Wednesday Wrap-up

Wed Wrap Up for 9/10/14

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Dr. Andrea Ferrari lecturing about sick kids.

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What to do with an ALTE baby?…….always admit for observation.

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Intussusception re-occurs 7-12% post reduction. Perhaps best to observe? How long?

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In DKA, beta-hydroxybutyrate is the ketone measurement of choice.

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In DKA, consider the use of a low dose insulin drip

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In HHS, give Fluids! Fluids! and Fluids! If not better consider super low insulin drip.

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And now for Dr. Wendy Chan lecturing on sick newborns.

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First 60 seconds =”Golden Minute” complete initial steps, reevaluate, and begin ventilation.

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In first 10 minutes of life, titrate O2 using air or air mixed w/ O2 (ranges 60% to 95%)

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Neonatal CPR primarily a resp problem. CPR is 3:1 ratio of compressions to breaths

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HR<60 after adequate vent and compressions, IV epi may be given at a dose of .01-.03 mg/kg

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Naloxone NOT indicated during initial resuscitation, even when opiate dependent mother.

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Hypothermia therapy is neuroprotective in moderate to severe hypoxic encephalopathy.

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Antenatal FS < 25, feed and recheck in 1 hour. If still < 25 mg/dl, dose is 2ml/kg of D10.

Dr. Ameer Hassoun 

1  Pediatric cardiac arrest is mainly respiratory in origin
2  CAB rule of CPR does not apply to neonates. Keep the ABC!
3  Some pediatric patients can survive even after prolonged CPR
                       References
Atkins et al. Circulation 2009; 119: 1484-1491
Kitamura et al. Lancet 2010 Apr 17;375(9723):1321-2
Kleinman M E et al. Circulation. 2010;122:S876-S908
Travers A H et al. Circulation. 2010;122:S676-S684
Berg M D et al. Circulation. 2010;122:S862-S875
Matos R I et al. Circulation. 2013;127:442-451
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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andygrock

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