Morning Report

Morning Report: Resuscitation in the disabled child

Resident Presenter: Shannon Pickup PGY 1

Summary : A 6 month old female, born premature w/ PMH of Hypoxic Ischemic Encephalopathy, IVH grade 1, arthrogryposis, G tube, recent cardiac arrest and tracheostomy, presenting w/ episode of cyanosis, hypoxia and bradycardia. On arrival she had retractions and tachypnea, SpO2 92%. Thick blood tinged sputum was suctioned from tracheostomy and respirations improved. Low-grade fever of 100.3. Poor neurologic status is at baseline. She occasional de-saturates into 90s, which improved w/ O2 and repeat suction. CXR showed no new infiltrate. Sputum gram stain positive for multiple organisms. Started on Bactrim based on previous culture sensitivities. Patient has at-home nursing, suction and O2. Respiratory condition improved and father feels comfortable to have pt discharge home.

Learning Points:

  1. Evaluating GCS in infants and non verbal kids
    GCS
  1. Tracheitis- Colonization vs infection is based on clinical picture such as changes in respiratory status, increased secretions, purulent secretions
  2. In tracheostomy patients with suspected infection, give broad-spectrum antibiotic coverage for S. aureus, S. pyogenes and H. influenza (vancomycin, ceftazidime, meropenem) or direct based on previous sensitivities
  3. Complete discharge summaries promptly and accurately to improve communication among providers and aid transition of care
  4. Discuss Medical Orders for Life Sustaining Treatment (MOLST) and DRN in the case of future EM or EMS resuscitation

 

References and EBM Article:

Cardon, G., Marcos, L. Tracheostomy: Complications in Fresh Postoperative and Late Postoperative Settings. Clinical Pediatric Emergency Medicine, 2010-06-01, Volume 11, Issue 2, Pages 122-130

Nageswaran, S Radulovic, A., Anania, A. Transitions to and from the Acute Inpatient Care for children with Life Threatening Illness. Pediatric Clinics of North America, 2014-08-01, Volume 61, Issue 4, Pages 761-783

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