entity Posted November 13, 2011 Share Posted November 13, 2011 (edited) okay, so from what I read, cyanosis peripherally may be normal for them? and if the case here is that the pipes that would normally allow the infants to temp compensate for not having the LV /aorta functioning is not working, are they now prone to similar symptoms to CHF/pulm edema? could that be why their O2 sat is lower? how are the child's lung sounds? am I way off? found some info on http://emedicine.med...treatment#a1127 if anyone wants to read up on it a bit.. edit: this is too complex for my head right now so according to the above, increased O2 for these kids might not be the best thing for them because it will further decrease pulmonary vascular resistance / increase pulmonary blood flow.. so maybe it will be trying to find a balance of the correct O2 levels / not necessarily giving 100% o2? Edited November 13, 2011 by entity Link to comment Share on other sites More sharing options...
FireEMT2009 Posted November 13, 2011 Share Posted November 13, 2011 And Defib, Epi could possibly cause the baby to go into cardiac arrest. You are trying to increase the contractility, rate, and oxygen deficit of an already overworked, overstressed, and under oxygen fed heart. Epi is the exact opposite, and epi will cause vasoconstriction instead of vasodilation. Epi is definately not the drug of choice of this little guy. I would stay away from those type of drugs especially since epi has a high oxygen demand. Link to comment Share on other sites More sharing options...
DFIB Posted November 13, 2011 Share Posted November 13, 2011 okay, so from what I read, cyanosis peripherally may be normal for them? and if the case here is that the pipes that would normally allow the infants to temp compensate for not having the LV /aorta functioning is not working, are they now prone to similar symptoms to CHF/pulm edema? could that be why their O2 sat is lower? how are the child's lung sounds? am I way off? found some info on http://emedicine.med...treatment#a1127 if anyone wants to read up on it a bit.. edit: this is too complex for my head right now so according to the above, increased O2 for these kids might not be the best thing for them because it will further decrease pulmonary vascular resistance / increase pulmonary blood flow.. so maybe it will be trying to find a balance of the correct O2 levels / not necessarily giving 100% o2? And Defib, Epi could possibly cause the baby to go into cardiac arrest. You are trying to increase the contractility, rate, and oxygen deficit of an already overworked, overstressed, and under oxygen fed heart. Epi is the exact opposite, and epi will cause vasoconstriction instead of vasodilation. Epi is definately not the drug of choice of this little guy. I would stay away from those type of drugs especially since epi has a high oxygen demand. Thanks guys, I read the articles and was a little surprised but it makes perfect sense to me after reading it a couple of times. THe Epi angle as well. What about body position? Do you think it would make any difference at all? Link to comment Share on other sites More sharing options...
romneyfor2012 Posted November 13, 2011 Author Share Posted November 13, 2011 The normal sat is around 78-80, today he/she is hovering around 70-72%. I do not think that positioning upright in a car seat will hurt, not sure it will help either, but worth a shot. To whoever said too much O2 is a bad thing in this condition, you are correct. That would be very bad. Physicians try to hold their patient to "their normal" sat, which could be anywhere from 60s-to low 80s depending on the patient and where they are in the process of repair, the good news is the parents are usually educated about O2 sats, and they can tell you where the patient should be. Now without reading my article, and using only the google articles you found can you tell me why too much O2 is a bad thing for this cyanotic patient ? Link to comment Share on other sites More sharing options...
entity Posted November 13, 2011 Share Posted November 13, 2011 (edited) The normal sat is around 78-80, today he/she is hovering around 70-72%. I do not think that positioning upright in a car seat will hurt, not sure it will help either, but worth a shot. To whoever said too much O2 is a bad thing in this condition, you are correct. That would be very bad. Physicians try to hold their patient to "their normal" sat, which could be anywhere from 60s-to low 80s depending on the patient and where they are in the process of repair, the good news is the parents are usually educated about O2 sats, and they can tell you where the patient should be. Now without reading my article, and using only the google articles you found can you tell me why too much O2 is a bad thing for this cyanotic patient ? haven't read your article yet, only the medscape one partially.. in regards to the too much O2 thing.. i was thinking, for icp, we try to hyperventilate to vasoconstrict centrally/decrease pressure in the brain.. the trouble with hyperventilation is that it can cause ischemia in that case.. going by that, here's my best guess. too much O2 will vasoconstrict systemic circulation.. this cause ischemia since the heart is probably not getting enough blood flow by default given their condition and given high O2 levels, maybe coronary circulation constricts too much (even though the blood is properly oxygenated?) have a feeling im way off lol edit: where is your link btw? i dont see anything so far.. edit #2: NVM, found it.. Edited November 13, 2011 by entity Link to comment Share on other sites More sharing options...
romneyfor2012 Posted November 13, 2011 Author Share Posted November 13, 2011 You are close but no cigar, not a brain thing. Look back on page 1, the box that has the weird lines below my post, the link is in white ink, if you drag your cursor over it, you can see the link if you want to cheat. Link to comment Share on other sites More sharing options...
entity Posted November 13, 2011 Share Posted November 13, 2011 I meant would coronary circulation react the same as cerebral in that it would vasoconstrict with inc o2.. Combined with low perfusion to heart b/c of the congenital defect, wont it make it worse? Link to comment Share on other sites More sharing options...
chappy Posted November 25, 2011 Share Posted November 25, 2011 Without reading the article, could it be an acid/base thing? If the child has compensated to living at a lower O2 sat, wouldn't blowing a lot of O2 into the kid put him into Respiratory Alkalosis? Link to comment Share on other sites More sharing options...
Sublime Posted December 11, 2011 Share Posted December 11, 2011 (edited) I would just try 10-12 LPM w/ a pedi non-rebreather. Try and find out what the childs normal 02 sat is (obviously it will be low) and titrate the 02 to that. If the child does not tolerate the mask then use the mask as blow by, monitor and rapid transport. Definitely not something you run into every day. Interested to see what the correct answer is. Edited December 11, 2011 by Sublime Link to comment Share on other sites More sharing options...
chbare Posted December 11, 2011 Share Posted December 11, 2011 I would just try 10-12 LPM w/ a pedi non-rebreather. Try and find out what the childs normal 02 sat is (obviously it will be low) and titrate the 02 to that. If the child does not tolerate the mask then use the mask as blow by, monitor and rapid transport. Definitely not something you run into every day. Interested to see what the correct answer is. That would be a bad move. Regardless of the flow, a non-rebreather delivers high FiO2 and you cannot titrate FiO2 with a non-rebreather mask. High FiO2 and subsequent elevations in SaO2/PaO2 will increase CaO2 and possibly lead to increased pulmonary blood flow, but compromised systemic perfusion. Is this a Sano modified procedure? An ominous possibility to consider with cyanosis in this case is proximal conduit obstruction. Link to comment Share on other sites More sharing options...
Recommended Posts