#聚光创作大赛#
#岳阳头条 ##平江县第一人民医院#
On the evening of March 29, shortly after Daniel Zhang, the doctor on duty at the First People's Hospital of Pingjiang County, took over the shift, he received an urgent call from Director Zhao Xiaoyang, "Doctor Zhang, inform the nurse to quickly vacate an emergency bed and prepare a ventilator, and the outer hospital is now going to transfer a child in extremely critical condition, and I am already on my way over." ”
After a while, the urgent 120 emergency sound came outside, and when the child arrived in the flat car, it was found that she was dying, her lips were cyanotic, she had difficulty breathing, and a large amount of secretions could be seen in her mouth and nose, but she was unable to cough at all. Director Zhao Xiaoyang's team immediately took rescue measures such as oxygen inhalation, sputum suction, and opening intravenous access.
It is understood that this year's 2-year-old child Tongtong (pseudonym), who was more than 1 year old due to bilateral eyelid drooping, was finally diagnosed with "myasthenia gravis (eye muscle type)" in Hunan Provincial Children's Hospital.
It turned out that a few days ago, Tongtong began to cough and cough up phlegm, when Tongtong's mother thought that the child was an ordinary "little cold", did not pay attention to it, and gave some oral "cold medicine" by herself, the symptoms did not improve significantly, but became more serious, and there was difficulty swallowing, choking on eating, slurred speech, accompanied by abdominal pain and vomiting.
Tongtong's mother was alone at home with the baby, inexperienced, thinking that the medicine was too bitter and the child couldn't eat it, so she stopped all the drugs for myasthenia gravis.
Shortly thereafter, Tongtong's mother found that the child was obviously short of breath and his spirit deteriorated significantly compared to before, so she took him to the local hospital for treatment, and soon after arriving at the hospital, he had a heartbeat and respiratory arrest, and after the local hospital doctors made every effort to rescue him, he finally recovered his heartbeat and breathing, and was immediately transferred to the First People's Hospital of Pingjiang County under the escort of 120.
(▲CT scan shows large consolidation in the left lung)
After understanding the situation, Director Zhao Xiaoyang considered that the child had myasthenia gravis crisis, and immediately made a decision to carry out a series of rescue measures such as tracheal intubation, invasive ventilator assisted breathing, improved ventilation, and sputum suction, and at the same time, accompanied by medical staff, he improved the emergency lung CT, and found that the child had a large area of consolidation in the left lung, and considered the possibility of aspiration pneumonia.
After returning to the ward, he continued to receive advanced life support, and was given a series of comprehensive treatments such as anticholinesterase, immunomodulation, and anti-infection, and the child's vital signs gradually stabilized. After Tongtong's condition was stabilized, Deputy Director Mao Changlin led the attending physician Zou Zhenyu to perform bronchoscopy, lavage, and remove a large number of sputum plugs.
(▲CT scan showed that the infection was significantly better than before)
Through the joint efforts of Director Zhao Xiaoyang's team, Tongtong's condition recovered well and was discharged from the hospital on April 9, with no cough, shortness of breath, cyanosis, fever, free walking, able to eat independently, no choking cough, and clear speech.
(▲Tongtong after recovering from her condition)
Director Zhao Xiaoyang's science popularization time
Director Zhao Xiaoyang introduced that myasthenia gravis (MG) is an autoimmune disease that affects the neuromuscular junction and causes symptoms of weakness. When symptoms worsen, muscle weakness worsens and can even lead to respiratory failure, known as myasthenic crisis (MC). for manifestations of disease development.
It is often caused by insufficient anticholinesterase drugs, and is often triggered by respiratory tract infection, major surgery (including thymectomy), excessive fatigue, childbirth, missed or discontinued anticholinesterase drugs, or the use of respiratory inhibitors morphine, neuro-muscle blockers such as gentamicin, streptomycin, etc.
Generalized muscle weakness progresses rapidly and worsens, with quadriplegia, laryngeal and respiratory muscle involvement, dyspnea, headache due to carbon dioxide retention, and even altered mental status within a few hours.
1. MG patients should pay attention to rest and avoid excessive fatigue;
2. After getting sick, you should seek medical attention in time, take medication under the guidance of a physician, and avoid self-medication reduction and discontinuation;
3. Pay attention to avoid the use of aminoglycosides and macrolide antibiotics, procaine and other narcotic drugs, β receptor blockers, quinine, penicillamine and other drugs that aggravate the transmission disorder of neuromuscular junction and cause ventilator paralysis;
4. Try not to go to crowded places to avoid MG crisis induced after respiratory tract infection.
Hunan Medical Chat Special Author: Daniel Zhang, First People's Hospital of Pingjiang County
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(Editor YT)