Principles of confidential care for patients 환자들 비밀보호 원칙

Principles of confidential care for patients

The next question is, “How would you make a diagnosis and treat febrile convulsions, status febrile convulsions if he is your child?

This is an example of a question-and-answer on internet pediatric and adolescent health counseling during “Ask and answer on any child medical care question thru the Internet done by myself about 10 years ago”.

Q&A. “How would you make a diagnosis and treat febrile convulsions, status febrile convulsions if he is your child?

Subject: For 1 hour 30 minutes febrile convulsions.

Age: 28 months old, Gender: Male

Past medical history:

1 time at age 7 months old, fever due to swollen throat,
2 times fever before the first birth day, 1 time at age 16 months old, and most of them did wake up by themselves. He was brought to the emergency room for all cases.
There were no significant sequelae.

Family history:

Dad said that he had twice febrile convulsion at the first 100 days old to age 6 years old and his mother also had one febrile convulsion as a child.

Examination findings:

Febrile convulsion, no abnormal EEG finding.

However, the convulsions that occurred at the age of 27 months old were different from usual, and I am quite worry a lot as a mother.

As one time, his throat was swollen and red and he had a fever.

Watching the child with a fever and this time I started looking at the clock.
After bubbling in his mouth and unconsciousness, difficulty breathing for 5 minutes, he woke up after showing a change as if crying while making a groaning sound. And the convulsions lasted more than an hour.

His doctor seemed to regard the convulsions as a post convulsions status. The convulsions lasted for 5 minutes, but he could have post convulsions status lasted more than 1 hour.
When he had arrived at the emergency room after 20 minutes of convulsion by the ambulance.
The nurses there said that the child was awake and told us not to worry, but after however that the convulsion persisted, they called the doctor in charge and the doctor administered suppositories of sedatives three times as first aid.

Still, the child did not wake up and did have the convulsions with holding fists tight, two legs stiff, eyes closed, moaning remain. After an hour and a half had passed, he repeated to sleep in pain and crying.

The doctor gave the bad sedative three times and then he said your child had post-convulsion status.
What is post-convulsion status and how can it be treated?
I am curious because there is no detailed explanation of the post-convulsion status anywhere.
He couldn’t walk after a convulsion as if a drunk person was paralyzed as if he was out of balance and bumped and fell.
Isn’t this Todd paralysis that may appear after febrile convulsion?
The emergency room doctor who has watched the convulsion looked inexperienced and is unreliable.
Pediatric neurologists don’t seem to believe that he has febrile convulsion lasting for the 1 hour and 30 minutes.

They thought he has simple febrile seizures.
It may be because there is no standard treatment method right now.
The result of the EEG test is normal and at the moment, he can walk well and not showing any after-effects.
It is recommended to use valium suppositories when convulsing only for the possible recurrence of febrile convulsion.
As a mother with poor medical knowledge, I write down the frustration of neither trusting nor trusting doctors.

How would you judge and deal with if he is your child?

Please give me a clear answer. A worried mother.

To dear worried mother

Hello. Thank you for asking. And thank you for giving me detailed information on your medical history and symptoms.

You did well as if in the morning, when in the medical rounding for the pediatric ward at a university hospital, one of the interns reported to the head professor on the progress of the patient’s illness who he was responsible for and treated over the past day.

Thank you.

I understand to some extent you who has been worried a lot during that time.

He has had a diagnosis, treatment from many famous and good doctors, but I am afraid and worry that I will be able to give you a better answer.

Today I posted an article about febrile convulsions on my homepage, www.drleepediatrics.com”.

Please read it.

In my opinion, your baby had a fever every time and he had a convulsion, and again, when he had a convulsion and also he had a fever, and when he did not have a fever, there was no convulsion, I think he had a febrile convulsion.

There are simple febrile convulsions and complex febrile convulsions and status febrile convulsion in a febrile convulsion.

By definition, if a febrile convulsion is lasting for more than 20 minutes, it is called a complex febrile convulsion. His convulsion lasted up to an hour and a half, and he did have Todd’s paralysis, so I think he had a complex febrile convulsion.

In addition, seeing that he had convulsions for more than 30 minutes and did not regain consciousness in the meantime, it seems that his convulsion fell into a “status febrile convulsion”.

There are three types of febrile convulsive.

About 5% of febrile convulsive can develop status febrile convulsion.

He seem to have received adequate treatment.

However, from now on, it would be a good idea to consult with a pediatric neurologist about preventing febrile convulsion from occurring again.

There are pros and cons of its prevention, and there is no unique form of way to prevent it.

If my child had a severe febrile convulsion, and my child had a persistent febrile convulsion, my child also received appropriate emergency treatment at the emergency medical center, hospitalized, and investigated to find what other abnormalities he had for convulsions. I will consult to other physician or send my child to a pediatric neurologist for follow-up treatment and prevention as directed by him.

However, here is an interesting article I read, so please read it.

■ “Principles of confidential care”

I am here to serve your health and well-being.

I will always try to provide the most appropriate treatment and service for you.

I believe anyone needs a little help sometimes.

I can’t cure all the sicknesses.

I am your doctor, not your friend.

I will not lie to you.

I promote your health and provide information about your behavior problems.

I am not here to judge what is right and what is wrong.

Parents train their children to behave morally, socially and culturally. (Source-Dr. Ann Bruner)

Your child doctors looked for the patient with “Principles of confidential care” in his mind.

When a child asks his mother for bread, she does not give a stone.

When a child asks his mother for fish, she does not give him a poisonous snake.

Our doctors always try to give their patients good bread and good fish.

And we stand to serve for the health and well-being of our patients.

Goodbye.
If you have more questions, please visit again. Thank you. Lee Sang-won .

Figure 275. Principles of confidential care. Source- Dr. Ann Bruner

환자에 대한 비밀 보장 원칙
인터넷으로 물어보세요에서 다음 질문은 “당신의 자녀라면 열성경련, 열성경련 상태를 어떻게 진단하고 치료할 것인가?”이다.
“약 10년 전 내가 인터넷으로 했던 아동의료 질문과 답변” 중 인터넷 소아청소년 건강상담 질의응답 예시입니다.

Q&A. “당신의 아이라면 열성경련, 열성경련 상태를 어떻게 진단하고 치료하겠습니까?
제목: 1시간 30분 동안 열성 경련이 발생했습니다.
나이: 28개월, 성별: 남자

과거 병력:
생후 7개월에 1회, 목이 부어 발열,
첫 출산일 전에 발열이 2번, 생후 16개월에 1번, 대부분 스스로 깨어났습니다. 그는 모든 경우에 응급실로 이송되었습니다.
심각한 후유증은 없었습니다.

가족력:
아빠는 생후 100일부터 6세까지 두 번 열성경련을 겪었고, 어머니도 어렸을 때 한 차례 열성경련을 앓았다고 합니다.

검사 결과:
열성 경련, 비정상적인 뇌파 소견 없음.
하지만 27개월에 발생한 경련은 평소와는 달랐기 때문에 엄마로서 걱정이 많이 됩니다.
한번은 목이 부어오르고 붉어지며 열이 나기도 했습니다.
열이 나서 아이를 바라보다가 이번에는 시계를 보기 시작했습니다.
입에 거품이 나고 의식불명, 5분간 호흡곤란을 겪은 뒤 신음소리를 내며 울 듯한 변화를 보이며 깨어났다. 그리고 경련은 한 시간 이상 지속되었습니다.
그의 의사는 경련을 경련 후 상태로 간주하는 것 같았습니다. 경련은 5분 동안 지속되었으나 경련 후 상태는 1시간 이상 지속될 수도 있었습니다.
구급차에서 20분간 경련을 일으키고 응급실에 도착했을 때.
간호사들은 아이가 깨어 있으니 걱정하지 말라고 했으나 경련이 계속되자 담당 의사를 불렀고 의사는 응급처치로 진정제를 3차례 처방했다.
그래도 아이는 깨어나지 않았고, 주먹을 꽉 쥐는 경련, 두 다리가 뻣뻣해지고, 눈을 감고, 신음소리가 계속됐다. 한 시간 반이 지나자 그는 고통과 울음에 잠을 반복했습니다.
의사는 나쁜 진정제를 세 번 투여한 후 귀하의 자녀가 경련 후 상태에 있다고 말했습니다.

경련 후 상태는 무엇이며 어떻게 치료할 수 있습니까?
경련 후 상태에 대한 자세한 설명이 어디에도 없어서 궁금합니다.
마치 술 취한 사람이 몸이 균형을 잃은 듯 몸이 마비된 것처럼 경련을 일으키고 부딪혀 넘어진 뒤 걷지 못하게 됐습니다.
열성경련 후에 나타날 수 있는 토드마비 아닌가요?
경련을 지켜본 응급실 의사는 경험이 없어 믿음직스럽지 못한 모습이었다.
소아 신경과 의사들은 그가 열성 경련이 지속된다고 믿지 않는 것 같습니다.
1시간 30분 동안.
그들은 그가 단순한 열성 발작을 앓고 있다고 생각했습니다.
현재로서는 표준적인 치료 방법이 없기 때문일 수도 있습니다.
뇌파검사 결과는 정상이며 현재는 잘 걸을 수 있고 후유증도 보이지 않습니다.
열성 경련이 재발할 가능성이 있으므로 경련 시 발륨 좌약을 사용하는 것이 좋습니다.
의학 지식이 부족한 엄마로서 의사를 믿지도, 믿지도 못하는 답답함을 적어 봅니다.

그 사람이 당신의 아이라면 어떻게 판단하고 처리하겠습니까?
명확한 답변 부탁드립니다. 걱정스러운 어머니.
걱정하는 엄마에게
안녕하세요. 물어봐주셔서 감사합니다. 그리고 귀하의 병력과 증상에 대해 자세히 알려주셔서 감사합니다.
아침에 대학병원 소아병동 회진에서 인턴 한 분이 지난 하루 담당하고 치료했던 환자의 병세를 주임교수님께 보고한 것처럼 잘하셨습니다. .
감사합니다.
그 동안 많이 걱정하셨을 부분은 어느 정도 이해가 됩니다.
많은 유명하고 좋은 의사들에게 진단과 치료를 받았지만, 더 나은 답변을 드릴 수 있을지 두렵고 걱정스럽습니다.
오늘 저는 제 홈페이지 www.drleepediatrics.com에 열성경련에 관한 글을 올렸습니다.”
꼭 읽어주세요.
제 생각에는 아기가 매번 열이 나고 경련이 있었고, 또 경련이 있을 때도 열이 나고, 열이 없을 때는 경련도 없었던 것 같아요.

열성 경련.
열성경련에는 단순열성경련과 복합열성경련, 상태열성경련이 있습니다.
열성경련이 20분 이상 지속되면 복합열성경련이라고 합니다. 그의 경련은 최대 1시간 30분 동안 지속되었고 토드 마비도 있었으므로 복합 열성 경련이 있었던 것으로 생각됩니다.
또한 30분 이상 경련을 일으키고 그 사이 의식을 회복하지 못한 것으로 보아 경련은 ‘열성경련상태’에 빠진 것으로 보입니인다.
열성경련에는 세 가지 유형이 있습니다.
열성경련의 약 5%에서 열성경련 상태가 발생할 수 있습니다.
그는 적절한 치료를 받은 것 같습니다.
하지만 앞으로는 열성경련이 다시 발생하지 않도록 소아신경과 전문의와 상담을 받아보시는 것이 좋을 것 같습니다.
예방에는 장점과 단점이 있으며, 예방할 수 있는 독특한 형태의 방법은 없습니다.
만약 우리 아이가 심한 열성경련을 보이고, 우리 아이가 지속적으로 열성경련을 보인다면, 우리 아이도 응급의료센터에서 적절한 응급처치를 받고 입원하여 경련에 대한 다른 이상소견이 있는지 조사하였습니다. 나는 다른 의사와 상담하거나 내 아이를 소아 신경과 의사의 지시에 따라 후속 치료 및 예방을 위해 소아 신경과 전문의에게 보낼 것입니다.
그런데 제가 읽은 흥미로운 글이 있으니 꼭 읽어보시기 바랍니다.

환자들의 비밀보호 원칙
나는 당신의 건강과 행복을 위해 여기에 왔습니다.
항상 고객님에게 가장 적합한 진료와 서비스를 제공하도록 노력하겠습니다.
나는 누군가에게 때때로 약간의 도움이 필요하다고 믿습니다.
모든 질병을 다 고칠 수는 없습니다.
나는 당신의 의사이지 당신의 친구가 아닙니다.
나는 당신에게 거짓말을하지 않을 것입니다.
나는 귀하의 건강을 증진하고 귀하의 행동 문제에 대한 정보를 제공합니다.
나는 무엇이 옳고 무엇이 그른지 판단하기 위해 여기에 있는 것이 아닙니다.
부모는 자녀가 도덕적, 사회적, 문화적으로 행동하도록 훈련합니다. (출처-앤 브루너 박사)
귀하의 담당 의사는 ‘비밀 진료의 원칙’을 염두에 두고 환자를 찾았습니다.
아이가 엄마에게 빵을 달라고 하면 엄마는 돌을 주지 않습니다.
아이가 엄마에게 생선을 달라고 하면 엄마는 독사를 주지 않습니다.
우리 의사들은 항상 환자들에게 좋은 빵과 좋은 생선을 제공하려고 노력합니다.
그리고 우리는 환자의 건강과 복지를 위해 봉사할 것입니다.
안녕히 가세요.
더 궁금하신 점은 다시 방문해 주세요. 감사합니다. 이상원 .

Principles of confidential care for patients

The next question is, “How would you make a diagnosis and treat febrile convulsions, status febrile convulsions if he is your child?

This is an example of a question-and-answer on internet pediatric and adolescent health counseling during “Ask and answer on any child medical care question thru the Internet done by myself about 10 years ago”.

Q&A. “How would you make a diagnosis and treat febrile convulsions, status febrile convulsions if he is your child?

Subject: For 1 hour 30 minutes febrile convulsions.

Age: 28 months old, Gender: Male

Past medical history:

1 time at age 7 months old, fever due to swollen throat,

2 times fever before the first birth day, 1 time at age 16 months old, and most of them did wake up by themselves. He was brought to the emergency room for all cases.

There were no significant sequelae.

Family history:

Dad said that he had twice febrile convulsion at the first 100 days old to age 6 years old and his mother also had one febrile convulsion as a child.

Examination findings:

Febrile convulsion, no abnormal EEG finding.

However, the convulsions that occurred at the age of 27 months old were different from usual, and I am quite worry a lot as a mother.

As one time, his throat was swollen and red and he had a fever.

Watching the child with a fever and this time I started looking at the clock.

After bubbling in his mouth and unconsciousness, difficulty breathing for 5 minutes, he woke up after showing a change as if crying while making a groaning sound. And the convulsions lasted more than an hour.

His doctor seemed to regard the convulsions as a post convulsions status. The convulsions lasted for 5 minutes, but he could have post convulsions status lasted more than 1 hour.

When he had arrived at the emergency room after 20 minutes of convulsion by the ambulance.

The nurses there said that the child was awake and told us not to worry, but after however that the convulsion persisted, they called the doctor in charge and the doctor administered suppositories of sedatives three times as first aid.

Still, the child did not wake up and did have the convulsions with holding fists tight, two legs stiff, eyes closed, moaning remain. After an hour and a half had passed, he repeated to sleep in pain and crying.

The doctor gave the bad sedative three times and then he said your child had post-convulsion status.

What is post-convulsion status and how can it be treated?

I am curious because there is no detailed explanation of the post-convulsion status anywhere.

He couldn’t walk after a convulsion as if a drunk person was paralyzed as if he was out of balance and bumped and fell.

Isn’t this Todd paralysis that may appear after febrile convulsion?

The emergency room doctor who has watched the convulsion looked inexperienced and is unreliable.

Pediatric neurologists don’t seem to believe that he has febrile convulsion lasting for the 1 hour and 30 minutes.

They thought he has simple febrile seizures.

It may be because there is no standard treatment method right now.

The result of the EEG test is normal and at the moment, he can walk well and not showing any after-effects.

It is recommended to use valium suppositories when convulsing only for the possible recurrence of febrile convulsion.

As a mother with poor medical knowledge, I write down the frustration of neither trusting nor trusting doctors.

How would you judge and deal with if he is your child?

Please give me a clear answer. A worried mother.

To dear worried mother

Hello. Thank you for asking. And thank you for giving me detailed information on your medical history and symptoms.

You did well as if in the morning, when in the medical rounding for the pediatric ward at a university hospital, one of the interns reported to the head professor on the progress of the patient’s illness who he was responsible for and treated over the past day.

Thank you.

I understand to some extent you who has been worried a lot during that time.

He has had a diagnosis, treatment from many famous and good doctors, but I am afraid and worry that I will be able to give you a better answer.

Today I posted an article about febrile convulsions on my homepage, www.drleepediatrics.com”.

Please read it.

In my opinion, your baby had a fever every time and he had a convulsion, and again, when he had a convulsion and also he had a fever, and when he did not have a fever, there was no convulsion, I think he had a febrile convulsion.

There are simple febrile convulsions and complex febrile convulsions and status febrile convulsion in a febrile convulsion.

By definition, if a febrile convulsion is lasting for more than 20 minutes, it is called a complex febrile convulsion. His convulsion lasted up to an hour and a half, and he did have Todd’s paralysis, so I think he had a complex febrile convulsion.

In addition, seeing that he had convulsions for more than 30 minutes and did not regain consciousness in the meantime, it seems that his convulsion fell into a “status febrile convulsion”.

There are three types of febrile convulsive.

About 5% of febrile convulsive can develop status febrile convulsion.

He seem to have received adequate treatment.

However, from now on, it would be a good idea to consult with a pediatric neurologist about preventing febrile convulsion from occurring again.

There are pros and cons of its prevention, and there is no unique form of way to prevent it.

However, here is an interesting article I read, so please read it.

■ “Principles of confidential care”

I am here to serve your health and well-being.

I will always try to provide the most appropriate treatment and service for you.

I believe anyone needs a little help sometimes.

I can’t cure all the sicknesses.

I am your doctor, not your friend.

I will not lie to you.

I promote your health and provide information about your behavior problems.

I am not here to judge what is right and what is wrong.

Parents train their children to behave morally, socially and culturally. (Source-Dr. Ann Bruner)

Your child doctors looked for the patient with “Principles of confidential care” in his mind.

When a child asks his mother for bread, she does not give a stone.

When a child asks his mother for fish, she does not give him a poisonous snake.

Our doctors always try to give their patients good bread and good fish.

And we stand to serve for the health and well-being of our patients.

Goodbye.

If you have more questions, please visit again. Thank you. Lee Sang-won .

Figure 275. Principles of confidential care. Source- Dr. Ann Bruner

Copyright ⓒ 2012 John Sangwon Lee, MD., FAAP