how usual resuscitative maneuvers can kill paediatric cardiac patients
TRANSCRIPT
HOW USUAL RESUSCITATIVE MANEUVERS CAN KILL PEDIATRIC CARDIAC PATIENTS
MICHELE DOMICO, MDCHILDREN’S HOSPITAL OF ORANGE COUNTY, CALIFORNIA
H Y P O P L A S T I C L E F T H E A R T S Y N D R O M E N O R W O O D P R O C E D U R E : S TA G E 1
B A L A N C I N G A C T B E T W E E N P U L M O N A RY A N D S Y S T E M I C VA S C U L A R R E S I S TA N C E
H L H S S TA G E 1 G O I N G S O U T H
GO AHEAD AND INTUBATE ME
DO NOT “OVER-DO” THE BLOOD PRESSURE RESUSCITATION
LOW DOSE EPI (1/10th DOSE) OR INODILATOR
W H E N I N T U B AT I O N A N D P O S I T I V E P R E S S U R E
V E N T I L AT I O N C A N A C T U A L LY D E C R E A S E
O X Y G E N AT I O N
PULMONARY BLOOD FLOW IS DEPENDENT ON TWO THINGS:
INTRATHORACIC PRESSURE
BLOOD FLOW TO THE BRAIN
GLENN (STAGE 2) PHYSIOLOGY
I F Y O U M U S T I N T U B AT E A S TA G E 2 ( G L E N N ) : L O W E R P E E P A N D S L I G H T LY E L E VAT E D P C O 2
G I V E T H E M A L L T H E F I O 2 Y O U W A N T
W H E N D E F I B PA D D L E S B E C O M E
Y O U R E N E M Y
P E R F E C T I S T H E E N E M Y O F G O O D
A N O N Y M O U S E L E C T R O P H Y S I O L O G I S T
YOU ARE NOT A TRUE INTENSIVIST UNTIL YOU’VE TRIED TO SHOCK SINUS TACH
D E - N O V O “ V TA C H ” I N H E A LT H Y C H I L D R E N I S M Y O C A R D I T I S U N T I L P R O V E N O T H E R W I S E
L E S S I N T E R V E N T I O N S T H E B E T T E R U N L E S S A N E C M O C I R C U I T I S N E A R B Y
N O R W O O D S TA G E 1 S I N G L E V E N T R I C L E PAT I E N T S S H O U L D H AV E S AT U R AT I O N S 7 5 - 8 5 % . D O N O T M A K E T H E M H I G H E R
I N C R E A S I N G S V R W I T H E P I C A N H A R M H L H S S TA G E 1 PAT I E N T S
S TA G E 2 ( G L E N N ) PAT I E N T S W I L L N O T O X Y G E N AT E W E L L W I T H H Y P E R V E N T I L AT I O N O R H I G H P E E P
D O N ’ T S H O C K T H E H E A LT H Y C H I L D W I T H P U L S AT I L E “ V TA C H ”
S U M M A R Y