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A 12 years child is attacked by a bear on 11 - 6 - 2019 at

A 12 years child is attacked by a bear on 11 - 6 - 2019 at 1 pm in Dhanbad. The bear attacked on the face of this child, his face is completely injured. Lastly bear is killed by villagers The condition of this child is very critical.

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Indeed the child is in crtitical condtion and life is at risk From 3rd picture i can see th e oral intubation is possible hence his ventilation should be secured earliest Second point how are his parameters Bp and pulse monitoring with iv fluids and securing him hemodynamically stable Now opthamologist is called to see whether his eyes and eye sight is intact or can be saved Now plastic and general or maxillofacial surgeon is called to do their duty to reconstruct the face of child Ofcourse it is a marathon work but nothing is greater than life Hence go ahead with sufficient BLOOD and plasma at your disposal I wish all the best and beautiful face to the unlucky child

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Victim must be referred to highest centre asap. Multiple specialist team needed for management including critical care specialist /anaesthetist, ENT surgeon, plastic surgeon,, optha surgeon, oral and maxilla facial surgeon. Multiple seating needed. Primarily airway must b secured (tracheostomy must be done) Shock must b treated carefully.

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Indeed the child is in crtitical condtion and life is at risk From 3rd picture i can see th e oral intubation is possible hence his ventilation should be secured earliest Second point how are his parameters Bp and pulse monitoring with iv fluids and securing him hemodynamically stable Now opthamologist is called to see whether his eyes and eye sight is intact or can be saved Now plastic and general or maxillofacial surgeon is called to do their duty to reconstruct the face of child Ofcourse it is a marathon work but nothing is greater than life Hence go ahead with sufficient BLOOD and plasma at your disposal I wish all the best and beautiful face to the unlucky child

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Thanks you so much CUROFY
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First take out the patient from shock prevent deadly infection integrity of respiratory system with intubation plenty of i/v fluids fortified with antbiotic cover. Once survival is made practicable.general surgeon ,opthalmologist , plastic surgeon have to co-ordinate to do a heroic job to have cosmetic look. I request all the competent available specialist to do there best to save the life.

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Primary problems are ventilation, shock, sepsis, nutrition, and vision Multisystem disciplinary trauma team comprising of surgeon, ENT, Faciomaxillarysurgeon, Cosmetic surgeon, Ophthalmologist, Intensivist, psychiatrist will be needed

I
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For such very critical case Multiple specialist team needed for management including crucial intensive care Tracheotomy is a must. Shock must be taken care of.

Thanks respected sir
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This is really ghastly injury Try to maintain Airway,breathing,infection control and thorough saline lavage with debridement (conservatively) Just put loose tacking stitches and reconstructions to be done later Take your plastic surgery colleague ' s help and management should be in a tertiary level hospital

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Life threatening injury Clean& Maintain airway Clean oral way Stabilise cardio respiratory system Repair injuries Reconstruction of lost parts.

A.R.V AND IMUNOGILOBULIN LOCAL INFILTRATION SHUD NE GIVEN
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Assess the vital parameters of the patient first. Definitely he will require intubation. Oral intubation is possible but there will be a problem in fixing the endotracheal tube, it will hinder the reconstruction of face later and also he might require prolonged ventilation. So tracheostomy is better option. After securing airway and breathing look for blood loss.... It seems he might have bled a lot. Blood sample for grouping and crossmatching and after results of CBC has come transfuse if necessary, till then resuscitate with fluids. Antibiotics should be started soon as there is risk of infection. Thorough washing and debridement of wound. Admit in ICU and take care of analgesia, oxygenation ,circulation, nutrition and general care. Call plastic surgeon and discuss the option of reconstructive surgery.

Thank you doctor
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Agree@Dr. Vijay Amera

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