C*****D
发帖数: 1299 | |
z******1
发帖数: 666 | 2 患儿家属缺乏医学知识。医生的责任可能在于缺乏和家属的沟通。多说几句话可能就避
免了这样的矛盾。 美国的医生好像都很有耐心的。
【在 C*****D 的大作中提到】
: 网上见一新闻。不知有无对儿科比较熟悉的。到底谁对。国内现在医患信任危机比较严
: 重。
: http://www.cq.xinhuanet.com/2011-09/15/content_23697721.htm
|
A*******s
发帖数: 9638 | 3 我还记得Hirschsprung's disease， 这个新生儿可能被怀疑得了这个病。
问题是这个孩子明显有便秘， 这很常见， 治疗也很规范化。 为什么会怀疑
Hirschsprung's disease 肯定有它的原因。 但如果把普通便秘当成Hirschsprung's
disease而导致手术治疗， 这个就是误诊。
看来没有什么客观上的后果， 所以不会有什么补偿。
【在 C*****D 的大作中提到】
: 网上见一新闻。不知有无对儿科比较熟悉的。到底谁对。国内现在医患信任危机比较严
: 重。
: http://www.cq.xinhuanet.com/2011-09/15/content_23697721.htm
|
C*****D
发帖数: 1299 | 4 这就是我不明白处。到底Hirschsprung's disease诊断过程对不对。如果对的，手术是
难免的。
在这儿，不是要活检诊断吗？
【在 A*******s 的大作中提到】
: 我还记得Hirschsprung's disease， 这个新生儿可能被怀疑得了这个病。
: 问题是这个孩子明显有便秘， 这很常见， 治疗也很规范化。 为什么会怀疑
: Hirschsprung's disease 肯定有它的原因。 但如果把普通便秘当成Hirschsprung's
: disease而导致手术治疗， 这个就是误诊。
: 看来没有什么客观上的后果， 所以不会有什么补偿。
|
z******1
发帖数: 666 | 5 估计是一个临床诊断，医生提出要先造漏。这种时候医生一般不愿意急着作结肠镜活检。
【在 C*****D 的大作中提到】
: 这就是我不明白处。到底Hirschsprung's disease诊断过程对不对。如果对的，手术是
: 难免的。
: 在这儿，不是要活检诊断吗？
|
A*******s
发帖数: 9638 | 6 回过头看显然是错误的， 但作为differential diagnosis并无不可。
【在 C*****D 的大作中提到】
: 这就是我不明白处。到底Hirschsprung's disease诊断过程对不对。如果对的，手术是
: 难免的。
: 在这儿，不是要活检诊断吗？
|
r*****2
发帖数: 309 | 7 新生儿48小时不排便，高度怀疑Hirschsprung's disease。其实深圳市儿童医院也没错
。但应该做活检来确诊。用石蜡油只能暂时性解决问题。Hirschsprung's disease会引
起colitis，进而肠麻痹。小孩就没救了，死亡率是很高的。如果真是Hirschsprung's
disease，这老爸是害了自己的孩子。现在关键是确诊在先。 |
L****n
发帖数: 12932 | 8 按着深圳医院的计划， 小孩也许现在身上已经多了个洞了。 这能叫没错嘛？ 这错的
离谱了。 你自己也说的应该确诊在先， 又不是紧急情况， 不能这么草菅的
其实深圳市儿童医院也没错
【在 r*****2 的大作中提到】
: 新生儿48小时不排便，高度怀疑Hirschsprung's disease。其实深圳市儿童医院也没错
: 。但应该做活检来确诊。用石蜡油只能暂时性解决问题。Hirschsprung's disease会引
: 起colitis，进而肠麻痹。小孩就没救了，死亡率是很高的。如果真是Hirschsprung's
: disease，这老爸是害了自己的孩子。现在关键是确诊在先。
|
r*****2
发帖数: 309 | 9 看看，别说国内的人对医生有信任危机，这里也好不到哪里去。对这个病没认识就别给
别人乱出主意。如果真是Hirschsprung's disease，发生肠麻痹的机率是很高的。真发
生了死亡率可到50%(in USA). 现在我们都是局外人具体情况也不能只听一家之言，不
是深圳儿童医院那边也没说话吗，别太早下定论谁对谁错。
【在 L****n 的大作中提到】
: 按着深圳医院的计划， 小孩也许现在身上已经多了个洞了。 这能叫没错嘛？ 这错的
: 离谱了。 你自己也说的应该确诊在先， 又不是紧急情况， 不能这么草菅的
:
: 其实深圳市儿童医院也没错
|
L****n
发帖数: 12932 | 10 i do like to know your reference regarding :"发生肠麻痹的机率是很高的。真发
more likely from bowel perforation (肠穿孔), rather than bowel paralysis.
and the former can be treated with npo/tpn/rectal decompression.
实际的问题就是， 没有确诊（活检）， 仅靠临床诊断是否需要手术。 algorithm 的
下面是if this is emergency (bowel extention, sign of rupture etc)-if no,
observe then biopsy。megacolon is only in 25% of all newborn intestinal
blockage. if yes, whether can be relieved conservatively (fleet enema,
rectal tube etc), if no, surgery, if yes go back to non emergency. 深圳医院
并没有follow 这个algorithm. 这如果在这里打起官司来会输的。 |
|
|
A*******s
发帖数: 9638 | 11 这个官司打不起来， 因为没有造成后果。
问题的关键是， 这个孩子在下3个月内究竟怎么样？如果一切正常了， 那就没什么可
说的。 如果还是有问题， 那就是另一回事了。
我们的信息是片面的， 所以结论可能为时过早。
【在 L****n 的大作中提到】
: i do like to know your reference regarding :"发生肠麻痹的机率是很高的。真发
: more likely from bowel perforation (肠穿孔), rather than bowel paralysis.
: and the former can be treated with npo/tpn/rectal decompression.
: 实际的问题就是， 没有确诊（活检）， 仅靠临床诊断是否需要手术。 algorithm 的
: 下面是if this is emergency (bowel extention, sign of rupture etc)-if no,
: observe then biopsy。megacolon is only in 25% of all newborn intestinal
: blockage. if yes, whether can be relieved conservatively (fleet enema,
: rectal tube etc), if no, surgery, if yes go back to non emergency. 深圳医院
: 并没有follow 这个algorithm. 这如果在这里打起官司来会输的。
|
s*******w
发帖数: 1879 | 12 好像的确小孩子不是普通的便秘。
小孩爸爸已经两天前带小孩去了广州，据说是学习洗肠技术。本来小孩爸爸已经对媒体
说两个月后去广州检查，但是现在小孩子又便秘很严重只能去。广州方面经过检查是说
小孩爸爸洗肠技术不行。
还有广州方面发现小孩当时发烧，觉得当天出院有危险，提出住院，但是小孩爸爸坚持
要小孩出院。
希望这孩子能健康吧。 |
r*****2
发帖数: 309 | 13 Since I am preparing my pediatric boards, I will refer the following
sentences from medstudy pediatric board review books regarding "hirschsprung disease".
"Enterocolitis usually occurs during the 2nd to 4th weeks and is characterized
by fever with explosive, foul-smelling stools. Bloody diarrhea is common,
as is abdominal distension. The prognosis for enterocolitis is poor, and the
mortality rate can be as high as 33% (sorry I exaggerated the rate). The
pathogenesis of enterocolitis is unknown. Delayed diagnosis is the
contributing factor for many cases of enterocolitis.
Once you suspect Hirschsprung's, process quickly with diagnostic evaluation.
The longer it takes for a diagnosis to be made, the more likely
enterocolitis may occur.
If the infant pretenses with an obstruction, create a stoma proximal to the
aganglionic segment. Once the patient is stable, perform a proximal
colostomy."
要外行来指挥内行,不乱套才奇怪呢. |
L****n
发帖数: 12932 | 14 hey, i sincerely do wish you good luck on your board exam because your logic
in the discussion here makes me a little worry. Preparing for board don't
necessarily make you a 内行。 preparing a patient for surgery and decision
process leading to surgery is something i do everyday for many years. so
please stick to the point and refrain from negative comments, which don't
showcase your professionalism very well among your peers.
main pathological mechanism of hirshsprung's disease is bowel obstruction
due to disarray colon smooth muscle contraction. Itself doesn't lead to
enterocolitis, if bowel is properly decompressed. Rush to surgery actually
may lead to entercolitis, which is a well known complication of bowel
surgery. particularly in patient with poor volume/electrolyte hemostatsis.
ie in one word, the goal is always to operate in a hemodynamically stable
patient with clear diagnosis, unless it is an emergency. In fact, yesterday
when i was replying to this thread, i was just finishing a 3 hour case on a
15 wk old baby(26wk preterm) who had bowel resection and then developed
entercolitis, this was the third surgery in recent weeks to take off dead
bowel and cleaning up adhesions.
hirschsprung disease".
characterized
the
evaluation.
【在 r*****2 的大作中提到】
: Since I am preparing my pediatric boards, I will refer the following
: sentences from medstudy pediatric board review books regarding "hirschsprung disease".
: "Enterocolitis usually occurs during the 2nd to 4th weeks and is characterized
: by fever with explosive, foul-smelling stools. Bloody diarrhea is common,
: as is abdominal distension. The prognosis for enterocolitis is poor, and the
: mortality rate can be as high as 33% (sorry I exaggerated the rate). The
: pathogenesis of enterocolitis is unknown. Delayed diagnosis is the
: contributing factor for many cases of enterocolitis.
: Once you suspect Hirschsprung's, process quickly with diagnostic evaluation.
: The longer it takes for a diagnosis to be made, the more likely
|
L****n
发帖数: 12932 | 15 even in your quoted textbook, the next logical step is to proceed to
diagnostic evaluation, ie, biopsy, not proceed quickly to colectomy.
and regarding lawsuit, yes there is no much damage (LUCKILY) , the damage of
public reputation could cost a lot more. they made a mistake, they need to
come clean, apologize and take necessary step to prevent this from happening
again. If i were the parent, i would make sure the attending knows what he/
she did wrong to my child.
evaluation.
【在 r*****2 的大作中提到】
: Since I am preparing my pediatric boards, I will refer the following
: sentences from medstudy pediatric board review books regarding "hirschsprung disease".
: "Enterocolitis usually occurs during the 2nd to 4th weeks and is characterized
: by fever with explosive, foul-smelling stools. Bloody diarrhea is common,
: as is abdominal distension. The prognosis for enterocolitis is poor, and the
: mortality rate can be as high as 33% (sorry I exaggerated the rate). The
: pathogenesis of enterocolitis is unknown. Delayed diagnosis is the
: contributing factor for many cases of enterocolitis.
: Once you suspect Hirschsprung's, process quickly with diagnostic evaluation.
: The longer it takes for a diagnosis to be made, the more likely
|
A*******s
发帖数: 9638 | 16 Without a detailed story on this case, I think it is premature to call on
any side for the wrong doing.
What if the hospital just discussed the possibility of Hirschsprung's as a
differential diagnosis and a possible surgery, then the family went for 2nd
opinion and exaggerated the fact?
Some families are just so difficult to deal with. |
r*****2
发帖数: 309 | 17 As I said before, I don't want to judge anybody, since we only hearded the
story from one side. There is no absolute right or wrong in medical field.
Nobody really need to trash his or her colleague just to make him/her smart
or superb, especially among our CMGs. I definitely will pass my boards and
as a pediatrician I just need to be cautious, suspect the possible diagnosis
, stabilize patient and call the surgical consult. Go or not go for surgery
it is surgeon's call, no matter it is right or wrong judgement. So I just
express my opinion from pediatrician side. Is it too premature to say who is
right or who is wrong? Be profession, I won't say anything about this case
anymore, no matter how terrible the comments will be. Now I kind understand why there are not so many attendongs
come to this board. This will be my last post and I will serious think again if I should or shouldn't post anything in the
future. I just wish everything best for this family. |
L****n
发帖数: 12932 | 18 "There is no absolute right or wrong in medical field."
-yes, but there is standard of care and sub-standard care. and i'm sure you
don't want to explain that to a jury
"Nobody really need to trash his or her colleague just to make him/her smart
or superb, especially among our CMGs. "
-This is also what i want to say to you. sticking to the point rather than throwing out judgement like "内行""外行" would be a good start.
"Go or not go for surgery it is surgeon's call"
-boy oh boy. Please don't say that in front your oral board examiners. You
can start planning on retaking the exam if they heard that. |
