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¡¾2426¡¿Shocked

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    We have repeatedly mentioned in obstetrics before that the key factor that determines whether a child can be delivered normally is the child¡¯s head.  For this reason, during normal delivery, the doctor's hands must protect the baby's brain and use standardized delivery gestures.

    When the doctor checks the fontanel, in addition to checking whether the fontanel closing time is normal or not, like the child with fever today, he will touch the front fontanel to see if there is any bulge or tightness.  If so, it may mean that the child has intracranial hypertension.  If the fontanel is too large and the head circumference is too large, you should suspect congenital hydrocephalus.  If the fontanelle is too small or closes prematurely, it is necessary to check whether the child's brain is underdeveloped.  All of the above causes represent lesions of the central nervous system and may cause clubfoot.

    When classmate Xie was checking the fontanel, classmate Wei brought a soft ruler over to help measure the child's head circumference.

    Classmate Duan checked the medical records of the temperature and blood pressure recorded by the nurse before taking the child.

    A series of neurosurgical examinations.  The child's state of consciousness was acceptable and he did not show any abnormality such as drowsiness.  The posterior fontanel is closed, which is normal.  The head circumference is 42cm, which is within the normal range.  There was no bulging or depression in the anterior fontanelle, and no abnormal intracranial pressure.  Pupil 3mm, normal.  The child's spine showed no deformity or abnormal curvature.  The weight is 81kg and the body length is 60cm, which shows that the child has good nutrition and is developing normally.  Only the left foot is deformed.  We need to take another X-ray of the bones to see if there are any bone deformities.

    It¡¯s just that clubfoot generally does not cause fever in children.  The doctor needs to continue to check the child's fever.  Classmates Xie and Duan put on stethoscopes to listen to the child¡¯s heart and lungs.

    Student Wei picked up a ballpoint pen and notes, asked the family members and recorded the child's medical history.

    "When did you find out your child had a fever?" Student Wei asked, tapping his pen on his notebook.

    The child's mother replied: "It must have been yesterday. We tried our best to rub alcohol on him to reduce his fever. If it couldn't be reduced, we took him to the hospital."

    People know that seeing a doctor is troublesome. If some parents see that their child's condition is not serious, they will try to find ways to reduce their child's fever at home. If it can be resolved, it is just a minor problem and they don't need to go to the hospital.

    "When did his foot look like this? Do you know?"

    After receiving the doctor¡¯s question, the child¡¯s mother seemed to have just discovered the abnormality in her son¡¯s left foot and said in surprise: ¡°When I took him for a physical examination before, the doctor never said there was anything wrong with his foot.¡±

    It means that this child¡¯s clubfoot was discovered now.  It is not surprising that many children have insignificant symptoms of congenital diseases, and they are not noticed until later symptoms become more and more prominent.

    "Did he vomit or have diarrhea?" Student Wei asked again.

    The child¡¯s mother shook her head.

    "Do you have a cough?"

    "It seems so," the child's mother said. "He was also crying, and his voice was hoarse from crying. We felt like he had a discomfort in his throat."

    The child¡¯s cry is hoarse, the throat is uncomfortable, and there is a problem with the glottis of the vocal cords?  Is it acute laryngitis in children?  Several young doctors were shocked.

    Pediatric laryngitis has an acute onset and rapid progression, which is most evident in this aspect.  Because children's larynx is small, laryngitis is prone to swelling. Children's throat emission is worse than that of adults, and airway secretions cannot be discharged on their own, which further aggravates the obstruction and eventually causes laryngeal obstruction and suffocation.  It is one of the most common emergency diseases in pediatrics that requires vigilance.

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