General PICU Quick facts

Question 1

Name the 7 causes of tachycardia.

Answer 1

1. CNS (pain, agitation, WD, Seizure)
2. Hypovolemia
3. Obstructive shock
4. Sepsis
5. Heart failure
6. Arrhythmia
7. Drugs

Question 2

Describe an approach to investigation for chylothorax

Answer 2

Think about the cause: either direct injury to lymphatics or pressure related

Start with sending fluid for analysis
Neck ultrasound
Chylo diet (Lipistart or low fat diet)

If fails after 1 week -> NPO
Then need to do further investigations…MRI, cath, echo

Also remember that you’re losing good fats, protein, immunoglobulins

• lose proteins (proteins C and S) related to clotting cascade and at risk of clot
• lose immunoglobulins and at risk of secondary immune deficiency

Question 3

What should you know for every patient?

Answer 3

What should you get from handover?

• what is the underlying anatomy
• what was the preoperative state
• what operation has been done
• what complications have occurred in the OR

What should you figure out?

• is the repair adequate
• are any complications present
• what is the likely ICU course

Question 4

What is the hallmark of transposition physiology?

Answer 4

Pulmonary artery oxygen saturation greater than the aortic oxygen saturation

Question 5

Quick notes on D-TGA

Answer 5

25-50% present with a VSD
May have restrictive or intact atrial septum - would require PGE or balloon atrial septostomy. Need to achieve adequate mixing at the atrial level
Can present with profound cyanosis in the absence of respiratory distress

Question 6

What is the hallmark of single ventricle physiology?

Answer 6

Pulmonary artery sat and aortic saturation are equal

These lesions either have ductal dependent pulmonary flow or ductal dependent systemic flow

Question 7

What are two types of ductal dependent pulmonary flow

Answer 7

Tricuspid atresia

Pulmonary atresia with intact ventricular septum

Question 8

Name two forms of ductal dependent systemic blood flow

Answer 8

HLHS

double inlet LV