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Monday, February 11, 2013

Fall on four limbs

Neonatal ICU. There are two of them. One in Cheluvamba, ground floor. Second in Kid's Hospital, top floor. NICU-2 is called Sick Baby Ward, and is more airy. But either of them houses the tiniest kids on earth.

Caution: Before touching any baby, use GermX (contains sterol kind of alcohol, probably) to clean your hands. Now, before you touch another baby, use GermX again. And this is in addition to the dettol+soap handwash that you've got to do before even entering the ward. Anyhow, I've decided that it's unethical to touch any kid unless it's essential for learning.

Pre-term babies invariably end up here. And their feet would be the smallest imaginable.

Photosensitive babies would be blindfolded. At times, there'd be the phototherapy unit shining bright UV light at them.

Not to forget the sensors. There's temperature control. And whenever it goes below the set - 36.5 or so, it'll beep. BEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEP.
So does the heart rate monitor. Oxygen Saturation. IV Infusion rate. Everything.

Talking about IV infusion, you should know how tough it is to find a vein and put a needle inside those tiny arms. The doctor who was doing that was later recruiting new babies (neonatals) into the ward. Mother complaining of jaundice. But the baby was pink instead of yellowish. So, no jaundice. But the kid showed us some reflexes.
Keep your finger on its lips, it'll open the mouth and put the tongue out. Suckling reflex.
Hold the baby by its chest and belly, facing down, and it'll extend all the limbs, in anticipation of falling down. Parachute reflex. And it stays till you die. Yeah, the last time I fell from cycle I fell with my hands and legs down and not even a mote of dust on my clothes.
And the most dazzling. Hold the baby upright and suddenly let it fall back to your hand below. It'll show surprise by dilating the eyes and extending the arms. Moro reflex.

And the 3 questions you can ask a newborn. Have you passed meconium (first stool) within 24 hours? Have you passed urine in 48 hours? Have you started taking feed?
3 Yes, your systems are perfect.


Going to see autopsy tomorrow.

Wednesday, February 6, 2013

4th Term

Apparently, third term is over.

And with that came a new fervor for learning.

Posted to paediatrics from yesterday, Feb 6, a day after I turned 20. Though we missed all the days of OBG posting, I've attended both the days of paediatrics.

Day 1:
When you take a case, why is it important to know the age? :P
Hemolysis at day 1 is different from that at day 6.

And how is child case history different from adults?
There's an entirely new spectrum of diseases that can occur.

Day 2:
Immunization.
The nurses welcome us (just me and Fadnis) warmly and give us a box of used vials to play with. We arranged them in the order they should be administered.
Age 0- BCG (0.05 mL for kids born in hospital, and 0.1 mL for kids coming from outside, is what the nurse told. And the vial said "0.05 mL for kids upto 1 month, 0.1 mL for kids above 1 month". You can guess why the rule of thumb works) Live attenuated freeze dried Bacillus Chalmette Guerin IP (IP? Dad replied via sms. Indian Pharmacopoeia. BP would be British. USP would be US) For subdermal use.
OPV - Oral Polio Vaccine (20 doses bottle. 1 dose = 2 drops = 0.1 mL)
Hepatitis B Vaccine. Live attenuated. For Intramuscular use.

Age 1.5 month:
OPV
Hep B
DPT (Diptheria, Pertussis, Tetanus) Intramuscular.

Age 2.5 months: OPV, Hep B, DPT

Age 3.5 months: OPV, Hep B, DPT

Age 9 months: Measles (Right shoulder. Should see whether intramuscular or subdermal)

And I forgot the rest.

The intramuscular DPT and Hep B are given in the anterolateral of those small thighs as deep as that small needle (23 or 26 something) goes. The quadriceps was becoming very prominent while administration.

BCG very superficially in the left deltoid area. The kids would be too small that they don't even cry for more than 2 seconds.

And a pregnant mother was being given Tetanus in the deltoid.

No OPV was given today because the Pulse Polio Programme is happening next week and it would be overdose.