hand surgery

6yrs old child brought in casualty with h/o fall from approx 11feet height.GCS - E1M1V1,gasping respiration.Interpret CT findings with Management???

Kindly Suggest Treatment 15y/F Children HYPOXIA Short of Breathing, Restless, Conscious is Present COViD-Negetive, Malaria-Negetive, Typhoid- Negetive,Mantoux10tu- Negetive,No- Fever, No- Cough, spo2- 98, RR- 19, PR- 69, Bp- 127/77 Quick Releaf -Olanzapine Injection {IM} Escitalopram 5mg -BD Doge Olanzapine 2.5 mg OD Dose Clonazepam 0.5 Mg OD Dose Stills Condition But Reduce Medicine Repeated Same Condition,

ABC OF : MENTAL RETARDATION....... ( INTELLECTUAL DISABILITY / INTELLECTUAL DEVELOPMENTAL DISORDER). MAY BE USEFUL. *** MENTAL RETARDATION :- ** BELOW AVERAGE INTELLIGENCE (IQ) AND SET OF LIFE SKILLS PRESENT BEFORE THE AGE 18 YEARS....... ** VERY COMMON....... ** MORE THAN 10 MILLION CASES PER YEAR IN INDIA....... ** TREATMENT CAN HELP, BUT THIS CONDITION CAN'T BE CURED....... ** CHRONIC : CAN LAST FOR YEARS OR BE LIFELONG....... ** REQUIRES A MEDICAL DIAGNOSIS....... ** LABORATORY TESTS OR IMAGING RARELY REQUIRED....... *** The American Psychiatric Association (APA) is responsible for naming, defining and describing mental disorders. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the APA replaced “ MENTAL RETARDATION ” (MR) with “ INTELLECTUAL DISABILITY ( ID ) OR INTELLECTUAL DEVELOPMENTAL DISORDER ( IDD ). *** POSSIBLE CAUSES OF MR / ID :- * Down Syndrome. Down syndrome is the most common genetic condition in the United States....... * Hydrocephalus....... * Cerebral Palsy....... * Lead Poisoning....... * Fanconi Anemia....... * Phenylketonuria (PKU)....... or Tay-Sachs disease....... * Muscular Dystrophy....... * Homocystinuria....... * TRAUMA BEFORE BIRTH, such as an infection or exposure to alcohol, drugs, or other toxins....... * TRAUMA DURING BIRTH, such as oxygen deprivation or premature delivery....... * SEVERE MALNUTRITION or other dietary issues....... * EARLY CHILDHOOD ILLNESS, such as WHOOPING COUGH, MEASLES, or MENINGITIS....... * SEVERE BRAIN INJURY.......etc etc....... *** SYMPTOMS OF MR / ID :- Symptoms of ID will vary based on the child’s level of disability and may include : * Failure to meet intellectual standards....... * Sitting, crawling, or walking later than other children....... * Problems with learning to talk or trouble speaking clearly....... * Memory problems....... * Inability to understand the consequences of actions....... * Inability to think logically....... * Childish behavior inconsistent with the child’s age....... * Lack of curiosity....... * Learning difficulties....... * IQ below 70....... * Inability to lead a normal life due to challenges communicating, taking care of themselves, or interacting with others....... *** IF THE CHILD HAS MR/ID, HE/SHE WILL PROBABLY EXPERIENCE SOME OF THE FOLLOWING BEHAVIORAL ISSUES : AGGRESSION DEPENDENCY WITHDRAWAL FROM SOCIAL ACTIVITIES ATTENTION-SEEKING BEHAVIOUR DEPRESSION DURING ADOLESCENT AND TEEN YEARS LACK OF IMPULSE CONTROL PASSIVITY TENDENCY TOWARD SELF-INJURY STUBBORNNESS LOW SELF-ESTEEM LOW TOLERANCE FOR FRUSTRATION PSYCHOTIC DISORDERS DIFFICULTIES PAYING ATTENTION ** Some people with ID may also have specific physical characteristics. These can include having a short stature or facial abnormalities. *** LEVELS OF MR / ID :- MR/ID IS DIVIDED INTO FOUR LEVELS, BASED ON CHILD’S IQ AND DEGREE OF SOCIAL ADJUSTMENTS....... *** DIAGNOSIS :- HOW INTELLECTUAL DISABILITY DIAGNOSED? To be diagnosed with ID, the child must have below average intellectual and adaptive skills. THE DOCTOR WILL PERFORM A THREE-PART EVALUATION : ** INTERVIEWS WITH PARENTS ** OBSERVATIONS OF THE CHILD ** STANDARD TESTS The child will be given STANDARD INTELLIGENCE TESTS, such as the STANFORD-BINET INTELLIGENCE TEST. This will help the doctor determine the child’s IQ. The doctor may  also administer other tests such as the VINELAND ADAPTIVE BEHAVIOUR SCALES. This test provides an assessment of the child’s daily living skills and social abilities, compared to other children in the same age group. ** It’s important to remember that CHILDREN FROM DIFFERENT CULTURES AND SOCIO-ECONOMIC STATUSES MAY PERFORM DIFFERENTLY ON THESE TESTS. To form a diagnosis, the child’s doctor will consider the test results, interviews with parents, and observations of the child . *** CHILD’S EVALUATION PROCESS MIGHT INCLUDE VISITS TO SPECIALISTS, WHO MAY INCLUDE: PSYCHOLOGIST SPEECH PATHOLOGIST SOCIAL WORKER PEDIATRICS NEUROLOGIST DEVELOPMENTAL PEDIATRICIAN PHYSICAL THERAPIST *** LABORATORY AND IMAGING TESTS MAY ALSO BE PERFORMED. These can HELP the child’s doctor DETECT METABOLIC AND GENETIC DISORDERS, as well as STRUCTURAL PROBLEMS with the child’s brain. ** OTHER CONDITIONS, such as hearing loss, learning disorders, neurological disorders, and emotional problems can also cause delayed development. Child’s doctor should RULE these conditions OUT BEFORE DIAGNOSING the child with ID. Parents, child’s school, and doctor will use the results of these tests and evaluations to develop a treatment and education plan for the child.......

21 yr old male presenting with intentional tremors of tongue,lip and fingers,urinary incontinence,fatigue throughout the day,GERD, On examination BP 120/100 pulse :normal range pls DX .@

20yrs old male driving a car involved in a highway MVC with Truck on .Patient groaning at scene.Scene to ED transport via ambulance about half n hour.Intubated and mechanically ventilated uppon arrival to emergency following ATLS. O/e - Pupils - Left 6mm NRTL,Right 4mm SRTL,GCS - E1V1M3-4.How to proceed with this case??