Doctors and government to be alert to avoid Gorakhpur type of incidents

Gorakhpur update:
1. IMA committee (Dr KP Kushwaha Expert, Dr Ashok Aggarwal NVP IMA and Dr BB Gupta IMA Gorakhpur President) to investigate the matter and submit report in 48 hours Oxygen therapy
2. Was it an oxygen system failure. Continuous reserve Oxygen supply must be available for atleast seven days. Why was the alarm not given a week back. Why ws oxygen supply allowed to cease. What were the engineers doing during this period?
3. Was there any medical negligence in treatments. Were the deaths medically avoidable.
4. Administrative negligence vs medical negligence.
Entry level NABH accreditation requirements for oxygen supply ( minimum standards)
- Medical gas and vacuum installations shall be maintained as per protocol.
- Daily, weekly, monthly and annual maintenance schedule, records of maintenance
- Daily check (Line pressure, heater coil, cylinder stock)
- To ensure that there is safe and continuous supply of medical gases and vacuum for the patients in the wards, ICUs, OTs.
- Medical gases form the very backbone of an SHCO. Without them it would be impossible to run a healthcare organization, as they play an essential role in the functioning of critical care units and key operational areas.
- It is recommended that: Medical gas installations are constructed as per norms and licenses obtained for Liquid Medical Oxygen (LMO) as per requirements.
- Strict safety requirements as per the norms are followed.
- Trained medical gas operators or technicians be available in the case of central supply and continuous supply.
- Maintenance should be done regularly as per requirements.
- Uniform colour coding of medical gas pipelines.
Encephalitis guidelines
1. Encephalitis is inflammation of the brain parenchyma, manifest by neurologic dysfunction (altered mental status, behavior, or personality; motor or sensory deficits; speech or movement disorders; seizure)
2. Normally reported rates of paediatric encephalitis-related hospitalization range from 3 to 13 admissions per 100,000 children per year. The incidence is highest among infants <1 year. In many cases of encephalitis, the etiology remains unknown despite extensive evaluation. Viruses are the most commonly identified infectious causes of encephalitis. Other infectious causes include bacteria, fungi, and parasites
3. Potential complications include status epilepticus, cerebral edema, fluid and electrolyte disturbance, and cardiorespiratory failure. Patients with severe encephalitis (ie, those with seizures, cardiorespiratory compromise, coma, or severe neurologic compromise) should be cared for in an intensive care unit with close cardiorespiratory monitoring and careful attention to neurologic status, fluid balance, and electrolyte status
4. The prognosis of viral encephalitis ( 5% of cases) varies depending upon the age of the patient, neurologic findings at the time of presentation, and the pathogen. The overall risk of death in childhood encephalitis ranges from 0 to 7 percent; however, the risk is increased with specific pathogens (eg, in herpes simplex encephalitis and eastern equine encephalitis). Long-term neurologic sequelae are common.
5. Survivors of childhood encephalitis should be monitored for long-term sequelae.
6. Scrub typhus encephalitis: Curable with doxycycline or erythromycin if diagnosed early. Look for fever, rash, local black eschar in the legs with enlarged, lymph nodes.
7. Japanese encephalitis: only 5% of all encephalitis like illness. Mortality 20% in the best of the centers. Preventable by vaccination.
8. Herpes simplex encephalitis: can be diagnosed due to temporal lobe localisation and is manageable with anti virals.
9. Lichi encephalitis is manageable with intra venous glucose.
10. The therapeutic options for serious enterovirus infections are limited. Intravenous immunoglobulin (IVIG) is often administered despite a lack of convincing evidence for efficacy.
11. Treat all children who present with suspected encephalitis with acyclovir pending viral studies
12. Empiric treatment for bacterial meningitis pending bacterial cultures also may be warranted if bacterial meningitis cannot be excluded.
13. Empiric treatment with doxycycline or erythromycin should be given till scrub typhus is ruled out
14. Prevention strategies include hand hygiene, appropriate management of pregnant women with active herpes simplex virus lesions, routine childhood immunizations, JE Vaccine, traveling immunizations, and insect control and avoidance measures. Control of culex mosquito.
15. All children who are hospitalized with encephalitis should be placed on airborne, droplet, and contact precautions at the time of admission, pending identification of a pathogen
Vendor payments: All payments to vendors should be given as advance or in time.
(Dr KK Aggarwal National President IMA)
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