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Care of the super sick infant - Dr. MacNeill

11/21/2013

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Picture
**Kids... look great until they plummet.  Appear well until very close to decompensation.

INTUBATION - DO IT BEFORE IT IS TOO LATE
**Intubate early for children who are doing poorly, do not wait until they are becoming increasingly hypoxic and bradycardic!

**40% of infant cardiac output goes to work of breathing - tremendous metabolic requirement.  May need to intubate for non-respiratory reasons - use blood gases

**Consider ketamine for sick neonate needing intubation/sedation

INTUBATE THE STOMACH TOO!!
**Decompress belly if needed:  Infant diaphragm more horizontal, does not help with breathing as much.  Distended gassy abdomen will severely inhibit breathing.  Use NG TUBE

RESUSCITATE!! GIVE FLUIDS FAST!!

**FLUIDS: use up to 60cc/kg, one little bolus of 20cc/kg often gross under resuscitation.  60cc/kg is not the maximum... its the start

DON'T FORGET THE SUGAR!!
**Blood sugar: In infant it can drop from normal to low quickly.  Can have wide range of symptoms or be asymptomatic.

**sugar problems: infant brain uses 90% of glucose, head to body ratio MUCH higher in infant.  Healthy infant uses 6-8 mg/kg/min sugar as opposed to 2mg/kg/min in adult

**Sugar: High, keep checking.  Normal, start basal rate.  Low, give bolus!

GET ACCESS NOW!!

**IO: Difficult in infant, but it is DIFFICULT in the very young.  We often wait too long to go to IO.  Don't!


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  • RESIDENCY
    • About CMC
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    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Prospective Visiting Students
    • UNC/Wake Forest Students
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction