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BABY BOY MAGNO

BABY BOY MAGNO. 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. 2d-echo showed PA hypertension

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BABY BOY MAGNO

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  1. BABY BOY MAGNO

  2. 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

  3. 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

  4. Patient was started on Dobutamine 10 • Meds were shifted to Piperacillin-Tazobactam, Amikacin and Pentoxyfylline • Ruling out new-onset sepsis

  5. 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)

  6. BABY BOY BRIONES

  7. 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

  8. 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

  9. CIRCUMSTANCES SURROUNDING DEMISE • Code called • ACLS initiated • Epinephrine IV and per ET given • Not revived • PCOD: respiratory distress syndrome

  10. BABY BOY FRIAS

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. CIRCUMSTANCES SURROUNDING DEMISE • Code called • ALCS initiated • Epinephrine per ET and per IV given • Not revived • PCOD: Septic shock (K. pneumoniae)

  18. BABY GIRL MUYANO, TWIN A

  19. 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

  20. 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

  21. 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

  22. 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

  23. CIRCUMSTANCES SUROUNDING DEMISE • Code called • ACSL intiated • Epinephrine per ET given • Not revived • PCOD: Septic shock (P. putida early onset; B. pseudomallei late onset)

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