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rehman_naveed

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Everything posted by rehman_naveed

  1. Hi Colleagues May I ask a question, What does free water deficit means for Hypernatremia? I know the definition but what does it actually means when treating hypernatermia with crystolloids solution. For example if serum Na is 190, free water content of 0.9% NaCl is 19%, 0.45% Saline is 59% and 0.2% Saline is 81%. How this will help in giving free water to a baby weight 4Kg with Na 190 mmol/L, who require approximately 576ml of Free water in 4 days to drop Na slowly to 142 mmol/L. Many Thanks in advance.
  2. So what is the question? 0.45% saline is the least you can give Hypernatremia in ELGA babies is likely not due to excessive Na intake
  3. We usually don’t intentionally give unless they are already on. We discontinue as well early no matter chest drain is out or in.
  4. Yes there is no VG, instead use PRVC for volume control ventilation
  5. Hi only difference is PEEP is added to PIP while in others PEEP is separate. Meaning the PIP which baby get includes PEEP. Rest of concepts are same.
  6. For #1, you answered yourself dark lung fields, so no RDS, hence no surfactant, looks like vascular phenomena rather than parenchymal as your scenario. Treatment lung protective strategy, and pulmonary vasodilation. for #2, adequate coverage, can be discharge with follow up
  7. Yes our anesthesiologists routinely use cuffed tubes for any procedures not restricted to CDH We didn’t find any severe adverse events though sometimes mild post extubation stridor, also cultural acceptance in NICU community is an issue. Naveed
  8. As Stefen Said there is no role of antacid while giving Ibuprofen. For first instance why you want to give antacids for Ibuprofen? if it is to prevent gastric irritation then answer is No. As far as RFT are concerned , all these side effects are transient and will resolve with time. all you need to do is to reduce fluids management and reduce if oliguria during therapy with ibuprofen.
  9. We usually do the same as what you mentioned, increase 20% fluids ad check Na frequently say Q6hrly. Once Normalize reduce TFI. Yes we replace free water with Na free solution but give maintenance Na which Baby any ways get from UAC heparin Saline ( 0.45% saline) and put 2mmol/Kg in TPN as acetate to tackle acidosis. We can go up as much as 200ml/kg/day and maximum Humidity to 95%. Never give saline bolus and NG drip with sterile water. I hope it helps
  10. We use nasal intubation to have stability, fixation is usual with tape
  11. The reason we use gel in term babies is to avoid admissions and transiently support feeds. On the other hand preterm <35wks is by default admitted to nicu so it doesn't make any sense to use gel in them plus you have to start IV D10w or formula NG feeds so gel has no role. Moreover gel is not 100% effective in preventing hypoglycemia same as vaccines are not 100% guaranteed. Having said that we use gels in terms because they have more glycogen reserves as compared to preterm and sustainability is more attainable in terms as compared to preterm.
  12. Hi Dr. Vira Thanks for the comments and I am glad that you like our book useful. The Frequency is not appropriate for this 630gm baby, change in frequency affect your tidal volume and hence CO2. Hz of 10 is too low for this baby and hence the first thing to change since PCo2 is too low, we need to act aggressively on it since the change in frequency affect PCO2 more than amplitude. Also as mentioned in the text, amplitude should never be changed by this number i.e by 6 but slowly in increments of 2. Regards Naveed
  13. Thanks @drnono for such a nice detailed answer, if u see the ECG in the question it is wide complex tachycardia, HR around 175, so not at all SVT by any means or even by definition. We can debate about lidocaine vs adenosine but I think from exam perspective I still stand that lidocaine is the answer and correct in book but @tarekhas a point and reference we can't ignore especially when there is VT and SVT aberency. Thanks for your comments. Don't know is there any pediatric cardiologist in this group who can comment to guide all folks.
  14. Thanks Tarek, will take a note of this and will amend it.
  15. Hi Tarek Thank you so much for the e mail and comments about Q2 of Cardiology. To my knowledge Adenosine has no role in Ventricular tachycardia. Here patient is stable with pulse and BP, so stable V Tach is treated with IV Lidocaine and pulseless V tach with defibrillation and not with synchronized cardio version. I am attaching a reference review article for our discussion.Unfortunately our site didn't upload >1.95MB files so as such I am sending DOI, it is free. Please see page 349. Please let me know what you think. Contrary what you said is what we do in Supraventricular tachycardia, IV adenosine when stable and synchronized DC shock when unstable. Thanks DOI: https://doi.org/10.3345/kjp.2017.60.11.344
  16. Thanks so much. This is what I want, share and spread the knowledge. These mcq's are great asset for fellows in training. Naveed
  17. Hi all, we have published the fifth edition of our e-book “NEOQUESTIONS 1to1” . Please feel free to distribute among your other colleagues to help them gain the knowledge of neonatology. https://docs.wixstatic.com/ugd/92a170_54197b618fb34a39a7702b7679a085ec.pdf With Best Regards NAVEED
  18. Hi all It gives me great pleasure to launch the fifth edition of our book titled "NEOQUESTIONS 1 to 1". Please feel free to share with your colleagues to help them gain knowledge of Neonatology. https://docs.wixstatic.com/ugd/92a170_54197b618fb34a39a7702b7679a085ec.pdf Naveed
  19. For infants with sepsis/ septic shock due to their third spacing secondary to capillary leaks plus they require multiple fluids blouses/ colloids etc, we use weight prior to sepsis call it as dry weight till he or she is back to dry weight. If the kid is still puffy for few wks or month, we take 25th percentile for that age and calculate all fluids based on it. I hope it helps Naveed
  20. This is what we do here in Canada as mentioned above by nashwa. There are no fixed numbers in short. naveed
  21. Thanks terek for reference. What is not mentioned in study how they excluded feto maternal hemorrhage. May be that is contributing to KB positive test. It is highly unlikely that abruptio fetal blood is lost. Fetus either die or present with severe shock/acidosis secondary impaired exchange of nutrition and acids across placenta but anemia is not likely unless it is feto maternal hemorrhage. Naveed
  22. Thanks Stefan and tarek let me frame this question in a different way. In abruptio placenta the blood lost is fetal blood or maternal blood? Thanks Naveed
  23. Hi Everybody, Greetings from Canada I have a quick question, in case of mom presented with severe abruption placenta, can the baby present with severe anemia? will you arrange O-ve blood ahead before delivery or standby? Thnaks
  24. There should be no reason to intentionally ventilate babies while cooling. How can ventilation cause comforts? we use low dose morphine infusion to keep them calm Naveed
  25. We never use laryngeal mask during resuscitation. All our fellows are well trained for intubation . Even in our level 2 we never use it
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