Dr Muhammad Sajjad

24/05/2026

Osborn’s wave , Hypothermia

22/05/2026

Management of Heat Stroke
Heat stroke is a medical emergency with:
Core temperature usually >40°C
CNS dysfunction:
Confusion
Delirium
Seizures
Coma
Mortality increases if cooling is delayed.
Initial ABC Approach
Airway
Assess airway protection
Intubate if:
GCS low
Recurrent seizures
Respiratory failure
Breathing
Oxygen if hypoxic
Monitor saturation
Circulation
IV access
Cardiac monitoring
BP monitoring
Rapid Cooling — Most Important Step
Target core temp:
Reduce to 38–39°C
Preferred Cooling Methods
Exertional Heat Stroke
Best:
Cold water immersion
Classical Heat Stroke
Use:
Evaporative cooling
Spray lukewarm water
Fan air circulation
Adjuncts
Ice packs:
Neck
Axillae
Groin
Fluid Therapy
Fluid of choice:
�
Start IV normal saline
Typical initial bolus:
500–1000 mL
Then reassess:
BP
Urine output
Electrolytes
Cardiac status
Avoid fluid overload.
Investigations
CBC
RFTs
LFTs
Electrolytes
CK level (rhabdomyolysis)
ABGs
ECG
Urinalysis
Manage Complications
Seizures
Benzodiazepines:
Diazepam
Lorazepam
Rhabdomyolysis
Aggressive IV fluids
Monitor renal function
Hypoglycemia
IV dextrose if needed
Electrolyte imbalance
Correct sodium/potassium abnormalities
DIC / Organ Failure
ICU management
Drugs NOT Useful
Avoid:
Paracetamol
NSAIDs
They do not help because heat stroke is not hypothalamic fever.
Monitoring
Continuous temperature monitoring
Urine output
Mental status
ECG
Renal function
Admission Criteria
Most patients require:
Emergency department observation
High dependency or ICU care if severe
Especially if:
Altered consciousness
Organ dysfunction
Persistent hyperthermia
Hypotension
Seizures

20/05/2026

Hand, Foot and Mouth Disease (HFMD) — Management
HFMD is a self-limiting viral illness, most commonly caused by Coxsackievirus A16 and Enterovirus 71. Management is mainly supportive, focused on hydration, pain control, and prevention of complications.
1. General Principles
No specific antiviral therapy in routine cases
Disease usually resolves in 7–10 days
Main goal: prevent dehydration + control fever/pain
2. Symptomatic Treatment
Fever & Pain
Paracetamol (Acetaminophen) first line
Ibuprofen if needed (if child >6 months and well hydrated)
Avoid aspirin in children (Reye syndrome risk).
Oral Lesions (painful ulcers)
Supportive care:
Cold fluids (milk, ORS, ice pops)
Soft, non-spicy diet
Topical/oral options (selected cases):
Oral lidocaine gels (very limited use in children)
Diphenhydramine + antacid “magic mouthwash” (older children/adults only)
Chlorhexidine mouth rinse (older children)
⚠️ Avoid overuse of topical anesthetics in small children (risk of toxicity/aspiration).
3. Hydration Management (most important)
Assess for dehydration:
Reduced urine output
Dry mucosa
Lethargy
If mild:
Oral fluids (ORS, milk, soups)
If moderate/severe:
IV fluids (normal saline or Ringer lactate)
4. Skin Lesions (hands/feet/buttocks)
Usually no treatment required
Keep skin clean and dry
Calamine lotion for itching
Avoid rupture of vesicles (prevents secondary infection)
5. Antibiotics?
❌ Not indicated unless there is:
Secondary bacterial infection (rare)
6. Severe / Complicated HFMD
Hospitalize if:
Persistent vomiting
Dehydration
Neurological signs (irritability, seizures)
Suspected Enterovirus 71 CNS involvement
Management:
IV fluids
Monitoring electrolytes
Supportive ICU care if severe encephalitis
7. Isolation & Prevention
Child should stay home until:
Fever resolves AND
Oral intake improves AND
Lesions dry
Prevent spread:
Hand hygiene (soap/water)
Avoid sharing utensils
Disinfection of toys/surfaces
8. Key Clinical Takeaway
HFMD is usually benign, but:
Dehydration is the main complication
Neurological involvement (EV71) is the danger sign

20/05/2026

Nevus comedonicus
Nevus comedonicus is a rare benign hamartomatous disorder of the pilosebaceous unit characterized by grouped dilated follicular openings filled with keratin plugs resembling blackheads. Management depends on:
Extent of lesions
Presence of inflammation/infection
Cosmetic concern
Associated nevus comedonicus syndrome
Clinical Types
Non-inflammatory type
Mainly comedone-like lesions.
Inflammatory type
Recurrent cysts, abscesses, sinus tracts, scarring.
Conservative / Medical Management
Topical Keratolytics
Useful in mild localized disease:
Tretinoin 0.025–0.1%
Adapalene
Tazarotene (often more effective)
Salicylic acid 2–6%
Ammonium lactate 12%
Urea creams
These help reduce keratin plugging but usually do not cure the lesion. �
NCBI +2
Anti-inflammatory Therapy
If inflamed:
Topical corticosteroids
Oral antibiotics for secondary infection:
doxycycline
clindamycin
cephalexin depending on severity
Intralesional triamcinolone for nodules/cysts
Combination therapy with topical retinoids + mild steroid may improve outcomes. �
Springer +1
Oral Retinoids
Isotretinoin
May help inflammatory/systematized variants but response is often incomplete.
Typical dose:
0.3–0.5 mg/kg/day initially
Relapse after stopping is common. �
Springer +1
Procedural Management
Comedone Extraction
Temporary cosmetic improvement only.
Lesions tend to recur because the abnormal follicular structure remains. Aggressive squeezing can cause inflammation and scarring. Community discussions also note that plugs are often hard keratin rather than ordinary acne material. �
Reddit +1
Laser Therapy
Useful for cosmetic improvement:
CO₂ laser
Er:YAG laser
Can reduce lesions with better cosmetic outcome in selected patients. �
NCBI +1
Surgical Excision
Most definitive treatment for localized lesions.
Indications:
Extensive scarring
Recurrent abscesses
Severe cosmetic disfigurement
Refractory disease
Small lesions:
complete excision with primary closure
Large lesions:
staged excision
graft/flap reconstruction may be needed
�
Springer
Suggested Practical Approach
Severity
Management
Mild localized
topical retinoid + salicylic acid
Mild inflammatory
add topical/oral antibiotics
Recurrent cystic disease
isotretinoin ± laser
Localized resistant lesion
surgical excision
Extensive cosmetically disturbing disease
CO₂/Er:YAG laser or staged surgery
Important Associations
Evaluate for Nevus Comedonicus Syndrome if there are:
Skeletal abnormalities
Eye defects
CNS symptoms/seizures
Developmental delay
Especially in extensive or childhood-onset disease. �

18/05/2026

Cazal necklace sign for dd mainly v.B3 deficiency 3d
Dementia
Diarrhea
Dermatitis ..
Cazal necklace sign for dd as
Pellegra
Carcinoid
Photosensitivity

14/05/2026

Ceftriaxone can cause a well-known reversible biliary phenomenon called biliary sludge or pseudolithiasis (“false gallstones”).
Gallbladder changes seen with ceftriaxone
Biliary sludge
Echogenic precipitates in gallbladder
Apparent gallstones on ultrasound
Gallbladder wall thickening occasionally
Rarely acute cholecystitis or biliary colic
Why it happens
Ceftriaxone is excreted partly through bile and can bind with calcium in bile, forming precipitates that appear like stones/sludge on ultrasound.
Risk factors
More common with:
High-dose ceftriaxone
Prolonged therapy
Dehydration
Fasting/NPO state
Renal impairment
Children (but adults can also develop it)
Clinical presentation
Many patients are asymptomatic. Symptomatic patients may develop:
Right upper quadrant pain
Nausea/vomiting
Fever (if complicated)
Mild cholestatic LFT derangement
Ultrasound findings
Typical USG findings:
Mobile echogenic material/sludge
Stone-like shadows appearing after starting ceftriaxone
Usually absence of true chronic gallstone disease features
Management
Often resolves spontaneously after stopping ceftriaxone
Hydration and symptomatic care
Switch antibiotic if clinically needed
Surgery usually not required unless true complications occur
Important distinction
This is called ceftriaxone pseudolithiasis because the “stones” often disappear within days to weeks after discontinuation of therapy.

11/05/2026

Bruton lines "deposition of lead in gums"
Due to "Lead poisoning"

11/05/2026

Air fluids level in cavitatorry lesion in right lung __
Right Lung Abscess

10/05/2026

Molluscum contagiosum
Umbilicated papules

09/05/2026

09/05/2026

Bamboo spine ankylosing spondylitis