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Fever - About medical emergencies at early children's age

Table of contents
Fever
Convulsive syndrome
Respiratory insufficiency
Infectious toxicosis
Acute allergic reactions
Circulatory unefficiency

On the basis of long-term clinical experience and data of literature it is possible to allocate (as emergence frequency) the following medical emergencies at early children's age: fever, a convulsive syndrome, respiratory insufficiency, the infectious toxicosis (passing in hard cases into infectious and toxic shock), acute allergic reactions and a circulatory unefficiency.

It should be noted that in the isolated look these states happen seldom. All complexity of medical emergencies also consists in it. The doctor defines the leading syndrome in the beginning and begins medical actions with this syndrome. In dynamics of supervision, conducting quickly a complex of examinations, the doctor has to establish the diagnosis of an illness and implement all volume of adequate pathogenetic therapy.

Fever is fervescence as reaction of endogenous pyrogen to the center of thermal control. Depending on rise height body temperature divide on subfebrile (37-38 °C), moderated (38,1-39 °C and high (a hyperthermia-39.1-41 °C).

At early children's age temperature increase is most often connected with infectious diseases (virus, bacterial, fungal, parasitic). Children with various damages of the central nervous system are especially inclined to rises in temperature. At the same time temperature increase can be followed by a convulsive syndrome (febrile spasms). Despite the known protective and adaptive character of a hyperthermia in an initial phase of the development (stimulation of synthesis of antibodies and products of interferon, the termination of development of viruses in a cell) at early children's age the hyperthermia is an alarming symptom, especially if temperature is above 38,5 °C.

In an initial stage of fever (infectious and toxic fever) mainly antipyretics are applied (paracetamol and its analogs - Panadolum, efferalgan, taylenol, and also analginum). An optimum dose of paracetamol for children of early age - 10 mg on 1 kg of body weight in 6-8 hours. It is better to give these drugs in the form of solutions (special children's forms), and at vomiting - in candles. Duration of reception is 3-5 days.

Well proved also non-steroidal anti-inflammatory drugs - inhibitors of prostaglandins (indometacin, Voltarenum and their analogs in a dose of 3 mg/kg of body weight a day).

Fever against acute heavy toxicosis (metabolic) can be stopped by nikotinamidny coenzymes of tissue respiration. Nikotinamid is appointed in a single dose of 5-8 mg to children of the first year of life or 10-15 mg to children at the age of 2-3 flyings, it is desirable parenterally (in the form of drop infusion on 50-100 ml of 10% or 5% of solution of glucose). Addition to therapy of an age dose of cocarboxylase exerts beneficial influence on the center of thermal control.
At fever at children with defeats of a nervous system are appointed alpha adrenoblocker Pyrroxanum (to children is more senior than months and till 3 years - 0,2-0,3 ml 3 times a day intramusculary) and nootropil (piracetam) in a dose of 0,2 g 3 times a day (to children till 5 flyings). In this situation effectively and physical cooling (a cold pack in a wet sheet, bubbles with ice at a headboard and large vessels), and also grinding of a body of the child mix of equal number of 40% of alcohol, water and vinegar. Treatment is followed by an oxygenotherapy.

It is necessary to remember that treatment of fever to some extent belongs to "cosmetic" therapy as does not influence the main pathological process. In dynamics of supervision over the patient the causal and pathogenetic treatment adequate to the diagnosis of an illness is appointed.



 
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