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Course in the Ward

Course in the Ward. 1 st Hospital Day. Patient presented with respiratory distress and fever. G iven oxygen supplementation at 4-5 liters per minute via mask . She was put on NPO and was started on IVF of D5 0.3 NaCl to run at 29 -30 drops/hr.

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Course in the Ward

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  1. Course in the Ward

  2. 1st Hospital Day • Patient presented with respiratory distress and fever. • Given oxygen supplementation at 4-5 liters per minute via mask. • She was put on NPO and was started on IVF of D5 0.3 NaCl to run at 29 -30 drops/hr. • CBC with platelet count and Chest X-ray were requested. • CBC showed leukocytosis (WBC18.20) and chest x-ray showed the presence of infiltrates on both lung fields. • Patient was given Cefuroxime 250mg/Iv (107 mkd), Paracetamol 100 mg/SIVP for fever and 0.65 % NaCl nasal drops.

  3. 1st Hospital Day • Patient was started on Gentamycin 30 mg/SIVP. • Patient had showed progression of respiratory distress. • ABG was requested and it showed respiratory acidosis with hypoxemia. • The patient was intubated, a nasogastric tube inserted and was admitted to the pediatric intensive care unit. • She was hooked to a cardiac monitor, pulse oximeter and mechanical ventilator. • Chest x-ray after intubation showed progression of the previously noted infiltrates bilaterally and the presence of endotracheal tube at the level of T2-T3. • Blood culture and sensitivity were requested. • Patient was referred to pediatric pulmonology for further evaluation and management. • Cefuroximewas discontinued and patient was started on Vancomycin. • Patient was also started on nebulization with Salbutamol.

  4. 2nd Hospital Day • Midazolamwas given. • Nebulizationwith Salbutamol alternating with salbutamol + Ipratropium was continued followed by chest physiotherapy. • Tracheal aspirate grams stain showed absence of microorganisms. • Repeat CBC showed low hemoglobin (82 mg/dL) • Patient was transfused with 70 mL PRBC. • Serum Na, K, SGPT and creatinine were requested and results were normal. • Indwelling catheter was inserted.

  5. 3rd Hospital Day • Meropenem300 mg/dose IV infusion every 8 hours (128 mkd). • Started feeding with milk formula was started at 30 ml every 3 hours given via nasogastric tube.

  6. 6th Hospital Day • Arterial blood gas determination showed metabolic alkalosis. • Chest x-ray showed confluence of densities in right upper lobe with slight shifting of minor fissure upwards, alveolar infiltrates are again seen in left upper and right lower lobe, and lung fields are slightly hyperaerated. • Endotrachealtube aspirate culture and sensitivity showed presence of Haemophilushaemolyticus. • Repeat CBC showed increased in hemoglobin from 82 to 119, and decrease in WBC from 17.8 to 11.1.

  7. 7thHospital Day • Swasgiven Hydrocortisone 30mg/SIVP every 6 hours (4.2 mkdose). • Midazolamwas decreased 1mL/hr.

  8. 9thHospital Day • Extubationwas done. Salbutamolnebulization was done and she was hooked to O2 per mask at 5 lpm. • Serum Na and K were done with normal results.

  9. 10thHospital Day • IV hydrocortisone was shifted to oral 2.5mL BID (Prednisone 10mg/5ml). • O2 was also shifted to funnel at 2-3lpm to maintain O2sat >95%.

  10. 11thHospital Day • O2/funnel was discontinued, NGT was removed. • Patient was transferred to ward. • Medications • Meropenem300mg/SIV infusion (128mkd) every 8 hours to complete 10 days • Gentamycin35mg/SIVP (5mkd) everyday until 11/22/10 • Prednisone 10mg/5ml 3.5 ml (1.4mkd) BID after feeding • Zinc 10mg/ml 1ml QD • Salbutamolnebulization 1ml + 1 ml NSS q6h • Zinc oxide cream apply over perianal area after each diaper change.

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