BABY BOY MAGNO. COURSE IN THE WARDS Admitted in the NICU as a case of t/c CDH Initially hooked to O2...
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Transcript of BABY BOY MAGNO. COURSE IN THE WARDS Admitted in the NICU as a case of t/c CDH Initially hooked to O2...
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BABY BOY MAGNO
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COURSE IN THE WARDS
Admitted in the NICU as a case of t/c CDH Initially hooked to O2 support at 10 lpm via
hood Still with retractions Intubated ET3L9 Hooked to MV 100% 20/5 60 0.4 Started on Meropemen and Amikacin Babygram showed CDH
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2d-echo showed PA hypertension ABGS showed respiratory acidosis PIP increased to 22 Started on Dopamine 10, Vecuronium and
Midazolam On the 4th DOL, underwent repair of hernia RR successfully weaned off to 40 The following day, Vecuronium and Midazolam
were discontinued
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Patient was started on Dobutamine 10 Meds were shifted to Piperacillin-Tazobactam,
Amikacin and Pentoxyfylline Ruling out new-onset sepsis
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CIRCUMSTANCES SURROUNDING DEMISE
Noted with bleeding per orem and per ET Code called ACLS initiated Not revived
PCOD: Dissiminated Intravascular Coagulopathy secondary to nosocomial sepsis (S. epidermidis)
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BABY BOY BRIONES
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COURSE IN THE WARDS
Infant of mother with uncompensated heart disease
Intubated at 1st minute of life for irregular respiration
Intubated ET3L7 Hooked to MV 100% 24/5 70 0.4 Intial ABG showed respiratory acidosis PIP increased to 30
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Dopamine 10 and Dobutamine 10 started Started on Meropenem and Amikacin Transferred to Cohort for growth of gram (-)
bacilli At the cohort noted hypothermic and in
respiratory distress with desaturation Patient thermoregulated Pressure continually increased with no relief of
the respiratory distress and desaturation
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CIRCUMSTANCES SURROUNDING DEMISE
Code called ACLS initiated Epinephrine IV and per ET given Not revived
PCOD: respiratory distress syndrome
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BABY BOY FRIAS
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COURSE IN THE WARDS
Born preterm to a 37 y/o multigravid Intubated due to irregular respiration Intubated ET2.5L8 Hooked to MV 60% 16/5 40 0.4 Started on Meropenem and Amikacin Babygram showed HMD, mild Weaned off to NCPAP on the 3rd DOL then
eventually to 2 lpm via NC
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Initial blood cs showed E. coli Transferred to cohort Bilirubin noted to be elevated Started on circular phototherapy Incremental feeding initated Noted tachycardic on the 6th DOL t/c PDA, for 2d-echo Started on Dobutamine 10
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Hooked back to NCPAP 30% PEEP 5 Started on Cefepime Plan is for DVET for sepsis Noted with coffee ground output per OGT on 8th
DOL Started on PPN Repeat blood CS showed K. pneumoniae,
ESBL. MIC to Cefepime sent
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Repeat CXR showed nosocomial pneumonia with atelectasis (10th DOL)
Put on right lung up MIC showed resistance to Cefepime Shifted to Ciprofloxacin Babygram showed dilated bowel loops FOBT was (+) A> NEC stage 1B Started on Metronidazole
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Started also on vitamin K and Famotidine Noted platelet 5 and decreased Hgb 81 s/p BT of 1 aliq pRBC and 1 aliq PC Atelactasis was resolved at this point but with
increassing infiltrates on babygram 14th DOL, ABGs metabolic acidosis Dobutamine increased to 20, started Dopamine
20 TFI increased to 154
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On the 15th day of life, noted with sclerama and edematous bilateral lower extremities
NCPAAP increased to 60% and 5 but still with respiratory distress
Intubate ET3L7.5 Noted bleeding per orem t/c fungal sepsis To start Fluconazole
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CIRCUMSTANCES SURROUNDING DEMISE
Code called ALCS initiated Epinephrine per ET and per IV given Not revived
PCOD: Septic shock (K. pneumoniae)
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BABY GIRL MUYANO, TWIN A
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COURSE IN THE WARDS Born preterm, 1st of twins via LSCS for multiple
gestation Intubated for respiratory distress Intubated ET2.5L5.5 Hooked to MV 60% 18/4 60 0.4 Started on Meropenem and Amikacin Noted with growth of Pseudomonas putida in
initial blood cs Transferred to cohort
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Noted increased wbc on repeat CBC Shifted to Cefepime MIC to Meropenem, Cefepime and Ciprofloxacin
sent Noted also ABGs showed persistent metabolic
acidosis Started to Dopamine 10 On the 4th DOL, noted with gr 2/6 continuous
murmur in left parasternal border
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t/c PDA, for 2d-echo ABGs still metabolic acidosis Started on Dobutamine 10 TFI 120 Repeat CBC showed hgb 44 s/p BT of 1 aliq pRBC x 2 doses Repeat improved to 133 MIC showed resistance to Cefepime Shifted back to Meropenem
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Dopamine and Dobutamine increased 20 Started on Epinephrine 0.3 Noted deteriorating BP (MAP < 30) Epinephrine increased to 0.5 Started on Hydrocortisone t/c fungal sepsis To start Fluconazole For DVET for sepsis
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CIRCUMSTANCES SUROUNDING DEMISE
Code called ACSL intiated Epinephrine per ET given Not revived
PCOD: Septic shock (P. putida early onset; B. pseudomallei late onset)