Ho Chi Minh City In a glass isolation room in the Intensive Care and Anti-Poison Department, doctors gently, carefully, and bit by bit insert an endoscope into the child's nose and down the throat to flush the respiratory tract.
Five minutes later, the water was sucked out of the child's trachea, carrying dirt, coal dust, and was turbid. Doctor Nguyen Van Loc, Head of the Intensive Care and Anti-Poison Department, Children's Hospital 2, said the water was less turbid than when the patient was first admitted. "At that time, the water used to clean the child's respiratory tract was as black as sewer water," said Doctor Loc, adding that the child was still in a serious state of infection.
The 13-year-old patient, one of 7 victims (including 5 children aged 13-15) who suffered severe burns in a fire in a rented room in Dong Nai half a month ago. To date, 5 people have died. This is the only child to survive, but with 70% burns (degree 3-4) on his body and respiratory burns, doctors "cannot say anything" about his recovery ability.
On June 19, she lay alone, unconscious in a closed isolation room set up in the middle of the Intensive Care Unit to ensure sterility. Her entire body was bandaged and white, revealing only the tip of her head and the tip of her nose, which had an endoscope attached to it for daily tracheal irrigation. There were many machines and equipment silently "beeping" in her head. The footsteps and movements of the doctors and nurses taking care of her were gentler and quieter than in other areas.
The danger for this patient is not only skin burns but also respiratory burns, because the burns are inside the body, making them difficult to observe, difficult to treat, and have many complications. This is the injury that doctors "fear most" in fire victims.
When the ambient temperature is too high, such as in a fire, the victim inhales hot air into the body, causing damage to the mucous membranes and airways from the nose to the lungs. First, respiratory burns cause edema and secretions in the airways; then the airways narrow, the body's lack of oxygen becomes even more lacking, causing more edema, and at some point, poisoning due to lack of oxygen. The victim can also be poisoned by gases formed during the burning process such as CO and Cyanide, leading to rapid death.
Patients with respiratory burns often suffer from very serious lung damage and respiratory failure. In the early stages, patients have airway obstruction due to phlegm, necrotic mucosa and sloughing off into the airway leading to death. In the late stages, patients develop pneumonia, progressive acute respiratory failure, with an 80% mortality rate. Therefore, patients with respiratory burns need to be treated promptly, taken to a ventilated area or given oxygen immediately to remove CO and Cyanide from the body.
During the treatment process, the patient's airway is endoscoped to clean, find foreign objects, and suction out blocked mucus. At the same time, the location and extent of internal burns are diagnosed to have an appropriate treatment regimen.
Doctors discuss Anh Khoa's health condition, June 16. Photo: My Y
At the same time, a 15-year-old boy was admitted to Nhi Dong 2 with the above patient, who had more severe skin and respiratory burns. This patient's entire body was black, and the trachea was washed many times, but the water that came out was only black, "proving that he was extremely dirty", according to Dr. Loc. The number of granulocytes (one of the factors that help the body fight infection) of the child dropped rapidly from more than 1,000 to only a few hundred after a few days, then down to a few dozen.
"At that time, it was somewhat predictable that the child would not survive, but we did not give up and said that while there is life, there is hope," said Dr. Loc.
He remembers that the atmosphere in the ward was always tense. Doctors continuously cleaned the patient's respiratory tract, provided hemodynamic support, treated infections, and debrided the skin. Infection control in the department was pushed to the highest level to limit infection. The department assigned a dedicated person to monitor the camera to monitor the infection control process. Doctors and medical staff from other departments who needed to come to examine and care for patients, such as performing bedside ultrasounds and physical therapy, also had to strictly follow the department's infection control procedures.
These best efforts still did not bring good results. After more than a week of treatment, the 15-year-old patient's condition worsened, with severe septic shock on a deep burn basis. He entered the stage of decompensated shock and irreversible shock, with end-stage functional disorders.
"We seemed to spend the whole night thinking about treatment methods but all came to a dead end," Dr. Loc emotionally recalled. Finally, "powerless", the doctors had to inform the family of the situation. On the afternoon of June 12, the doctors sent the baby home after nearly 10 days of tireless efforts, and he passed away at home.
"On the last day before he died, his respiratory tract was still cleaned. We hoped to help him reduce his infection, but there was really nothing we could do," said the head of the Intensive Care and Anti-Poison Department.
After the 15-year-old died, the doctors encouraged each other to stay motivated and try to save the remaining 13-year-old. She had her first skin graft surgery, thanks to her mother donating skin from her thigh.
After discussion, doctors checked the breathing tube and prepared to flush the baby's airway again on June 16. Photo: My Y
The children were victims of a fire in a rented room in Dong Nai on June 3, suspected to have been started by a jealous man. This person was also among those burned and died. Two other 13-year-old children, with 80-90% burns on their bodies, were treated at Children’s Hospital 1 and have both died.
The remaining victim is being treated at Cho Ray Hospital, suffering from 10% skin burns but severe respiratory burns - an equally dangerous condition.
"The children's passing leaves behind immense pain not only for their families but also for us doctors," Dr. Loc shared.
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