for Kia owners

[2win]

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stick with your Obamoid and maybe you'll get a Ford Focus!
glty
Until then : called 1 am for intubation of a 25 weeks kid.
Disaster with capitals - periods of severe bradycardia, no IV acces.
What you gonna do?
Tube? Size? IV access? Drugs? "Evidence based medicine" - about survival and complications?

 

[Jeff05]

stick with your Obamoid and maybe you'll get a Ford Focus!
glty
Until then : called 1 am for intubation of a 25 weeks kid.
Disaster with capitals - periods of severe bradycardia, no IV acces.
What you gonna do?
Tube? Size? IV access? Drugs? "Evidence based medicine" - about survival and complications?

is there a pulse? if no, start compressions.
can you ventilate with mask? if yes and sats holding, attempt IV access. in this situation IO line may be faster.
drugs - atropine 0.1mg/kg IM (min dose 0.1mg) immediately.
tube 3.0 uncuffed, miller 00.
i suppose when intubated and stable attempt to minimize FiO2.

 

[coprolalia]

Know your PALS/NALS. When in doubt, give epinephrine.

No drugs for the tube. If you can't intubate a 25-weeker (preemie or FT post birth? not clear) without anything... well... what can I say? Double-ought Miller. 2.5 or 3.0 uncuffed ETT. Brutane™. Unless this ain't a preemie...

O2 is what matters here. O2 and epinephrine - depending on the weight - even down the tube.

PALS/NALS.

Survival? Even if it's a preemie, he's not necessarily f**ked. You gotta try your best. But, you're going to get ROP, NEC, IVH, and probably all the other complications that go with extreme prematurity. (Sometimes it's not such a bad thing to not be able to get the tube in and resuscitate them in the long run... if you follow me 🙁 .)

Glad I wasn't you, 2win. I hate those situations.

-copro

 

[2win]

is there a pulse? if no, start compressions.
can you ventilate with mask? if yes and sats holding, attempt IV access. in this situation IO line may be faster.
drugs - atropine 0.1mg/kg IM (min dose 0.1mg) immediately.
tube 3.0 uncuffed, miller 00.
i suppose when intubated and stable attempt to minimize FiO2.

There are few difficult tasks to be performed - the IV access....
I think that the main access is obtained through umbilical vein catheterization.
Now they are coming possible questions for the oral exam but also some clinical "pearls"...
UVC - single lumen versus double lumen.
UVC - size... What size you will choose?
UV anatomy.
Technique for placement.
Type of solution that are suitable for infusion.
Let's say that the catheter is placed - you start fluid infusion and suddenly the blood pressure drops...What is part of the DD (think to the catheter position)?
Regarding the IO access - does it work? If you guys have any experience please share.

Second - airway...
Multiple attempts by others made vizualisation impossible.
ETT 3 is to big - 2.5 could work.
There is no LMA for this age.
Fiberoptic successful but with ett#3 - doesn't pass though... 2.5 ett to small to fit on fiberoptic.
What now? Retrograde intubation in neonate? And if you tried in the past - please share again...
On a personal note I tried in the past ultrasound identification of trachea in morbidly obese patients. Never tried in a kid and as you imagine in a neonate.