Autism
INTRODUCTION:
- Autism spectrum disorder (ASD) is the name for a range of similar conditions, including Asperger syndrome, that affect a person’s social interaction, communication, interests and behaviour.
- In children with ASD, the symptoms are present before three years of age, although a diagnosis can sometimes be made after the age of three.
- There’s no “cure” for ASD, but speech and language therapy, occupational therapy, educational support, plus a number of other interventions are available to help children and parents.
Signs of ASD:
Spoken language
- Delayed speech development , or not speaking at all
- Frequent repetition of set words and phrases
- Speech that sounds very monotonous.
- Preferring to communicate using single words
Responding to others
- Not responding to their name being called.
- Rejecting cuddles initiated by a parent or carer
- Reacting unusually negatively
Interacting with others
- Being unusually intolerant of people entering their own personal space
- Little interest in interacting with other people or children of same age group(Lack of social reciprocity)
- Preferring to play alone
- Rarely using gestures or facial expressions when communicating
- Avoiding eye contact
Behaviour
- Repetitive movements.
- Have a familiar routine
- Strong like or dislike of certain foods
- Unusual sensory interests
DIAGNOSIS:
- Psychologist – a healthcare professional with a psychology degree, plus further training and qualifications in psychology
- Psychiatrist – a medically qualified doctor with further training in psychiatry
- Paediatrician – a doctor who specialises in treating children
- Speech and language therapist – a specialist in recognising and treating communication problems
TREATMENT:
- Behavioral management therapy.
- Cognitive behavior therapy.
- Early intervention.
- Educational and school-based therapies.
- Joint attention therapy.
- Medication treatment.
- Nutritional therapy.
- Occupational therapy
Perineal Lacerations
INTRODUCTION:
- A perineal tear is a laceration of the skin and other soft tissue structures (innervated by Pudendal nerve)which, in women, separate the vagina from the anus.
- Perineal tears mainly occur in women as a result of vaginal childbirth, which strains the perineum.
- Tears vary widely in severity.
- The majority are superficial and require no treatment, but severe tears can cause significant bleeding, long-term pain or dysfunction.
- A perineal tear is distinct from an episiotomy, in which the perineum is intentionally incised to facilitate delivery.
- An occult injury to the perineum without noticeable injury occurs in 0.5–2% women following vaginal delivery.
- Perineal hematoma after trauma is due to Rupture of bulbar urethra
- During childbirth, Pubococcygeus is most often injured by a tear of the perineum
- As much as 35% primipara women have shown to have sustained occult sphincter injury as seen on anoendosonogram.
CLASSIFICATIONS:
- First-degree tear: laceration is limited to the fourchette and superficial perineal skin or vaginal mucosa
- Second-degree tear: laceration extends beyond fourchette, perineal skin and vaginal mucosa to perineal muscles and fascia, but not the anal sphincter
- Third-degree tear: fourchette, perineal skin, vaginal mucosa, muscles, and anal sphincter are torn; third-degree tears may be further subdivided into three subcategories:
- 3a: partial tear of the external anal sphincter involving less than 50% thickness
- 3b: greater than 50% tear of the external anal sphincter
- 3c: internal sphincter is torn
- Fourth-degree tear: fourchette, perineal skin, vaginal mucosa, muscles, anal sphincter, and rectal mucosa are torn
Lignocaine
LIGNOCAINE
- Dose of lignocaine for spinal anesthesia is 5%
- Maximum safe dose of lignocaine with adrenaline is 7 mg/kg wt
- Maximum safe dose of lignocaine for spinal anesthesia is 25-100 mg
- Concentration of lignocaine is used in epidural anaesthesia is 2%
- Maximum dose of lignocaine which can be given with adrenaline for ocular blocks is 7mg/kg
- Local anaesthetics acts by blocking nerve conduction.
- Small fibers and non myelinated fibers are blocked more easily than large myelinated fibers.
- Lignocaine is used as anesthetic and class IB antiarrhythmic in 2% jelly, 4% injection form
- 2-10% is the concentration of lignocaine used for topical anaesthesia
- High first pass metabolism is seen in Lignocaine
- Lignocaine is used in Ventricular tachycardia
- Best used in digoxin induced arrhythmia Lignocaine
- Drug of choice in lignocaine toxicity is Diazepam
- Lignocaine can be used in Ventricular fibrillation, Spinal anaesthesia & Epidural anaesthesia
- A patient selected for surgery was induced with Thiopentone iv through one of anti cubital vein complains of severe pain of whole hand. The next line of management IV lignocaine through same needle
- Lignocaine is a amide
- Lignocaine in high dose produces Convulsion, Respiratory depression & Hypotension
- Adrenaline is added to Lignocaine injection for Less bleeding at the site, Higher doses can be given & Prolonged duration of action
- Lignocaine can penetrate through mucous membrane
- Lignocaine can precipitate malignant hyperthermia
- Percentage of adrenaline with lignocaine for local infilteration is 1:50000
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