HIT

Click on the above title/link, read the provided information on HIT and answer the following questions.

Q: Which patient population in the PICU is at greatest risk for HIT?
Q: How do you treat HIT?

Hemianopsia

Ouestion: If your patient has Right hemianopsia, where would you place the objects for them to see?

Winkler County Case: FAQs

Most of you have probably heard of the Winkler County Case, here is some updated information from TNA. This will also give you an idea of what joing an organization can do for you!

Snake Envenomation: Slideshow

This is a great slide show on snake envenomations...something we see in our ICU. This one is just for fun. No answers!

American Association of Critical Care Nurses

Click on the title and visit the AACN website. This is the first step to join your peers on the journey toward excellence. Here you can join the AACN and reep all the benefits of membership including a reduced price on your pediatric CCRN exam. I encourage all of you to join a professional organization such as AACN or ANA or TNA.

I challenge you to look into the different organizations and review their benefits and join the one that suits you best. If you can not afford to join now please send me which organization you would like to choose and why. If you are already a member, let me know which organization and what you enjoy about it.

This will count as a response and towards the next quater.....don't let Gail take all the points! LOL

Congratulations

Congrats to Gail, she has answered ALL the questions correctly. I hope you all continue to utilize this site to stretch and grow as a nurse in the PICU!

The Answers

Pulsus Paradoxus- cardiac tamponade, there are a few others as well, this is one we might see in the unit as well as the CCRN

ECG findings- hyperkalemia, and K+

Recurrent Syncope- prolonged QT

WPW- do NOT give digoxin because it can increase the ventricular rate and cause V Tach
Bonus- intial treatment is cardioversion, drug of choice amiodarone and your definative treatment is ablation

Wolff-Parkinson-White Syndrome

Click on the above link to learn more about WPW, you will see this on your CCRN exam!

Here is another great website with pictures http://www.merck.com/mmpe/sec07/ch075/ch075h.html

Question: Why is digoxin NOT suggested as a drug of choice for treatment of WPW?

Bonus: If a patient presents with atrial fibrillation and WPW what is your initial and definative treatment for this patient?

Recurrent Syncope in a 10-Year-Old Boy

Background
Figure 1. (Click to enlarge)
A 10-year-old boy is brought to an outpatient pediatric clinic by his parents with a history of multiple fainting spells. These spells are sometimes complicated by generalized tonic-clonic "seizurelike" activity. The patient first started experiencing these attacks 8 months ago. His mother has noticed that the fainting most often occurs either in the early morning, after the sounding of an alarm clock, or during some type of sports activity. The child states that the seizures occur without warning, and they are sometimes associated with urinary incontinence or vomiting. According to the patient's family, the child remains unconscious for about 1 minute, after which he awakens abruptly, with no evidence of confusion and full recall of all of the events preceding the attack.
The patient was born full-term, without any complications. He has no chronic medical conditions and is not on any medications. As a result of experiencing similar symptoms, his father was diagnosed with epilepsy and started on treatment at the age of 8 years; however, the father has been without treatment and has not had any attacks since the age of 14. The patient's paternal uncle had also been diagnosed with epilepsy at the age of 10; he died during a seizure at the age of 19. The patient has an 8-year-old brother who is well, with no history of seizures or fainting spells.
On physical examination, the patient is a well-appearing and well-developed boy whose weight and height are in the 50th and 60th percentiles, respectively. His oral temperature is 98.6°F (37.0°C). His pulse is strong at 66 bpm, with a regular rhythm. His blood pressure is 105/65 mm Hg, and his respiratory rate is 15 breaths/min. The examination of his head and neck is normal. The lungs are clear to auscultation and normal respiratory effort is noted. Cardiac auscultation reveals normal S1 and S2 heart sounds, and no audible murmurs, rubs, or gallops are heard. His abdomen is soft, with no tenderness. No organomegaly is detected. The neurologic examination reveals intact cranial nerves and intact speech. Sensory and motor functions are normal in all extremities, without any pronator drift. The deep tendon reflexes are brisk and symmetric throughout. The patient's Romberg sign is negative, and his gait is stable.
The laboratory analysis, including a complete blood cell (CBC) count and a basic metabolic panel with serum electrolytes (including calcium and magnesium), is noted as normal. A chest radiograph and a computed tomography (CT) scan of the brain are also both normal. An electrocardiogram (ECG) is obtained (see Figure 1).
Questions answered incorrectly will be highlighted.
What is the diagnosis?

Heart Sounds

Click on Heart Sounds above to hear heart sounds and murmurs, you will have to scroll through the information first

Can't miss ECG findings

Life-Threatening Condition :The tracing shows a regular rhythm at 75 bpm. A P wave is present in front of each QRS complex, indicating that the rhythm is sinus. A flattened P wave (black arrow), prolonged PR interval (blue bar), borderline widened QRS complexes (green bar), and -- more pathognomonic -- pointed, narrow, and tented tall T waves (red arrow) are all features of _____?. The patient's serum _____ when the tracing was recorded was 7.2 mEq/L.

Please add yourself as a Follower

My intent is for this site to be open only to PICU so that we can post information important and confidential to give best care to our patients. I am still figureing out how this all works....so bare with me.

Pulsus Paradoxus

What is pulsus paradoxus (PP), also known as paradoxic pulse and paradoxical pulse? It is an exaggeration of the normal variation in the pulse during the inspiratory phase of respiration, in which the pulse becomes weaker as one inhales and stronger as one exhales. The modern definition of pulsus paradoxus is the greater than 10 mm Hg inspiratory decline in systolic arterial pressure. It is a sign that is indicative of several conditions including cardiac tamponade, pericarditis, pericardial effusion, hypovolemia, and pulmonary embolism. Non cardiac causes include asthma and emphysema.[1]
The paradox in pulsus paradoxus is that, on clinical examination, one can also detect beats on cardiac auscultation during inspiration that cannot be palpated at the radial pulse.[1] It results from an accentuated decrease of the blood pressure, which leads to the (radial) pulse not being palpable and may be accompanied by an increase in the jugular venous pressure height (Kussmaul sign). As is usual with inspiration, the heart rate is slightly increased,[2] due to decreased left ventricular output.[3]


This is what you will see on
your monitor if pt has Artline




Q: What should you do if you suspect this?
A: Notify Dr.
Q: you also note an increased CVP/RAP and /or narrow pulse pressure, and increased heart rate… What might be your differential diagnosis be?
A: give me your answer, if you are correct I will give you points

Blogging in the PICU