Neonatal Resuscitation

Following is the algorithm in use for neonatal resuscitation:

Birth

•Clear of meconium?
•Breathing or crying?
•Good muscle tone?
•Colour pink?
•Term gestation?

Yes - Routine care [Provide warmth, Clear airway and dry]
No -

•Provide warmth
•Position, clear airway
•Dry, stimulate, reposition
•Give oxygen
Evaluate respirations, heart rate and colour.

If breathing, HR>100 and Pink, give supportive care.
If there is apnoea or HR<100

•Provide positive pressure ventilation

If ventilating, HR>100 and Pink, give supportive care.

If HR<60:

•Provide positive pressure ventilation

•Administer chest compressions 

If after this HR>60, go back to previous step (provide PPV).
If HR<60, administer epinephrine.

Malignant Glaucoma

Definition

Malignant glaucoma is characterised by a shallow anterior chamber associated with raise intraocular pressure and in the presence of a patent iridotomy. The condition usually follows intraocular surgery but has also been described following laser iridotomy and has even been associated with miotic therapy.

Mechanism

It is probably due to misdirection of the ciliary processes into or around the vitreous.

Anterior displacement of the lens iris diaphragm causes a shallow anterior chamber.

Diagnosis

1. Shallow anterior chamber with raised or normal IOP after a intraocular surgery.
2. Ultrasound biomicroscopy

Differential Diagnosis

1. Intumescent lens
   
2. Choroidal neoplasm
3. Central retinal vein occlusion
4. Secondary pupil block
   

Stapedectomy

It is a surgical procedure in which the stapes is removed and replaced with a prosthesis, a piston usually made of teflon/stainless steel/gold. Its a mode of treatment for otosclerosis (otospongiosis). Another procedure, stapedotomy is done sometimes (a hole is punched into the footplate of stapes and the implant fixed there).

Indications

1. Conductive deafness due to fixation of stapes.
   
2. Air bone gap of at least 40 dB.
   
3. Presence of Carhart's notch in the audiogram of a patient with conductive deafness.
   
4. Good cochlear reserve as assessed by the presence of good speech discrimination.
   

Contraindications

1. Poor general condition of the patient.
   
2. Only hearing ear.
   
3. Poor cochlear reserve as shown by poor speech discrimination scores
   
4. Patient with tinnitus and vertigo
   
5. Presence of active otosclerotic foci (otospongiosis) as evidenced by a positive flemmingo sign.
   
6. Conductive deafness due to Ehlers-Danlos Syndrome (EDS)
   

Complications

1. Facial palsy
   
2. Vertigo in the immediate post op period
   
3. Vomiting
4. Perilymph gush
5. Floating foot plate
6. Tympanic membrane tear
7. Dead labyrinth
8. Perilymph fistula
9. Labyrinthitis
10. Granuloma (Reparative)

Chronic Pharyngitis

Definition

It is a chronic inflammatory condition of the pharynx characterised by hypertrophy of the mucosa, seromucinous glands and sub epithilial lymphoid follicles.

2 types

1. Chronic catarrhal pharyngitis
2. Chronic hypertrophic (granular) pharyngitis

Aetiology

1. Prolonged/Repeated infections
2. Mouth breathing (due to any reason)
3. Chronic irritants (Eg. tobbacco chewing, ciggarettes etc)
4. Faulty voice production.
5. Environmental pollution.

Clinical Features

Symptoms

1. Pain in throat
2. Foriegn body sensation in throat
3. Tiredness of voice
4. Cough

Signs

1. Congestion of posterior pharyngeal wall, which may have red nodules. (Chronic hypertrophic/granular pharyngitis)
2. Hypertrophy of lateral pharyngeal bands.
3. Increased mucous secretions may cover the mucosa.

Treatment

1. Identification of cause and its correction.
2. Warm saline gargles.
3. Mandl's throat paint is useful in preventing secondary infections.
4. Cautery of lymphoid granules.

Glaucoma Surgeries

1. Canaloplasty
2. Laser trabeculoplasty
3. Nd:YAG Laser peripheral iridotomy
   
4. Diode laser cycloablation
5. Trabeculectomy
   
6. Glaucoma drainage implants