Anticoagulation

Cite this article as: Marc Anders. Anticoagulation, Don't Forget the Bubbles, 2013. Available at: https://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: Marc Anders. Weaning opioids and steroids, Don't Forget the Bubbles, 2013. Available at: https://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: Marc Anders. Muscle relaxation, Don't Forget the Bubbles, 2013. Available at: https://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: Marc Anders. Intubation, Don't Forget the Bubbles, 2013. Available at: https://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: Marc Anders. Inotropes and vasopressors, Don't Forget the Bubbles, 2013. Available at: https://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…

Analgesia and sedation

Cite this article as: Marc Anders. Analgesia and sedation, Don't Forget the Bubbles, 2013. Available at: https://doi.org/10.31440/DFTB.3867Intravenous 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…

Nitric oxide

Cite this article as: Marc Anders. Nitric oxide, Don't Forget the Bubbles, 2013. Available at: https://doi.org/10.31440/DFTB.3693Definition: nitric oxide (NO) is produced in the endothelium by eNOS (endothelial nitric oxide synthase).

Myocarditis

Cite this article as: Marc Anders. Myocarditis, Don't Forget the Bubbles, 2013. Available at: https://doi.org/10.31440/DFTB.3794See 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…

Heart failure and ventricular assist device (VAD)

Cite this article as: Marc Anders. Heart failure and ventricular assist device (VAD), Don't Forget the Bubbles, 2013. Available at: https://doi.org/10.31440/DFTB.3790Modified 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…

ECMO antibiotics

Cite this article as: Marc Anders. ECMO antibiotics, Don't Forget the Bubbles, 2013. Available at: https://doi.org/10.31440/DFTB.3783 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…

ECMO

Cite this article as: Marc Anders. ECMO, Don't Forget the Bubbles, 2013. Available at: https://doi.org/10.31440/DFTB.3778Inclusion 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…

Cardiomyopathy

Cite this article as: Marc Anders. Cardiomyopathy, Don't Forget the Bubbles, 2013. Available at: https://doi.org/10.31440/DFTB.3772Basic 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,…