FireMedic65 Posted March 1, 2009 Share Posted March 1, 2009 Sorry, I'm on break.. call someone else Link to comment Share on other sites More sharing options...
chbare Posted March 1, 2009 Author Share Posted March 1, 2009 UDS: Negative UA: + for ketones CBC: Leukocytosis of 17.5, slightly decreased Hbg and Hct, Plt's WNL. Chemistry: NA+: 133, K+: 3.2, CL-: 102, CO2: 17, BUN: 29, Creatinine: 1.9, Glucose: WNL per age. CT: Large left sided subdural hematoma is noted with mass effect findings (Midline shift and compression of the ventricle). You perform funduscopy and note retinal bleeding to both eyes. So, we are thinking shaken baby syndrome? Take care, chbare. Link to comment Share on other sites More sharing options...
ERDoc Posted March 2, 2009 Share Posted March 2, 2009 What nationality/ethnic background are the parents? Hmmm...a creatinine of 1.9 is pretty high in a newborn. Link to comment Share on other sites More sharing options...
chbare Posted March 2, 2009 Author Share Posted March 2, 2009 We will say Caucasian. Yes, high BUN and Creat. Further history from the parents state around 3 days of not eating well. Or, "hardly anything by mouth for three days." In addition, they report a few episodes of emesis. Take care, chbare. Link to comment Share on other sites More sharing options...
fireflymedic Posted March 2, 2009 Share Posted March 2, 2009 I'm still pretty suspicious of shaken baby syndrome - thinking if shaken around enough we could have some kidney damage as well. However, throwing a wild one out there but that could fit the bill is polycystic kidney disease. Sometimes presents with intracranial bleeds - so have to admiit that's sitting in my head especially if things fit the bill. Let's get a realistic picture of this kid's kidney function as well. Oh BTW, I'm pulling whatever doc is deciding to be doing something more important and getting his opinion. I'm a medic not a doc ! According to NR - I don't diagnose I just treat (yeah right ya can't treat properly unless you have some idea of what's going on). So let me have a little more info - CT of kidneys - we see any cysts there? I know it's a wild ballgame, but I'm gonna play it though SBS is pretty strong too. Link to comment Share on other sites More sharing options...
chbare Posted March 2, 2009 Author Share Posted March 2, 2009 Shaken baby is a consideration. However, lets say shaken baby has been eliminated. Is there anything else in the history that could point to another cause or other causes? Kidney disease may be a consideration; however, with a history of not drinking, vomiting, elevated BUN/Creat & ketones in the urine, could we consider another common problem? Take care, chbare. Link to comment Share on other sites More sharing options...
DartmouthDave Posted March 2, 2009 Share Posted March 2, 2009 Hello, A PPT and an INR would be nice. Also, platelets (if not a part of the CBC) would be nice as well. As for the infant rapid transport a NeuroSx facility. The little one needs an EVD and an evacuation of the SDH. The infant has an IO so let’s get some sedation (Fentanyl/Versed gtts) and an other line. If we are still bagging I would connect to a ventilator and vent to a low normal PaCo2. Mannitol20% as per the Broselow tape. Dilantin loading dose as per Broselow. Foley cath OG as well Then, send a lackey to the library to search PubMed and the data bases for other consideration. Let’s just say we were budget friendly. When we did the head CT a chest and abd was done as well. Anything? ETA for transport? Or, would it be faster to do a ground run? Link to comment Share on other sites More sharing options...
Mateo_1387 Posted March 2, 2009 Share Posted March 2, 2009 I am going to go ahead and start surgery. Go ahead and relieve the pressure in the brain to improve circulation and decrease swelling. My 15 day Spenac paramedic class went over Pediatric neural surgery for all of 1/2 hour, so I am adequately prepared for such. Plus, I stayed in a Holiday Inn last night. On a serious note, the potassium is slightly low. Being born at home, it is doubtful the baby received a K+ shot. Potassium could be causing her to not have adequate blood clotting, leading to extended bleeding. Link to comment Share on other sites More sharing options...
logos Posted March 2, 2009 Share Posted March 2, 2009 I am going to go ahead and start surgery. Go ahead and relieve the pressure in the brain to improve circulation and decrease swelling. My 15 day Spenac paramedic class went over Pediatric neural surgery for all of 1/2 hour, so I am adequately prepared for such. Plus, I stayed in a Holiday Inn last night. On a serious note, the potassium is slightly low. Being born at home, it is doubtful the baby received a K+ shot. Potassium could be causing her to not have adequate blood clotting, leading to extended bleeding. The shot they give babies at birth is Vitamin K which is an small organic molecule. Despite similar names in medicine, it is quite different than potassium which exists as a salt, symbol K on the periodic table. However, you are right that Vitamin K is given to prevent bleeding in newborns. Link to comment Share on other sites More sharing options...
Mateo_1387 Posted March 2, 2009 Share Posted March 2, 2009 The shot they give babies at birth is Vitamin K which is an small organic molecule. Despite similar names in medicine, it is quite different than potassium which exists as a salt, symbol K on the periodic table. However, you are right that Vitamin K is given to prevent bleeding in newborns. Aw Hell. I flubbed. You are correct. I was meaning to talk about vitamin K. Thanks for clearing it up ! Link to comment Share on other sites More sharing options...
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