OSTEOPOROSIS IS A CONDITION WHERE THERE IS LESS BONE MASS,LESS BONE DENSITY DUE TO LESS CALCIUM IONS IN THE BONE,RESULTING IN EARLY&SPONTANEOUS FRACTURES ESPECIALLY IN WOMEN AFTER MENOPUASAL AGE.MORE THAN 50%OF WOMEN IN THE AGE GROUP OF 60-70YRS SUFFER FROM THIS DISABILITY,ALL OVER THE WORLD 90%COME TO KNOW THIS ONLY AFTER SUSTAINING A FRACURE.
SELF DIAGNOSIS BEFORE A FRACTURE&WITHOUT AN X-RAY:
THE NAILS ARE BRITTLE ,&BREAK EASILY,SPECIALLY IN THE TOE NAILS,WHICH PEEL EASILY,LIKE ONION SKIN.THEY ARE SOFT LIKE A PIECE OF SOFT CLOTH. THIS IS A THAT A FRACTURE SPINE IS INEVITABLR IN THE NEAR FUTURE.NOW THE PATIENT SHOULD TAKE A SUITALPREMONITARY SIGN.NOW THE PATIENT SHOULD TAKE A WLL QUAKIFIED DOCTOR"S ADVICE.
APLAIN XRAY CAN CONFIRM THE DIAGNOSIS
Wednesday, May 4, 2011
Friday, March 4, 2011
AUTISM-SPECTRUM DISORDER ( A .D .H .D)
This is a psycho social disorder found in few children in the age group of2-5 years.
This a mental condition in which child finds difficulty in ,making any kind of communication by any or many of the five special senses,or unable to socialise or establish any kind of relationship with other people easily.
It is said that very big intellectuals/celebrities,like Eienstien,Bill gates suffered from autism during their infancy.This is fully crrectable ,provided ,it is recognised early &appropriate environemental stimulation given at early age itself.
This is also known as attention deficit hyper active disease.
chief charecteristic features of identification of this disorder:
1) unsatisfactory social interaction
2)unsatisfactory ,visual,verbal auditory communication.
3)show of disinterest on anything sourounding the child
OTHER MINOR POINTS OFTEN FOUND IN MAJORITY :
1)LESS ATTENTION TO SOCIAL STIMULI
2)LESS SMILE,/LESS LOOK AT OTHERS.
3)LESS EYE CONTACT
4)REPEATING WHAT OTHERS SAY
5)SENSORY ABNORMALITY-90%
6)POOR MUSCLE TONE-80%
7)TOE WALKING
8)MANTAL RETARDATION--MOSTLY
9)STRONG GENETIC BASIS.
AUTHER'S CONCEPTUAL THOUGHTS :
All the afore said clinical features are difficult to identify by non medical people.On the contrary it will be easier to identify that certain signs of intelligence are present or not &such signs keep increasing as they grow This intellectual improvement is continuous about a new "sign every week or atleast every month,once.IF A PARENT IS UNABLE TO identifysuch intelligent signs periodically ,then they should consult a senoir pediatritian or a child psychologist
This a mental condition in which child finds difficulty in ,making any kind of communication by any or many of the five special senses,or unable to socialise or establish any kind of relationship with other people easily.
It is said that very big intellectuals/celebrities,like Eienstien,Bill gates suffered from autism during their infancy.This is fully crrectable ,provided ,it is recognised early &appropriate environemental stimulation given at early age itself.
This is also known as attention deficit hyper active disease.
chief charecteristic features of identification of this disorder:
1) unsatisfactory social interaction
2)unsatisfactory ,visual,verbal auditory communication.
3)show of disinterest on anything sourounding the child
OTHER MINOR POINTS OFTEN FOUND IN MAJORITY :
1)LESS ATTENTION TO SOCIAL STIMULI
2)LESS SMILE,/LESS LOOK AT OTHERS.
3)LESS EYE CONTACT
4)REPEATING WHAT OTHERS SAY
5)SENSORY ABNORMALITY-90%
6)POOR MUSCLE TONE-80%
7)TOE WALKING
8)MANTAL RETARDATION--MOSTLY
9)STRONG GENETIC BASIS.
AUTHER'S CONCEPTUAL THOUGHTS :
All the afore said clinical features are difficult to identify by non medical people.On the contrary it will be easier to identify that certain signs of intelligence are present or not &such signs keep increasing as they grow This intellectual improvement is continuous about a new "sign every week or atleast every month,once.IF A PARENT IS UNABLE TO identifysuch intelligent signs periodically ,then they should consult a senoir pediatritian or a child psychologist
The intellgence signs are present from age one month onwards & is a continuous Copying what elders do is a sign of intellgenceprocess.
What are the signs of intelligence(parents should ask the doctor)
Here are some examples:
At age one month :mother talks to new bornwhich listens carefully.After 1-3 minutes the baby makes1)bodily movements.2)babbles some sounds.3)hand movements obvious4)eye contact established with mother.5)looks at another person when interrupted atleast for a second.6)maks us know that its vision&hearing are good7)Obviously body language &sounds establish communication attempt without any doubt.If these are not found at age 3 months parents should consult an 'appropriate' doctorInnumerable signs of intelligence can be had from the auther by e-mail(drselvarajp@yahoo.com)
CONCLUSION&SUMMARY:
All babies are not born with adequate intelligence.At least 2-5 %childrn have sub standard intelligence,&they need to be identified early.parents must be vigilant to look for intellgence signs periodically from age one month ,when such intelligence signs ,are invisible they should report to an experienced doctor who will catogorise wheather it is1)hypothyroid state,2)Hearing disorder,3)vision disorder,4)small/big headcircumference, 5)Downs syndrome,6)Autismspectrumdisorder7)behaviur disorder 8)sensory system disorder 9)congenital metabolic/aminoacid disorder--All will cause permanent &irrevocable B R A I N D A M A G E ..Saturday, February 19, 2011
TWIN BABIES --HOW TO TAKE CARE?
The following principles are applicable for triplets/quadriplets also.
Main principles;
beware of1)infection 2)aspiration 3)sids(sudden infant death syndrome)
prevention of infection: 1)use of mask on face by all elders.2)hand washing with antiseptics 3)fumigation of room (modified method)4)restrictd or absolute prevention
of outsiders/friends to enter baby room. 5)barrier nursing 6)nursing mother's hygiene/sanitation.
First 30 days are very important.brest milk contains cholostrum&it is a must for first week.It specifically prevents a neonatal diarrhoel disorder.
some pediatricians ,intra muscular human immunoglobulins on an empirical basis,
once a week for 6weeks in low birth weight babies if they are precious babies.
use of steroidinjection to mother can prevent possible lung immaturity.All said &done ,well trained pediatricians should be present for neonatal resucitation procedure.A good luxurious cry is a must&is the sign -quo-non against a possible
mental retardation.
5)warmth:maintanace of body emperature above normal is important There will not be any weight gain if there is any hypothermia.so room temperature maintanance is essential.
6)good nutrition vitamin ,minerals +iron are necessary.
7) neonatal screening test is necessary,specially thyroid status(T3 T4 TSH)THIS ESSENTIALLY TELLS UPON THE BABY'S INTELLIGENCE.
8)Any body coughing is not to be allowed into baby's room,as the main problem that can develope is respiratory infection.
9)modified fumigation of baby 's room
10) uMBILLICAL STUMP DRESSING .COMMENEST ROUTE OF ENTRY OF MICROORGANISMS .Absolute aseptic precaution for dressing umbillical cord stump till it falls down &even for one week later.Never touch stump with bare hands.Use gloves.
11)Betadine is best all purpose antiseptic.
12)never be hurry fora baby bath.sponge bath is sufficient.
BOTTLE STERILISATION;Unstrile practice will lead to diarrheal disorders,besides sugar intolerance /cow's milk intolerance ,breast milk intolerance (galectose intolerance) -all may contribute or agravate ehisting diarrhoea.Hence soya been milk is the preferred alternative ,in such state..Redness in the buttocks /anal region is the hall mark of sugar intolerance.
Not more than two people should handle babies.They should wear apron /over coats.
ASPIRATION :Single most common dangerous enemy to babies.It is nothing but milk getting into the respiratory tract,due to faulty feeding technique.causing severe cough ,respiratory distress.Prevention is stressed.treatment is done only in hospital,by a suction machine/broncoscopic aspiration
perfumes:Avoid all perfumes as it may cause allergic bronchiolitis leading to respiratory distress, /vomitingsleading to aspiration
Main principles;
beware of1)infection 2)aspiration 3)sids(sudden infant death syndrome)
prevention of infection: 1)use of mask on face by all elders.2)hand washing with antiseptics 3)fumigation of room (modified method)4)restrictd or absolute prevention
of outsiders/friends to enter baby room. 5)barrier nursing 6)nursing mother's hygiene/sanitation.
First 30 days are very important.brest milk contains cholostrum&it is a must for first week.It specifically prevents a neonatal diarrhoel disorder.
some pediatricians ,intra muscular human immunoglobulins on an empirical basis,
once a week for 6weeks in low birth weight babies if they are precious babies.
use of steroidinjection to mother can prevent possible lung immaturity.All said &done ,well trained pediatricians should be present for neonatal resucitation procedure.A good luxurious cry is a must&is the sign -quo-non against a possible
mental retardation.
5)warmth:maintanace of body emperature above normal is important There will not be any weight gain if there is any hypothermia.so room temperature maintanance is essential.
6)good nutrition vitamin ,minerals +iron are necessary.
7) neonatal screening test is necessary,specially thyroid status(T3 T4 TSH)THIS ESSENTIALLY TELLS UPON THE BABY'S INTELLIGENCE.
8)Any body coughing is not to be allowed into baby's room,as the main problem that can develope is respiratory infection.
9)modified fumigation of baby 's room
10) uMBILLICAL STUMP DRESSING .COMMENEST ROUTE OF ENTRY OF MICROORGANISMS .Absolute aseptic precaution for dressing umbillical cord stump till it falls down &even for one week later.Never touch stump with bare hands.Use gloves.
11)Betadine is best all purpose antiseptic.
12)never be hurry fora baby bath.sponge bath is sufficient.
BOTTLE STERILISATION;Unstrile practice will lead to diarrheal disorders,besides sugar intolerance /cow's milk intolerance ,breast milk intolerance (galectose intolerance) -all may contribute or agravate ehisting diarrhoea.Hence soya been milk is the preferred alternative ,in such state..Redness in the buttocks /anal region is the hall mark of sugar intolerance.
Not more than two people should handle babies.They should wear apron /over coats.
ASPIRATION :Single most common dangerous enemy to babies.It is nothing but milk getting into the respiratory tract,due to faulty feeding technique.causing severe cough ,respiratory distress.Prevention is stressed.treatment is done only in hospital,by a suction machine/broncoscopic aspiration
perfumes:Avoid all perfumes as it may cause allergic bronchiolitis leading to respiratory distress, /vomitingsleading to aspiration
Wednesday, February 16, 2011
Aggressive Medical Treatment
AGGRESSIVE MEDICAL TREATMENT
Introduction :
Sometimes when a patient is very serious, conventional Text book treatment may not help. The medical ethics & scientific / statistical data often forces a physician to treat a patient as per therapeutic text book guidelines otherwise he is liable for a penal action for violating medico legal restrictions.
Definition :
No Text Book in medical literature gives precise method of treatment for any serious case. Then what constitutes an aggressive treatment. Text book of pediatrics (world renouned) by Waldoo Nelson says “any case which is very serious, should be subjected to aggressive medical treatment” no example of such aggressive treatment is available in any world medical literature.
Then how does a physician go about?
Hence an attempt is made to explore what is a serious case & what is aggressive treatments & how to identify, and what medical / surgical treatment would be best to revive that patient. All the case history examples given here, were treated by this author.
Actually, all the quoted cases need ICU like Treatment, but ICU facility is not available even in major District level hospitals. Hence the suggested modality of treatment.
Which is a serious case? Serious, very serious & extremely serious case depends upon the various clinical parameters which is one very abnormal from the normal.
Guide lines for assessment of a serious case.
Prognosis OK Bad Worse Worst
Parameters Normal Serious Very Serious Extremely serious
Consciousness Conscious Unconscious No response
to stlimuli Unconscious pupils slightly reacting to light
H R 80-120 120-200 > 200 fibrillation 400
R R 20-40 40-60 60-80
Acidotic Over 80
- same
Temp. 98.6
< 94
>104 < 90 cold
> 106 < 8006 ice cold
Other Physical Signs/ Symptoms
Fits No fits Continuous Status Epileptics Decerebrate spasm
Vomit No vomit Continuous
vomiting Haemetmesis Emesis + Acidotic breathing
Abd
Dis Nil Mild-moderate Mod-severe + Dyspnoea +
Tachypnoea All 3
Chest pain Nil Resostrernal Pain +
sweatings Pain + sweat +vomit + arrythmia
BP 130/80 Systolic 80
Diosystolic 60
Sys – 180
Dias – 100
Sys 60
Diast 0
Syst 200
Diasb 120
140 No BP
Recordable brady cond hypothermia.
Hydration Normal 5-10%
Dehydration 10-15%
Dehydration > 15% not revivable
Miclim “ Oliguria Anuria Anuria
Bun “ 50%
Increase 75%
Increase 100%
increase
Requires
Dialysis Requires
dialysis
Pulse oxymet 100% 80-90% 60-80% < 60 %
ECG Hh N Hh 60 40-60
40
Aim: When the physician is confronted with a very bad case, there are two options before him.
1. Treat the patient with drugs in the prescribed dosage, when the physician knows the outcome is likely to be poor & the progress is extremely bad, he may choose the second option.
2. Treat patient in the drugs which could be 4-8 times more than normal pharmacological level. This is most likely to yield a better result when the physician in his experience already knows the outcome with conventional dose.
3. Many experienced physicians (over 20-30 yrs service) can objectively & subjecting make assessment of a bad case as one that is not likely to survive even with best medical treatment.
4. When confronted with such a case, what is the harm in treating with a different way that may carry at least 5% chance for a survival? After all the treatment is absolutely scientific. Many bad cases are refused to be seen & ref. to government hospitals where the patients ultimately succumbs to his illness, or dies on the way to hospital & physicians refer such cases knowing fully well that the patient will die. How many physicians are there in the world to take up such cases as a challenge, and try to do their best, after informing the possible prognosis to the patients attender and also after getting his signature in an “informed consent paper.”
Meningo coccus attacks moninges & brain. But all the body organs are also affected as there is inter connection. When there is bacteremia / septicemia viraemia, then all body organs are simultaneously targeted when it is known as multi – organ failure syndrome (MOFS) where mortality rate is highest. So when there is a clinical / lab evidence of MOFS, why not a non conventional therapy instituted which may carry at least 5-10% good progress?
Here are some of the challenging type of cases treated by this author using the principle of Aggressive Medical treatment.
1. A 17 Years old boy sustained high voltage electric shock. (owning an electrical goods shop). Had status epileptics plus, decerebrate spasm. He was treatd with (1) Diazapam 20 mg Iv bolus + 20 mg in IV drip (2) Lasix 20 ml IV bolus 10 ml in drip (3) Dexamethprone 16 mg IV bolus + 16 mg in 20% glucose 200 ml IV drip. Ref to CMC Hospital 200 km away. The boy woke-up after 3 Hours asking for “Masala Dosai” a favourite eatable. The CMC doctors said, there is no need for further treatment. The boy is alive at Thiruvannamalai Tamil Nadu even this day.
2. An adult bitten by a poisonous cobra was treated by anti snake venom seerum. He was in coma for 3 days therefore he was given a blood transfusion donated by a snake-charmer who was bitten by poisonous snakes many number of times. Reason for such a selection of blood donar was that his blood was prescribed as it contain specific gama globlns against snake-venom and this immunoglobulin did he trick. He became conscious on day 5 & discharged on day 10.
3. 3 days old neonate stung by scorpion. Body was literally ice cold. Heart rate – could not be counted as it was so rapid (should be around 300 / mt.Lytic cock tail therapy started with spahenus venesection. Drug dosage was doubled & duration treatment doubled (4 days) steroid & diuretic were also added to exert an anticon vulsant anticerebral edema measures) & thwart – an acute renal failure. Discharged fit on day 7. Neonate had peripheral circulatory failure & treated by digoxin till heart rate came down to 140 / mt.
4. Diarrhoeal dehydration mortality in Children Hospital Egmore, Chennai, due to dehydration; is 15% aggressive - redehydration can bring about increased survival & reduced mortality rate. Author has treated 24 such cases & were successful. Method employed is double vaneseation done in all cases and fluid calculated at 400 ml / kg in 15% dehydration + acidosis + Hypo electrolytaemia. 100 ml / kg iv. Pushed very slowly for first 4 hrs. then 200 ml / kg IV pushed in the next 8 hrs. remaining 100 ml / kg allowed to drip slowly at 60 drops / mt. A dose of Lasix + Dexamethasone given to prevent pulmonary edema (6 cases out of 30 died of pulmonary / cerebral edema & is presumed to be due to sepsis & multi organ failure syndrome.
5. Generalised cyanosis in a normal new born. A new born baby suddenly developed cyanosis which was starting from periphery from all 4 links to abdomen thorax & then face. Cause could not be assessed by pediatrician, pediatric surgeon & Anesthetist (intensive case). Dexa methasone was given 3 doses within 1 hour & then Belamethesone inhaler was delivered into the lungs by a special technique through tube & chest compulsion. Baby became pink within 30 mts. Thereafter steroid was stopped in a tapering dose but baby developed bleeding though mouth & nose. A blood transmission was simultaneously given to arrest to bleeding. Baby became normal on day 3. The culprit was parents who administered thualsi-water from temple & that the baby got aspirated.
6. Poison ingerion – 20 year old boy. He took tab gradinal 60 mg, hargatil 50 mg & phenergan 25 mg – each 60 tables – total 180 tables at about 10 pm & attempted to commit suicide. He was seen at 8 a.m. next day when he was fully unconscious – comatose. No stomach wash given as it was too late (pupils dilated HR 60 mt RR 20 / mt). He was given (1) IV drip continues Isolyte P 6 bottles 24 hrs. (2) Inj Lasix 1000 mg IV bolus & 100 mg IV drip 12 X Hly. Bladder cathetrised periodically. Became conscious after 48 Hrs. & 50% dose given on day 3 discharged fit on day 5 when he could pass urine as before. Bladder control returned after 3 days. (3) Dexmethasone 16 mg IV bolus 16 mg IV drip for 4 days to prevent or relieve cerebral edema.
Diuresis & anticerebral edema measures alone were tried & is alive today.
7. Resuscitation of a just dead child. 1 year old injection penicillin given at TI cyeles India Arakonam, child cried & stopped breathing once for all. O/E no heart No respiration. Pupils dilated muscle tone – reflexes nil Inj adrenaline, Adsenalius & dexa & Deriphyllin & vensection for IV line. ET tube put & breathing attempted by blowing air like mouth to mouth, continues positive pressure ventilation – improvised method attempted. Child saved & is alive today child was brought by a lady doctor plastic surgeon from ticyeles to GH Arakonam – year 1977.
8. Neonatal Tetanus
Apart from many supportive treatment requirement, anti convulsant dosage above discussed. Venesection for IV line & Diaza pam 200 mg in IV drip. Initial rate 60 / dnps / mt . Later when convulsion is under controle dose reduced to 20 drops / mt. During recurrence of fits drip rae raised to 60/ mt.
In Dexametharone 0.5 mg Qid for 1 week & later tapered & stopped to prevent dextral edema.
The diazepam drug regimen was continued from 5-10 days & drug dosage reduced as pev clinical improvement.
2-3 small blood transfusion given (1) to supply in immunoglobulin (2) nutrition.
Milk was not given for 2 weeks for fear of aspiration.
Partial parenteral nutrition + blood transfusion helped to maintain nutritional status.
Author is not vouching that this is the correct treatment for these cases. But it is different from conventional drug – dosage practice in vogue.
The lesson learnt by the author is that when a case is dangerously ill & felt to be unlikely to survive the insult, very bold steps to be used with more drugs, higher dosage, of course very cautiously with masterly expectancy is required to produce better clinically rewarding results.
Introduction :
Sometimes when a patient is very serious, conventional Text book treatment may not help. The medical ethics & scientific / statistical data often forces a physician to treat a patient as per therapeutic text book guidelines otherwise he is liable for a penal action for violating medico legal restrictions.
Definition :
No Text Book in medical literature gives precise method of treatment for any serious case. Then what constitutes an aggressive treatment. Text book of pediatrics (world renouned) by Waldoo Nelson says “any case which is very serious, should be subjected to aggressive medical treatment” no example of such aggressive treatment is available in any world medical literature.
Then how does a physician go about?
Hence an attempt is made to explore what is a serious case & what is aggressive treatments & how to identify, and what medical / surgical treatment would be best to revive that patient. All the case history examples given here, were treated by this author.
Actually, all the quoted cases need ICU like Treatment, but ICU facility is not available even in major District level hospitals. Hence the suggested modality of treatment.
Which is a serious case? Serious, very serious & extremely serious case depends upon the various clinical parameters which is one very abnormal from the normal.
Guide lines for assessment of a serious case.
Prognosis OK Bad Worse Worst
Parameters Normal Serious Very Serious Extremely serious
Consciousness Conscious Unconscious No response
to stlimuli Unconscious pupils slightly reacting to light
H R 80-120 120-200 > 200 fibrillation 400
R R 20-40 40-60 60-80
Acidotic Over 80
- same
Temp. 98.6
< 94
>104 < 90 cold
> 106 < 8006 ice cold
Other Physical Signs/ Symptoms
Fits No fits Continuous Status Epileptics Decerebrate spasm
Vomit No vomit Continuous
vomiting Haemetmesis Emesis + Acidotic breathing
Abd
Dis Nil Mild-moderate Mod-severe + Dyspnoea +
Tachypnoea All 3
Chest pain Nil Resostrernal Pain +
sweatings Pain + sweat +vomit + arrythmia
BP 130/80 Systolic 80
Diosystolic 60
Sys – 180
Dias – 100
Sys 60
Diast 0
Syst 200
Diasb 120
140 No BP
Recordable brady cond hypothermia.
Hydration Normal 5-10%
Dehydration 10-15%
Dehydration > 15% not revivable
Miclim “ Oliguria Anuria Anuria
Bun “ 50%
Increase 75%
Increase 100%
increase
Requires
Dialysis Requires
dialysis
Pulse oxymet 100% 80-90% 60-80% < 60 %
ECG Hh N Hh 60 40-60
40
Aim: When the physician is confronted with a very bad case, there are two options before him.
1. Treat the patient with drugs in the prescribed dosage, when the physician knows the outcome is likely to be poor & the progress is extremely bad, he may choose the second option.
2. Treat patient in the drugs which could be 4-8 times more than normal pharmacological level. This is most likely to yield a better result when the physician in his experience already knows the outcome with conventional dose.
3. Many experienced physicians (over 20-30 yrs service) can objectively & subjecting make assessment of a bad case as one that is not likely to survive even with best medical treatment.
4. When confronted with such a case, what is the harm in treating with a different way that may carry at least 5% chance for a survival? After all the treatment is absolutely scientific. Many bad cases are refused to be seen & ref. to government hospitals where the patients ultimately succumbs to his illness, or dies on the way to hospital & physicians refer such cases knowing fully well that the patient will die. How many physicians are there in the world to take up such cases as a challenge, and try to do their best, after informing the possible prognosis to the patients attender and also after getting his signature in an “informed consent paper.”
Meningo coccus attacks moninges & brain. But all the body organs are also affected as there is inter connection. When there is bacteremia / septicemia viraemia, then all body organs are simultaneously targeted when it is known as multi – organ failure syndrome (MOFS) where mortality rate is highest. So when there is a clinical / lab evidence of MOFS, why not a non conventional therapy instituted which may carry at least 5-10% good progress?
Here are some of the challenging type of cases treated by this author using the principle of Aggressive Medical treatment.
1. A 17 Years old boy sustained high voltage electric shock. (owning an electrical goods shop). Had status epileptics plus, decerebrate spasm. He was treatd with (1) Diazapam 20 mg Iv bolus + 20 mg in IV drip (2) Lasix 20 ml IV bolus 10 ml in drip (3) Dexamethprone 16 mg IV bolus + 16 mg in 20% glucose 200 ml IV drip. Ref to CMC Hospital 200 km away. The boy woke-up after 3 Hours asking for “Masala Dosai” a favourite eatable. The CMC doctors said, there is no need for further treatment. The boy is alive at Thiruvannamalai Tamil Nadu even this day.
2. An adult bitten by a poisonous cobra was treated by anti snake venom seerum. He was in coma for 3 days therefore he was given a blood transfusion donated by a snake-charmer who was bitten by poisonous snakes many number of times. Reason for such a selection of blood donar was that his blood was prescribed as it contain specific gama globlns against snake-venom and this immunoglobulin did he trick. He became conscious on day 5 & discharged on day 10.
3. 3 days old neonate stung by scorpion. Body was literally ice cold. Heart rate – could not be counted as it was so rapid (should be around 300 / mt.Lytic cock tail therapy started with spahenus venesection. Drug dosage was doubled & duration treatment doubled (4 days) steroid & diuretic were also added to exert an anticon vulsant anticerebral edema measures) & thwart – an acute renal failure. Discharged fit on day 7. Neonate had peripheral circulatory failure & treated by digoxin till heart rate came down to 140 / mt.
4. Diarrhoeal dehydration mortality in Children Hospital Egmore, Chennai, due to dehydration; is 15% aggressive - redehydration can bring about increased survival & reduced mortality rate. Author has treated 24 such cases & were successful. Method employed is double vaneseation done in all cases and fluid calculated at 400 ml / kg in 15% dehydration + acidosis + Hypo electrolytaemia. 100 ml / kg iv. Pushed very slowly for first 4 hrs. then 200 ml / kg IV pushed in the next 8 hrs. remaining 100 ml / kg allowed to drip slowly at 60 drops / mt. A dose of Lasix + Dexamethasone given to prevent pulmonary edema (6 cases out of 30 died of pulmonary / cerebral edema & is presumed to be due to sepsis & multi organ failure syndrome.
5. Generalised cyanosis in a normal new born. A new born baby suddenly developed cyanosis which was starting from periphery from all 4 links to abdomen thorax & then face. Cause could not be assessed by pediatrician, pediatric surgeon & Anesthetist (intensive case). Dexa methasone was given 3 doses within 1 hour & then Belamethesone inhaler was delivered into the lungs by a special technique through tube & chest compulsion. Baby became pink within 30 mts. Thereafter steroid was stopped in a tapering dose but baby developed bleeding though mouth & nose. A blood transmission was simultaneously given to arrest to bleeding. Baby became normal on day 3. The culprit was parents who administered thualsi-water from temple & that the baby got aspirated.
6. Poison ingerion – 20 year old boy. He took tab gradinal 60 mg, hargatil 50 mg & phenergan 25 mg – each 60 tables – total 180 tables at about 10 pm & attempted to commit suicide. He was seen at 8 a.m. next day when he was fully unconscious – comatose. No stomach wash given as it was too late (pupils dilated HR 60 mt RR 20 / mt). He was given (1) IV drip continues Isolyte P 6 bottles 24 hrs. (2) Inj Lasix 1000 mg IV bolus & 100 mg IV drip 12 X Hly. Bladder cathetrised periodically. Became conscious after 48 Hrs. & 50% dose given on day 3 discharged fit on day 5 when he could pass urine as before. Bladder control returned after 3 days. (3) Dexmethasone 16 mg IV bolus 16 mg IV drip for 4 days to prevent or relieve cerebral edema.
Diuresis & anticerebral edema measures alone were tried & is alive today.
7. Resuscitation of a just dead child. 1 year old injection penicillin given at TI cyeles India Arakonam, child cried & stopped breathing once for all. O/E no heart No respiration. Pupils dilated muscle tone – reflexes nil Inj adrenaline, Adsenalius & dexa & Deriphyllin & vensection for IV line. ET tube put & breathing attempted by blowing air like mouth to mouth, continues positive pressure ventilation – improvised method attempted. Child saved & is alive today child was brought by a lady doctor plastic surgeon from ticyeles to GH Arakonam – year 1977.
8. Neonatal Tetanus
Apart from many supportive treatment requirement, anti convulsant dosage above discussed. Venesection for IV line & Diaza pam 200 mg in IV drip. Initial rate 60 / dnps / mt . Later when convulsion is under controle dose reduced to 20 drops / mt. During recurrence of fits drip rae raised to 60/ mt.
In Dexametharone 0.5 mg Qid for 1 week & later tapered & stopped to prevent dextral edema.
The diazepam drug regimen was continued from 5-10 days & drug dosage reduced as pev clinical improvement.
2-3 small blood transfusion given (1) to supply in immunoglobulin (2) nutrition.
Milk was not given for 2 weeks for fear of aspiration.
Partial parenteral nutrition + blood transfusion helped to maintain nutritional status.
Author is not vouching that this is the correct treatment for these cases. But it is different from conventional drug – dosage practice in vogue.
The lesson learnt by the author is that when a case is dangerously ill & felt to be unlikely to survive the insult, very bold steps to be used with more drugs, higher dosage, of course very cautiously with masterly expectancy is required to produce better clinically rewarding results.
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