Question
A 9-month-old infant has a slight runny nose, a mild cough, and is unwilling to eat. They have been taking baby syrup and cough granules. After three days, the runny nose and cough have worsened, and there is also coughing at night with a sensation of phlegm. The child had taken cefradine in the evening, and half an hour later, they started to have a slight fever.
Answer
(1) Patients should be positioned in a lateral recumbent position. For patients under local anesthesia, instruct them to allow mouth secretions to flow out of the mouth corners, not to swallow, so that bleeding can be observed. For patients under general anesthesia, before they awaken, attention should be paid to any swallowing movements; if present, check for bleeding. (2) Three hours after surgery, patients can start with liquid food, and six hours later, they can rinse their mouth with saltwater. If there is pain at the incision site, a cold compress can be applied to the neck. (3) On the second day after surgery, a layer of white membrane may appear on the wound site, which is a normal reaction. The white membrane usually begins to fall off 5 to 7 days after surgery, with granulation tissue forming at the wound site and the surface epithelium starting to grow. If the white membrane appears grayish, be aware of the possibility of infection. Antibiotics can be used, and rinse with a 0.5 to 1% hydrogen peroxide solution. Complications and their management: (1) Bleeding: Bleeding within 24 hours after surgery is primary bleeding and is relatively common, often occurring within 6 hours after surgery. It may be due to insufficient meticulousness in surgery, residual tissue or incomplete hemostasis, or the vascular constriction effect of adrenaline in anesthetic agents disappearing after anesthesia; it may also be due to already existing small bleeding points that are triggered by activities in the throat, coughing, or temporary increases in blood pressure. A deficiency of vitamin C, decreased thromboplastin content, or sudden changes in weather can also promote postoperative bleeding. Secondary bleeding often occurs 5 to 6 days after surgery and is mainly due to the white membrane starting to fall off as the throat moves.