Pediatrics On Call (LANGE On Call) by Charles Pohl, Kathleen Bradford, Clara Callahan, J. Carlton

By Charles Pohl, Kathleen Bradford, Clara Callahan, J. Carlton Gartner

I. On-Call ProblemsII. Laboratory TestsIII. Bedside ProceduresIV. Fluids and ElectrolytesV. dietary administration of the Pediatric sufferer VI. Blood part TherapyVII. Ventilator ManagementVIII. administration of Perioperative ComplicationsIX. known MedicationsAppendix

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A. Respiratory Alkalosis. Caused by a primary decrease in PCO2 and seen in patients with hyperventilation (anxiety, fever, high altitude, salicylates, mechanical ventilation, sepsis, pneumonic processes, CNS disorders, hyperthyroidism) and urea cycle disorders. B. Metabolic Alkalosis. Caused by elevation in serum HCO3, which can be caused by a net loss of H+, gain of HCO3, or loss of extracellular fluid volume. A useful classification is based on urine Cl− levels. 1. Saline responsive. Involves urine Cl− levels < 10 mEq/L, which indicates renal reabsorption of Cl− has occurred and patient will respond to saline replacement.

Types i. Flexible suction catheters. Better for mucus and thin secretions than are tips. Used for NP and artificial airway suction. ii. Rigid plastic (Yankauer) tips. Better for particulate matter than are catheters. Attached via wide-bore tubing to portable or wall suction units. Wall suction is more powerful, up to −300 mm Hg. b. Regulation of suctioning. Set at −80 to −120 mm Hg; may be adjusted at the source or by varying occlusion of side port of catheter tip. c. Intervals of suction. Limit to 20–30 seconds to avoid irritation and potential vagal stimulus.

Peripheral vasodilatation? If present, reevaluate current support and check mechanical ventilator settings if patient is intubated. 3. CNS. There may be somnolence or obtundation, anxiety or confusion, psychosis, tremors, headache, or papilledema. In the absence of direct CNS injury, presence of these findings indicates inadequate cerebral perfusion or oxygenation, or both. 4. Lungs. Listen for decreased breath sounds, stridor, rales, crackles, or wheezes. If metabolic acidosis is present, compensatory mechanisms include deep, rapid respirations (Kussmaul breathing).

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