**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!
Your comment will be posted after it is approved.
Leave a Reply.