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.
3️⃣Spot diagnosis(picture 3)
Mention some causes?
4️⃣Spot diagnosis (picture 4)
1️⃣ Choice ((3)) Soot depositsaround the face & mouth
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
((other causes will be discussed later ))
2️⃣Menkes syndrome(Steely hair disease… Kinky hair disease))
Low copper levels
Symptoms: Bone spurs Brittle, kinky hair, Feeding difficulties
floppiness (hypotonia) Low body temperature Mental
deterioration Pudgy, rosy cheeks Seizures Skeletal changes
Abnormal appearance of the hair under the microscope.
Serum ceruloplasmin Serum copper level
X-ray of the skeleton or x-ray of the skull
Genetic testing may show a change (mutation)
- Inflamed (Gingivitis) red, soft, shiny and bleed easily.
- Non-inflamed gingival enlargement: poor dental hygiene.
- Hormonal states: pregnancy, puberty.
- Nutritional deficiency: scurvy.
- Drugs: ciclosporin, phenytoin, calcium channel blockers.
- Genetic conditions: MPS, fucosidosis,
infantile systemic hyalinosis and primary amyloidosis,
Fabry’s syndrome, tuberous sclerosis, Sturge-Weber .
- Blood conditions:ALL , lymphoma or aplastic anemia.
- Systemic diseases: Wegener granulomatosis, sarcoidosis,
Crohn disease, Type 1 neurofibromatosis, Kaposi sarcoma.
Definition: hyperexcitability of CNS and peripheral nervous system due to ionic alternation
Causes : low (H+, Ca2+ , M g2+ ).
Alkalosis (low H+) causes tetany with (Ca2+ , M g2+).
Low K+ prevent & increased K+ precipitate low Ca+ tetany.
K+ has no effect on low M g2+ tetany.
Ionized Ca is 40-50% (4.0-5.2 m g/dL) of total calcium.
Tetany mostly develops when Ca2+ (ionized) < 2.5 mg/dL
(equivalent to total Ca 5 mg/dL).
In hypoalbuminemia total Ca is low (< 7 m g/dL), but
ionized Ca2+ is norm al, so no tetany.
Acidemia increases ionized calcium levels by displacing
calcium from albumin.
Ionized magnesium is 75% of total Mg (1.6 -2.6 mg/dL)
< 1.0 mg/dL may ca use tetany.
carpopedal (wrist and ankle) spasm,
Latent tetany: only manifests after stimulation
- Trousseau sign (tourniquet causes ischemia and tetany)
2.Chvostek sign( facial nerve stimulation)