Pediatric minor emergencies in OPD practice 1

Summary

In 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

00:00

🚨 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.

05:00

🔋 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.

10:01

🤔 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.

15:01

👶 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.

20:01

🏠 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.

Keywords

💡Pediatric Emergencies

Pediatric Emergencies refer to sudden and serious health conditions that require immediate medical attention in children. In the video, this term is central as the speaker discusses various scenarios of pediatric emergencies, such as foreign body aspiration and seizures, and how to manage them in an office setting.

💡Foreign Body Aspiration

Foreign Body Aspiration is a medical emergency where an object is breathed into the airway. The speaker uses this term to describe a case of an 18-month-old girl who is suspected of ingesting a plastic toy, emphasizing the importance of identifying complete airway obstruction as a critical and life-threatening condition.

💡Laryngeal Obstruction

Laryngeal Obstruction occurs when the larynx is blocked, preventing air from passing through. The script mentions this as a dangerous situation in children who have aspirated a foreign body, as it can lead to immediate life-threatening distress and requires urgent intervention.

💡Bronchial Foreign Body

A Bronchial Foreign Body refers to an object that has entered one of the bronchi, which are the main air passages in the lungs. The speaker explains that while it is an emergency, it is not as immediately life-threatening as a laryngeal obstruction, allowing for a more controlled and less urgent response.

💡First Aid Measures

First Aid Measures are immediate actions taken to save a life or alleviate symptoms until professional medical help arrives. The script discusses the use of first aid, such as the Heimlich maneuver, in cases of foreign body aspiration, but also cautions against its use when the child is already coughing.

💡Button Battery Ingestion

Button Battery Ingestion is a dangerous form of foreign body ingestion where a small, round battery is swallowed. The speaker highlights the severe risks associated with this, including electrical burns and tissue damage, and stresses the urgency of medical intervention in such cases.

💡Seizures

Seizures are uncontrolled electrical discharges in the brain that can cause changes in behavior, movements, and consciousness. The script discusses differentiating between seizures and other episodes like breath-holding spells or syncope, and the importance of recognizing signs such as loss of consciousness or abnormal movements.

💡Green Flags and Red Flags

Green Flags and Red Flags are terms used to describe signs that can help in the differential diagnosis of conditions like seizures. Green flags suggest a benign condition, while red flags indicate a more serious underlying issue. The speaker uses these terms to guide the evaluation of a child's symptoms.

💡Excessive Crying

Excessive Crying in infants can be a symptom of various conditions, ranging from benign to serious. The script presents a case of a child with unexplained crying and discusses the systematic approach to identifying the cause, emphasizing the importance of a thorough physical examination and observation.

💡Household Poisoning

Household Poisoning occurs when a child ingests toxic substances found in everyday household products. The speaker advises against routine stomach washing and the use of activated charcoal in these cases, and instead recommends a careful assessment for signs of corrosive ingestion or other serious symptoms.

💡Unknown Bite

An Unknown Bite refers to a situation where a child presents with a bite or sting of unknown origin. The script discusses the importance of identifying potentially dangerous bites, such as those from scorpions or snakes, and the signs that can help differentiate them from less severe insect bites.

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