VROČINSKI KRČI PRI OTROKU, OSKRBA NA TERENU IN TRANSPORT - Miklič, Marko (M. Miklič, 2010)
Vročinski krči so najpogostejša oblika cerebralnih krčev pri otrocih, pojavijo se pri 2-5 % vseh otrok med starostjo 6 mesecev in 6 let pri povišani telesni temperaturi. Najpogosteje so vzrok okužbe dihal, prebavil ali vnetje srednjega ušesa ter druga infekcijska stanja. Ključno je razlikovanje med vročinskimi krči in krči ob okužbi centralnega živčevja, saj sta zdravljenje in prognoza obeh stanj bistveno drugačna. Velika večina krčev je enostavnih. Če krči trajajo dlje kot 15 minut, so parcialni, jih spremljajo fokalni nevrološki izpadi oziroma se ponovijo znotraj 24 ur, govorimo o zapletenih vročinskih krčih. Redka oblika je vročinski epileptični status, ki je lahko tudi smrten. Sicer krči praviloma izzvenijo sami od sebe in nimajo posledic. Reakcija staršev ob povišani telesni temperaturi pogosto privede do prehitrega zniževanja temperature, ki je pomemben obrambni mehanizem organizma. Metode zniževanja so fizikalne in medikamentozne. Pri vročinskih krčih je pomembno, da starši ostanejo mirni, otroka namestijo v ustrezen položaj in ga opazujejo do prihoda ekipe nujne medicinske pomoči, če je le-ta potrebna. Pri nujni medicinski pomoči je bistvenega pomena kvaliteten sprejem klica, ki ekipi zagotovi zadosten vir podatkov in s tem boljšo pripravo na samo intervencijo. Pomembno je dobro poznavanje pripomočkov za oskrbo otrok, ki jih imamo na voljo. Sam transport, in pa predaja v bolnišnici, naj bi potekal po usklajenem protokolu. Zavedati se je potrebno, da je otrok v takšni situaciji zelo prestrašen in da mu pravilen pristop zdravstvenega osebja, in tudi prisotnost staršev, zmanjša stres, ki ga doživlja. V empiričnem delu diplomske naloge smo s pomočjo anketirancev, ki so obiskali razvojno ambulanto in otroški dispanzer Zdravstvenega doma Krško, izvedli raziskavo na temo seznanjenosti staršev o povišanju telesne temperature in vročinskih krčev. V anketi, ki smo jo izvedli v mesecu marcu 2010, je sodelovalo 60 staršev, ki so odgovorili na 14 anketnih vprašanj. Anketo smo izvedli anonimno, uporabili smo deskriptivno metodo dela. Rezultate smo analizirali in predstavili v obliki grafov. Febrile seizures are the most common seizure disorders in childhood, affecting 2-5 % of children between age 6 months and 6 years. The most common causes are upper respiratory tract infections, otitis media, gastroenteritis or other infections. Differentiation of febrile seizures from seizures secondary to central nervous system infections is essential due to different treatement and prognosis for these two conditions. Vast majority of febrile seizures are simple. Those with focal onset or showing focal neurologic features, with prolonged duration (greater than 15 minutes) or which reccur within 24 hours are considered complex. Rare condition is febrile status epilepticus which can in small percent of children lead to death. Usually febrile seizures have excellent outcome with no need for drug intervention. Parents tend to keep child´s body temperature down early during feverish illness although fever is important immune defensive mechanism. Methods for lowering body temperature are physical and medicamentous. With febrile seizures it is important for parents to stay calm, put their child in correct position and watch them until arrival of medical team if that is neccessary. Emergency team should carefully take all important information when they receive emergency call so that the team is fully prepared for intervention. It is essential to know how to properly handle special equipment for child management. Special protocols are used for transport and child handover in hospitals. Child is usually very frightened in such situations which makes correct approach of medical team and the presence of their parents crucial. In the empirical part of the graduation work, we get the necessary information through respondents who visited development and child dispensary in health center Krško. We conducted a survey on the topic, parents knowledge about increase in body temperature. In the survey which was conducted in March 2010, participated 60 parents, who answered the 14 questions. We conducted an anonymous survey and we used descriptive method. Results were analyzed and presented in the form of graphs.