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bimalc

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bimalc last won the day on November 7

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About bimalc

  • Rank
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  • Birthday 10/09/1982

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  • First name
    Bimal
  • Last name
    Chaudhari
  • Gender
    Male
  • Occupation
    Resident
  • Affiliation
    Children's Hospital of Pittsburgh
  • Location
    Pittsburgh, PA

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  1. It is a scandal that this is even still a debate. To suggest we should routinely intubate without NMB is about as evidence based as suggesting neonates don't feel pain.
  2. Can you provide more context on the patient population/circumstances you are interested in? I doubt there are general guidelines given the wide array of underlying etiologies which might lead to hypoglycemia. In general, my approach includes assessment of the reason for the original hypoglycemia, current degree of enteral tolerance/expected tolerance, present glucose levels, risk of critical hypoglycemia with weaning of GIR. At a high-level, though, I view the IV glucose as ensuring metabolic stability while enteral nutrition established. Depending on the urgency of coming off IVF we will
  3. In terms of BPD prevention we are incredibly aggressive about trial of extubation early in life with a culture that does not view early extubation 'failure' as failure; rather we celebrate everyday that these babies spend without an ET tube. For those babies that do go on to develop severe BPD, we have a dedicated BPD-ICU providing developmentally appropriate care by a neonatologist led team of medical providers, nurses and therapist specifically practicing in this patient population. That unit will keep kids admitted for months or even years if needed and extubate to high levels of non-inva
  4. I'm assuming you mean PREMILOC dosing? My units do not use it officially because our BPD program is so good and also because of questions about magnitude of effect on NDI long term, but my deep suspicion is that, in most parts of the US, the hesitancy is driven by fear of legal liability in light of the Canadian and American Academy of Pediatrics positions recommending against routine use of post-natal steroids. Overall, I think the published evidence is sufficient to support but not mandate a change in practice, but no one in the AAP asks my opinion.
  5. I am not aware of such a case, but I must ask what led you test for both conditions?
  6. As a practical matter, it is unlikely because the volumes are so small that when dissolved in feeds over the course of the day their impact is negligible
  7. This is so important, not just for development for for the water loss. People think isolettes are magic, but every time we open them we cause water loss.
  8. We have staff dedicated to reviewing charts, running a checklist for every patient as they approach discharge and rounding with the medical team to call attention to items on the discharge checklist that need attention and to give the medical team an opportunity to highlight 'unusual' discharge needs. For emerging follow-up indications which our institution has not formally added to the discharge planner's checklist (for example, currently we do not have formal guidelines for follow-up in nephrology clinic as we just recently hired our first neonatal nephrologist, but we try to flag babie
  9. If you are asking about enteral supplementation for the 'normal' hyponatremia that ELBWs get after the initial diuresis is complete, our goal is to correct this over a week, though often it takes us 2 weeks to get it right. We follow electrolytes and increase dosing every 2-3 days, paying at least as much attention to the chloride as the Na (we occasionally need to do a mix of NaCl and NaHCO3)
  10. You can, in the sense that it is physically possible, however this is likely not advisable as the volumes involved are too large. 0.9% NaCl is 154mEq/L. 1mEq Na = 1mmol. 1mmol Na/kg = ~6.5mL/kg. Over the course of a day 4mmol/kg/d is ~25mL/kg/d. By way of comparison, our local liquid NaCl preparation is 2.5mEq/mL so 4mmol/kg/d is <2mL/kg/d. My advice is that if NaCl tablets are not available in your country but you have a pharmacy capable, see if you can source NaCl powder. 146g NaCl plus QS sterile water to 1000mL final volume will give you a bulk solution of the appropriate con
  11. No electrolytes (except possible Ca) in the first day or so, introduce modest amounts of Na and K in IVF/PN on day 2 or 3 based on diuresis and serum Na level. Closer monitoring is required in ELBW/EPT infants. In my experience in the early going the biggest problem people get into is giving too much free water as opposed to being off on the amount or timing of Na administration. After a couple of days the biggest problem, especially in ELBWs, is that massive amounts of acetate given in TPN to compensate for the normal RTA are not adjusted quickly enough and people overshoot and end up with
  12. At my new institution, we have fixed ratio "K-cocktail" available during codes with (I believe) Insulin, glucose, calcium and bicarbonate. I can get the exact concentrations/doses on Monday when I am back in the unit if you'd like.
  13. I trained using Rocuronium for intubation and during GA for bedside OR cases. When the hospital trying to conserve roc we used vecuronium as a muscle relaxer for intubated patients who needed it. At my current institution, we use succinylcholine for non-emergent intubation and vecuronium if continued paralysis is required.
  14. Can you clarify if you are referring to premature infants with intact bowel or post-surgical short gut/intestinal failure patients? Your options/goals are somewhat different in each setting.
  15. 1-4 ug/kg/h infusions, usually the lower end of that spectrum, titrating by 0.5 to 1 to effect. Obviously respiratory depression is an issue, but these drips are almost exclusively used in intubated patients so less of a concern. Less uniform practice in my group, historically have used methadone or morphine to come off high dose infusions, but we're increasingly using dexmedetomidine for much the same reason/effect as @frvg666 uses clonidine when coming off larger exposures.
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