Non-invasive hemodynamic monitoring guides resuscitation in pediatric meningococcemia
•
2 gostaram•2,905 visualizações
A 2-year-old boy presented with fever, vomiting, and lethargy. He was drowsy, tachycardic, hypotensive, and had a rash. Fluid resuscitation and antibiotics were given. USCOM monitoring showed an initially low cardiac index and high systemic vascular resistance, but improving hemodynamics over time with treatment.
Recomendados
Mais conteúdo relacionado
Mais procurados
Mais procurados (20)
Destaque
Destaque (20)
Semelhante a Non-invasive hemodynamic monitoring guides resuscitation in pediatric meningococcemia
Semelhante a Non-invasive hemodynamic monitoring guides resuscitation in pediatric meningococcemia (20)
Mais de Uscom - Case Studies
Mais de Uscom - Case Studies (11)
Último
Último (20)
Non-invasive hemodynamic monitoring guides resuscitation in pediatric meningococcemia
- 1. Meningococcemia - Pediatric History 2 y/o boy. Taken to Pediatrician with history of sudden onset of fever, vomiting and lethargy for 4 hours. Referred to walk-in clinic at hospital. Presentation Drowsy and pale, dark rings around eyes Temperature 38.7o C CVS: HR 180 bpm, BP 70/26 mmHg Cool peripheries, capillary refill time 5 sec RS: RR 54 ipm, dyspnea, cyanosis SaO2 100% in oxygen NS: GCS 10 then 9, no neck stiffness Fine blanching rash on abdomen/chest. Petechial spot on the face. www.uscom.com.au The Measure of Life
- 2. Meningococcemia - Pediatric Distance blood cell travels / minute Treatment Parameter Base Age wise Fluid bolus 40 ml/kg Measure norms Epinephrine 0.15 mcg/kg/min MD (m/min) 12 18-30 Hypodynamic SVI (ml/m2) 30 40-55 SV (ml/kg) 1.2 1.5-2.4 SVV (%) 45 <15 Hypovolemia / FTc (ms) 278 300-375 Fluid responsive HR 180 85-115 SVRI (d.s.cm/m2) 1120 1000-1600 Normal Systemic SVR (d.s.cm) 1889 1500-2000 Vascular Resistance CI (l/min/m2) 2.8 3.5-5.0 CO (l/min) 2.0 2.5-4.0 Low Cardiac Index Vpk (ms) 0.8 1.1-1.6 www.uscom.com.au The Measure of Life
- 3. Meningococcemia - Pediatric 60 minutes Sedated, mechanical ventilation Afebrile CVS: HR 180 - 150 bpm, BP 70/26 - 90/30 mmHg Capillary refill time 5 - 3 sec Acidosis improved SaO2 100% in oxygen www.uscom.com.au The Measure of Life
- 4. Meningococcemia - Pediatric Treatment Parameter Base 60mins Age wise Fluid bolus 20 ml/kg norms Norepinephrine 0.1 mcg/kg/min MD (m/min) 12 21 18-30 Normodynamic SVI (ml/m2) 30 50 40-55 SV (ml/kg) 1.2 20 1.5-2.4 SVV (%) 45 38 <15 Hypovolemia / FTc (ms) 278 312 300-375 Fluid responsive HR 180 150 85-115 SVRI (d.s.cm/m2) 1120 690 1000-1600 Low Systemic SVR (d.s.cm) 1889 899 1500-2000 Vascular Resistance CI (l/min/m2) 2.8 3.8 3.5-5.0 CO (l/min) 2.0 2.6 2.5-4.0 Adequate Vpk (ms) 0.8 1.3 1.1-1.6 Cardiac Index www.uscom.com.au The Measure of Life
- 5. Meningococcemia - Pediatric Sedated, mechanical ventilation Afebrile CVS: HR 150 - 115 bpm, BP 90/30 - 100/48 mmHg Capillary refill time 3 - < 2 sec No acidosis www.uscom.com.au The Measure of Life
- 6. Meningococcemia - Pediatric Treatment Parameter Base 60min 90min Age wise Fluid bolus 20 ml/kg norms Norepinephrine 0.2 MD (m/min) 12 21 32 18-30 mcg/kg/min SVI (ml/m2) 30 50 58 40-55 SV (ml/kg) 1.2 20 2.6 1.5-2.4 SVV (%) 45 38 19 <15 Mild volume FTc (ms) 278 312 310 300-375 deficit and HR 180 150 112 85-115 vasodilation SVRI (d.s.cm/m2) 1120 690 897 1000-1600 SVR (d.s.cm) 1889 899 1324 1500-2000 CI (l/min/m2) 2.8 3.8 4.6 3.5-5.0 CO (l/min) 2.0 2.6 3.8 2.5-4.0 Vpk (ms) 0.8 1.3 1.5 1.1-1.6 www.uscom.com.au The Measure of Life
- 7. Meningococcemia - Pediatric Summary Paracetamol and appropriate antibiotics for meningococcemia were given within the first hour. Hemodynamics monitored as appropriate treatment administered. Conclusion USCOM gave guidance during the resuscitation, in a very rapid way, without any invasive procedure. www.uscom.com.au The Measure of Life
Notas do Editor
- Low MD - 12 (Typical 18-30) = Hypodynamic circulationLow SVI & High SVV = probably HypovolemiaNormal SVRI – 1120 (Typical 1000-1600)Low CI – 2.8 (Typical 3.5-5.0)Low Vpk – 0.8 (Typical 1.1-1.6)Epinephrine (also known as adrenaline) is used as a drug to treat cardiac arrest and other cardiac dysrhythmias resulting in diminished or absent cardiac output. Its actions are to increase peripheral resistance via α1receptor-dependent vasoconstriction and to increase cardiac output via its binding to β1 receptors.http://en.wikipedia.org/wiki/Epinephrine
- Normal MD - 21 (Typical 18-30) =Normodynamic circulationNormal SVI 50 & Normal-Low FTc 312 = probably mild HypovolemiaLowSVRI – 690 (Typical 1000-1600) = Relative HypovolemiaNormal CI – 3.8 (Typical 3.5-5.0)Normal Vpk – 1.3 (Typical 1.1-1.6)
- Normal MD - 32 (Typical 18-30) =Normodynamic circulationNormal SVI 58, CI 4.6 & FTc 310 = Relative HypovolemiaLowSVRI – 897 (Typical 1000-1600) = HypovolemiaNormal Vpk – 1.5 (Typical 1.1-1.6)