Prolonged QT syndrome

Cite this article as: Anders, M. Prolonged QT syndrome, Don't Forget the Bubbles, 2013. Available at: http://doi.org/10.31440/DFTB.3681Definition: prolonged QTc interval, calculated by Bazett’s formula: QTc = QT : sqr (previous RR interval). normal <440 ms (460 ms in women and children).

Open chest

Cite this article as: Anders, M. Open chest, Don't Forget the Bubbles, 2013. Available at: http://doi.org/10.31440/DFTB.3705Negative 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…

Nutrition

Cite this article as: Anders, M. Nutrition, Don't Forget the Bubbles, 2013. Available at: http://doi.org/10.31440/DFTB.3905Facts: 1. Nutritional support for children in PICU is important to prevent deficiency and remain in a positive or neutral neutrogen balance 2. Overfeeding is associated with adverse effects 3. There is no clear evidence supporting PN over TPN 4. If…

Maintenance fluids

Cite this article as: Anders, M. Maintenance fluids, Don't Forget the Bubbles, 2013. Available at: http://doi.org/10.31440/DFTB.3901Maintenance fluid [ml/hr] requirements for ≤10 kg: Wt / kg 3 5 7 9 10 Active 12 20 28 36 40 Inactive 6 10 14 18 20 Fever add 10 % for every 1 o Celsius Hypothermia deduct 12 % for every…

Fluids

Cite this article as: Anders, M. Fluids, Don't Forget the Bubbles, 2013. Available at: http://doi.org/10.31440/DFTB.3689Anion 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…

Chest drains

Cite this article as: Anders, M. Chest drains, Don't Forget the Bubbles, 2013. Available at: http://doi.org/10.31440/DFTB.3699If 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,…

Blood products

Cite this article as: Anders, M. Blood products, Don't Forget the Bubbles, 2013. Available at: http://doi.org/10.31440/DFTB.3678Pump 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…

Anticoagulation

Cite this article as: Anders, M. Anticoagulation, Don't Forget the Bubbles, 2013. Available at: http://doi.org/10.31440/DFTB.3723UNFRACTIONATED 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…

Weaning opioids and steroids

Cite this article as: Anders, M. Weaning opioids and steroids, Don't Forget the Bubbles, 2013. Available at: http://doi.org/10.31440/DFTB.3890Withdrawal from drugs (principally opioids) prolongs hospital admissions and causes morbidity! Gradual weaning of drug dosing aims to prevent the onset of withdrawal abstinence syndromes: regime one: 10% reduction in original dose per day weaning over 10 days…

Muscle relaxation

Cite this article as: Anders, M. Muscle relaxation, Don't Forget the Bubbles, 2013. Available at: http://doi.org/10.31440/DFTB.3883Definition: Muscle relaxants block transmission at the neuromuscular junction (NMJ) by interfering with nicotinic cholinergic receptors (AChRs). They are large polar molecules with small volumes of distribution that are not orally bioavailable and do not cross the placenta or blood-brain…

Intubation

Cite this article as: Anders, M. Intubation, Don't Forget the Bubbles, 2013. Available at: http://doi.org/10.31440/DFTB.3880Indication: to secure the airway: severe airway obstruction/inadequate protective reflexes (coma or prolonged seizures) to facilitate ventilation: hypoxaemic and/or hypercarbic respiratory failure Intubation should NOT be attempted by the inexperienced if more skilled personnel are available. Two doctors always present if…

Inotropes and vasopressors

Cite this article as: Anders, M. Inotropes and vasopressors, Don't Forget the Bubbles, 2013. Available at: http://doi.org/10.31440/DFTB.3876Definition: 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…