Introducing Paediatric ECG Central

The lovely people at the Princess Margaret Hospital for Children in Perth have given us permission to publish the (hot off the press) updated version of their Paediatric ECG Guidance. ECG Central will be a great resource to have on Don’t Forget the Bubbles for quick reference when interpreting ECGs at work. It covers v We…

Inotropes and vasodilators

Vasodilators: Decreasing the pressures against which the heart works (systemic and pulmonary afterload); decreasing the work of the heart hence myocardial O2 demand. Usual indications for vasodilator therapy are: systemic vasodilation (LV afterload reduction), pulmonary vasodilatation (RV afterload reduction), systemic hypertension, improving coronary blood flow. Beware that infants, in response to low CO, increase afterload…

Haemofiltration and dialysis

Indications: Correction of water overload To remove larger quantities of water from the body than the kidney is able to achieve in order to enable the administration of therapeutic fluids such as parenteral nutrition To remove excess electrolytes Correction of disorders of acid/base homeostasis, including inborn errors of metabolism, particularly metabolic acidosis Liver failure (but…

Renal Failure

Definition: acute kidney injury (AKI) is failure of the kidneys to regulate electrolyte, acid-base and fluid homeostasis adequately with concomitant reduction in glomerular filtration rate (GFR). pRIFLE (paediatric Risk, Injury, Failure, Loss, End-Stage Criteria). Chronic renal failure: hyperfiltration, estimated creatinine clearance <75 ml/min/1.73m2 , hypertension, microalbuminuria.

Open chest

Negative impact on haemodynamics and respiratory parameters after median sternotomy was first described in 1975, with emphasis on “compression of the heart and producing a cardiac tamponade”. Indications for delayed sterna closure and open chest: ‘Large’ heart syndrome Haemodynamic instability after temporal sternal approximation Low cardiac output post CPB ECMO or VAD cannulation Severe arrhythmia…

Fluids

Anion gap = Na+ + K+ – (Cl– + HCO3–). normal 8-12 mEq/l. Total body water (TBW) = intracellular fluid (ICF) plus extracellular fluid (ECF). [Weight x 600 ml in adults (500 ml in female), Weight x 650 ml in paeds, Weight x 700 ml in neonates] ECF = intravascular fluid (plasma and lymph in the vessels) plus interstitial fluid (between…

Chest drains

If losses >10 ml/kg/hr in a postoperative patient, notify surgeon immediately. In the first two hours, losses may be up to 5 ml/kg/hr, thereafter it should be less than 2 ml/kg/hr. If losses exceeds these levels, check ACT, aPTT, PT, fibrinogen, platelets and TEG, and transfuse accordingly. If significant losses continue, notify surgeons. Insertion of…

Blood products

Pump blood Pump blood is the blood remaining in the bypass circuit on the completion of bypass. It is a mixture of the patient’s own blood, other fluids and any bank blood used to prime the bypass circuit. Unfiltered pump blood has a low Hct and contains large amounts of heparin and inflammatory cytokines. The…

Anticoagulation

UNFRACTIONATED HEPARIN (UFH) Indications: Low dose heparin infusions are used in the maintenance of central venous lines, arterial lines and the prevention and treatment of deep vein thromboses. Administration: Heparin can be administered by intravenous and subcutaneous routes. This protocol applies to the intravenous route only. Heparin is compatible with 5% dextrose, 0.9% NaCl and…