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Bradycardia

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- Pulse rate < 60 / min

Causes:

1. Physiologicas : Atheletes, Sleep
2. Pathological – Severe Hypoxia, Hypothermia, Sick sinus Syndrome, Myxemdema, Obstructive Jaundice, Acute inferior wall infarction, Raised ICT, Raised IOP, II^o and III^o Heart blocks, Drugs (Beta Blockers, Verapamil, Diltiazen, Digoxin)

Treatment is to treat the cause.

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Beri Beri

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Occurs due to deficiency of vitamin B₁(Thiamine)

• Dry Beri Beri – Peripheral Nerves
• Wet Beri Beri – Heart
• Wernicke Korsakopy Syndrome – CNS

Dry Beri Beri: The earliest changes are a symmetric non specific polyneuropahty involving motor,sensory and reflex arcs beginning particularly in nerves of fact and lower lets.

Wet Beri Beri:

1. High out put CCF occurs
2. Causes edema due to lack of thiamine, glucose is completely metabolized to lactic & pyuretic acid – causes peripheral vasodilatation and transudation of fluids through capillaries
3. Resulting anemia can also cause edema.

Wernicke – Korsakoff Psychosis: ?Maxillary bodies are mainly affected Hallucination and confbulation are common

Shosin Beri Beri: Acutely fulminant form of heart failure.

Mercury poisoning:

1. Poisonous Compounds : HgCl₂ (Corrosive lublinate) : Mercuric Oxide, Mercuric Iodide, Mercuric Cyanide, Mercuric Cyanide ( Vermilan)
2. Fatal dose : 1 – 4 g
3. Fatal Period : 3 – 5 days
4. Symptoms :
1. ?I phase : Acrid metallic taste with burning sensation in mouth and mucouse membranes. Hematemesis and Hemetezia are present; Circulatory collapse occurs; Inhalation – Nervous symptoms.
2. II Phase: If he survives occurs in 1 – 3 dyas. Glossitis and ulcerative gingitis with severe infarction and loosening of teeth and necrosis of jaw occur. Renal tubule necrosis causes albuminuria, Cylinduria, Uremia and acidosis. Membranous colitis, develops – dysentery.

Treatment : Gastric lavage with 5% Sodium formaldehyde sulphoxylate, Egg whites, Mild or Charcoal – Precipitose mercury, BAL 3-5 mg / Kg i.m every 4 hrs for 2 days, HD if there is kidney damage.

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BRAIN ABSCESS

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??????????? Brain abscess is? a collection of pus in the parenchyma of the brain. Brain abscess may by due to bacterial, fungal etiology among the head injury patients with penetrating injuries, the organism causing abscess is staphylococcus aureus.

Clinical features

??????????? Patient present with fever, headache, photophobia, neck stiffness, blusrring of vision, projectile vomiting.

Treatment

??????????? Surgical decompression may be needed in some patients. Patient should be treated with broad spectrum antibiotics, antiedema measures and steroids.

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BITE AND STINGS

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Humans can afflicated by bites and stings of various animals

1. Scorpion sting – cause toxic myocarditis, toxic cardiomyopathy in adults. It causes ARDS, hypotension in children
2. Snake Bites
1. Cobra – neurotoxic – It causes muscle paralysis, and the cause of death is due to respiratory paralysis
2. Viper-Viper venom is vasculotoxic. It causes hemolysis and DIC. It can lead to acute renal failure due to hemolysis. It affects the clotting system leading to consumption coagulopathy
3. Sea snake – The venom of sea snake is myotoxic
3. Bee – The venom contain formic acid

Wasp – The venom contains alkali – patient should be treated with vinegar

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