There was no obvious cause of cough or fever 20 days ago, and intravenous cefazolin was ineffective. 8 days ago, the cough became worse, accompanied by shortness of breath, which was paroxysmal. After cardiotonic treatment with cefoperazone, salbutamol and digitalis, the condition was mild and severe, and cough and asthma worsened in the last two days. After the onset, the child's spirit is poor, he can eat milk, sleep is unstable, and he defecates 4-5 times a day. With breast valve, normal urine output, weight gain 1kg, and a history of night terrors and hyperhidrosis. She was in good health before, and a second child gave birth to 1. She gave birth at full term, breast-fed, and did not add cod liver oil, calcium and complementary food.
Physical examination: T37.2℃, P 186 times/min, R 70 times/min, Bp80/50mmHg, weighing 8kg, body length 63cm, head circumference 40cm, chest circumference 39cm, front chimney 2×2cm, normal development, moderate nutrition, acute and severe, irritability, automatic posture, skin. The skull shape is normal, the occipital baldness (), eyelid edema, sclera yellow stain, pharyngeal congestion, cyanosis around the mouth, shortness of breath, nasal fan (), concave sign (), no deformity in the chest, wheezing and moderate to fine moist rales can be heard in both lungs. Hairless skin, small heart boundary, heart rate 186 beats/min, flat and soft abdomen, liver 3cm below ribs, no tenderness, normal spleen and both sides, normal bowel sounds, mild sunken edema of both lower limbs, Budd-Chiari sign (-) and double nipple sign (-).
Laboratory examination: blood routine: hemoglobin 9 1 g/l, red blood cell: 4. 23× 10 12/L, leucocyte11.0×109/l, 65% lobulated and 35% lymphoid. Routine urine and normal stool.
I. Diagnosis and diagnostic basis
(a) Diagnosis of bronchopneumonia: heart failure
(2) Diagnostic basis
1. The first symptom is cough, mainly manifested as dyspnea, restlessness, shortness of breath and fever.
2. Physical examination: cyanosis around the mouth, nasal fan sign (), concave sign (), wheezing and moist rales in both lungs, signs of heart failure: increased breathing > 60 beats/min, significantly increased heart rate (> 180 beats/min), dull heart sounds, large liver and edema in both lower limbs.
3. The number of white blood cells and neutrophils in the blood increased.
Second, differential diagnosis.
1. viral pneumonia
2. Staphylococcus pneumonia
3. Mycoplasma pneumonia
Third, further inspection.
1. Check pathogens (bacterial culture and serum antibody)
2. Blood gas analysis and X-ray chest film
3. Liver and kidney function, blood electrolyte
4. Electrocardiogram and echocardiography
Fourth, the principle of treatment.
1. Pathogen therapy: antibiotics
2. Treatment of heart failure: cardiotonic agents, diuretics and vasodilators.
3. Symptomatic treatment: oxygen inhalation, expectorant, spasmolytic and antiasthmatic.
4. Application of glucocorticoid