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Seema Shah

丁香诊所 急诊科

急诊科视频 / 时长49分钟

丁香诊所全科培训课程 44:如何诊治走路拐瘸的儿童

¥12.00

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课程介绍

在丁香诊所「全科医生强化培训班」中,美国加州 Rady Children Hospital 儿科副教授 Seema Shah 与大家一起讨论《走路柺瘸的儿童》。

本次课主要从背景、正常与异常步态鉴别、瘸拐的评估和病例回顾四个方面进行介绍。

儿童瘸拐是步态异常,通常由疼痛、虚弱或畸形引起。发病平均年龄为 4 岁,男女比例为 2:1,最常见的诊断为暂时性滑膜炎,以髋部和膝盖多见,80% 患者会出现疼痛,其中 77% 为良性病因。

在采集病史时,除了发病症状,还包括全身症状和创伤史,确定疼痛部位及疼痛性质,以及晨间僵硬等其他症状。体格检查时,除了大体情况外,还要仔细观察步态和各关节的活动范围,以及肌肉骨骼系统、皮肤、淋巴和神经系统、胃肠道和泌尿系统。可让父母协助,保持一定距离观察。偏瘫步态,特伦佰氏步态等均属于异常步态。依靠患儿年龄、异常部位、症状持续时间及异常步态的类型对瘸拐作出诊断,并与其它疾病如化脓性关节炎、骨髓炎等进行鉴别诊断。

学龄前儿童瘸拐的原因有骨折、关节积血、毒性滑膜炎等急性病因和布朗特病、脑性瘫痪、椎间盘炎等慢性病因。而学龄儿童主要有骨折、肌炎等急性原因和股骨头骨骺骨软骨病、Baker 囊肿等慢性原因。并根据具体病例阐述各种病因导致瘸拐的诊断及治疗。

更多精彩内容请点击此处观看丁香公开课全部课程。

封面图片来源:shutterstock 网站

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Seema Shah 丁香诊所 急诊科

Seema Shah,美国加州 Rady Children Hospital 儿科副教授、急诊科主任、质量管理委员会主任。

Education:
1993-2000, Combined Undergraduate/Graduate Program BS - Biology; BA – Spanish; MD University of Missouri, Kansas City, MO
2000-2003, Intern & Resident, Pediatrics University of California, San Diego, CA
2004-2007, Fellow, Pediatric Emergency Medicine University of California, San Diego, CA 2013-2014 Teaching Fellowship, American College of Emergency Physicians

Licensure and Certification:
2002-present, California Medical Board, Medical License
2000-current, Pediatric Advanced Life Support
2004-current, Advanced Trauma Life Support
2003-current, Board Certification, Pediatrics 2009-current Board Certification, Pediatric Emergency Medicine

Previous Employment:
2003-2004, Staff Physician, Children’s Specialists Juvenile Hall, San Diego, CA
2003-2004, Pediatrician La Jolla Pediatrics, La Jolla, CA
2003-2004, Pediatrician Kaiser Permanente, San Diego, CA
2003-2005, Staff Physician, Children’s Specialists Polinsky Children’s Center for Child Abuse San Diego, CA
2003-2009, Attending Physician Children’s Specialists, San Diego, CA
2003-2013, Staff Physician San Diego Hospice, Pediatric Program San Diego, CA
2007-present, Attending Physician, Emergency Department Rady Children’s Hospital San Diego, San Diego, CA
2009-2013, Assistant Clinical Professor of Pediatrics University of California San Diego
2013-present, Associate Clinical Professor of Pediatrics University of California San Diego

University Service:
UCSD:
2008-present, Pediatric Emergency Medicine Fellowship Interview Committee
2010-2012 , Medical Student Clerkship Director, PEDS 429
2010-2014, Director, Pediatric Emergency Medicine Resident Education
2010-present, Member, Pediatric Emergency Medicine Fellowship Scholarship Oversight Committee
2011-present, Internal Review Committee, Pediatric Emergency Medicine Fellowship
2011-present, Associate Program Director, Pediatric Emergency Medicine Fellowship
2012-2014, Member, Residency Review Committee, UCSD Pediatrics Residency
2013-present Member, Admissions Committee, UCSD School of Medicine
2014-present Facilitator, Pediatrics Practicum, UCSD School of Medicine
2014 Member, Residency Interview Committee, UCSD Pediatrics Residency
RCHSD:
2008-2010, Director, Patient Quality Assurance, Division of Emergency Medicine
2008-2010, ED Advisory Committee, Division of Emergency Medicine 2008-2010 Community Outreach Coordinator, Division of Emergency Medicine
2008-present, Contributor, ED Mortality & Morbidity Conference
2008-present, Contributor, Trauma Mortality & Morbidity Conference
2010-present, Co-creator and moderator, Pediatric Emergency Medicine Regional Conference (semi-annual) September 21, 2010 February 17, 2011 August 30, 2011 February 16, 2012 October 29, 2012
February 14, 2013, October 29, 2013 February 20, 2014 September 30, 2014 February 19, 2015
2014-present, Trauma Liaison, Trauma Advisory Committee
2014-present, Clinical Director, Division of Emergency Medicine
2014-present, Member, RCHSD Quality Improvement Committee
2014-present, Chair, RCHSD ED Quality Assessment and Process Improvement Committee

Memberships:
2000-present, Fellow, American Academy of Pediatrics
2007-present, Member, Section on Emergency Medicine, American Academy of Pediatrics
2014-present, Member, American College of Emergency Medicine

Honors and Awards:
2000 Research Award, University of Missouri-Kansas City

External Professional Activities:
Poster Presentations 「Infective Endocarditis: An Immunohistochemical Analysis of Vegetations,」 Creighton University, Nebraska; November 1996
「Infective Endocarditis: An Immunohistochemical Analysis of Vegetations,」Infectious Disease Society of America Meetings; September 1998
「Three Year Old Boy with Respiratory Distress,」American Academy of Pediatrics Meetings; October 2007
「Emergency Medicine Resident Self-Instruction on Pediatric Radiography,」American College of Emergency Physicians; October 2014
Invited Presentations – Regional:「Pediatric Respiratory Infectious Emergencies.」Emergency Department, Tri-City Medical Center, Oceanside, CA. 1/2009
「The Febrile Neonate.」Emergency Department, Scripps Memorial Hospital Encinitas, Encinitas, CA. 6/2009
「Visual and Radiographic Diagnosis.」Pediatric Emergency Medicine Regional Conference, Rady Children’s Hospital San Diego. 9/2010
「Emergency Medicine Resident Self-Instruction on Pediatric Radiography,」American College of Emergency Physicians Meetings; October 2014.

Other Activities:
2003-2008 Board of Directors, Make-A-Wish Foundation, San Diego Chapter
2008-present Medical Advisor, Make-A-Wish Foundation, San Diego Chapter
2008 JCC Maccabi Games

Student Instructional Activity:
Grand Rounds Lectures: Pediatric Respiratory Infectious Emergencies. Pediatric Grand Rounds, Scripps Mercy Hospital, San Diego, CA. 7/2008
Pediatric Respiratory Infectious Emergencies. Pediatric Grand Rounds, Naval Medical Center, San Diego, CA. 8/2008
Pediatric Endocrine Emergencies. Pediatric Grand Rounds, Naval Medical Center, San Diego, CA. 6/2010
Pediatric Endocrine Emergencies. Pediatric Grand Rounds, Scripps Mercy Hospital, San Diego, CA. 9/2010
Pediatric Surgical Emergencies. Pediatric Grand rounds. Scripps Mercy Hospital, San Diego, CA. 5/2013
Pediatric Core Lecture Series, UCSD Department of Emergency Medicine: Pediatric Endocrine Emergencies 10/2006 Pediatric Respiratory Infectious Emergencies 3/2009 Pediatric Respiratory Emergencies 1/2011 Pediatric Gastrointestinal Emergencies 12/2011 UCSD EM Orientation to Pediatrics 7/2012 UCSD EM Orientation to Pediatrics 7/2013 Neonatal Emergencies 07/2014
Noon Conference Lectures, UCSD Department of Pediatrics: Pediatric Endocrine Emergencies 04/2011 Pediatric Gastrointestinal Emergencies 10/2011 Pediatric Surgical Emergencies 10/2013
UCSD Pediatric Emergency Medicine Fellows Conferences: Pediatric Trauma Review. 2006 Pediatric Respiratory Infectious Emergencies. 10/2007 Pediatric Skin Disease, Review. 6/2007 Pediatric Respiratory Infectious Emergencies. PEM Fellow Board Review. 6/2007 Patient Quality Assurance in the Emergency Department. Pediatric Emergency Medicine Fellow Orientation, 07/2009 Patient Quality Assurance in the Emergency Department. Pediatric Emergency Medicine Attending Seminar Series. 10/2009 Pediatric Endocrine Emergencies. Pediatric Emergency Medicine Attending Seminar Series 08/2010 Neonatal Resuscitation 6/2013
Emergency Medicine Core Lecture Series, NMCSD Department of Pediatrics: 06/2010, 02/2011, 06/2012, 11/2012 , 10/2013
Rady Children’s Hospital San Diego Lectures: Pediatric Intubation Skills. Paramedic Education, Rady Children’s Hospital. Preceptor for skills station quarterly since 2007
Encounters with Snakes, Spiders, Jellyfish, & Stingrays. Advanced Topics in the Emergency Department (for RNs). 5/2008
Emergency Medicine Core Lecture Series, UCSD School of Medicine (3rd and 4th year students): Respiratory Emergencies 09/2011
Respiratory Emergencies 11/2011 Neurologic Emergencies 1/2012
Infectious Disease 3/2012 Respiratory Emergencies 09/2012
Respiratory Emergencies 01/2013
Faculty Advisor: Beena Patel, MD, UCSD Pediatric Emergency Medicine Fellow, 07/2008 – 06/2011
Julia Magana, MD, UCSD Pediatric Emergency Medicine Fellow, 07/2011 – 07/2014
Christy Riestenberg, UCSD Medical Student, PEM ISP Project, 2012-13 Yvette Wang, UCSD Pediatrics Resident, 07/2013 - present

Clinical Research:
2003-2008 Co-investigator; Interleukin-8 concentrations in cerebrospinal fluid and plasma of children with suspected bacterial and aseptic meningitis
2011-now Member, Emergency Medicine Kawasaki Disease Research Group
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