We got an amazing glimpse into some of the cases Dr. Christo Philip (Emergency Medicine) has taken care of in Duncan Hospital – a secondary referral center for > 11 million patients in Northern Bihar and Nepal. Some highlights of the lecture:
18 y/o woman with sore throat, respiratory distress with bull-neck appearance- on intubation was noted to have pseudo membrane
- Corynbacteria diphtheria: pseudo membrane can obstruct airway and bleed profusely. Toxin can spread in blood. Treat w/ penicillin or erythromycin, diphtheria antitoxin. High mortality (50%)
14 y/o boy with abnormal behavior at home, found to have rabies.
- RNA Lyssavirus, spread via peripheral nerves to CNS (travels 1-2mm/day). 80% develop classic Furious Form, 20% develop Paralytic form.
- Remember: hydrophobia based on involuntary pharyngeal muscle spasms during attempts to drink.
- Palliative Care important: Haloperidol used in Philippines studies
45 y/o man with involuntary movements, found to have tetanus
- “Spatula test” : spasm of the masseters on touching the posterior pharyngeal wall. + test is the involuntary contraction of the jaw (biting down on the “spatula”) and a negative test result would normally be a gag reflex (high sensitivity + specificity)
- Treatment: Metronidazole (for mild cases), early airway management with aggressive sedation (diazepam up to 400-800mg daily, magnesium, vecuronium), tetanus immunoglobulin,
4 y/o male with difficulty feeding, keeping head up after wedding celebration with various foods, found to have botulism
- Clostridium botulism: begins w/ weakness, diplopia, dysarthria, then generalized weakness. No h/o fevers. Triad: bulbar palsy w/ descending paralysis, lack of fever and clear sensorium
5 y/o female with difficulty breathing and tachycardia to 150s, found to have been bitten by Indian Red scorpion (Mesobuthus tamales)
32 y/o woman with breathlessness, fatigue, ascites, Kussmaul’s sign and prominent “X” and rapid “Y” descent with constrictive pericarditis.
- Constrictive pericarditis: associated with exaggerated interventricular dependence, pericardial knock (sudden cessation of ventricular filling early in diastole, mistaken for S3) as well hepatomegaly, ascites, spider angiomata, palmar erythema and depedent edema.
- Some say: if the heart is NOT palpable it is constrictive pericarditis. If palpable, it is restrictive cardiomyopathy, if it is NOT palapable constrictive pericarditis. 🙂
2 y/o male with abdominal distension, respiratory distress, found to have congenital hypothyroidism.
Much more to learn: on additional topics such as Organophosphate poisoning (learn how to titrate atropine!), Intermediate Syndrome, status epileptics (learn when it’s necessary to skip to phenobarbital). Visit the Residency Website!