Introducing Paediatric ECG Central

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Davis, T. Introducing Paediatric ECG Central, Don't Forget the Bubbles, 2014. Available at:

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…

Bleeding lips and cardiac arrest

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Yamamoto, L. Bleeding lips and cardiac arrest, Don't Forget the Bubbles, 2013. Available at:

This is a 2 1/2 month old male who presented to the ED with a 2 week history of intermittent low grade fevers. He was seen by his primary physician 2 weeks prior to this ED visit for chapped/bleeding lips and mucocutaneous lesions.

Inotropes and vasodilators

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Anders, M. Inotropes and vasodilators, Don't Forget the Bubbles, 2013. Available at:

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

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Anders, M. Haemofiltration and dialysis, Don't Forget the Bubbles, 2013. Available at:

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

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Anders, M. Renal Failure, Don't Forget the Bubbles, 2013. Available at:

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

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Anders, M. Open chest, Don't Forget the Bubbles, 2013. Available at:

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…


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Anders, M. Fluids, Don't Forget the Bubbles, 2013. Available at:

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

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Anders, M. Chest drains, Don't Forget the Bubbles, 2013. Available at:

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…