Care of the super sick infant - Dr. MacNeill

**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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