ORGANOPHOSPHATE Poisoning

ORGANOPHOSPHATE Poisoning

Introduction 

Organophosphates poisonings common in Malaysian hospitals , hold a very high level of mortality. Because of this, medical personnels must thoroughly understand the pathophysiology and signs and symptoms of organophosphate poisoning , and also its management. 

Organophosphates include insecticides (malathion, parathion, diazinon, fenthion, dichlorvos, chlorpyrifos, ethion), nerve gases (soman, sarin, tabun, VX), ophthalmic agents (echothiophate, isoflurophate), and antihelmintics (trichlorfon). 

Herbicides (tribufos [DEF], merphos) are tricresyl phosphate–containing industrial chemicals

INCONSOLABLE Crying Child

INCONSOLABLE Crying Child

Epidemiology 

Inconsolable crying children can be troublesome for parents and emergency department doctors , especially in the middle of the night.A comprehensive management is needed to determine the cause and provide the proper relief to the child.

Differential Diagnosis

1.Common Causes of an inconsolably Crying Infant

• Infantile colic
• Corneal Abrasion or eye foreign body
• Hair tourniquet (hair strangulating appendage)  eg at finger, toe, penis
• Teething
• Insect Bite

Approach NIH STROKE Scale

Approach  NIH STROKE Scale

The NIH Stroke Scale (NIHSS) ( The National Institutes of Health Stroke Scale) is a tool used by healthcare providers to objectively quantify the impairment caused by a stroke. It composed of 11 items, each of which scores a specific ability between a 0 and 4.

 For each item, a score of 0 typically indicates normal function in that specific ability, while a higher score is indicative of some level of impairment.

NIHSS total score is based on the summation of 4 factors. These factors are left and right motor function and left and right cortical function. The NIHSS assesses each of these specific functions by the stroke scale item listed in the chart below.

Approach To Neonatal CYANOSIS

Approach To Neonatal CYANOSIS

Cyanosis commonly divided into 2 :

• Central Cynosis
• Peripheral Cyanosis

Central cyanosis is a bluish discoloration of the skin, mucus membranes and tongue that is observed when deoxygenated hemoglobin is > 3g/dL in arterial blood or > 5g/dL (>3.1mmol/L) in capillary blood. It is associated with a low arterial partial pressure of oxygen (PaO2) and low hemoglobin oxygen saturation (SaO2) as measured by oxymetry. 

Another type of cyanosis, called peripheral cyanosis, involves a bluish discoloration of the skin but sparing of the mucus membranes & tongue. In this type, a normal PaO2 value is detected. In this case, increased oxygen extraction due to sluggish movement through the capillaries leads to increased deoxygenated blood on the venous side. Vasomotor instability, and vasoconstriction caused by cold, low cardiac output and polycythemia can all cause this slow movement through the capillaries.

Approach To Newborn FEVER

Approach To Newborn FEVER

Definitions

Fever is an extremely common pediatric presentation and has many different causes. Fever is not an illness but rather a sign. The physician’s job is to attempt to diagnose the cause of the fever and to determine if that cause requires treatment or not.

Fever is defined as a core body temperature greater than 38°C (100.4°F) in infants younger than 28 days and greater than 38.2°C in infants older than 1 month. Core body temperature is best estimated by rectal temperature.

Approach to RABIES

Approach to RABIES

Introduction

Rabies is a zoonotic disease (a disease that is transmitted from animals to humans), caused by the rabies virus, of theLyssavirus genus, within the family Rhabdoviridae. Domestic dogs are the most common reservoir of the virus, with more than 95% of human deaths caused by dog-mediated rabies.

Approach to HEADACHE

Approach to HEADACHE 

The gold standard for diagnosis and management of headache is a careful interview and clinical examination. 

Headache Red Flags—“SNOOP”

• Systemic Symptoms : (fever, weight loss) or 
• Secondary Risk Factors : (HIV, systemic cancer) 
• Neurological Symptoms or abnormal signs (confusion, impaired alertness or consciousness) 
• Onset : sudden, abrupt, or split-second 
• Older : new onset and progressive headache, especially in middle age >50 yr (giant cell arteritis) 
• Previous Headache History : first headache or different (change in attack frequency, severity, or clinical features) 

STEROIDS In Spinal Injury

STEROIDS In Spinal Injury

The Congress of Neurological Surgeons and the American Association of Neurological Surgeons released a revised version of the original 2002 evidence-based guidelines for management of acute cervical spine and spinal cord injuries

Of 112 recommendations (the previous version contained 76), 19 are classified as level I recommendations, 16 as level II, and 77 as level III.

Malaysian 3rd Edition Dengue CPG

Malaysian 3rd Edition Dengue CPG

Download : Dengue CPG 3rd Edition 

List of Recommendations : 

Recommendation 1

♥ The baseline HCT and WCC should be established as early as possible in all patients With suspected dengue infection.
♥ Serial FBC and HCT must be monitored as the disease progresses.