Hut wet yet now 5_6307526513491185527.pptx

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1. 3 year old male child Solomon brought by her grandmother to the OPD with chief complaints of . fever for 2 days . Swelling on both sides of jaw for 5 days . Lethargy for 2 days . Cough and cold for 4 days

2. History of presenting illness . Fever for 2 days low grade , intermittent , not associated with chills and rigor, not associated with cough and cold ,no diurnal variation . H/o cough and cold for 4 days . No h/o running nose . No h/o nasal obstruction . No h/o abdominal pain . No h/o loose stools . No h/o seizure attack . No h/o ear discharge . No h/o ear pain . No h/o urinary incontinence

3. H/o both sides of jaw swelling initially small in size and then suddenly increased within 1 days H/o lethargy for 2 days Past history : no h/o similar complaints in the past Family history : Antenatal history : Natal history : Full term , normal delivery, weight 3.5 kg, baby engaged at birth Postnatal history : no h/o NICU admission Diet history: exclusive breast feeding up to 6 months then complimentary feeds Immunisation history : Birth and 45 days vaccine given , no other vaccines given

4. On Examination Lethargic, afebrile Pallor present No icterus No cyanosis No clubbing No lymphadenopathy No pedal edema Dehydration present INSPECTION Skin peeling present over anterior aspect of neck Ulcer present over right foot medial aspect with surrounding skin peeling

5. Systemic Examination CVS - S1 S2 Heard , no murmur Heart rate - 46 / min Peripheries cold , BP87/37 Rs - BAE present RR 36 / min Abdomen- soft liver span 6 cm Cns - tone normal

6. Course Day 1 - Day 2 9.15 pm - child went into sudden arrest HR 10 /min spO2 20% - CPR initiated & bag and mask ventilation started - child intubated with 4 size uncuffed ETtube - inj adrenaline 1,00,000 dilution 1st dose given - after 3rd dose of adrenaline , no improvement in heart rate - HR nil , sp02 nil - bilateral pupils dilated - despite all the efforts child could not be revived and declared dead at 9.45 pm

7. Cause of death Complete heart block / shock Diagnosis A case of diphtheria