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tarek

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Posts posted by tarek


  1. I can appreciate Dilated bowel loops no portal vein gas no pneumatosis 

    any Gastric Residual, vomiting, bloody stools 

    check for electrolytes esp Na 

    Do CRP, blood Cs start antibiotics according to your antibiogram

    serial x ray follow up

    blood gas to check for metabolic acidosis

    CBC monitoring to check for further drop of platlets 

    regarding pedia surgical consultation 

    in NEC I & NEC II they have no rule but if you can involve them if you have suspecion 

    NEC III THEY SHOULD INTERVENE EITHER PUTTING A DRAIN OR TAKE THE PATIENT TO OR 

    Treat the patient as a whole and do not treat the x ray

    • Like 1

  2. @rehman_naveed

    Regarding Q2 in cardiology

    The answer and critique need review ventricular tachycardia with pulse so stable ( normal BP normal CRT ) so medication here we can consider adenosine then expert consultation.

    Ventricular tachycardia with pulse unstable ( low BP , prolonged CRT ) so sybchronized cardioversion starting with 0.5 j/ kg

    Pulseless Ventricular tachycardia same as VF management is defebrillation start with 2 j/ kg


  3. The placental circulation brings into close relationship 2 curculation systems: the maternal and the fetal

    in severe abruptio

    the mother will present with shock and fetus may die

    detection of fetal blood in a maternal bleeding is worrisome

     The clinical manifestations and prognosis depends on the amount of fetal blood and the rapidity with which it occurs

    see the attached study

    25-30.pdf

    • Like 1

  4. If you from the history that there is antepartum hemorrhage and you have the time to arrange O -ve PRBCs

    It will be more superior than NS

    If the baby deliverd and resuscitation was required and O- ve blood not there you will give 10 ml/ kg NS over 5-10 minutes 

    In side nicu after stabilization of the baby you can arrange for cross matched PRBCs if the baby us really anaemic

    • Like 1

  5.  According to NRP textbook

    What are the limitations of a laryngeal mask?

    Laryngeal masks have several limitations to consider during neonatal resuscitation. •The device has not been studied for suctioning secretions from the airway.

    •If you need to use high ventilation pressures,air may leak through the seal between the pharynx and the mask, resulting in insufficient pressure to inflate the lungs. •Few reports describe the use of a laryngeal mask during chest compressions. However, if endotracheal intubation is unsuccessful, it is reasonable to attempt compressions with the device in place.

    •There is insufficient evidence to recommend using a laryngeal mask to administer intratracheal medications. Intratracheal medications may leak from the mask into the esophagus and not enter the lung. 

    •Laryngeal masks can not be used in very small newborns.

    Currently, the smallest laryngeal mask is intended for use in babies who weigh more than approximately 2,000 g. Many reports describe its use in babies who weigh 1,500 to 2,000 g. Some reports have described using the size-1 laryngeal mask successfully in babies who weigh less than 1,500 g.

    This study by Prof Kary Roberts in USA

    Laryngeal Mask Airway for Surfactant Administration in Neonates:A Randomized,ControlledTrial

     

     

    • Like 2

  6. Thanks @bimalc

    For your valuable comments

    For antibiotics choice it differ from full term to preterm babies 

     NEC  has  not  been  shown  to  occur  in  germ-free  animals. While  bacterial  and  viral  pathogens  including  Escherichia  coli,  Klebsiella  spp, Clostridium  spp,  Staphylococcus  epidermidis,  rotavirus,  and  enterovirus  have  been implicated,  no  single  organism  has  been  consistently  associated  with  NEC.  Blood cultures  are  positive  in  only  20–30%  of  cases.  While  colonization  by  normal  gut flora  supports  the  intestinal  mucosa  through  toll-like  receptors,  pathological  bacteria  induce  inflammation  and  apoptosis  by  signaling  pathways  such  as  nuclear factor-κB.  The  growth  of  these  noncommensal  bacteria  may  also  result  in  endotoxin release, leading to mucosal damage.(Gomella)

    This suggestion was mentioned in Gomella

      Antibiotic regimen  should  cover  pathogens  that  can  cause  late-onset  sepsis  in  premature infants.  Add  anaerobic  coverage  if  bowel  necrosis  or  perforation  is  suspected. Reasonable antibiotic regimens include a.  Vancomycin, gentamicin, and clindamycin (or metronidazole).

    b.  Vancomycin and piperacillin/tazobactam.

    c.  Vancomycin, gentamicin, and piperacillin/tazobactam.

    d.  Term  infants  may  be  treated  with  ampicillin,  gentamicin,  and  clindamycin. 

    • Like 1
    • Thanks 1

  7. I can appreciate dilated bowel loops small and large intestine

    air up to rectum

    Wall looks thin but either thin or thick can be presentvin NEC

    No portal vein gas

    No evidence of pneumatosis intestinalis

    My suggestions:

    check previous x ray to rule out dilated fixed loops

    Check if the patient on CPAP how much flow and how much PEEP 

    Is there is abdominal tenderness wall oedema dilated veins

    Any other signs of feeding intolerance how much milk he is recieving and EBM or artificial

    How much is platlets

    Any metabolic acidosis

    Next x ray do with lateral decubitus

    Ultrasound abdomen for diagnosis of NEC is more sensitive than x ray but need some one who is expert

    ( take the patient as full and not x ray only)

    If you going to start antibiotics i like tazocin +vancomycin

    Involve pediasurgery to make them aware

     

     

     

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