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Dr.Abdulmateen A. Shukri
juestion 1:
What do you
think about
this patient
who is HIV
pos., there is
exertional
dyspnea and
dry cough?
 Answer: Pneumocystic carinii
pneumonia
Ä CXR shows diffuse interestitial disease in a pt
who have AIDS with low CD4+ count.

Ä Treatment is with TMP-SMX

If not improved , add steroids.
 PCP
Transbronchial biopsy is not necessary
in most cases.
 PCP
Ä If desensitized then add alternatives.
Ä Add alternative regimens
Clindamycin + Primaquine
 Case ͙
Ä A 24 year-old man is brought to the DMAT
Ä by paramedics. The patient has pin-point
Ä pupils, and is comatose. The patient has
Ä minimal bowel sounds and respiratory
Ä depression.
Ä HR 60 BP 82/42 RR 4 T 94.6
Ä The patient͛s pupils dilated to 4 mm, but his
Ä respiratory effort did not improve after a 2
Ä mg naloxone bolus given by paramedics.
 In this Case
Ä DIAGNOSIS of OVERDOSE
Ä VITAL SIGNS
Ä ʹ Blood Pressure
Ä ʹ Pulse
Ä ʹ Respiratory Rate
Ä ʹ Temperature
Ä CLINICAL FINDINGS
Ä ʹ CNS Depression
Ä ʹ Miotic pupils
Ä ʹ Track marks
Ä ʹ Depressed bowel sounds
 Another Case ͙
A previously healthy 15-year-old boy has cramping periumbilical pain;
after several hours, the pain shifts to the right lower quadrant and
becomes constant. He vomits several times and is brought to the
emergency department. The abdomen is tender on deep palpation of
the right lower quadrant. Findings on chest and abdominal x-ray films
are normal. Leukocyte count is 15,000/mm3. Urinalysis shows 3
leukocytes/hpf. Which of the following is the most appropriate initial
management?

A. Supportive treatment at home; return at once if the pain increases

B. Barium enema
C. CT scan of the abdomen
D. Intravenous pyelography and cystography
E. Surgical exploration of the abdomen
Ä Answer:
E.
 Image 2: This
Child is a victim
of RTA with
fracture of
femur. How do
treat him?
Ä îMost children with fractures of the femur
have a satisfactory outcome with any
reasonable form of treatment.͟
Ä Decision making:Age
Ä Mechanism of injury
Ä Fracture pattern & location
Ä Associated Injuries
Ä Surgeon preference
 Pediatric Femoral Fracture Treatment
Ä Immediate or Early Spica Cast-
ideal patient

Ä Less than 5 years old

Ä Less than 50 lbs
Ä Initial shortening not excessive
Ä Isolated injury

Ä Note -Spica casts used for decades and can work

for almost any pediatric femur fracture
Fiberglass lighter,
easier to x-ray
through
Often strong
enough to obviate
need for
connecting bar
Compartment Syndrome complicating
after treatment with cast spica