有幾點值得大家思考下
從內文資料分析,小baby有先天性有VSD(ventricular septal defect),餵奶時面色變紫其實可能有cyanotic heart disease如tetralogy of fallot (TOF)
TOF包括4個元素:VSD、Right ventricular outflow tract obstruction、overriding aorta和right ventricular hypertrophy
在嚴重VSD時情況下,右心室會逐漸變厚,不單止令到肺部血管壓力增加,同時當出現right to left shunt時,便會令小baby的血含氧量變低,因為右心室部分的血液不能經過肺部血管去oxygenate,而是直接shunt去左心室再經大動脈運到身體各處,這叫Eisenmenger syndrome,不過在發達國家如香港,這並不常見。
因為VSD令到更多血液流經肺部和心室,當小baby經過長期的volume overloading便可能會出現心臟衰竭。短期內可以試用藥物控制,但長遠還是要手術修補。
* 小baby可能會同時有右心室厚大(right ventricular hypertrophy)、cyanotic heart disease、肺高血壓(pulmonary hypertension)等問題
當baby出現體重過輕(failure to thrive)、面色變紫(cyanosis)、水腫或呼吸急速困難時,便代表小baby情況其實需要盡快以手術修補VSD或心臟結構異常以改善情況。
以往在初生兒先天性心臟發育不全的患者,有時候會先進行palliative staged surgery,先透過pulmonary artery banding(PAB)減少初期的left to right shunt和過多血液流向肺部(pulmonary over circulation)。不過近年研究發現早期直接primary definitive corrective surgery有更好的效果,但視乎個別情況,如臨床考慮和家屬的想法等,仍有不少病人需要先進行PAB再進行修補手術。
初生兒或兒童外科是非常複雜而且極為專門的專科,本身會去train pediatric surgery的醫生就極少,選擇去做這科的醫生一定都是有熱誠和深愛兒科才會去做,這比成人外科training所需要的成本、心血和時間多很多。
那我們回歸這個併發症:complete heart block
心臟是一個博大精深的器官,一些小小的disruption已經可以影響心臟自動發電心跳的功能。Complete heart block是VSD/TOF repair其中一個罕見的併發症,亦是有文獻documented的。
當然,沒有人會想有併發症,但梅菲定律告訴我們,anything that can happen will happen
不幸地,小baby似乎有complete heart block導致的心跳過低(Bradycardia)的併發症。很多家屬都反射性的想找原因,深信一定有人犯錯才會這樣,其他VSD/TOF repair的baby術後咩事都無,卻只有我的心肝寶貝出事。這種反應是可以理解的,但這是不是代表一定是醫療失誤?還是inadvertent的不幸?這是值得深思的一點
大家都不在手術現場,其實很難評論到底醫生有沒有犯錯、有沒有醫療失誤。目前仍然為口同鼻拗,但如我之前所講,當傳媒大肆報導醫生手術失誤害病人要安裝心臟起博器時,便已經嚴重傷害了醫生的reputation,就算到最後還他清白都好,damage has been done
更加重要的是,如小baby出現complete heart block,是需要治療和安裝永久性心臟起博器以確保心跳速度正常,過久的心跳過慢有導致心臟和器官衰竭的風險。但無奈的是,當家屬不信任醫療團隊時,再正路的醫療意見都不會被接納。
*先天性心臟病非常複雜,同樣是心漏病可以有非常不同的臨床狀況和治療方案。以上為general的分析,並不套用任何病人身上。
failure to thrive 在 HOKK fabrica Facebook 的精選貼文
生日快樂,Arianna!🎂
說起希臘裔美國作家Arianna Huffington,大家也許會馬上從她的姓氏Huffington聯想到知名新聞博客網站The Huffington Post。在成立這個年收3000萬美元的新聞平台背後,Arianna Huffington曾跌倒過許多次。年輕時,Arianna Huffington立志要做個作家,然而她被37間出版社拒絕出書;後來與美國國會參議員Michael Huffington離婚後,她曾參選加州州長,最終落敗;經歷事業與婚姻挫敗之後,她決定成立Huffington Post,終令她重新掘起,成為「網媒女王」。💪🏼
正如Arianna Huffington本人所說,失敗是成功的一部份;沒有過去的種種挫敗,就不會啟發她創立這個新聞博客網站。失敗不是世界末日,只是黎明來到前的晚上而已。💫
💬我們得接受自己有時會做錯決定,然後弄得一塌胡塗──你要知道失敗不是成功的相反詞,而是成功的一部份。
We need to accept that we won’t always make the right decisions, that we’ll screw up royally sometimes – understanding that failure is not the opposite of success, it’s part of success.
– Arianna Huffington,作家、The Huffington Post 共同創辦人和Thrive Global創辦人
💌💌💌
#hfHerWords #AriannaHuffington
#HOKKfabrica #原來不只一種模樣
failure to thrive 在 AppWorks Facebook 的最讚貼文
Launching and running a company is no small feat, but its rewards can be huge.
A 2019 survey from London-based company SME Loans found that 64 percent of the UK workforce wants to set up a business, and a massive 83 percent of 18- to 24-year-olds dream of self-employment. Despite these high numbers, comparatively few people end up starting their own companies, and even fewer people end up running successful ones.
Many aspiring entrepreneurs have great ideas for startups, but ideas are cheap, and execution is everything. So, what are some of the key things to know before starting your own company?
1. Failure is a part of the process.
People have a tendency to focus on others' successes and overlook their failures. Remember, the lessons learned from failing to provide entrepreneurs with the necessary skills to better execute their business plans in the future.
2. Entrepreneurship can consume your life.
Remember, nothing worthwhile comes easy, and you will have to sacrifice a lot of your free time so that you can give your startup the attention it needs to thrive.
3. You will doubt yourself at times.
Doubt is a normal human emotion, especially if you've been working on your startup for a while without seeing much success. One way to overcome self-doubt is by analyzing what you've done right and what you can do better.
4. The first few years are especially challenging.
According to data from the Small Business Administration, only 50 percent of businesses with employees survive the first five years, and only a third survive 10 years or longer. These statistics are a reflection of how difficult it is to start a successful company.
5. Entrepreneurship can come with a lot of satisfaction.
Job satisfaction is priceless, and it can be a major contributing factor to a happy and fulfilled life. If you're not happy with your current job, it may be time to start thinking about pursuing that startup you've always dreamed of creating. Many of the jobs in our economy have been created by ambitious and forward-looking entrepreneurs. They had a vision and were willing to stop at nothing to execute it.
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Would love to give it a go despite all these? We are now accepting applications for AW#21. Come build with us. https://bit.ly/2UXnt8l
by Joy Chiang, Alumni Community Manager of AppWorks
failure to thrive 在 Failure to Thrive - CRASH! Medical Review Series - YouTube 的必吃
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