Tuesday 26 December, 2006

Rant: parents of chronically ill children

Posted in Michael Tam, Paediatrics, Rants at 18:45 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Warning: the following is a rant of my personal opinions on the issue.

This article for inspired by a comment received by a family member of a chronically ill child. The comment is representative of many “difficult parents”. In this article, I will dissect it and give you an alternative way of thinking.

I’m not a doctor but a grandmother of a baby that was born with Christmas Tree Anomaly. As a result she has short gut syndrome. She was admitted to hospital for dehydration after a gastro virus made her vomit. They were hydrating her very well but as always before they seem to overdo it and now she is in ICU because her sodium and potassium levels shot up. So when your calculating the IVs, please consider that this is a person’s life you are messing with. This is a 15 month old beautiful baby girl that is spending her 2nd Christmas in the hospital all because her levels were not being watched properly and they did not account for what was already in her body when they smacked another IV drip up there. Doctors, listen to your patients and their parents. They may know more than you think they do and maybe more than you do. After all, this baby is the little girl that will be sneaking up on Christmas morning to peek at presents that someone loves so dearly. And one day it may be your loved one.

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Sunday 30 July, 2006

Paediatric resuscitation on a card

Posted in Emergency, Emergency Dept., General Practice, Michael Tam, Paediatrics, Resources, Wards at 23:27 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Resources

Paediatric Resuscitation Card

High resolution scan (600 DPI) of the paediatric resuscitation card given to medical officers commencing a paediatrics rotation at The Sydney Children’s Hospital. [2.71 Mb]

One of the best resources I received when I worked at The Sydney Children’s Hospital, Randwick, was a laminated card (the size of a business card) attached to my ID badge lanyard. On this card included normal values for weight, heart rate, respiratory rate for infants and children, the correct dosage for a variety of emergency drugs as well as the recommended sizes for endotracheal tubes, nasogastric tubes and indwelling catheters by age.

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Sunday 11 June, 2006

Fluid resuscitation

Posted in Emergency, Emergency Dept., In The Field, Michael Tam, Paediatrics, Wards at 21:55 by Michael Tam

Index: Intravenous fluid therapy :: Printer friendly

Original article by: Michael Tam

There is only “one” rule for both adults and children:

Normal saline :: 10-20 mL/kg bolus :: fast as you can

If someone is shocked and requires emergency fluid resucitation, your fluid of choice is 0.9% NaCl or “normal saline”. Don’t fluff around with colloids or Hartmann’s solution – choose bog standard saline.

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Sunday 14 May, 2006

Gastroenteritis in children

Posted in Emergency Dept., General Practice, Michael Tam, Paediatrics, Resources at 22:41 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Resources

Managing Young Children and Infants with Gastroenteritis in Hospitals

NSW Department of Health Circular (2002/26). Issued 28 June 2002.

Factsheet: Gastroenteritis

Children’s Hospital Westmead / Sydney Children’s Hospital

Oral rehydration protocol

Lyell McEwin Hospital Emergency Department

Infectious gastroenteritis in children is very common, more so during “gastro” season. For most children, the aetiology is a viral infection and the course of the illness will be relatively mild. They will not require medical investigation or in hospital management. For a minority of children, they may have severe symptoms and present with significant dehydration.

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Tuesday 2 May, 2006

IV rehydration therapy in children

Posted in Emergency Dept., Michael Tam, Paediatrics, Wards at 17:25 by Michael Tam

Index: Intravenous fluid therapy :: Printer friendly

Original article by: Michael Tam

Before you start with intravenous rehydration therapy in children, you should ask yourself the following questions:

  1. Can I use oral rehydration?
  2. Do I need to take blood for blood tests? (if so, do it from the intravenous cannula immediate after insertion)
  3. Do I need to give resuscitation fluids?
  4. Do I need to replace any special / continuing losses for the child?

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“Maintenance” IV fluids in euvolaemic neonates

Posted in Emergency Dept., Michael Tam, Paediatrics, Wards at 12:53 by Michael Tam

Index: Intravenous fluid therapy :: Printer friendly

Original article by: Michael Tam

Baby Beer

Oral intake is always preferable

Neonates (birth to 4 weeks) should be treated as different from other children and have their own needs for fluids. Before you write up fluids for a neonate, you should be asking yourself the following questions:

  1. Why are you writing this up rather than the neonatal team?
  2. Are you actually sure that this neonate is euvolaemic?
  3. Why does this neonate need IV fluids?
  4. Does the neonate have some acute illness or congenital issue that makes “normal” or “usual” fluid management inappropriate?

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“Maintenance” IV fluids in euvolaemic children

Posted in Emergency Dept., Michael Tam, Paediatrics, Wards at 11:49 by Michael Tam

Index: Intravenous fluid therapy :: Printer friendly

Original article by: Michael Tam

This is for children:

IV fluid type

  • 0.45% NaCl + 2.5% dextrose + 10 mmol KCl
  • 500 mL bag

IV fluid rate

4 mL/kg/hr for first 10 kg of body weight

+ 2 mL/kg/hr for next 10 kg

+ 1 mL/kg/hr for the remainder

There is no “autopilot” method for children. Calculate it properly each time. The smaller the child, the more important it is for the rate to be correct. In larger children, you could probably round to the closest 5 mL/h for convienience. If the rate is > 100 mL/h (for maintenance), you should be using adult type fluids.

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