![]() Epiglottitis?
0 Comments
![]() **Kids... look great until they plummet. Appear well until very close to decompensation. INTUBATION - DO IT BEFORE IT IS TOO LATE **Intubate early for children who are doing poorly, do not wait until they are becoming increasingly hypoxic and bradycardic! **40% of infant cardiac output goes to work of breathing - tremendous metabolic requirement. May need to intubate for non-respiratory reasons - use blood gases **Consider ketamine for sick neonate needing intubation/sedation INTUBATE THE STOMACH TOO!! **Decompress belly if needed: Infant diaphragm more horizontal, does not help with breathing as much. Distended gassy abdomen will severely inhibit breathing. Use NG TUBE RESUSCITATE!! GIVE FLUIDS FAST!! **FLUIDS: use up to 60cc/kg, one little bolus of 20cc/kg often gross under resuscitation. 60cc/kg is not the maximum... its the start DON'T FORGET THE SUGAR!! **Blood sugar: In infant it can drop from normal to low quickly. Can have wide range of symptoms or be asymptomatic. **sugar problems: infant brain uses 90% of glucose, head to body ratio MUCH higher in infant. Healthy infant uses 6-8 mg/kg/min sugar as opposed to 2mg/kg/min in adult **Sugar: High, keep checking. Normal, start basal rate. Low, give bolus! GET ACCESS NOW!! **IO: Difficult in infant, but it is DIFFICULT in the very young. We often wait too long to go to IO. Don't! ![]() The BounceBack Patient The "BounceBack" Patient offers use an opportunity... to either be as foolish as we were before or to make up for previous mistakes. With all patient encounters (whether 1st encounter, 2nd encounter, or 102nd encounter) keep these simple rules in mind:
![]() Important questions to ask:
S&S - syncope, bleeding, dyspnea, trauma, fatigue, weakness Workup- What to expect with hemolytic process: - CBC (Hgb) - peripheral smear (takes some time, but will often give definitive dx) - retic count - increased - haptoglobin - decreased - bilirubin - LDH - increased - urinalysis - Coombs (direct and indirect) - Type and Cross Intrinsic vs Extrinsic Hemolysis - Intrinsic = structural or enzymatic defect - Extrinsic = mechanical or toxic destruction Key points
![]() Case 1 - Lower extremity weakness
> Stanford classification - A involves the aortic root, B is limited to the descending aorta > Prsenting sx of type B dissections- chest or back pain, abrupt onset of pain > Imaging - CXR - 56,5% are nl, TTE - usef for aortic root, CT best sensitivity and specificity Therapy
Case 2 - Fatigue - dyspnea
b. Admitted to hospital - heparin drip stopped and echo gotten - shows right heart strain c. CTA showed massive Bilateral PEs Predictors of Complications from PE
Submassive PE - Rigth ventricle with dilitation and systolic dysfunction, CT - RV dysfunction, elevated BNP or troponin ![]() Why this matters!
How about a Score?
On exam AMS, HR>125, RR>30, SBP <90, Temp <35 or >40 Step 2. Use MD Calc Check boxes. Simple rule: With no high risk findings and women under 80, dischcarge and men under 70.
Urea >20 RR >30 Blood Pressure - SBP <90, DBP <60 Age >65 More of these is higher mortality in 30 days Blood Cx?
HCAP
A phenomenal time was had by all who attended Dr. Bustin's Nerve Block Extravaganza!!
You can use this link while working to access the quick reference cards: https://www.evernote.com/pub/smfoxmd/cmcnerveblocksdr.bustin ![]() Cocaine
Treatment of hypertension
Levothyroxine
![]() BASICS
Seizure
Syncope
Red flags of syncope - exertional (not after the exertion), family hx, cp, palpitations, syncope, brought on by sudden loud noise, febrile illness, abrupt syncope, <10 years ![]() Case 1 - Bloody Diaper in the Neonate Common causes of BRBPR in kids 1. Ingested maternal blood 2. Necrotizing enterocolitis 3. Milk protein allergies 4. Anal fissure Key learning points 1. Hgb nadir at 6-8 weeks in full term down to 9g, premies drop faster and farther, 7g by about 3-4 weeks 2. Reassess potentially sick frequently 3. NEC is possible in full term, keep it in your differential! Nec info: Mortality 15-30%. Pathophys: intestinal immaturity and over active immune response Generally affects preterm infants, but not uncommon and increasing in frequency in full term infants Case 2 - 14 month old cold, seizing baby
History of an Takayasu arteritis and new seizures. ICH seen on CT Takayasu Arteritis Most commonly involved vessel
|
Archives
August 2018
Categories
All
|