[兒內(nèi)] 學(xué)會處理兒科急癥（[children] to learn to deal with pediatric emergencies）

1、兒內(nèi) 學(xué)會處理兒科急癥（children to learn to deal with pediatric emergencies）children to learn to deal with pediatric emergenciesThe incidence and mortality of childrens infectious diseases decreased significantly, but chronic disease increases gradually, has now reached 10% 20% of all pediatric diseases.The ch

2、ronic disease in children in the incidence of social problems should be 2.5 times higher than that of normal children.Should strengthen the pediatric disease - community doctors (especially severe) sensitivity training, and give timely and proper diagnosis and treatment, rescue or transit, and striv

3、e to avoid misdiagnosis and mistreatment or be inopportune or inappropriate transport.Early recognition of severeMost childrens disease is a common and multiple diseases, such as flu, diarrhea or other most acute infection. The general condition is not serious, a few days can be cured after treatmen

4、t. But some children with serious illness, and lack of specific performance, the younger the symptom is not typical. We should strengthen the early sensitivity to severe disease training community physicians, pay attention to risk signal of serious illness, giving appropriate diagnosis and treatment

5、, rescue or transit, and strive to avoid misdiagnosis and mistreatment or be inopportune or inappropriate transport.Sign 1: the temperature is too high or too lowHigh fever is common in acute infection in children. The infection can be caused by various pathogens fever. Persistent fever, or with low

6、 reaction, listlessness or lethargy and fever after the mental state is still poor, skin and mucous membrane damage, heart, liver and kidney damage or dysfunction, which is a critical condition performance.Low temperature common in cold injury, malnutrition or infection, neonatal or infant body temp

7、erature does not rise.Sign 2: eating or water difficultiesChildren not to eat food, water, often indicates serious illness. The doctor should be asked in detail and on-site observation, children can eat water. In the history and physical examination, the doctor should pay attention to whether childr

8、en with heart lung disease or neurological symptoms associated with severe infection. As a newborn or infant nasal mucosa is very delicate, rich in blood vessels, therefore in the acute inflammation induced when easy hyperemia and edema caused by nasal congestion, nasal secretions or even sticky nos

9、e scab can also lead to eating, when sucking breath and affect eating, so attention should be paid to the differential.3: signs of recurrent or severe vomitingShould pay attention to the times, and vomit vomit characters. If the bile, coffee or bloody vomit, indicating severe illness. Physical exami

10、nation, should pay attention to whether muscle tension, pain and other symptoms of acute abdomen, should also be noted that there is no meningeal irritation, convulsions, consciousness disorders, neuropsychiatric symptoms of increased intracranial pressure higher. Because when the children of centra

11、l nervous system infections or other brain diseases, recurrent or severe vomiting is common.Symptoms 4: convulsionAlso called convulsion seizures or convulsions, often prompts children serious illness. Should pay attention to the patients body temperature, the general condition, state of consciousne

12、ss, neurological signs, particular attention should be given to the presence of intracranial infection or focal brain lesions signs.5 symptoms: disturbance of consciousnessWhen there are different levels of consciousness, that children with serious illness. Early dull eyes showed only to the surroun

13、ding environment to stimulate indifference. The occurrence of coma, it would lose the initiative response to the outside world.Doctors need to pay close attention to the temperature of children, whether accompanied by vomiting, dyspnea, dehydration, acidosis, and accompanied symptoms and signs of th

14、e nervous system. The common symptom of severeRespiratory systemA hoarse voice, dysphonia and wheezing.A wheezing, irritability and tachypnea: infants aged 50 preschool age more than 40 beats / min.The difficulty in breathing: chest, supraclavicular fossa and the intercostal space is depression, thr

15、ee concave syndrome.The cardiac insufficiency: heart rate, pulse count, and enlargement of the liver.The symptoms of infection and systemic cyanosis.The above symptoms in acute laryngitis, airway foreign body, bronchial asthma, severe pneumonia.Digestive systemAfter dehydration, acidosis.A lethargy

16、or coma.The orbital and deep fontanelle.The skin elasticity is poor (skin pinch from 1, after the release of restitution is very slow (2 seconds).A pale, cold acra, hypotension or shock.Can not drink or drink a little, no urine.A deep breath and rhythm is not the whole.The systemic symptoms of infec

17、tion.The above symptoms in severe diarrhea. In the summer season, poisoning symptoms of toxic type bacillary dysentery is often very serious, not parallel to the extent of dehydration.Severe infectionThe high or low temperature.The reaction is low, dull eyes.The convulsions and coma.The tension bulg

18、ing fontanelle.The poisoning symptoms of infection.A visceral dysfunction.The disseminated intravascular coagulation.The skin petechia and ecchymosis.The above symptoms are common in sepsis, meningitis, endocarditis, visceral abscess.acute poisoningDisturbance of consciousness, pediatric sudden unex

19、plained severe convulsions or other unexplained neuropsychiatric symptoms, should pay attention to the possible acute poisoning.The doctor in history, special attention should be paid to inquire about the onset after, without medication, whether exposure to toxic plants, pesticides or chemicals, whe

20、ther the same patients around, and emergency medicine home situation.To determine if the poisoning should be clear, name, quantity, composition, poison ingestion, ingestion of time of onset, the main manifestations and treatment.In the examination, should pay attention to whether the diagnosis with

21、symptoms, such as mental, oral mucosa has no corrosion, pupillary changes, respiration, blood pressure and pulse is regular, there is no abdominal and hepatosplenomegaly, whether limb tremor and muscular paralysis, and detailed records.To improve the prognosis of epilepsyEpilepsy is caused by a vari

22、ety of causes of chronic brain dysfunction syndrome. In the treatment of epilepsy, community doctors should first understand the essence, grasp the important principles of antiepileptic drug treatment:1. after diagnosis treatment as soon as possible. General seizures 2 should start medication.2. rea

23、sonable choice of antiepileptic drugs. Should be selected according to the type of drug seizures or epilepsy syndrome.3. as monotherapy, single drug treatment is ineffective, may be considered for rational combination therapy.4. regular medication, adequate treatment. Reasonable dressing or withdraw

24、al, avoid self adjustable medicine, withdrawal and drug abuse.5. avoid staying up late and drinking.6. of science education. According to the survey, patients with epilepsy in the rural area of our country medical treatment in up to 12% Youyi or shaman. Some parents of children with intractable epil

25、epsy of children lose confidence, give up give up treatment, education and guidance, so that children lost to relieve symptoms and reduce the damage, the opportunity to obtain good outcome. To help parents of children with epilepsy to recognize the features of chronic disease, not because of the att

26、ack in the short term is not under control will lose confidence, noncompliance, frequent for medical dressing. Parents are eager to make the children get radical mentality, so that it can easily listen to cure epilepsy recipe, recipe advertising, rushing around, resulting in huge economic losses, an

27、d even mental collapse.Community doctors should guide residents to get rid of the chronic diseases, epilepsy discrimination attitudes and behavior, to provide children with a good social atmosphere, and encourage children to actively participate in appropriate sports and recreational activities, enh

28、ance childrens social participation ability, shorten the distance between them and the normal children. For the seizure control in children, without strictly prohibited the swimming, riding a bicycle, to prevent hurt their self-esteem. The attack has not yet fully control, can make the group activit

29、ies.The identification of pathological cryingThe physiological causes of crying including hunger urination, defecation, weary, the law of life disorder, clothing or environmental discomfort, teething, unmet demand or desire etc.Including pathological crying: causes rickets, infectious diseases, func

30、tional abdominal pain, vitamin A, D poisoning, headache, etc. Abdominal pain is the common cause of children crying. Screaming pain often prompts.The diagnosis and treatment procedures1. suspected physiologic cry should identify the cause. The common causes of hunger. The urination or defecation. Th

31、e downtown feel. The adorable teeth out. The night.3. suspected pathological crying should clear etiology. The temperature. If you have a fever, accompanied by other symptoms (such as cough, diarrhea, vomiting, etc.) can be considered infectious diseases. The history. Ask the children with no histor

32、y of trauma, there is no lack of vitamin D, there is no history of excessive vitamin D and other drug or poison contact history. The careful examination. Attention to the bone joint with no local swelling, bleeding, there are no signs of focal lesions (such as skin ulcers, eczema, prickly heat, oral

33、 ulcer, thrush, etc.) have listlessness and frequent vomiting or stiff neck, there are no signs of rickets (such as bald, head, skull softening, beaded ribs etc.). The timely referral. For unknown reasons the intense crying need for close observation, especially to closely observe patients complexio

34、n and mental status. If the general condition of patients, should be timely referral.The medical record obviously 6 months of birth, paroxysmal crying. After the age of 1 is more obvious, one night is crying. Get parents fret, seriously affect the life and work.The most common cause of infant crying

35、 case analysis is mostly caused by abdominal pain, intestinal spasm. Research shows that about half of all children with paroxysmal abdominal pain caused by acute and chronic constipation, constipation can be said is the most common etiology of children with acute abdominal pain, paroxysmal crying.

36、Breast fed infants stool generally, soft, easy to discharge. With the increase of age, breast reduction or weaning, add food supplement, many infant constipation, some even intractable constipation.I was born 2 months later due to lack of breast-feeding by mixed feeding, 5 months after complete with

37、 formula feeding. Then obviously reduced stool frequency, dry, often 2 3 days crying half days the stool again.The doctor diagnosed it as constipation caused by constipation after crying, crying ease. The parents to guide the adjustment of the diet, increase green vegetables rich in cellulose, given

38、 the short-term laxative, such as cholac, maintain defecate unobstructed, obviously improve the phenomenon of crying.For severe constipation, may be given special treatment formula. At the same time, the training of daily bowel habits.Treatment of acute feverFever can be divided into low (37.5 to 38

39、 DEG C), moderate fever (38.1 to 39 DEG C), high (39.1 to 40.4 DEG C) and ultra high (greater than 40.5 DEG C). According to the duration of fever was divided into acute fever ( 2 weeks).Acute feverThe etiology of acute fever of children respiratory tract infection, diarrhea, gastroenteritis, laryng

40、itis, pneumonia is the most common cause of common cause.The characteristics of sudden onset, a sore throat, runny nose, cough, nausea, vomiting, diarrhea, etc. Check can be found in lymph nodes and spleen enlargement, and meningeal irritation.Children with fever with rash virus infection, common in

41、 exanthema subitum or measles rubella and varicella.Most of the acute infectious disease not rash. When a rash, the rash should analyze the characteristics, distribution, eruption time (day of fever), associated symptoms and general condition of children, combined with vaccination history and epidem

42、iological features of infectious disease diagnosis etc.1. low moderate fever. Fever is one of the defense function of the body to resist disease, helps the body to remove pathogenic microorganisms, so for low and moderate fever generally do not need special treatment. As long as the general conditio

43、n of the child good eating, or water is basically normal, indicates that the condition is not serious, can be treated at home.Study at home, parents should be every 2 to 5 hours to give children a temperature measured, accompanied by diarrhea to leave fecal specimens and sent to the hospital laborat

44、ory. Avoid giving children cover too thick, to prevent the effects of cooling.2. high fever. The physical cooling. Cold water or ice cold compress bag, alcohol sponge bath, water bath, etc., can be used for early family nursing fever or history of febrile convulsion. The drug cooling. No obvious of

45、heat or by physical cooling effect, the proper use of acetaminophen and Bloven antipyretic. A history of febrile seizures can advance in fever early medication.If sweating, pale, weak and feeble collapse phenomenon etc. after treatment, drinking water should be timely,When necessary to give intraven

46、ous fluids.Children with early viral infection often high fever, after the treatment effect is not ideal or retreat and rise. Attention should be paid to the dosing interval for this type of children, usually 4 to 6 hours before taking medicine again.To master the essentials of treatment of convulsi

47、onThe correct guidance of parentsCommon childhood febrile seizures occur in 2 to 5 years old children with fever, more than early (usually within 12 hours, no more than 24 hours), convulsions temperature rises sharply. After the convulsion, patients are generally in good condition, soon regained con

48、sciousness after the onset, without other neuropsychiatric symptoms.In fact, the vast majority of seizure duration is very short, the medical personnel arrived, the majority has eased. Therefore, correctly guide the treatment of convulsion in the scene to deal with parents of infants and young child

49、ren to master the following Essentials:1. not to rush to the hospital. It may be due to improper handling postural asphyxia, increase the risk of life.The 2. is the convulsions of the children will be flat, head to the side, so as to avoid the inhalation of discharge from the mouth caused by suffoca

50、tion.3. in order to prevent children from aspiration and asphyxia, family or rescuer should always guard on the side, ready to wipe vomit.4. as far as possible not to stimulate the children, not to children forced to fill in any of the items.5. minutes of attack is still not relieved or with a histo

51、ry of convulsive status in patients with a history of taking the above measures, should also help.6. close observation of characteristics of seizures. Because the detailed description for the attack by the method of patient care, do on-site treatment, to maintain smooth breathing, you can make it th

52、rough the attack, to attack after further treatment according to the situation.Treatment of convulsion site1. if the convulsion has eased, community physicians should be asked in detail about the specific performance, seizure duration, consciousness and body condition, there is no accompanying disea

53、ses (such as fever, duration and brain trauma), and detailed records.2. if the long time does not relieve convulsion, can be intravenous or rectal administration of diazepam sedation.3. in the absence of treatment or after treatment still can not control, need to be transported to the hospital as so

54、on as possible in children. In transit, stretch to keep children in the neck, with particular attention to prevent the inadvertent cover with the nose lead to suffocation.Treatment of acute diarrheaDiarrhea refers to the increased frequency of defecation (compared with normal defecation times) and (

55、or) change (stool consistency reduced, rare, watery or bloody purulent stool), is a global disease caused by different causes, is one of the most important causes of death in children under 5 years old.For the duration of diarrhea in children with acute diarrhea in 2 weeks. The vast majority of chil

56、dren with non infectious causes or caused by viral infection, given general symptomatic treatment, especially the prevention and correction of electrolyte imbalance, a few days can be gradually recovered. Some bacterial enteritis require antimicrobial therapy should be selected reasonably according

57、to the clinical characteristics.For the duration of 2 weeks to 2 months of persistent diarrhea and disease for more than 2 months of chronic diarrhea, should advise parents to referral.Diagnostic procedures1. according to the course of analysis, children with acute diarrhea is still persistent or ch

58、ronic diarrhea. For the majority of acute diarrhea or intestinal infection caused by improper diet. The etiology of chronic diarrhea complicated, different age is not a cause.2. for acute diarrhea, should first consider the acute intestinal infection, should also pay attention to whether there are other systems (especially respiratory infection). It should identify whether there are problems such as excessive feeding, feeding, feeding too much too fast. Also