Dr.Hithaishini

MBBS || MD Paediatrics || FDM || PGPN(Boston)

[Dr.Hithaishini @HITHAISHINI10]

Imagine a life where no one judges, where hearts accept as gently as they breathe... a world free of jealousy, pride, selfishness, hate, greed - only kindness, loyalty, and hands reaching for one another & rising together. What a beautiful place that would have been….

[Oren Gottfried, MD @OGdukeneurosurg]

They are both bad, but one is worse.

[Ahmed @AB_drmd]

🚨🚨🚨 مريض يعاني من إمساك. وش العلاقة؟ وش العلامة السريرية، والتشخيص؟

[Dr sthanu subramanian @drsthanus]

The clinical pathway and risks associated with Refeeding Syndrome, a dangerous metabolic complication that arises when nutrition is reintroduced too quickly after prolonged starvation.

https://t.co/pAgBxMmU1p

[CardiovascularCorner @TrackYourHeart]

Trauma years ago. Chronic cough now.
A bulge that comes and goes with breathing… explain this

[Oren Gottfried, MD @OGdukeneurosurg]

What’s going on? What is the difference between the left and right one?

[world paradise @worldparadiseX]

Would you guess the location without Googling?

[nervemed @nervemed]

Important Heart Xrays

[Power of Positivity @LIVEpositivity]

Yes! Claiming this today 🙏

[Dr.Hithaishini @HITHAISHINI10]

#HAEMORRHAGIC DISEASE OF NEWBORN (HDN)

[Dr.Hithaishini @HITHAISHINI10]

#Asthma

[Oren Gottfried, MD @OGdukeneurosurg]

Bye bye stroke

[Dr. Nikhil @DrNikhilMD]

2️⃣ What exactly is a hiccup?

• Sudden involuntary contraction of diaphragm + intercostals
• ~35 milliseconds later → abrupt glottic closure
• Produces the “hic” sound

[Dr. Nikhil @DrNikhilMD]

3️⃣ Clinical classification (very high yield)

• Acute <48 hours → benign
• Persistent >48 hours to 1 month → evaluate
• Intractable >1 month → organic pathology likely

👉 Duration decides urgency.

[Dr. Nikhil @DrNikhilMD]

4️⃣ Core mechanism

Reflex arc:

• Afferent → vagus, phrenic, sympathetic
• Central → brainstem + C3–C5
• Efferent → phrenic nerve → diaphragm

Neurotransmitters:

• GABA, dopamine, serotonin

Physiology:

• ↓ CO₂ → worsens hiccups
• ↑ CO₂ → suppresses hiccups

👉 Explains causes and treatment.

[Dr. Nikhil @DrNikhilMD]

6️⃣ Chronic hiccups → think SYSTEM

Mnemonic: HICCUPS

• Head → stroke, tumor, MS, meningitis
• Irritation → ear, lung, mediastinum
• Cardiac → MI, pericarditis
• Chemistry → uremia, electrolytes, alkalosis
• UGI → GERD, PUD, pancreatitis
• Psychogenic
• Substances → alcohol, dexamethasone, drugs

[Dr. Nikhil @DrNikhilMD]

🔟 Investigations (stepwise)

Tier 1:

• Electrolytes, Ca²⁺, renal function
• LFT, CBC

Tier 2:

• ECG
• Chest X ray
• ABG

Tier 3:

• CT brain/chest/abdomen
• Endoscopy
• Lumbar puncture

[Dr. Nikhil @DrNikhilMD]

1️⃣1️⃣ Management Step 1: Home remedies

Usually effective in acute hiccups:

• Breath holding
• Valsalva manoeuvre
How to do it:
Take a deep breath → close mouth + pinch nose → bear down like defecation for 10–15 sec → repeat 2–3 times
• Breathing into a paper bag
• Pulling on the tongue
• Sneezing
• Swallowing 1 tsp sugar
• Sipping iced water
• Knees to chest (diaphragm compression)
• Drinking water while closing nose and ears
• Sudden fright

👉 Aim: increase CO₂ or interrupt reflex arc

[Dr. Nikhil @DrNikhilMD]

1️⃣2️⃣ Management Step 2: Physical maneuvers + treat cause

Interrupt reflex arc:

• Nasopharyngeal stimulation (finger/catheter/swab)
• Lifting uvula
• Smelling salts to induce gasp

Second-line:

• Carotid sinus massage ⚠️
• Supraorbital pressure
• Phrenic nerve compression at neck
• Thyroid cartilage compression

Other:

• NG tube aspiration
• Auditory canal manipulation
• Rare: rectal massage

Treat cause:

• GERD → PPI
• Correct electrolytes
• Stop offending drugs
• Remove ear irritant

⚠️ Risk: bradycardia, local injury

[Dr. Nikhil @DrNikhilMD]

1️⃣4️⃣ Management Step 4: Surgical / invasive

• Phrenic nerve block
• Phrenic nerve transection

⚠️ Risk: severe pulmonary impairment
👉 Only for refractory cases