6 years child presented to ER after trapped in a house fire


#1

6 years child presented to ER after trapped in a house fire… What of the following make you consider intubation??
1 Electrical burn.
2. Carboxyhaemoglobine 10%
3.soot deposits around face & mouth.
4. 3 % burn of left side of chest.

2️⃣( picture 2) A one Y old boy presented with FTT, hypotonia, muscle weakness hypothermia and seizure disorder.
1.most likely diagnosis.
2.Relevant investigations.

3️⃣Spot diagnosis(picture 3)
:arrow_forward:Mention some causes?

4️⃣Spot diagnosis (picture 4)

:sparkling_heart::sparkling_heart:ANSWERS :sparkling_heart::sparkling_heart:

1️⃣ Choice ((3)) Soot depositsaround the face & mouth

:arrow_forward: reasonable approach is to consider prophylactic intubation is
soot deposits around face and mouth because is suggestive of
inhalation injury. This is associated with a higher mortality as the
airway quickly become oedematous making obtaining a definitive
airway difficult.

:sparkling_heart::sparkling_heart:((other causes will be discussed later )) :sparkling_heart::sparkling_heart:

2️⃣Menkes syndrome(Steely hair disease… Kinky hair disease))
:arrow_forward:Low copper levels
:arrow_forward:Symptoms: Bone spurs Brittle, kinky hair, Feeding difficulties
floppiness (hypotonia) Low body temperature Mental
deterioration Pudgy, rosy cheeks Seizures Skeletal changes

:arrow_forward: Abnormal appearance of the hair under the microscope.
:arrow_forward:Serum ceruloplasmin Serum copper level
:arrow_forward: (fibroblast) culture
:arrow_forward: X-ray of the skeleton or x-ray of the skull
:arrow_forward: Genetic testing may show a change (mutation)

3️⃣Gingival Hyperplasia

  1. Inflamed (Gingivitis) red, soft, shiny and bleed easily.
  2. Non-inflamed gingival enlargement: poor dental hygiene.
  3. Hormonal states: pregnancy, puberty.
  4. Nutritional deficiency: scurvy.
  5. Drugs: ciclosporin, phenytoin, calcium channel blockers.
  6. Genetic conditions: MPS, fucosidosis,
    infantile systemic hyalinosis and primary amyloidosis,
    Fabry’s syndrome, tuberous sclerosis, Sturge-Weber .
  7. Blood conditions:ALL , lymphoma or aplastic anemia.
  8. Systemic diseases: Wegener granulomatosis, sarcoidosis,
    Crohn disease, Type 1 neurofibromatosis, Kaposi sarcoma.

4️⃣Tetany

:arrow_forward:Definition: hyperexcitability of CNS and peripheral nervous system due to ionic alternation
:arrow_forward:Causes : low (H+, Ca2+ , M g2+ ).

:point_right:Alkalosis (low H+) causes tetany with (Ca2+ , M g2+).

:point_right:Low K+ prevent & increased K+ precipitate low Ca+ tetany.

:raised_hand:K+ has no effect on low M g2+ tetany.

:raised_hand:Ionized Ca is 40-50% (4.0-5.2 m g/dL) of total calcium.

:point_right:Tetany mostly develops when Ca2+ (ionized) < 2.5 mg/dL
(equivalent to total Ca 5 mg/dL).

:point_right:In hypoalbuminemia total Ca is low (< 7 m g/dL), but
ionized Ca2+ is norm al, so no tetany.

:point_right:Acidemia increases ionized calcium levels by displacing
calcium from albumin.

:point_right: Ionized magnesium is 75% of total Mg (1.6 -2.6 mg/dL)
< 1.0 mg/dL may ca use tetany.

:arrow_forward:manifestations.
:point_right:carpopedal (wrist and ankle) spasm,
:point_right:laryngospasm.
:point_right:Latent tetany: only manifests after stimulation

  1. Trousseau sign (tourniquet causes ischemia and tetany)
    2.Chvostek sign( facial nerve stimulation)