can have
dangerous consequences and the benefits
are never been proven
and most of the household chemicals you
know they may not uh
get benefited by an suppose there are
some corrosives that can produce more
damage
so it's it's better to avoid stomach
wash in your another of course you want
to
do it as a punishment for the child also
that you want repeats attack but that's
not our intention of course so we are
not going to do it
stomach is dangerous in the peripheries
what about activated charcoal even same
group has also mentioned that its role
is also doubtful
yeah so it's got a different role in
some medications and other things about
cinnamon already pointed out but i tried
coming to you with the household
injection
this came kind of chemicals usually the
role of uh
charcoal is limited and better to avoid
it okay so single dose active attack
should be administered really in the
management of poison patients that is a
statement from
uh the most ecology group both european
and american
great evidence so better to avoid that
then uh whom to refer then suppose the
child like this comes to you wanting to
refer
look up for evidence of corrosive
injection because some of these
toilet cleaning agents are strong assets
so uh one evidence for that may be to
look at the child's
no child order because just across this
substance without you know
damaging his uh pharynx and uh so you
can look at the firings and uh oral
because like
everything is looking plain and nice
unlikely has taken anything across you
but if there is a
white sting or a erosions or congestion
then be
careful uh there will be more damage
inside so you should refer to the child
immediately
for any systemic science issues or the
sensory we should refer any significant
case in terms of repeated or waiting
especially you should refer the child
and there is this i met a partial list
of dangerous household items if
parents say that this is the one they
ingested then you should be very careful
okay because
these are the conditions uh these are
the things which we have encountered
children with severe mobility and
mortality in our you know institute who
existed this for example kerosene or any
hydrocarbon petrol diesel any
hydrocarbon
can pertain painting comfort eucalyptus
oil and neem oil they can put in the
central toxicity already is you know as
i mentioned that first they can come to
status
any household drugs which like
paracetamol poisoning already as
mentioned suppose somebody in the
household is taking some uh psychiatric
medications
or hype um hypoglycemic agents if child
has taken better
because they can have complications
sorry sir three more minutes
sorry yeah sorry uh
yeah uh we're coming to second last uh
case uh i mean
almost last case yeah three-year-old
child has bought history of alleged
history of
unknown fighter on his right leg
sustained by playing outside so he's
complaining of some pain at the locker
side yeah so
except for the pain nothing is there
shadows come to you so what are the
dangerous bites in our area
see there are a lot of things that can
bite you there a lot of insects are
there but
actually what can kill you are only very
few what in our experience in our area
what we are seeing is always take
scorpion or sometimes
be things like you know all this
dangerous
spiders black with spider and all those
things dangerous stuff is not seen in
this part of the country likely
so we need to identify when a child
comes with an unknown bite we need to
just figure out whether
it's one of these three okay so how do
you identify a snake bite
uh it's very easy of course if they've
seen it there's no problem
otherwise the the first important sign
for a snakebite is a significant local
reaction
especially if the sealing is increasing
rapidly and suppose they say that the
injection was only in the toss of
reaction it can be absolutely crystal
clear because there will be no sign at
all
locally and of course flying box if it
is there is useful
according to normal developers know this
how to do a holographic coating time
you just need like any clean glass test
tube or any wire take one two to three
ml of blood keep it for 20
minutes doesn't what definitely
something is wrong neurological
manifestations okay process to start
with they can have any kind of
respiratory paralysis muscle for this
obviously this is i don't think we
should know but the clinical
manifestation of
snake pain is a function of not only the
amount of vietnamese ingested it's also
the
how much time has elapsed since died so
a patient a child who's got a little
dose coming to you the half an hour they
look completely normal
but a child who's got a suddenly the
boss not enough to kill him
but coming after say 10 hours they have
significant local symptoms and you know
all those things so
you should also take the time into
consideration when they even evaluate
height
okay what about scorpio so scope
interesting of course the typical thing
all of us can recognize
is the characteristic autonomic strong
possible the taken parasympathetic
or of our activities hypertension
profuse sweating
uh no bronchorian cremation and
rapism etc so but the issue with this is
commonly mistaken for shock
we had a excellent session on stroke
pythagorean so the problem is is a child
like this comes actually there is no
history of
noise nobody knows something has become
this child child comes to you with the
science you'll be
uh looking at tachycardic called
extremities
or few sweating and you know the quantum
cft
many times they be given iv fluids uh
starter on catecholamines and then
referred
okay but that's this can be dangerous if
it is copy and stick and why because
you know first four to six hours of
scope instinct is
giving more catecholamines to that child
is actually can precipitate
kadhikarya is dangerous so please avoid
doing this
so how to recognize this is this if you
carefully look at the child the bp be on
the higher side of normal
hypertension you know so that is a
immediately a suspicion you should
suspect that you have a child with shock
and hypertension
so that that say that it's having a
category strong then look for
parasympathetic science if you're using
shock they can apply for some refuse
orders
secretions those things are useful in
shock so that means to make you suspect
that maybe a catecholamine storm maybe a
scorpion sting
then the most important thing is that
they won't have any signs of cardiac
toxicity at
the first four to six hours when the
autonomic storm is happening if you look
at the heart access protector
there will be no gallop there will be no
line condition except for some conducted
sounds without secretions no
gravitations
nor respiratory degrees work out
breathing there is no hepatomegaly
so absence of this should make you
suspect that this could be a
they may not encourage cardiac failure
or cryogenic shock but of course
if timeless around six to eight hours
after scorpion sting in the child has
the same presentation
then usually they laugh uh you should
think of cardiac shock and manage
accordingly that time they allow gallup
there now
let's play distress epidemically and
baby will be also on the lower side of
normal
okay all right yeah this thing this
thing is really la
i mean if it's not like threatening
unless there is large number of stings
but we
are we have seen children getting very
sick with even only one or two
of these things you know the child has
come with their children with enough
access or even acute language in any
ideas so it should be taken seriously
yeah sometimes they can do badly
so when to refer this little bit unknown
bite is stacked right of course if you
know it's tank but if you have it
doesn't suspect
even a cell looks completely normal
because they still need to be observed
for 24 hours unless you're the facility
to do that for your place
and if child has tosses any signs of
neurotoxicity
please uh don't understand that we have
an innumerable number of cases like this
where
children with the neuropathy have been
referred and all the way they have
arrested and they have
died by the time they reach the hospital
or any other testing center they would
have been
dead long back cardiac arrest because
sometimes in your doctor you can
progress very fast
so if you are referring a child with
already having your onset of neuropathy
in terms of process unless it is few
minutes
please uh somehow get a and secure the
airway before referring
uh try to get you know indicate the
child or accommodation otherwise
of course the new stigma and atropine is
an option uh the second option
but that works only for cobra bite for
credit bite which is a pre-synaptic
blockage
may not work and child can rapidly
progress so
every production is very important by
referring this style stop it
generally local dependent no systemic
features of an autonomic storm
child not been you can observe them but
if there are dynamic strong please refer
and when you're referring please give
the first loss of processing 30
micrograms per kilo
thank you
thank you dr nancer for the elaborate
presentation and
the sharing your experience and
knowledge with us
for a long time we will have a
discussion in the chat box i
5.0 / 5 (0 votes)