General Inpatient Supportive Care Flashcards
ABCs of medicine
- Airway
- Breathing
- Cardiovascular stability
In that exact order of importance. This is the order in which you assess a critically ill individual.
Ventilation in the case of diaphragmatic hernia
This is somewhat of a special case
Intubation here must be endotracheal, not just bag and mask. Bag and mask will also ventilate the gut, which in the case of diaphragmatic hernia is going to limit the thoracic volume available for ventilation.
Classic presentation of choanal atresia
- Aka nasal septum
- Infant is dusky and cyanotic, struggles to breathe when at rest. But, when they start crying, they become pink again.
- This is because babies are generally obligate nose breathers, except when they are crying.
- Intubate with endotracheal tube until surgery may be performed to repair obstruction
When a baby’s HR is < 60 despite PPV and 100% oxygen, the next step is. . .
. . . chest compressions
Do compressions for 30 seconds, then give epinephrine
In an infant with RDS of the newborn, the degree of tachypnea often precludes ___
In an infant with RDS of the newborn, the degree of tachypnea often precludes oral feeding
NG tube is usually required
Parkland fluid for burns
- 50% in first 8 hours
- 50% in next 16 hours
- Parkland formula:
- % body surface area covered by 2nd or 3rd degree burns x 4 x body weight in kg
Rule of 9’s (child vs adult)
Routine ultrasounds in Beckwith-Wiedemann patients
Since these patients at at increased risk for abdominal tumors (hepatoblastoma, Wilm’s tumor, neuroblastoma), serial abdominal ultrasounds with view of the kidneys are recommended every 2-3 months until 4 years of age.
If you cannot obtain venous access in an infant, what is the next type of access to try?
Intraosseous line in the proximal tibia
Crystalloid of choice for ongoing fluid losses in the setting of burn in a child (> 1 month - 18 years)
- LR + dextrose is the fluid of choice
- 4,2,1 rule:
- 4 mL/kg/hour for the first 10 kg
- 2 mL/kg/hour for the next 10 kg
- 1 mL/kg/hour for the remaining weight
- In children < 14, Parkland’s formula is:
- 3 mL x % of TBSA affected (by 2nd and 3rd degree) x body weight in kg
Modified Parkland’s formula
- Used to guide initial fluid therapy in the setting of burns
- Formula:
- Vol. of LR to be administered in 24 h = x mL x % TBSA (2nd or 3rd degree) x body weight in kg
- Where x = 2 for > 14 y.o. and x = 3 for < 14 y.o.
- x used to be 4 for adults, but this was more than necessary and often precipitated heart failure. Kids tolerate fluids well, so no change needed there.
- Administer half of this volume in first 8 hours, and the rest over the subsequent 16 hours
Holliday-Segar method
- For approximating daily maintenance fluids for a child
- 100 mL/day for the first 10 kg
- 50 mL/day for the next 10 kg
- 20 mL/day for each kg thereafter
4-2-1 rule
- Method for approximating hourly maintenance fluids in a child
- 4 mL/kr/hr for the first 10 kg
- 2 mL/kg/hr for the next 10 kg
- 1 mL/kg/hr for each kg thereafter
Optimal maintenance fluids in infants vs children vs adolescents and adults to maintain electrolyte balance
- Infants: 1/4 NS with 10% dextrose and 20 mEq/L KCl
- Children: 1/4 NS with 5% dextrose and 20 mEq/L KCl
- Adolescents and adults: 1/2 NS with 5% dextrose and 20 mEq/L KCl
Three goals of fluid management
-
Achieve and maintain adquate hydration
- Achieved through fluid and sodium
-
Maintain electrolyte homeostasis
- Achieved through adding 20 mEq/L KCl
-
Prevent catabolism
- Achieved through adding dextrose
