a systems approach for neonatal critical care " 1 thru 10"
TRANSCRIPT
1 thru 10
DISCLAIMER
No one offered to pay me anything for what I am about to say. I did, however, borrow, use and steal almost all of the concepts I am about to talk about.
1 thru 10
1. Fluids, Electrolytes,Nutrition
2. Glucose
3. Respiratory
4. Cardiovascular
5. Hematology
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History
Systems approach is older than me
Babies can’t tell you what’s wrong
Captures all the information
Brings order to chaos
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1.FLUIDS AND NUTRITION
Primary focus of Neonatal Care
Can change hourly
Responsible for decreasing Mortality
Responsible for decreasing Morbidity
Louise Recht
“Aunt Louise, The
Mother of Neonatal
Care”
Taught the French
Technique of Gavage
Feeds
Led the Nursing Staff
and Wet Nurses
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1.FLUIDS AND NUTRITION
PARENTERAL
Central vs. Peripheral
Angiocaths invented in the 60’s
Intra abdominal injections of fluid
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1.FLUIDS AND NUTRITION
INS AND OUTS
IV FLUID URINE
TPN STOOL
FORMULA OSTOMY
LIPIDS REPLOGLE
COLLOIDS
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1.FLUIDS AND NUTRITION
INTAKE
Admission Fluids
D10 at 80 ml/kg/day
Starter TPN--- D10 with 2gm A.A.+ 200mg/100ml of CaGluconate
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2. GLUOSE
QUICK FORMULA TO CALCULATE GLUCOSE INFUSION RATE (GIR)
MG/KG/MIN = (dex conc.) X rate (cc/hr)
Current wt( kg) x 6
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2. GLUOSE
GLUCOSE INFUSION RATE (GIR)
A 3 Kg baby given 80ml/kg day of D10W
10 x 10 ml/hr = 5.5 mg/kg/min
3 kg x 6
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3. RESPIRATORY
Clinical Exam (changes, new problems, O2 sats)
Disease State
Blood Gases
Radiology
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3. RESPIRATORY
LEVEL OF SUPPORT
ROOM AIR
NASAL CANULA,VAPOTHERM
CPAP, ASSISTED VENTILATION
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4. CARDIOVASCULAR
Clinical Exam (changes, new problems, O2 sats)
Disease State
Blood Gases
Radiology
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5. HEMATOLOGY
HEMOGOLBIN/HEMATOCRIT
WHITE COUNT AND DIFF
PLATELET COUNT
COAGULATION PROFILE
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5. HEMATOLOGY
ANEMIA vs POLYCYHTEMIA
THROMBOCYTOPENIA vs POLYCYTOSIS
NEUTROPENIA vs LEUKEMOID
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5. HEMATOLOGY
TRANSFUSIONS (number, last time)
FRESH FROZEN PLASMA
EPOGEN,NEUPOGEN,FACTORS
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6.GI/BILIRUBIN/LIVER
Most Varied Clinical Exam
Organomegaly
Jaundice
Stool ( output, type, heme +/-)
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6.GI/BILIRUBIN/LIVER
BILIRUBIN
UNIQUE TO NEWBORNS
PRETERMS AT RISK
PHOTORX, EXCHANGE, IVIG
ULTRASOUNDS, CT, DOPPLERS
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7. INFECTIOUS DISEASE
SUBTLE TO CATASTROPHIC PRESENTATION
LITTLE WARNING
MATERNAL ENVIRONMENT
NICU ENVIRONMENT
PUBLIC ENVRIRONMENT
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7. INFECTIOUS DISEASE
CULTURES,CULTURES,CULTURES
CBC,CRP INDICATE TRENDS
TITERS ARE LIMITED
RADIOLOGY
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7. INFECTIOUS DISEASE
BACTERIAL
GROUP B STREP E.COLI
STAPH SPECIES KLEBSIELLA
PSEUDOMONAS H. INFLUENZAE
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7. INFECTIOUS DISEASE
VIRAL
HERPES SPECIES HIV
TOXOPLASMOSIS CMV
ENTEROVIRUS RUBELLA
HEPATITIS PARAMYXOVIRUS
INFLUENZA( H1N1, etc)
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7. INFECTIOUS DISEASE
FUNGAL/OTHER
SYPHILLIS TUBERCULOSIS
CHLAMYDIA CANDIDA
PNEUMOCYSTIS PROTOZOAN
MYCOPLAMSA ACREMONIUM
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8.MEDICATIONS
OFTEN AS NUMEROUS AS AN ADULT
“1 THRU 10” IS YOUR FRIEND
BEGINNING, DOSING, ENDING
TOXICITY
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8.MEDICATIONS
WHILE THIS CATEGORY SERVES AS A PLACEHOLDER TO KEEP TRACK OF
MEDICATIONS, THEY ARE DISCUSSED AS PART OF THE SYSTEM
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8.MEDICATIONS
1. FLUIDS AND NUTRITION
VITAMINS, IRON
HUMAN MILK SUPPLEMENTS
ELECTROLYTE SUPPLEMENTS
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8.MEDICATIONS
3. RESPIRATORY
SURFACTANT
DIURETICS
STEROIDS
AERSOLIZED MEDS, INHALED MEDS
APNEA MEDS- CAFFIENE,THEOPHYLLINE
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8.MEDICATIONS
4. CARDIOVASCULAR
BLOOD PRESSURE MEDS( RAISE/LOWER)
DIGOXIN
ANTI-ARRYTHMIC
DIURETICS
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8.MEDICATIONS
9. NEUROLOGIC
PHENOBARBITAL
PHOSPHENYTOIN
SEDATION MEDS
ANTI-SEIZURE MEDS
PARALYTIC MEDS
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8.MEDICATIONS
10. SOCIAL
MEDICATIONS THAT THE MOTHER IS TAKING THAT CAN BE EXCRETED IN THE BREAST MILK
GENERAL AFFECT OF THE PARENTS THAT MAY RAISE CONCERN
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9. NEUROLOGICAL
SEIZURES AND IVH PRIMARY ISSUES
TONICITY
METABOLIC DISORDERS
EVOLUTIONARY PROCESS vs STATIC
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9. NEUROLOGICAL
STUDIES, STUDIES, STUDIES
HEAD ULTRASOUNDS
EEG, vEEG, CT, MRI
ALMOST ALL STUDIES REQUIRE FOLLOW UP
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9. NEUROLOGICAL
ONE OF THE BEST PREDICTORS FOR NORMAL NEUROLOGIC DEVELOPMENT IS A NORMAL
NEUROLOGIC NEWBORN EXAM
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9. NEUROLOGICAL
BRAIN COOLING (TOTAL BODY COOLING)
RX FOR HIE - TIME SENSITIVE
APPEARS TO REDUCE MORTALITY
APPEARS TO NOT INCREASE MORBIDTY
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10. SOCIAL
IDENTIFICATION OF PRIMARY CAREGIVERS
WHO COMES TO THE BEDSIDE
COMMUNICATE THE “1 THRU 10”
BEST ROLE IN REDUCING MALPRACTICE SUITS
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10. SOCIAL
SOCIAL SERVICE OFTEN KEY
GOSSIP IS DEADLY
NICU PSYCHOSIS
MEDICAL ERRORS- inform, address, apologize