Monday, 18 November 2019
Ischaemic time
Cardiac musc 20 min
Peripheral nerve 8 hrs
Skeletal musc 24 hrs
Bone 72 hrs
Tuesday, 22 May 2018
Drowning
Drowning is a major cause in head injuries and death
• Initial peak
– Toddler age group
• Second peak
– Male adolescents
• Children younger than 1 year of age
– Often drown in bathtubs, buckets, and toilets
• Children 1–4 years of age
– Likely drown in swimming pools where they haveb beenunsupervised temporarily (usually for < 5 min)
– Typical incidents involve a toddler left unattendedt temporarilyor under the supervision of an older sibling
• Adolescent and young adult age groups (ages 15–24 years)
– Most incidents occur in natural water
• Approximately 90 % of drowning occur within 10 yardso ofsafety
• Parent should be within an arm’s length of a swimmingc hild (anticipatory guidance)
Mechanism of injury
• Initial swallowing of water
• Laryngospasm
• Loss of consciousness
• Hypoxia
• Loss of circulation
• Ischemia
• CNS injury (the most common cause of death)
• Acute respiratory distress syndrome (ARDS) may develop
• Salt water drowning classically associated with:
– Hypernatremia
– Hemoconcentration
– Fluid shifts and electrolyte disturbances are rarely seenc linically
• Fresh water drowning classically associated with:
– Hyponatremia and hemodilution
– Hyperkalemia
– Hemoglobinuria and renal tubular damage
• Management of drowning and near drowning
– Cardiopulmonary resuscitation (CPR) at the scene
– Admit regardless of clinical status
– All children with submersion should be monitoredi inthe hospital for 6–8 h
– If no symptoms develop can be discharged safely
– 100 % oxygen with bag and mask immediately
– Nasogastric tube for gastric decompression
– Cervical spine immobilization if suspected cervicali injuries
– Positive end expiratory pressure (PEEP) and positivep ressure ventilations in case of respiratory arrest
– Continuous cardiac monitoring
– Bolus of normal saline or Ringer’s lactate
– Vasopressors
– Defibrillation if indicated
Wednesday, 17 May 2017
APPEARANCE OF OSSIFICATION CENTRES AT VARIOUS JOINTS
OSSIFICATION
CENTRE
|
APPEARANCE
|
FUSION
|
Capitate
|
2 months
|
-
|
Hamate
|
3 months
|
-
|
Triquitral
|
3 years
|
-
|
Lunate
|
4 years
|
-
|
Traphezium, Traphezoid and Scaphoid
|
5-6 years
|
-
|
Pisiform
|
10-12 years
|
-
|
Lower end of Ulna
|
5-6 years
|
17-18 years
|
Lower end of Radius
|
2 years
|
18-19 Years
|
OSSIFICATION
CENTRE
|
APPEARANCE
|
FUSION
|
Capitulum
|
1 year
|
-
|
Medial Epicondyle
|
5-7 years
|
16-17 years
|
Trochlea
|
9-11 years
|
-
|
Lateral Epicondyle
|
11 years
|
-
|
Conjoint Epiphysis(By the fusion of Lateral epicondyle,
Trochlea and Capitulum)
|
Formed at 14-16 years
|
16-17 years
|
(Lower end of Humerus)
|
Mentioned
|
16-17 years
|
OSSIFICATION
CENTRE
|
APPEARANCE
|
FUSION
|
Head
|
½ -1 year
|
-
|
Greater Tubercle
|
3 years
|
-
|
Lesser Tubercle
|
5 years
|
-
|
Conjoint Epiphysis
|
5-6 years
|
18-19 years
|
Acromion Process
|
14-15 years
|
17-18 years
|
OSSIFICATION
CENTRE
|
APPEARANCE
|
FUSION
|
Head of femur
|
½ -1 year
|
17-18 years
|
Greater trochanter
|
4 years
|
17-18 years
|
Lesser trochanter
|
12-14 years
|
17-18 years
|
Tri-radiate Cartilage
|
-
|
13-15 years
|
Iliac crest
|
14 years
|
18-20 years
|
Ischial Tuberosity
|
16-17 years
|
20-21 years
|
OSSIFICATION
CENTRE
|
APPEARANCE
|
FUSION
|
Lower end of Femur
|
9th month of IUL
|
18-19 years
|
Upper end of Tibia
|
10th month (At birth)
|
18-19 years
|
Upper end of Fibula
|
4 years
|
18-19 years
|
OSSIFICATION
CENTRE
|
APPEARANCE
|
FUSION
|
Lower end of Tibia
|
1 year
|
16-17 years
|
Lower end of Fibula
|
1 year
|
16-17 years
|
OSSIFICATION
CENTRE
|
APPEARANCE
|
FUSION
|
Manubrium
|
5th month
|
Fuses with First piece of body at old age
|
First piece of body
|
5th month
|
4th piece fuses with 3rd piece at
14 years and remaining pieces fuse with one another between 14-25 years.
|
2nd piece of body
|
7th month
|
|
3rd piece of body
|
7th month
|
|
4th piece of body
|
10th month (At birth)
|
|
Xiphisternum
|
3 years
|
Fuses with 4th piece at 40 years
|
OSSIFICATION
CENTRE
|
APPEARANCE
|
Calcaneum
|
5th month
|
Tallus
|
7th month
|
Cuboid
|
10th month (At birth)
|
Tuesday, 29 November 2016
Peripheral signs of AR:
Watson's water hammer pulse
Corrigan's pulse (rapid upstroke and collapse of the carotid artery pulse)
low diastolic and increased pulse pressure
de Musset's sign (head nodding in time with the heart beat)
Quincke's sign (pulsation of the capillary bed in the nail; named for Heinrich Quincke)
Traube's sign (a 'pistol shot' systolic sound heard over the femoral)
Duroziez's sign (systolic and diastolic murmurs heard over the femoral artery when it is gradually compressed with the stethoscope)
Also, these are usually less detectable in acute cases.
Landolfi's sign (alternating constriction & dilatation of pupil)
Becker's sign (pulsations of retinal vessels)
Müller's sign (pulsations of uvula)
Mayen's sign (diastolic drop of BP>15 mm Hg with arm raised)
Rosenbach's sign (pulsatile liver)
Gerhardt's sign (enlarged spleen)
Hill's sign - a ≥ 20 mmHg difference in popliteal and brachial systolic cuff pressures, seen in chronic severe AI. Considered to be an artefact of sphygmomanometric lower limb pressure measurement.
Lincoln sign (pulsatile popliteal)
Sherman sign (dorsalis pedis pulse is Quickly located & unexpectedly prominent age>75 yr)
Ashrafian sign (Pulsatile pseudo-proptosis)
Cor en sabot(boot shaped heart)- TOF
Cor bovinum- 3° syphilis. N chronic AR..
Wednesday, 16 November 2016
New Juvenile Law
- The bill mandates setting up Juvenile Justice Boards and Child Welfare Committees in every district. Both must have at least one woman member each.
- Once the bill becomes law, the decision to try a juvenile 16 years or older as an adult will be taken by the Juvenile Justice Board, which will have a judicial magistrate and two social workers as members. If the board decides against it, the juvenile will be sent for rehabilitation.
- The Child Welfare Committees will look at institutional care for children in their respective districts. Each committee will have a chairperson and four other members, all specialists in matters relating to children.
- The government says it listed the bill more than a dozen times in the monsoon session and the ongoing winter session but it could not be taken up due to disruptions. The opposition, led by the Congress, had assured support to pass the bill today.
- The bill aims to "consolidate and amend the law relating to children alleged and found to be in conflict with law and children in need of care and protection by catering to their basic needs through proper care, protection, development, treatment, social re-integration, by adopting a child-friendly approach."
- The proposed law also aims at adjudicating and disposing cases dealing with juveniles keeping in mind "the best interest of the children and their rehabilitation."
- India is a signatory to the UN Convention on the Rights of the Child which mandates that all children under the age of 18 years be treated equal. The pending bill has been criticised for violation of the Convention.
- The bill also deals with adoption of children and lays down the eligibility criteria for adoptive parents. A central adoptive resource agency will frame the rules for adoption, which will be implemented by state and district level agencies.
Tuesday, 15 November 2016
Year Opium Act / Other Regulations
1857 Only the central govt can cultivate opium
1878 Import export of opium prohibited
1919 Import Export permitted
1919 Indian Medical Degrees Act
1923 Workmens Compensation act
1930 Dangerous Drugs
1933 Indian Medical Councils Act - Uniform Standard
1933 Dangerous Drugs
1938 Dangerous Drugs
1940 Drugs and Cosmetics
1948 Declaration of Geneva
1948 ESI
1948 Indian Factory Act 63
1950 Drug Control Act for Maximum Price
1951 Plantation Labour Act
1954 Durham
1954 Drugs and Magic Remedies not for Abortion, Contraception, Increased Sex, Menstruation, Venereal Diseases
1955 Medicinal and Toilet preparation Act
1956 Indian Medical Councils Act
1960 Court for Juvenile Offenders
1960 Geneva Convention Act - Red Cross Emblem
1962 Drugs and Cosmetics
1964 Durham
1971 Acccepted by West Bengal ( 9.2.1971)
1974 Bengal Medical Act
1986 COPRA
Drugs and Schedules
C Biological and Special Products
H Poisons
L Antibiotics, Antihistamines
IPC related to Medical Entrance Exams
81 - Act likely to cause harm, but done without criminal intent, and to prevent other harm
82 - Act of a child under seven years of age
83 - Act of a child above seven and under twelve of immature understanding
84 - Act of a person of unsound mind
85 - Act of a person incapable of judgment by reason of intoxication caused against his will
86 - Offence requiring a particular intent of knowledge committed by one who is intoxicated
87 - Act not intended and not known to be likely to cause death or grievous hurt, done by consent
88 - Act not intended to cause death, done by consent in good faith for person's benefit
89 - Act done in good faith for benefit of child or insane person, by or by consent of guardian
90 - Consent known to be given under fear or misconception. Consent of Insane person. Consent of child
91 - Exclusion of acts which are offences independently of harm caused
92 - Act done in faith for benefit of a person without consent
93 - Communication made in good faith
94 - Act to which a person is compelled by threats
95 - Act causing slight harm
96 - Things done in private defence
97 - Right of private defence of the body and of property
98 - Right of private defence against the act of a person of unsound mind, etc.
99 - Acts against which there is no right of private defence
100 - When the right of private defence of the body extends to causing death
101 - When such right extends to causing any harm other than death
102 - Commencement and continuance of the right of private defence of the body
103 - When the right of private defence of property extends to causing death
104 - When such right extends to causing any harm other than death
105 - Commencement and continuance of the right of private defence of property
106 - Right of private defence against deadly assault when there is risk of harm to innocent person
191 - Giving false evidence
192 - Fabricating false evidence
193 - Punishment for false evidence
194 - Giving or fabricating false evidence with intent to procure conviction of capital offense
195 - Giving or fabricating false evidence with intent to procure conviction of offense punishable with imprisonment for life or imprisonment, 195A - Threatening any person to give false evidence
196 - Using evidence known to be false
197 - Issuing or signing false certificate
198 - Using as true a certificate known to be false
199 - False statement made in declaration which is by law receivable as evidence
200 - Using as true such declaration knowing it to be false
201 - Causing disappearance of evidence of offense, or giving false information to screen offender
202 - Intentional omission to give information of offense by person bound to inform
203 - Giving false information respecting an offense committed
204 - Destruction of document or electronic record to prevent its production as evidence
205 - False impersonation for purpose of act or proceeding in suit or prosecution
206 - Fraudulent removal or concealment of property to prevent its seizure as forfeited or in execution
207 - Fraudulent claim to property to prevent its seizure as forfeited or in execution
208 - Fraudulently suffering decree for sum not due
209 - Dishonestly making false claim in Court
210 - Fraudulently obtaining decree for sum not due
228 - Intentional insult or interruption to public servant sitting in judicial proceeding, 228A - Disclosure of identity of the victim of certain offenses etc.
229 - Impersonation of a juror or assessor, 229A - Failure by person released on bail or bond to appear in Court
269 - Negligent act likely to spread infection of disease dangerous to life
270 - Malignant act likely to spread infection of disease dangerous to life
271 - Disobedience to quarantine rule
272 - Adulteration of food or drink intended for sale
273 - Sale of noxious food or drink
274 - Adulteration of drugs
275 - Sale of adulterated drugs
276 - Sale of drug as a different drug or preparation
277 - Fouling water of public spring or reservoir
278 - Making atmosphere noxious to health
279 - Rash driving or riding on a public way
280 - Rash navigation of vessel
281 - Exhibition of false light, mark or buoy
299 - Culpable homicide
300 - Murder
301 - Culpable homicide by causing death of person other than person whose death was intended
302 - Punishment for murder
303 - Punishment for murder by life convict
304 - Punishment for culpable homicide not amounting to murder, 304A - Causing death by negligence, 304B - Dowery death
305 - Abetment of suicide of child or insane person
306 - Abetment of suicide
307 - Attempt to murder
308 - Attempt to commit culpable homicide
309 - Not Applicable as per latest hearing
310 - Thug
311 - Punishment
312 - Causing miscarriage
313 - Causing miscarriage without woman's consent
314 - Death caused by act done with intent to cause miscarriage
315 - Act done with intent to prevent child being born alive or to cause it to die after birth
316 - Causing death of quick unborn child by act amounting to culpable homicide
317 - Exposure and abandonment of child under twelve years, by parent or person having care of it
318 - Concealment of birth by secret disposal of dead body
319 - Hurt
320 - Grievous hurt
321 - Voluntarily causing hurt
322 - Voluntarily causing grievous hurt
323 - Punishment for voluntarily causing hurt
324 - Voluntarily causing hurt by dangerous weapons or means
325 - Punishment for voluntarily causing grievous hurt
326 - Voluntarily causing grievous hurt by dangerous weapons or means 326A - Voluntarily causing hurt by use of acid,etc. 326B - Voluntarily throwing or attempting to throw acid
327 - Voluntarily causing hurt to extort property, or to constrain to an illegal act
328 - Causing hurt by means of poison, etc. with intent to commit an offence
329 - Voluntarily causing grievous hurt to extort property, or to constrain to an illegal act
330 - Voluntarily causing hurt to extort confession, or to compel restoration of property
331 - Voluntarily causing grievous hurt to extort confession, or to compel restoration of property
332 - Voluntarily causing hurt to deter public servant from his duty
333 - Voluntarily causing grievous hurt to deter public servant from his duty
334 - Voluntarily causing hurt on provocation
335 - Voluntarily causing grievous hurt on provocation
336 - Act endangering life or personal safety of others
337 - Causing hurt by act endangering life or personal safety of others
338 - Causing grievous hurt by act endangering life or personal safety of others
339 - Wrongful restraint
340 - Wrongful confinement
341 - Punishment for wrongful restraint
342 - Punishment for wrongful confinement
343 - Wrongful confinement for three or more days
344 - Wrongful confinement for ten or more days
345 - Wrongful confinement of person for whose liberation writ has been issued
346 - Wrongful confinement in secret
347 - Wrongful confinement to extort property, or constrain to illegal act
348 - Wrongful confinement to extort confession, or compel restoration of property
349 - Force
350 - Criminal force
351 - Assault
352 - Punishment for assault or criminal force otherwise than on grave provocation
353 - Assault or criminal force to deter public servant from discharge of his duty
354 - Assault or criminal force to woman with intent to outrage her modesty, 354A - Sexual Harassment and punishment for sexual harassment, 354B - Assault or use of Criminal force to woman with intent to disrobe, 354C - Voyeurism, 354D - Stalking
355 - Assault or criminal force with intent to dishonour person, otherwise than on grave provocation
356 - Assault or criminal force in attempt to commit theft of property carried by a person
357 - Assault or criminal force in attempt wrongfully to confine a person
358 - Assault or criminal force on grave provocation
359 - Kidnapping
360 - Kidnapping from India
361 - Kidnapping from lawful guardianship
362 - Abduction
363 - Punishment for kidnapping, 363A - Kidnapping or maiming a minor for purposes of begging
364 - Kidnapping or abducting in order to murder, 364A - Kidnapping for ransom, etc.
365 - Kidnapping or abducting with intent secretly and wrongfully to confine person
366 - Kidnapping, abducting or inducing woman to compel her marriage, etc., 366A - Procuration of minor girl, 366B - Importation of girl from foreign country
367 - Kidnapping or abducting in order to subject person to grievous hurt, slavery, etc.
368 - Wrongfully concealing or keeping in confinement, kidnapped or abducted person
369 - Kidnapping or abducting child under ten years with intent to steal from its person
370 - Trafficking in persons, 370A - Exploitation of a trafficked person
371 - Habitual dealing in slave
372 - Selling minor for purposes of prostitution, etc.
373 - Buying minor for purposes of prostitution, etc.
374 - Unlawful compulsory labour
375 - Rape
376 - Punishment for rape, 376A - Punishment for causing death or resulting in persistent vegetative state of victim, 376B - Sexual Intercourse by a man with his wife during separation, 376C - Sexual Intercourse by a person in authority, 376D - Gang Rape, Intercourse by any member of the management or staff of a hospital with any woman in that hospital, 376E - Punishment for repeat offenders
377 - Unnatural offences
493 - Cohabitation caused by a man deceitfully inducing a belief of lawful marriage
494 - Marrying again during lifetime of husband or wife
495 - Same offence with concealment of former marriage from person with whom subsequent marriage is contracted
496 - Marriage ceremony fraudulently gone through without lawful marriage
497 - Adultery
498 - Enticing or taking away or detaining with criminal intent a married woman
503 - Criminal intimidation
504 - Intentional insult with intent to provoke breach of the peace
505 - Statements conducing to public mischief
506 - Punishment for criminal intimidation
507 - Criminal intimidation by an anonymous communication
508 - Act caused by inducing person to believe that he will be rendered an object of the Divine displeasure
509 - Word, gesture or act intended to insult the modesty of a woman
510 - Misconduct in public by a drunken person
Wednesday, 17 February 2016
Death Stages
The seven stages of death
1. Pallor Mortis - post mortem paleness which happens in those with light/white skin almost instantly (in the 15–25 minutes after the death) because of a lack of capillary circulation throughout the body.
2. Algor mortis - reduction in body temperature following death. This is generally a steady decline until matching ambient temperature. The Glaister equation estimates the hours elapsed since death as a linear function of the rectal temperature: (98.4°F - rectal temperature in Fahrenheit)/1.5
3. Rigor mortis - one of the recognizable signs of death, caused by chemical changes in the muscles after death, causing the limbs of the corpse to become stiff and difficult to move or manipulate.
In humans, it commences after about three to four hours, reaches maximum stiffness after 12 hours, and gradually dissipates until approximately 48 to 60 hours after death.
4. Livor mortis - settling of the blood in the lower (dependent) portion of the body, causing a purplish red discoloration of the skin. When the heart stops functioning and is no longer agitating the blood, heavy red blood cells sink through the serum by action of gravity. It starts twenty minutes after death and reaches its maximum within 6-12 hours.
5. Putrefaction - decomposition of proteins in a process that results in the eventual breakdown of cohesion between tissues and the liquefaction of most organs. The exact rate of putrefaction is dependent upon many factors such as weather, exposure and location. Thus, refrigeration at a morgue or funeral home can retard the process, allowing for burial in three days or so following death without embalming. The rate increases dramatically in tropical climates.
6. Decomposition - process by which organic substances are broken down into simpler forms of matter. Various sciences study the decomposition of bodies under the general rubric of forensics because the usual motive for such studies is to determine the time and cause of death for legal purposes.
7. Skeletonization - the last vestiges of the soft tissues of a corpse or carcass have decayed or dried to the point that the bones of the skeleton are exposed. By the end of the skeletonization process, all soft tissue will have been eliminated, leaving only disarticulated bones....
By Dr. Piya Gupta