6 Case of the day - 28/8/18

Bex 28/8/18

Rohinga -

8yo girl. malaises, sweats and fever, poor appetite. Refusing fluids and food, Pain in her neck (front of neck)

Irritable, drooling No lymphadenopathy Unable to see oropharynx.

HR 125, Cool peripheries.

Secondary care is in a hospital in a buddhist run city.

1 What is diagnosis 2 What are 3 cardinal features of condition 3 What clinical sign in the video

Opisthotinus - She had tetanus

Trismus - muscles of mastication, fifth nerves ?Reesus sardonicus - that fixed grin Opisthotinus

Autonomic Instability (HR instability, BP instability (up and down))

There is a sign of tetanus called the spatula sign! Spatula triggering oropharyngeal spasm

Some rodent baits - contain strychnine - can cause similar spasms

Ask tetanus about vaccination status!

Remember tetanus in your differential of a child presenting with dysphagia

These patients will get triggered by noise and bouncing.