Friday, November 6, 2015

10 Problems of Doctors : Society does not Understand

1. Hectic Schedule: Lack of time for Socials
Most fields in Medicine are hectic as we are dealing with patient's life or are on cover on duties. So naturally time for Social activities are compromised. This will gradually affect the social standings and relationships unless you are a great diplomat. People rarely accept the lack of time and assume it as not being given a priority, Be it at Home or Parties.

2. Doctors are not God
If I say this, people will readily say Yes they aren't who said so. But the expectation doesn't tell us that. Society doesn't understand that everything is not in our hand and we can not know everything every time. Sometimes expectations are so much, when they can;t be fulfilled are turned into rage. Doctors aren't god and cannot be expected to be like God. Even a doctor who assumes himself God is ignorant.

3. All Doctors don't earn Millions
We'll like in every field the successful, clever and the best people make it, not all get opportunity and space to make millions. However, still it is one of the best paid occupations. 

4. Doctors Get Ill too
Once there was a consensus among people that Doctors don't get ill because they have all the medicines and even though they get ill , should be fine by evening. I am sure the thinking process has changed a lot by now.

5. All Doctors Don't Have Bad Handwriting
The most common thinking is doctors handwriting are bad, but the fact is most doctors write beautiful handwriting and next time try to take a notice. 

6. All Doctors don't look after all symptoms
The modern society is changing on it, but the convention is still prevalent. I have heard patient saying that "This doctor knows only about Bone and Joint problems, What sort of a doctor is he?" It may not be that the doctor cannot but ethically he isn't looking at all your problems.

7. Anesthesists only makes people Sleep
But the fact is, he/she makes the modern medicine possible. There are lot of things to do to maintain a life while the patient is at sleep painlessly. They are even involved in most complicated procedures and critical care as well.

8. Doctor couldn't Diagnose my problem
Even modern medicine cannot diagnose all the problem, or while approaching a disease, it may take sometime before reaching a diagnosis.

9. Doctors Charge too much- They loot
While all over the world, Medical and health care industry is the most expensive because it is the field requiring the most Investment for education, most skilled man power and requiring most sacrifices.

10. Even Doctors Smoke and consume Alcohol
Though you are advised by doctors not to some or drink, they are as human as you are and they do smoke and often more than the general population. To curb stress of studies, work and life, doctors get into smoking habit, despite  knowing every pathology it causes.

So the Doctor is a bit different that you think, He is no different than you. Respect your doctor and know his limitations, obligations. Next time you visit a doctor, share a smile of warmth and I am sure you'll get the best courtesy in return.

Sunday, November 1, 2015

Approach to a floppy Infant: Video and Powerpoint

Floppy Infant- Basically a term used to denote a Hypotonic child who is unable to maintain normal posture at rest and on manuevers as per expected for that age.  
Floppy infant refers to those children presenting with generalized hypotonia, most often arising out of an insult incurred during fetal or neonatal period.

Useful indicators of weakness are: 

  1.  Ability to cough and clear airway secretions (‘cough test’)- Apply pressure to the trachea and wait for a single cough that clears secretions. If more than one cough is needed to clear secretions, this is indicative of weakness. ( Nowadays not performed )
  2. Poor swallowing ability as indicated by drooling and oropharyngeal pooling of secretions. 
  3. The character of the cry — infants with consistent respiratory weakness have a weak cry. 
  4. Paradoxical breathing pattern — intercostal muscles paralysed with intact diaphragm.

Here is a presentation of Appoach to a floppy child , You can even download it.
Hope it is helpful.

If any thing new has been added, please leave a comment below.

Sunday, October 18, 2015

Neonatal Resuscitation Protocol NRP 2015 AHA

American Heart Association the consensus organisation governing Neonatal resuscitation has released its 2015 Revision this October , 2015.
It keeps updating.

This Version has added 
  1. ECG lead attachment over Cord pulsation or Heart sounds
  2. LMA has been added to NRP

Read Full here

Friday, April 24, 2015

Thompson Scoring in HIE : Severity and Prognostic grading

Thompson Score 


Score                  0                  1                                2                                     3
Tone              normal            hyper                           hypo                          flaccid
LOC                normal         hyper alert, stare       lethargic                        comatose
Fits                 none              < 3 per day                 > 2 per day
Posture         normal            fisting, cycling            strong distal flexion       decerebrate
Moro              normal          partial                        absent
Grasp             normal          poor                          absent
Suck              normal           poor                          absent ± bites
Respir            normal          hyperventilation         brief apnea                     IPPV (apnea)
Fontanel       normal            full, not tense               tense              













Maximum Score = 22
Infants scoring 1–10 are considered to have
mild HIE, 11–14 have moderate HIE and
15–22 are considered to have severe HIE

Thompson CM, Puterman AS, Linley LL, Hann FM, van der Elst CW, Molteno CD, Malan AF. The value of a scoring system for hypoxic ischaemic encepha­lopathy in predicting neurodevelopmental outcome. Acta Paediatr 1997; 86: 757-61

Tuesday, April 14, 2015

Case of Cyanotic CHD : PGE1 saves life

A Single Male baby was born at 38 weeks of gestation with birth weight of 3.1 kg through Normal vaginal delivery. At birth the child cried immediately. At 15 minutes of life, the child had central cyanosis. There was no respiratory distress and heart rate was normal range.

Child was shifter immediately to NICU. Saturation was 70% and with oxygen reached up to 84%. On auscultation, chest was normal and there was a faint murmur on heart auscultation. Hyperoxia test was also performed, the baby failed the test.

Immediately Echo screening was done to see if there was any duct dependent circulation. ECHO showed large VSD with over-riding of Aorta with severe pulmonary stenosis. PDA was seen with 

Left to right shunt measuring 3mm. It was case of TOF with PDA (Duct-dependent ) as baby had severe PS.

Chest Xray was ordered. Xray showed oligemic lung fields with upturned apex of cardiac silhouette. 
In any scenario, Prostene would have been started but since ECHO showed patent PDA, it was with holded and monitoring was planned. On the second day, the baby was deteriorating, saturation was not maintained, reached upto 60%. Generally SpO2 above 75% is adequate for Cyanotic heart diseases. ECHO was reassessed and PDA was still patent at 2-3mm.  The desaturation was not explained by CHD. So child was kept under CPAP and finally intubated for drop in saturation.

After intubation, the problem was the SpO2 got worse to 30-40%. Since cardiologist was at the spot, reassessment was done with ECHO. PDA was patent with 2 mm size. A trial of PGE1-Prostene was given.
After 5 minutes the SpO2 came to 60%, heart rate improved from 100 to 120 and by 10 minutes SpO2 was 87% under MV and baby looked much better.


It was a case of closure or narrowing of PDA in duct depended circulation. The child was saved by PGE1 which keeps the PDA open, until the definitive management- BTS Blalock Taussing Shunt.