[The hospital responded that the child with fever was turned away by the nurse: misbehaving, suspended from work]
April 25, Zhengzhou, Henan. Some parents said that children with fever went to a hospital and were turned away by the nurse in the rescue room responsible for nucleic acid testing. The front desk staff asked medical staff to do nucleic acid in the rescue room. The doctors on duty in the rescue room did not open the door for a long time, and there were elderly people waiting to see a doctor outside the door. The hospital in question responded that the nurse was suspended for improper handling; it also understood that the nurse had postpartum depression, and arranged for evaluation and intervention.
The content of this news has too little information, and I suspect it is distorted, so it is difficult to judge. A few questions: 1. The nurse in the rescue room measures nucleic acid? Pull it down, you have to go to the fever clinic to test the nucleic acid, and arrange for the nurse in the emergency room to test it. This is unlikely. 2. Is the rescue room for parents to enter as soon as they want? Not! This is the place where patients are rescued. If patients come to the emergency department, they need to go through the nurse’s triage first. Those in critical condition go to the rescue room. Ordinary emergency patients go to the ordinary emergency department and do not need to go to the emergency department to see the outpatient department. If everyone goes to the rescue room and fills up the rescue room, then the real emergency patient comes, how to rescue it? If you are morally perfect, please stop here! Because each of us may get sick, or even suddenly become seriously ill, maintaining the order of the emergency room involves everyone’s vital interests! 3. Should the child have a fever, should he enter the rescue room? If you just have a fever, you definitely shouldn’t! I’ve talked about this question a long time ago, and I’ll talk about it again today. Warm reminder: What I am going to talk about below is scientific knowledge, science is science, facts are facts, and morality is perfect. Otherwise, I must go back, that’s it! 1. Causes of fever There are many reasons why children have fever. Generally speaking, we are divided into two categories: The first category is infectious fever. In other words, there are external enemies such as bacteria and viruses invading our body, causing the body to react and causing fever. In this pneumonia epidemic, the fever caused by the new coronavirus is of this type. Common children’s tonsillitis, pneumonia, meningitis, tuberculosis, measles, chickenpox and other infectious diseases, etc., are all of this category. The fever of most children is infectious fever. The second category is non-infectious fever. The characteristic of this category is that there are many kinds of diseases, but not many children have fever due to this. For example: rheumatic fever, leukemia, and the relatively common Kawasaki disease, and so on. There are so many reasons that can cause fever, and their early performance is similar. So, we are all “quacks”, really. In the early stages of fever, almost no doctor can accurately say the cause of the fever, because although we have a good medical knowledge, we have never learned fortune-telling. 2. Is fever, especially high fever, a serious condition? The severity of the child’s condition cannot be reflected solely on the basis of high fever temperature, long duration, and the therapeutic effect of antipyretic drugs. In other words, whether the temperature of the fever is high, whether the fever is 3 days or 5 days, and the effect of anti-fever medicines are not proportional to the severity of the disease. The indicator of whether to seek medical attention is not only the temperature, but other conditions of the child are also very important. The following points should be paid close attention to by parents: 1. Fever of a baby, especially within 6 months; 2. Poor mental condition, listlessness; or reluctance to eat; 3. Difficulty or rapid breathing; 4. Skin bruising, Pale, gray, spot-like; or visible rash; 5. crying constantly; 6. oliguria. and many more. The younger we are, the more we must be cautious. 3. Will fever cause pneumonia and even burn out the child’s brain? Obviously, fever does not produce pneumonia, but fever may occur with pneumonia. No explanation for this. The point is that fever does not cause brain damage! This sentence is not what I said casually, but a quote from Uptodate, an authoritative international medical community. This is already a medical conclusion. However, some children have convulsions when they have a fever. Why? In medicine, it is called febrile convulsion. In other words, convulsions may occur when a child has a fever, which we call febrile convulsions. It has several characteristics: 1. The age of onset is 3 months to 5 years old. There are also those whose onset is outside this age group, which is called complex febrile seizures. 2. Convulsions occur suddenly when the body temperature is above 38 degrees Celsius. 3. The onset of most febrile seizures does not exceed 10 minutes. The cause of febrile seizures is still unclear, but it is related to the child’s brain development and genetic factors. Take care to prevent the child from being traumatized during the attack, and do not use the method of “pinching people”, it is useless and may irritate the child. Many parents believe that since febrile seizures are caused by fever, can the occurrence of febrile seizures be prevented by retreating the fever in time when the child has a fever? Can’t! my country’s most authoritative literature on children’s fever, the “Evidence-Based Guidelines for the Diagnosis and Management of Several Issues in Acute Fever of Unknown Etiology in Children between 0 and 5 Years Old in China”, clearly points out this point. Although fever does not affect the brain, will febrile seizures affect the brain and hurt the nerves? Don’t worry, the scientific community has not found definitive evidence for this. A large number of studies have denied this view: a. Studies have shown that 1 month after the first febrile seizure and 1 year later, the children’s performance in cognition, motor ability, and adaptive behavior is related to There is no change from normal children. b. In a National Collaborative Perinatal Project (NCPP) study in the United States, even children with febrile seizures for more than 30 minutes (except for children with epilepsy) did not develop permanent dyskinesia, nor did they show up Impairment of intellectual development. c. Similar studies have been conducted in the United Kingdom and Denmark, and the results are consistent. 4. When should the fever be reduced and how should it be reduced? In most cases, fever is a beneficial physiological mechanism. When the temperature rises appropriately, it can slow down the growth and replication of some bacteria and viruses, and enhance their own immune function. However, when the temperature is too high, above 40 degrees Celsius, the above effects are not obvious or even the opposite. Fever can also accelerate the body’s metabolism and increase the consumption of oxygen. For normal children, this will generally not have any serious impact, but for children with abnormal cardiopulmonary function, it may be harmful. Since fever is not harmful to most children, why do we need to reduce fever? Some parents say that children feel uncomfortable when they have a fever! Yes, every parent should have experienced fever, and know that fever is uncomfortable. For most children, the main effect of fever is discomfort, that is, feeling uncomfortable. Therefore, our purpose of reducing fever is mainly to alleviate the discomfort caused by the child’s fever. Moreover, we need to know: the first choice for antipyretics is oral antipyretics. What medicine should I use? There are only two antipyretics recommended by the World Health Organization (WHO) for children: one is acetaminophen, which is taken orally at a dose of 15 mg/kg each time, and the shortest interval between two medications is 6 hours. The American Academy of Pediatrics recommends that children under 3 months do not use acetaminophen. The second is ibuprofen. The dose of ibuprofen is 10mg/kg each time, and the shortest interval between two administrations is 6-8 hours. Do not use ibuprofen for children under 6 months. The antipyretic effect and safety of ibuprofen and acetaminophen are similar. Paracetamol combined with ibuprofen is not recommended for children’s fever, nor is it recommended to alternate acetaminophen and ibuprofen for children’s fever. The safety of medication is related to the healthy growth of children. Other antipyretic drugs for children, such as aspirin, analgin, nimesulide, etc., should not be used by children. It should be noted that even the two drugs, acetaminophen and ibuprofen, are not completely safe. Studies have pointed out that the risk of gastrointestinal bleeding is about 17/100,000; the use of ibuprofen to reduce fever in children with hypovolemia increases the chance of renal damage; the use of ibuprofen when chickenpox occurs, the risk of group A streptococcus infection Has increased. Therefore, medication should be used with caution, please follow the doctor’s advice. 5. Summary A large number of studies have shown that, both at home and abroad, most parents believe that fever is harmful. No matter the cause or effect of fever, treatment or antipyretic is needed. Therefore, Uptodate clearly pointed out: the need to educate patients, their parents and caregivers to change these concepts. The main content of education includes: fever is not a disease, but a physiological response. In otherwise healthy children, if the cause of fever is clear and fluid loss has been replenished, most fever is benign and self-limiting; fever does not cause brain damage. If you have signs of a serious illness, you should consult a healthcare professional. There is no evidence that fever makes the condition worse. The initial measures to lower children’s body temperature include more fluids and reduced activity. If children feel unwell, they may need to use antipyretics to treat fever. The lowered body temperature of the child after treatment with antipyretics does not help determine whether it is a bacterial or viral infection. Children who are undergoing fever treatment do not need to wake them up to receive antipyretic treatment. Children who are receiving antipyretic drugs should no longer use cough and cold compound preparations, which often contain antipyretic drugs; simultaneous administration of compound preparations and antipyretic drugs may cause accidental overdose. Antipyretic drugs should be administered according to body weight, not age. The above points are the authoritative views of the current international medical community. Moms and dads can take a closer look, if they encounter a fever in the future, they may not be so anxious. If you have any doubts about the content of this article, please consult the following references yourself. References:  Luo Shuanghong, Shu Min, etc., Evidence-based guidelines for the diagnosis and management of several problems in acute fever of unknown etiology in children aged 0 to 5 years in China (standard edition). Chinese Journal of Evidence-Based Pediatrics 2016, 11(4): 81-95 . Nesse RM, Williams GC.Evolution and Healing. London:Phoenix; 1994. World Health Organization.Pocket book of hospital care for children: guidelines for the management of commonchildhood illnesses-2nd ed. 2013.[4 ]Losko SM. The safety of ibuprofen suspensionin children. Int J Clin Pract Suppl. 2003, (135): 50-53. Leaffer EB, Hinton VJ, Hesdorffer DC. Longitudinal assessment of skill development in children with first febrile seizure. Epilepsy Behav 2013; 28:83.Martinos MM, Yoong M , Patil S, et al. Recognition memory is impaired in children after prolonged febrile seizures. Brain 2012; 135:3153.Verity CM, Greenwood R, Golding J. Long-term intellectual and behavioral outcomes of children with febrile convulsions. N Engl J Med 1998; 338:1723. Nørgaard M, Ehrenstein V, Mahon BE, et al. Febrile seizures and cognitive function in young adult life: a prevalence study in Danish conscripts. J Pediatr 2009; 155:404.  Uptodate. Pathophysiology and treatment of fever in infants and children.