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Cardiovascular Pediatric Critical Illness and Injury | Derek S. Wheeler | Springer
Authors: Bradley Fuhrman Jerry Zimmerman. Hardcover ISBN: Imprint: Mosby. Published Date: 14th April A thorough understanding of the diseases and disorders affecting the pediatric central nervous system is vital for any physician or health care provider working in the PICU. The Central Nervous System in Pediatric Critical Illness and Injury has been written by an international panel of experts to provide readers with an in-depth discussion on the resuscitation, stabilization, and ongoing care of the critically ill or injured child with central nervous system dysfunction.
Cardiovascular Pediatric Critical Illness and Injury
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Noninvasive Positive Pressure Ventilation Noninvasive positive pressure ventilation is useful as a bridge to intubation or support in reversible causes of respiratory failure. Settings and mode depend on cause of respiratory failure. In the apprehensive or young child, initially placing the mask without flow, then increasing pressures in 2 cm H2O increments to clinical improvement, may be helpful.
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Young children may require sedation with ketamine 0. A high-flow nasal cannula 15 L in adolescents, up to 8 L in toddlers can be used for preoxygenation in addition to the face mask and while intubating. Prophylactic atropine 0. Its use is not recommended in the septic patient. Paralytic agents include depolarizing agents, such as succinylcholine 1. Cuffed endotracheal tubes ETTs are used in children older than 1 month, provided the cuff pressure can be maintained at less than 20 cm H2O to avoid tracheal mucosal ischemia Box 3 for sizing.
ETT placement is confirmed by visible chest wall rise, breath sounds in both axillae, continuous pulse oximetry, mist in ET tube, and end-tidal CO2 with either colorimetric device or capnography. Difficult Airway The unanticipated difficult airway is rare in children. However, complications and intubation attempts may occur more commonly than perceived.
A gum elastic bougie may be used standard fits 6.
Laryngeal mask airways LMA; Table 2 are essential rescue devices. The LMA is inserted into the mouth and blindly passed along the palate and posterior pharynx until resistance is met.
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A partial seal around the larynx is formed with cuff inflation. The rotational technique where the device is initially placed with the cuff facing the palate then simultaneously advanced and rotated may improve successful placement in children younger than 7 years. LMAs are also successfully used in neonatal resuscitation. However, preparation and practice must occur before the difficult airway scenario. Their use is an acquired skill and may, in children, increase time of intubation particularly in inexperienced users and during cervical spine immobilization.
Needle cricothyrotomy is alternatively used, but significant CO2 retention limits its effectiveness.
Unfortunately, this setup is rigid and may easily become dislodged. Alternatives include using IV tubing attach IV tubing to the angiocatheter, cut the tubing, and attach a 2. Use the mm needle with EZ-IO system. A hemostat or needle driver clamped on the needle and secured distally may improve the ability to assess for extravasation.
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- Cardiovascular Pediatric Critical Illness and Injury | mondconsmarolea.gq.
Bone marrow infusion is painful, and conscious children should receive cardiac lidocaine via the IO before fluid infusion 0. Any fluid, medication, or blood product may be given IO. Use of the line for less than 24 hours decreases complications. The femoral vein is used most commonly because of the distance from the airway and chest during resuscitation efforts. Landmarks and technique are similar to adults. Gentle pressure should be used to avoid vessel collapse in the young child.
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