W***e 发帖数: 5422 | 1 【 以下文字转载自 NextGeneration 讨论区 】
发信人: WeAre (大狮子), 信区: NextGeneration
标 题: 朋友家孩子进了ER!求助!
发信站: BBS 未名空间站 (Mon Feb 18 20:24:57 2013, 美东)
朋友带五岁的儿子来美国玩,结果昨天下午开始发高烧,晚上三点呕吐,惊厥,抽搐,
立刻打了911,给送儿童医院ER了。点滴退烧药也没降下来温度,因为持续抽搐,医生
给打了三针睡觉的药,现在还睡着。朋友说儿子现在有时睁开眼睛但是没有意识,说话
没有反应。还在睡觉药的控制之中。做了无数检查,也没发现有任何问题。
医生说还要继续观察,以免有任何并发症。因为一般孩子高烧惊厥就一下就好了,他家
这个一直在抽。
请问各位妈妈,有谁遇到过这种情况吗?有可能是哪方面的问题?
本来后天的飞机还要回国呢,现在估计要在这里住几天了。 |
l*h 发帖数: 4124 | 2 no one can help you with such hearsay.
【在 W***e 的大作中提到】![](/moin_static193/solenoid/img/up.png) : 【 以下文字转载自 NextGeneration 讨论区 】 : 发信人: WeAre (大狮子), 信区: NextGeneration : 标 题: 朋友家孩子进了ER!求助! : 发信站: BBS 未名空间站 (Mon Feb 18 20:24:57 2013, 美东) : 朋友带五岁的儿子来美国玩,结果昨天下午开始发高烧,晚上三点呕吐,惊厥,抽搐, : 立刻打了911,给送儿童医院ER了。点滴退烧药也没降下来温度,因为持续抽搐,医生 : 给打了三针睡觉的药,现在还睡着。朋友说儿子现在有时睁开眼睛但是没有意识,说话 : 没有反应。还在睡觉药的控制之中。做了无数检查,也没发现有任何问题。 : 医生说还要继续观察,以免有任何并发症。因为一般孩子高烧惊厥就一下就好了,他家 : 这个一直在抽。
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a**********2 发帖数: 3726 | 3 Sorry to hear that. Most likely it's febrile seizure. You can google febrile
seizure for more information.
Good luck. |
l*h 发帖数: 4124 | 4 extended febrile seizure in 5 year olds? do you believe there is no major
underlying disease?
febrile
【在 a**********2 的大作中提到】![](/moin_static193/solenoid/img/up.png) : Sorry to hear that. Most likely it's febrile seizure. You can google febrile : seizure for more information. : Good luck.
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a**********2 发帖数: 3726 | 5 That's a possibility. But in practice, always go from common to uncommon.
【在 l*h 的大作中提到】![](/moin_static193/solenoid/img/up.png) : extended febrile seizure in 5 year olds? do you believe there is no major : underlying disease? : : febrile
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l*h 发帖数: 4124 | 6 so you think extended febrile seizure in 5 year olds is common? so medicine
is as simple as fever + seizure = febrile seizure?
【在 a**********2 的大作中提到】![](/moin_static193/solenoid/img/up.png) : That's a possibility. But in practice, always go from common to uncommon.
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a**********2 发帖数: 3726 | 7 Well, can you please tell LZ what might be the cause? I know you have more
experience than me. So I can also learn from you. Thank you very much.
medicine
【在 l*h 的大作中提到】![](/moin_static193/solenoid/img/up.png) : so you think extended febrile seizure in 5 year olds is common? so medicine : is as simple as fever + seizure = febrile seizure?
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W***e 发帖数: 5422 | 8 医生诊断说是febrille seisure。但是所有的lab work都是negative的,没有任何
virus或者感染。医生说白细胞数量还是很高,也许是有某些感染他们还没发现。不过
现在体征已经很平稳了,也有一点意识了,就是还不太能控制自己的身体。没有完全清
醒。不知道还需要再等多久才能恢复。
做了两次mri,也抽了脊髓液,都没有问题。现在就怕有任何脑损伤。 |
l*h 发帖数: 4124 | 9 Is the doctor a child neurologist or a general pediatrician?
I don't think you can put febrile seizure down as a diagnosis when it's so
serious requiring such a long sedation. Let's see what happens when sedation
is lifted.
【在 W***e 的大作中提到】![](/moin_static193/solenoid/img/up.png) : 医生诊断说是febrille seisure。但是所有的lab work都是negative的,没有任何 : virus或者感染。医生说白细胞数量还是很高,也许是有某些感染他们还没发现。不过 : 现在体征已经很平稳了,也有一点意识了,就是还不太能控制自己的身体。没有完全清 : 醒。不知道还需要再等多久才能恢复。 : 做了两次mri,也抽了脊髓液,都没有问题。现在就怕有任何脑损伤。
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W***e 发帖数: 5422 | 10 是er的医生会诊的。我们这里的儿童医院很大,还有很多研究中心,应该不会出现有非
常大偏差的误诊。可是就是查不出原因来。连医生都很困惑。
孩子一直昏迷了50多个小时才开始有点意识,不知道是不是一开始医生为了控制惊厥给
注射的麻药量太大了,孩子本身对麻药的代谢又慢,导致一直睡觉不醒。医生说深度睡
眠的药是在周一下午7点就停了,可是周三下午孩子还没有完全清醒呢。按说不应该这
么久的。 |
W***e 发帖数: 5422 | 11 刚打过电话,孩子醒了,一切都正常了,说话,活动全没问题了,身上的管子全撤了,
开始自己吃饭。就是躺得太久,没吃饭,胃里是空的,没啥体力,人比较虚。估计明后
天就出院了。 |
a**********2 发帖数: 3726 | 12 I am not pediatrician, just looked it up in Uptodate, here is some
information I re-wrote.
1. Febrile seizure usually occurs in children younger than 6 year old.
2. If the patient has status epilepticus (持续抽搐, continuous seizures or
intermittent seizures without neurological recovery), it could be a special
subtype of febrile seizure, called febrile status epilepticus. Most ED
physicians are not aware of this (never taught in medical school, nor tested
in USMLE exams). Some patients have a recent viral or bacterial illness,
some may have family history of epilepsy.
3. Febrile status epilepticus lasts longer than 30 minutes, other features
are the same as febrile seizure. Treatment is antiepileptic medications. |
l*h 发帖数: 4124 | 13 this would be odd in many ways for febrile seizure to stand:
1. age of first seizure.
2. seizure duration for children at this age.
3. fever and high WBC count but no other abnormality? this only means the
right place hasn't been looked at.
4. drug response: unless phenobarbital was used there is no explanation to
the long depression of consciousness if there is no serious underlying
pathological condition. but considering the circumstances, it would be very
very odd to use this drug: benzodiazopines are first line and faster and
safer. failure to respond to lorazepam itself indicate bad long-term outcome
of the seizure. barbiturates are second line but since the seizure was on
for some time, a slow barbiturate such as pheno- should not be used, instead
should use a fast one such as pento-. even pheno- should not last this long.
for non-neurologists to use deep sedation protocol, there is no long-lasting
drugs such as phenobarbital.
this kid deserves a rare case report if no pathological condition (not
necessarily neurological as primary condition) is found in the next 3-5
years.
【在 W***e 的大作中提到】![](/moin_static193/solenoid/img/up.png) : 是er的医生会诊的。我们这里的儿童医院很大,还有很多研究中心,应该不会出现有非 : 常大偏差的误诊。可是就是查不出原因来。连医生都很困惑。 : 孩子一直昏迷了50多个小时才开始有点意识,不知道是不是一开始医生为了控制惊厥给 : 注射的麻药量太大了,孩子本身对麻药的代谢又慢,导致一直睡觉不醒。医生说深度睡 : 眠的药是在周一下午7点就停了,可是周三下午孩子还没有完全清醒呢。按说不应该这 : 么久的。
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