Sunday, 27 May 2018

Fistula test Interpretation

How are the results of Fistula test interpreted?
1. In fistula over the dome of the lateral semicircular canal: Increase pressure causes conjugate horizontal deviation of the eyes towards the normal side. As pressure is maintained, jerk nystagmus develops with fast component towards the affected ear. As pressure is released, eyes return to normal
2. Fistula of the lateral semicircular canal (anterior to the ampulla) causes deviation of eyes, to the affected side
3. Vestibular erosion causes rotatory horizontal nystagmus towards the diseased ear
4. Fistula of the posterior semicircular canal causes vertical movement of eyes.

Tuesday, 22 May 2018


Drowning is a major cause in head injuries and death
• Initial peak
– Toddler age group
• Second peak
– Male adolescents
• Children younger than 1 year of age
– Often drown in bathtubs, buckets, and toilets
• Children 1–4 years of age
– Likely drown in swimming pools where they haveb beenunsupervised temporarily (usually for < 5 min)
– Typical incidents involve a toddler left unattendedt temporarilyor under the supervision of an older sibling
• Adolescent and young adult age groups (ages 15–24 years)
– Most incidents occur in natural water
• Approximately 90 % of drowning occur within 10 yardso ofsafety
• Parent should be within an arm’s length of a swimmingc hild (anticipatory guidance)
Mechanism of injury
• Initial swallowing of water
• Laryngospasm
• Loss of consciousness
• Hypoxia
• Loss of circulation
• Ischemia
• CNS injury (the most common cause of death)
• Acute respiratory distress syndrome (ARDS) may develop
• Salt water drowning classically associated with:
– Hypernatremia
– Hemoconcentration
– Fluid shifts and electrolyte disturbances are rarely seenc linically
• Fresh water drowning classically associated with:
– Hyponatremia and hemodilution
– Hyperkalemia
– Hemoglobinuria and renal tubular damage
• Management of drowning and near drowning
– Cardiopulmonary resuscitation (CPR) at the scene
– Admit regardless of clinical status
– All children with submersion should be monitoredi inthe hospital for 6–8 h
– If no symptoms develop can be discharged safely
– 100 % oxygen with bag and mask immediately
– Nasogastric tube for gastric decompression
– Cervical spine immobilization if suspected cervicali injuries
– Positive end expiratory pressure (PEEP) and positivep ressure ventilations in case of respiratory arrest
– Continuous cardiac monitoring
– Bolus of normal saline or Ringer’s lactate
– Vasopressors
– Defibrillation if indicated