FATALITY BY SPINNING ROLL MACHINE

8yrs old male child victim of head injury on 22nd of this month in morning,due to the rain a car went into the wrong direction provoked a frontal impact with a tree.Not wearing seat belt.O/e - Unconscious, disoriented with gasping immediately intubated and mechanically ventilated as per ATLS protocol.Pupils - B/l 6mm very slow reactive,GCS - E1V1M3 upon arrival,BP - 160/80mmhg,P/r - 58/mt,Abdomen - soft,non tender with positive bowel sounds,Chest - Full of crepts.Neurosurgeon and paediatrician has seen the case.Poor prognosis explained to attendants. DIAGNOSIS AND MANAGEMENT PLAN??

37 year old male was found unconscious at home. Taken to the ED by family members. ECG given. interpretations?

Three episodes of seizures with in two years in a 47 yr old female with out any childhood or family history of epilepsy *Chief Complaints* Presented with three episodes of generalized tonic clonic seizures. 1st episode was 3 yrs ago during sleep. The husband heard a loud sound during sleep and noticed rolling up of eye balls of his wife with stiffness of the limbs with tonic clonic movements lasted for 5 mts. She was unresponsive with frothing of mouth. He called the ambulance and was taken to Medical college casuality. Before arriving she became concious and asymptomatic. She received iv fluid and suggested CT brain but failed to do the investigation.2nd episode was after an year while attending a marriage function she became unconcious. 3rd was witnessed by the husband, exactly similar to the first ,about 3 days ago while watching some program in the TV.No post ictal head ache / vomiting / weakness. *History* No family history of seizures.No known medical or neurological illnesses. *Vitals* Stable. Bp120/ 80 mmhg . Afebrile. *Physical Examination* No external markers for a neurocutaneous syndrome. No focal neurological deficits. *Investigations* EEG- NORMAL. BASIC BLOOD WORK UP- NORMAL.MRI BRAIN FOR DISCUSSION. *Diagnosis* Very clear in the MRI brain *Management* Ref the case to Neurosurgeon for further management

A 19yr young girl presented with a/h/o suicidal ingestion of chlorphos..around 50-100ml.. O/E drowsy.. Occasionally responding to v/c.. BP 151/98mmhg HR 135/Min Spo2 90%on 5lt o2 B/l gross crepts + GCS E4M5V5 B/L pupil pin point LR + With intermittent fasiculations.. I admitted her under my care in ICU. Pt was intubated in ER and putted on mechanical ventilation as pts condition deteriorated very soon.. She became unconscious,, not responding,, with b/l chest gross crepts ++.. (ARDS with pul edema?) with persistent seizures.. E1M1V1 She was putted on Pralidoxime infusion,, Atropine infusion,, Lasix,, epsolin,, dexamethasone,, esmolol,, soda bicarb,, magnesium sulphate intermittent bolus doses.. Now after 12 hrs of therapy.. Her GCS has improved,, E4VtM5.. Vitals stable.. Fighting for extubation.. Moving all limbs.. Any more suggestions plz..

Tino26yrs/m/quarry labour hx of sudden faint andfall down with floating in mouth and unconscious for few minutes. Not consulted any one Today morning such attack for few minutes. Came to me. Bp_100/76 Pulse 60pm feeble with feeling of poor volume Ecg is attached Pl interprete ECG and guide