You also shouldn't give
Ceftriaxone & calcium products simultaneously or in the same IV line (especially for pediatric patients, even more especially for neonates). The calcium will crystalize and accumulate particularly in the lungs and kidneys. Guidelines differ, but it's safest to wait for about 48 hours before giving the other substance.
Ceftriaxone & calcium products simultaneously or in the same IV line (especially for pediatric patients, even more especially for neonates). The calcium will crystalize and accumulate particularly in the lungs and kidneys. Guidelines differ, but it's safest to wait for about 48 hours before giving the other substance.
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Untreated septic arthritis, which lead to destruction of the joint and bones
Ironically, the patient has a club foot deformity in the other foot, so he practically lost his ability to walk by now.
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This one was taken two months ago
This one was taken a few days ago, notice the bat wing sign of pulmonary edema
PNES: Psychogenic Non-Epileptic Seizure, also known as pseudo-seizure
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pseudo-seizure
Tongue biting is usually lateral in real seizures, but medial in PNES
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Photo
Video-EEG monitoring is the “gold standard’’ for diagnosis of PNES. This is in contrast to other psychogenic symptoms, which are almost always a diagnosis of exclusion.
PNES should be suspected in all patients with frequent seizures despite taking medications. The combined electroclinical analysis of the clinical semiology being clearly incompatible with epileptic seizures and the ictal EEG being normal allow a definitive diagnosis in the vast majority of cases. Limitations of video-EEG monitoring include the fact that ictal EEG may be negative in some partial seizures or uninterpretable if movements generate excessive artifact.
PNES should be suspected in all patients with frequent seizures despite taking medications. The combined electroclinical analysis of the clinical semiology being clearly incompatible with epileptic seizures and the ictal EEG being normal allow a definitive diagnosis in the vast majority of cases. Limitations of video-EEG monitoring include the fact that ictal EEG may be negative in some partial seizures or uninterpretable if movements generate excessive artifact.
Semiology of PNES include persistent eye closure at the onset of the attack, gradual onset; side-to-side head movements; pelvic thrusting; opisthotonic posturing; stuttering; weeping; pseudosleep; discontinuous (stop and go), irregular, or asynchronous (out of phase) activity; and gradual onset or termination.
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The gaze in seizure (temporal vs extratemporal), syncope, and in PNES
Any seizure with eyes closed at the onset of the attack should raise suspicion for a psychogenic seizure. PNES are identified by the typical eye closure from the beginning and the long duration of the event, typically over 5 minutes, which are both very rare in epileptic seizures or syncope. Although closed eyes are typical for PNES, observing open eyes is not a reliable indicator for epileptic seizures. In fact, an upward gaze is often seen in patients having a syncopal episode.
Reflex seizure is a weird type of seizure where the patient will consistently have seizure every time he is exposed to a stimulus (the seizure becomes, in a way, like a reflex).
Flashing lights are the most common triggers, other triggers include music, reading, orgasm, certain points during the menstrual cycles, touching or moving a particular part of the body, ... etc
Flashing lights are the most common triggers, other triggers include music, reading, orgasm, certain points during the menstrual cycles, touching or moving a particular part of the body, ... etc
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Reflex seizure
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This is a reflex seizure induced by nothing other than changing the baby's diapers
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This is a reflex seizure induced by nothing other than changing the baby's diapers
You can see the change in the baby's facial expressions, a myoclonus of the right arm (0:15) and the tonic seizure in its lower limbs afterwards.