Inotropes and vasopressors

Definition: Inotropes: sympathomimetic agent which act on the sympathetic (or adrenergic) nervous system (β-receptors) resulting in positive inotropic (increase in contractility), chronotropic (increase in heart rate), dromotropic (increase in conduction of impulse) and lusitropic effect (improved diastolic relaxation) Vasopressors: sympathomimetic agent which act on the sympathetic (or noradrenergic) nervous system (α-receptors) resulting in vasoconstrictor effect The ideal…

Analgesia and sedation

Intravenous anaesthetic agents (see table): classified as barbiturates (thiopentone) and non-barbiturates (propofol and ketamine) thiopentone use is largely limited to induction in status epilepticus and for treatment of raised ICP; it has no analgesic properties and is in fact anti-analgesic at sedative doses propofol is suitable for induction (bolus) and maintenance of sedation/anaesthesia (infusion); it…

Myocarditis

See cardiomyopathy , but cardiac MRI or endomyocardial biopsy to confirm diagnosis Symptoms:  Very nonspecific in children: malaise, fever, poor appetite, tachypnea, tachycardia, chest pain, abdominal pain, myalgia, fatigue, cough, oedema, hepatomegaly, murmur. Investigations: See also cardiomyopathy Nonspecific T changes on ECG Cardiac enzymes are not elevated in most patients with myocarditis Echo is mandatory to…

Heart failure and ventricular assist device (VAD)

Modified Ross heart failure classification: Class Symptoms I Asymptomatic II Mild tachypneoa or diaphoresis with feeding. Dyspnea on exertion in older children III Marked tachypnea or diaphoresis with feeding; marked dyspnea on exertion; prolonged feeding time with failure to thrive IV Tachypnea, retractions, grunting or diaphoresis at rest   Causes: Congenital, skeletal myopathy with cardiac involvment (e.g….

ECMO antibiotics

Indication Prophylaxis Timing Duration ECMO (cannulation, chest revision, reoperation on ECMO, decannulation) – if not on anitbiotics with both gramnegative and grampositive cover already Cephazolin 50mg/kg up to 1g IV or (if cephazolin unavailable)Cephalothin 50mg/kg up to 2g IV Optimal timing for Beta-Lactams: administer 30 – 60min before incision 2nd dose 25mg/kg if operation > 3hrs, continue 25mg/kg 8hrly,…

ECMO

Inclusion criteria: >34/40 weeks gestation age, reversible cardiac, pulmonary, or cardiopulmonary failure, mechanical ventilation <14 days. Exclusion criteria: Major intracranial haemorrhage, lethal malformation, severe neurological injury, untreatable cardiac or pulmonary malformation. Clinical indications: Failure to wean off cardiopulmonary bypass, oxygenation index >40 on two or more ABG despite maximum therapy [OI = (MAP * FiO2…

Cardiomyopathy

Basic investigation: ECG, CXR, ECHO, FBE, clotting, UEC  (incl. Ca++, Mg++, Fe++, PO4—), CRP, ESR, albumin, LFT, TFT, BNP, troponin I, troponin T, lactate, ABG, VBG. Extended investigation: Cardiac MRI. 24 hr Holter monitor. Blood: amino acids, carnitine, acyl-carnitine, ammonia, Cu, caeruloplasmin, transferrin ioforms, pyruvate, selenium, vitamins. Urine: amino acids, organic acids, pligosaccharide screen, MPS…

Berlin heart VAD Excor

Definition: Paracorporal, pneumatically driven, pulsatile flow mechanical support device driven by a central driving unit (Ikus®) and different sizes of blood pumps (10, 25, 30, 50, 60, 80ml), can be used as RVAD, LVAD or BIVAD. Aim: Bridge to transplant or bridge to recovery Standard settings: Driving pressures for Systole and Diastole (Chamber Size /…

Central venous catheters

Use of central venous catheters in the acute care setting is an integral approach to deliver fluids, blood products, nutrients, medications, obtaining blood specimens, maintaining emergency vascular access, and for haemodynamic monitoring. Risk factors: Mechanical complications (malposition, occlusion, dislodgement, tamponade), infection, pneumothorax, thrombosis Insertion: Ask nurse to complete the checklist and to stop you if…

Infection

Surgical site infection (superficial/deep/organ): Prevalence 5-10% Within 10-14 days post surgery Most common: Staphylococcus aureus Risk factors: neonate, HLHS, hospitalization prior surgery, TPN, emergency procedures, long CPB Blood stream infection: Prevalence 5-10% Within 10-14 days post surgery Most common: gram negative organism (Pseudomonas, Enterobacter) Risk factors: surgical complexity, open sternum, low body weight, longer duration…