医用dcm_幼儿和医用眼球镊子的根本原因分析

医用dcm

This has been a very stressful week. Our four year old had a piece of metal in his cornea. Twice. That's two different pieces over multiple days in the same eye. In one week. He's great now, no lasting damage and no vision trouble. That's not his eye pictured at right.

这是非常紧张的一周。 我们四岁的孩子的角膜上有一块金属。 两次。 同一天多天来，这是两个不同的片段。 在一个星期内。 他现在很棒，没有持久的伤害，也没有视力障碍。 那不是他的右眼。

He was having trouble sleeping and was complaining about his eye hurting. He's had eyelashes in his eye before so we check it out, didn't see much, and flushed with saline eye drops anyway. He wouldn't fall asleep and kept waking in a start. About 1 in the morning it was clear that he was in some considerable pain and wasn't going to sleep. We looked again with a bright flashlight. Turns out that little kids not only don't like standing still but they don't like staying still with a bright light in their eyeball. We did get a hint of something, right on the surface of the eye next to the pupil. I couldn't get it out with the edge of a tissue so we headed to the emergency room.

他入睡困难，并抱怨眼睛受伤。 之前他的眼睛里有睫毛，所以我们检查了一下，没看见太多，反正用盐水眼药水冲洗了一下。 他不会睡着，一开始就一直醒着。 大约在凌晨1点，很明显，他正处于某种痛苦中，并且不会入睡。 我们再次用明亮的手电筒看了看。 事实证明，小孩子不仅不喜欢站着不动，而且不喜欢在眼球旁保持明亮。 我们确实在瞳Kong旁边的眼睛表面上得到了一些暗示。 我无法用纸巾的边缘弄出来，所以我们去了急诊室。

The very kind doctor at the ER took a look with a slit lamp and exclaimed: "It's something metal!" She numbed the eye and tried to remove it but quickly decided it was out of her expertise and call the on call ophthalmologist. They woke up the eye surgeon and brought him in to check it out. We found ourselves with a tired toddler and a tired (but kind) eye doctor after 2am trying to get this metal out of his little eye with some kind of special set of medical eyeball tweezers. Again, may I mention that while my son is and was a trooper, no one likes to hear "eyeball" and "tweezers" in the same sentence, especially when combined into one super scary term: "medical eyeball tweezers."

急诊室的一位好心的医生用裂隙灯看了一眼，然后大叫：“这是金属的东西！” 她麻木了一下，试图摘除它，但很快就认为那是她的专长，因此请值班眼科医生就诊。 他们叫醒了眼科医生，把他带进去检查。 凌晨2点后，我们发现自己有一个疲倦的小孩和一个疲惫(但善良)的眼科医生，试图用某种特殊的医用眼球镊子将这种金属从他的小眼睛中取出。 再说一遍，我可以提一提，虽然我儿子是士兵，但没有人喜欢用同一句话听“眼球”和“镊子”，特别是当组合成一个超级可怕的术语时：“医用眼球镊子”。

His patience exhausted, my baby fell asleep crying. The doctor said I got all the metal and 80% of the rust.

他的耐心累了，我的宝宝哭着入睡。 医生说我得到了所有的金属和80％的Rust。

Rust? Yes, rust. Rust that looks roughly like this.

锈？ 是的，生锈。 看起来像这样的Rust。

Iron rusts in the eye very quickly and creates a rust ring (iron oxide). That ring often needs to be removed as well usually with the equivalent of an "eyeball Dremel tool," like this one below.

铁很快在眼中生锈，并形成Rust环(氧化铁)。 通常也需要使用等效于“眼球Dremel工具”的方式来移除该戒指，如下图所示。

We were told to return the following day to get the remainder of the rust. We went home, tired but feeling reasonably comfortable that this strange thing was a fluke and that everything would be cool. The following day an attempt was made to get the last bit of rust but bless him, he wouldn't stay still so the we and doctor decided against further trauma. The chances are that the very small bit of rust will just dissipate. If not, we'd deal with it later when he's older.

我们被告知第二天要归还剩余的Rust。 我们回到家，很累，但是感到很舒服，因为这奇怪的事是a幸的，一切都会变得很酷。 第二天，他尝试着除掉最后的锈，但保佑他，他不会静止不动，所以我们和医生决定不再遭受创伤。 极少数的锈蚀可能会消散。 如果没有，我们会在他长大以后再处理。

My son went to school and the next day came home complaining about his eye. The doctor had said it would feel like there was something in his eye (even though it had been removed) and that this was common. However, he couldn't sleep and insisted something was wrong. We have learned to listen to little people, even and especially at 2am.

我儿子上学，第二天回家抱怨他的眼睛。 医生曾说过，感觉好像眼中有什么东西(即使已经去除了)，这很普遍。 但是，他无法入睡，并坚持认为出了点问题。 即使在凌晨2点，我们也学会了倾听小人们的声音。

There was something new in his eye - the same eye.

他的眼睛里有些新东西-同一只眼睛。

I could only assume that the doctor didn't get everything the last time. Off to the ER again (don't mess with eyes) but this time they were not wiling to wake up the eye doctor. We saw him a few hours later first thing in the morning. I asked if it was the same piece and he said, "no, it's the same eye but a different location. You can tell because the original rust ring is a marker."

我只能以为医生上次没有得到一切。 再次去急诊室(不要弄乱眼睛)，但是这一次他们并不想唤醒眼科医生。 几个小时后，我们早上见到他。 我问它是否是同一块，他说：“不，它是同一只眼睛，但位置不同。您可以分辨出来，因为原始的防锈圈是标记。”

He was shocked to say the least. "In 30 years I've never seen someone get something in their eye twice. Not even in people who grind metal for a living."

至少他感到震惊。 “在30年中，我从未见过有人两次看到他们的东西。甚至在以磨金属为生的人中也没有。 ”

He tried to get it out but my baby wasn't having it. The decision was made (and not lightly) to use general anesthesia to perform the eye surgery procedure and get it out. This kind of thing requires one stays completely still and you just can't ask a 4 year old to do that.

他试图把它弄出来，但我的孩子没有了。 决定(并非轻率地)使用全身麻醉进行眼外科手术并将其取出。 这种事情需要一个人完全静止不动，而你却不能要求4岁的孩子这样做。

I just couldn't get my head around the idea that this was a new piece of metal. What if a third one showed up? What was he doing or what was he around to cause this? Was he banging metal cars together? Was it shavings off his metal bed? Maybe sandbox sand being thrown in the air? Something from our new car?

我只是无法理解这是一块新金属的想法。 如果出现第三个人怎么办？ 他在做什么或他在周围是什么原因引起的？ 他在撞金属车吗？ 是从他的金属床上刮下来的吗？ 也许沙盒沙子被扔向空中？ 我们的新车有东西吗？

My wife and I became obsessed with "root causing." I spent a day moving through my son's life, touching everything. Toys, beds, toothbrushes, car seats, furniture. No luck.

我和我的妻子迷上了“根本原因”。 我花了一天的时间抚摸儿子的一生，抚摸着一切。 玩具，床，牙刷，汽车座椅，家具。 没运气。

We were at the hospital yesterday and he was put under and had the procedure done. The doctor said it was successful and not only did he get th second piece of metal out but also cleaned up the now two rust rings.

昨天我们在医院里，他被放下并完成了手术。 医生说这是成功的，不仅他拿出了第二块金属，还清理了现在的两个锈环。

We asked again, "How do we keep this from happening again?"

我们再次问：“我们如何防止这种情况再次发生？”

The doctor said, "You've got to find the cause or it very well could reoccur. The thing is..." he reiterated, "I've never seen this, even in metal grinders or folks in manufacturing."

医生说：“您必须找到原因，否则很可能会再次发生。问题是……”我重申，“即使在金属磨床或制造业的人中，我也从未见过。”

We took baby home with a healthy dose of paranoia. Should he wear glasses until this is figured out? Then we had an idea. Where does a 4 year old come in contact with grinding metal. Why our son and not the other kids?

我们带着健康的偏执狂把婴儿带回家。 在解决之前，他应该戴眼镜吗？ 然后我们有了一个主意。 4岁的孩子在哪里接触磨削金属。 为什么我们的儿子而不是其他孩子？

Wait. Metal grinders. Where does my son go where metal grinds together?

等待。 金属研磨机。 我儿子要去哪里，金属一起研磨？

The playground swing. Specifically the tire swing. I've seen him spin on the swing for hours with his head parallel to the ground, eyes wide open looking at the clouds.

操场的Swing。 特别是轮胎的摆动。 我已经看到他在Swing上旋转了几个小时，他的头与地面平行，睁大了眼睛看着云。

I went to the playground, found the swing and touched the metal ball where the hip joint fits into the bearings. My finger came out covered in what looked like glitter. Metal shavings. The tire swing joint was dry and cold - effectively a metal grinder rotating directly over his eyes.

我去了操场，发现了Swing并碰到了金属球，在该金属球中，髋关节正好适合于轴承。 我的手指被覆盖着看起来像是闪光的东西。 金属屑。 轮胎的摆动接头干冷，有效地使一个金属磨床直接在他的眼睛上方旋转。

There's nothing more satisfying than The Answer.

没有什么比答案更令人满足了。

I spoke to the principal of the school and he made some calls and actually spoke to the designer of the playground product who hooked him up with the designer of the swivel. They are swapping the Tire Swing Hanger for a Heavy Duty hanger that includes a rubber boot to cover the joint.

我和学校的校长谈过，他打了一些电话，实际上是和游乐场产品的设计师谈过，后者将他与转环的设计师联系起来。 他们将轮胎Swing悬挂架换成重型悬挂架，该悬挂架包括一个用于覆盖接头的橡胶靴。

This was a clear and satisfying end to a very painful experience for the little guy. I'm just happy we figured it out but I think we are going to be paranoid about eyeballs for a the foreseeable future.

对于小家伙来说，这是一次非常痛苦的经历的清晰而令人满意的结局。 我很高兴我们解决了这个问题，但是我认为在可预见的未来，我们会对眼球产生偏执。

翻译自: https://www.hanselman.com/blog/root-cause-analysis-for-toddlers-and-medical-eyeball-tweezers

医用dcm