Recently, City Children’s Hospital received a child PNP TR, Female, 4 years old, living in Binh Tan. Taking the medical history recorded on the morning of the same day of admission, the mother cleaned up the things on the mezzanine #3m, the child played nearby climbed into the bed near the sliding door of the mezzanine, the child jumped through the sliding door, lost his balance and fell down the floor. On the ground floor, after the fall, the child lost consciousness #5 minutes and then cried, nosebleed, swollen eyes and forehead, the family took the child to the local hospital, gave first aid and then transferred to the City Children’s Hospital. Here, the child was lethargic, did not open his eyes, the Glasgow coma score was only 8 points (normal 15 points, pulse 75 times/min, blood pressure 90/50 mmHg, rough lungs, tender abdomen, ecchymosis hematoma on forehead area) T, swelling and bruising of the eyes on both sides, pupils on both sides 3mm, positive light reflection, blood in the nose on both sides.
Take a shot CT-scan of the brain recorded Bilateral frontal and temporal fossa epidural hemorrhage, left subarachnoid hemorrhage, midline unchanged. The sphenoid wing (T) fissure, the craniofacial fissure, is the fissure along the frontal attachment (T) joint and passes through the bilateral orbital ceiling, the bilateral ethmoid sinus wall, and the anterior and posterior wall of the frontal sinus. Fracture of the left orbital ceiling bone displaced posteriorly to the eyeball, monitored for entrapment of the superior rectus muscle (T). There are air bubbles in the bilateral orbits, intracranial air bubbles.
Chest CT scan: pulmonary contusion lesions with scattered hemorrhage in the dorsal lobes of the lungs on both sides, high-density left pleural effusion, followed by blood.
Abdominal CT scan: No solid organ damage was recorded on abdominal CT scan before and after contrast injection. High-density fluid retention in the gastric lumen, not excluding low-density, low-density intra-abdominal free-fluid bleeding.
X-ray showed no broken limbs
Neurosurgery consultation, general surgery, and thoracic surgery in ophthalmology have not yet undergone surgical intervention, so the child was transferred to the ICU for further treatment.
Diagnosis: Bilateral frontal and temporal fossa epidural haemorrhage, left subarachnoid hemorrhage, complex fracture of craniofacial bone, orbital ceiling fracture, follow up superior rectus occlusion – bilateral pulmonary contusion – N1 daily life accident.
The children were given mechanical ventilation, intravenous fluids, blood transfusions, blood products to stop bleeding, antibiotics, sedation to prevent cerebral edema, and merocells on both sides of the nose. Children continue to receive intensive care treatment, closely monitored in coordination with specialties to handle appropriately according to disease progression.
Through this case, we pay attention to parents in the days leading to Tet, Tet, accidents that can happen at home in young children such as falls, buckets of water, ponds, burns, electric shocks, accidental ingestion of chemicals. substances, foreign bodies in the airways, gastrointestinal tract, poisoning, …, there is always someone to take care of young children. Especially in the Tet season, besides decorating the house beautifully to welcome Spring and celebrate Tet, parents design their house to be safe for children such as the windows are covered with nets, the stairs are covered with lids, and the doors are closed. Close the railing, lock carefully, electric sockets with lids, irons, car exhausts, boiling water bottles, etc. keep them high out of reach of children, buckets of water are covered or all water is emptied, ponds have little water. , electrical decorations, wire connections must be shielded, cotton bottles, heavy objects, desks and cabinets are properly fixed to avoid falling, chemicals, gasoline, medicines, sharp objects sharp… keep out of reach of children. Children enjoying Tet safely need the attention of parents to avoid unfortunate accidents
Doctor 2 Nguyen Minh Tien
City Children’s Hospital