At the beginning of the New Year 2016, the cardiothoracic surgery department of Nanjing Children’s Hospital admitted several consecutive cases of children with pustular chest, the children were between 2-10 years old, all of them had normal development and normal nutrition, and their medical history was almost all due to gradual aggravation of cold to pneumonia with fever, some of them had fever at first, up to 40 degrees, after which their body temperature gradually returned to normal under medical intervention. After hanging anti-inflammatory water in the primary hospital for a few days-2 weeks, there was no significant improvement, and chest X-ray at Nanjing Children’s Hospital showed pleural effusion and pulmonary atelectasis. After the drainage tube was placed, pus flowed out and splitting wrapping appeared, and medical treatment was ineffective, so he was referred to surgery.
Because of the rapid progress of medical science, many doctors in primary and even large hospitals nowadays sometimes delay treatment if they do not actively participate in continuing education and learning, relying only on experience.
In this article, I would like to talk to you about how to avoid pediatric pneumonia from developing into pneumothorax and how to treat it when it appears.
First, pay attention to fever in children over 2 years old
At present, parents or grandparents attach great importance to fever in children younger than 2 years old, especially in children within 1 year old, because they think that children are small and have poor resistance and must be treated promptly, which may also validate the reason that all the children we admit and treat for pustulosis are over 2 years old. For older children, parents or grandparents think that the child has resistance, what’s the big deal about a cold, who’s child doesn’t get sick, it will be fine in a few days.
In this way, a part of the child if there is a decline in resistance or other susceptibility factors at this time, very easy to develop pediatric pneumonia, and further progress, if not timely interrupt the disease process, may appear pleural effusion, abscess chest, etc..
Therefore, for children with colds, especially accompanied by fever, it is important to see a doctor in a timely manner so that the doctor can listen to the lungs to see if there is an ancient frontal egg pure word owed to the treatment swindle “Jing fishy net weevil yo women fishy thorny hollow pregnant miscellaneous 笆 cons Zan Xia shoulder〉 mu ridge
Second, the importance of chest X-ray examination
For children with fever above 38℃ and persist for more than 2-3 days, especially accompanied by the following symptoms: coughing, wheezing or faster breathing than usual, flapping of both sides of the nose; poor mental state, children are usually in good spirits, but now suddenly appear irritable, prone to crying or lethargy; do not want to eat or the amount of food is significantly less than before.
If these symptoms appear, you should be alert to the fact that your child is seriously ill and is no longer a common cold, but may have progressed to bronchitis or pneumonia, so in addition to blood tests, examinations and targeted medication, you must check the chest X-ray, and some children may need a chest CT.
Chest X-ray can promptly indicate whether there is pleural effusion, pulmonary atelectasis or other lung lesions in the chest cavity.
Timely closed drainage of the chest cavity
If the child’s condition progresses rapidly and the chest X-ray indicates pleural effusion, a timely thoracentesis should be performed to extract the fluid and send it for laboratory tests and bacterial culture in order to detect sensitive antibiotics.
If the pleural fluid is not easy to penetrate after thoracentesis or the fluid is thicker, and the review of chest X-ray or ultrasound indicates that the fluid forms a parcel, then closed chest drainage should be performed without hesitation, and the chest X-ray should be reviewed daily or every other day so that the drainage tube can be adjusted in time to keep the drainage unobstructed and supplemented with sensitive antibiotics, so that most children can be cured and will not progress to abscess chest.
IV. Bronchoscopy
If the child’s chest X-ray indicates the presence of pulmonary atelectasis, fiberoptic bronchoscopy needs to be actively performed while the child is being treated. The vast majority of children are unable to cough up sputum effectively due to infection, pain and discomfort, sputum clots blocking the bronchus or other rare causes such as foreign body misaspiration, etc. After bronchoscopy, sputum aspiration and alveolar lavage can effectively treat pulmonary atelectasis caused by infection and foreign body misaspiration.
V. Early thoracoscopic flushing and drainage of abscess thorax
For children who have progressed to abscess thorax, abscess thorax forms a package in the chest cavity, closed drainage of the chest cavity cannot effectively drain the pus, the duration of the disease is more than 2 weeks, and the effect of medical treatment is not obvious, at this time, the thoracic fiber plate has not yet been formed, at present, thoracoscopic flushing of abscess thorax is used to flush out the pus in the chest cavity. After the operation, the thoracic cavity will be continuously flushed with diluted iodophor solution for 24-48 hours, which can achieve a more satisfactory treatment effect.
Sixth, fiberboard stripping or lobectomy
Pneumonia, pleural effusion and abscess chest are not effectively controlled, and the duration of the disease is 3 weeks and above, at this time, the child’s abscess chest has already appeared to be mechanized to form a fibrous plate.
At this stage (3-6 weeks), we find that in most children, the pus has not completely mechanized, forming a thick (0.5 cm thick) fibrous plate in the wall layer and a thin fibrous plate in the dirty layer, in the middle of which the pus has not yet mechanized, compressing the lung into a mass and making it impossible to open the lung effectively.
In most children, the lung can be reopened after fibrous plate debridement and lobectomy is not necessary. However, in a very small number of children, the lung is destroyed or the lung cannot be opened even after repeated bulging of the lung.
Summary
For pediatric colds and pneumonia with fever, parents must pay attention and promptly go to the hospital for examination and treatment, and must be alert to the evolution of pediatric pneumonia into abscess chest.