Recently, City Children’s Hospital received 1 case of QLN infant, 5 months old, male, living in Ben Luc Long An. The medical history recorded that, 2 hours after admission, the child fell from a motorbike while traveling with his mother, carrying his father on the road due to a collision with another motorbike, after falling, the child was lethargic, admitted to Ben Luc hospital, gave first aid, transferred City Children’s Hospital. Here the child is lethargic, the Glasgow coma score is 7 points, the lips are purple, SpO2: 90%, the limbs are warm CRT <2s, the pulse is clear 150 l/min, the breathing is 24 l/min, the right head hematoma is enlarged. Size 7 x 5 cm, treated with endotracheal intubation to help with breathing, mechanical ventilation, and cerebral edema. Brain CT scan showed a small amount of subarachnoid hemorrhage in the frontotemporal frontal region, a small amount of subarachnoid hemorrhage and a small amount of subarachnoid hemorrhage in the frontotemporal lobes on both sides. Hematoma under the scalp of the right frontal forehead, was consulted by the Department of Neurosurgery: there is currently no indication for surgery, so he was transferred to the Department of Outpatient Resuscitation. Diagnosis: subdural hemorrhage, subarachnoid hemorrhage in the frontal, parietal, and temporal regions. Right frontal skull fracture – Traffic accident. Treatment of cerebral edema, correction of electrolyte disorders, acid-base. Progress in surgical resuscitation: after 1 day of treatment for children with high fever for 4 consecutive days, Hct gradually increased from 28% to 44%, platelets gradually decreased from 213 000/microL to 81 000/microL, leukocytes from 9500/microL down to 5000/microL, liver enzyme AST. ALT are all elevated, NS1 antigen rapid test is positive. On day 5, the child entered shock. Mild pulse 196 times/min, blood pressure 70/50 mmHg, CRT > 3 seconds, skin bursting should be diagnosed by doctors as day N5. The child received anti-shock fluid according to the regimen, the child’s condition was not favorable, so he was changed to high-molecular solution, invasive arterial blood pressure measurement, central venous pressure measurement to guide the infusion and administration of fluids. vasopressor drug use.

Treatment of children with both shock and traumatic brain injury causing intracranial hemorrhage is very difficult for doctors because of the risk of brain edema and bleeding for the child. Doctors have adjusted the appropriate anti-shock fluid while continuing to prevent cerebral edema for the child, as well as correcting coagulation disorders by infusing fresh frozen plasma, cold precipitate, and platelet concentrate. results after 2 days of treatment for dengue shock, the child’s shock condition improved after more than 2 weeks of supportive treatment for the liver and brain, the child’s state of consciousness gradually improved, the child was weaned from the ventilator, took oxygen, then breathed air. God, suck well. The child was discharged from the hospital and had periodic neurological re-examination.

Through this case, we pay attention to parents this Tet season, the rainy weather is erratic, children can get dengue fever even if they have other diseases, so parents actively kill mosquitoes, larvae, bed nets and need Monitor and detect early signs to take your child to a medical facility in time. That is, if you see a child with a high fever for more than 2 days, showing one of the following signs, you need to take the child to the hospital immediately.
· Irritability, irritability, irritability or lethargy
· Stomach-ache
Nosebleeds, bloody teeth or vomiting blood, black stools
· Cold hands and feet, lying in one place without playing, giving up breastfeeding, eating and drinking

Doctor 2 Nguyen Minh Tien
City Children’s Hospital