Indian Journal of Practical Pediatrics | Year: 2015
Cardiac conditions leading to emergencies fall under three main categories, namely: undiagnosed congenital heart diseases (CHD) with decompensation, CHDs with complications due to interventions and acquired heart diseases. A systematic approach to acute heart failure, dysrhythmias, hypercyanotic spells and hypertensive crisis which are the common cardiac emergencies is dealt with in this article. © Indian Academy of Pediatrics.
Nursing in critical care | Year: 2010
Establishing and sustaining enteral feeding in critically ill children is challenging and has met with many problems. The aim of this study was to investigate (a) how actual calorie intake compared with estimated caloric requirements and (b) whether feeding guideline adherence resulted in improved nutritional intake. A prospective observational study was undertaken over 1 month in a tertiary referral paediatric intensive care unit (PICU) in the northwest of England. Forty-seven children were studied, with a wide range of diagnoses in a 1-month period. Only 47% of the children had enteral feeds started within our 6 h post-admission target. Over half (55%) of the children received less than half of their estimated calorie requirements, but if feeding guidelines were followed, this resulted in a significantly higher (p = 0.004) delivery of the child's estimated requirements. This study found that many children are not receiving adequate nutrition in PICU and that the use of feeding guidelines significantly improves calorie delivery in PICU patients. This paper highlights the dearth of research related to enteral feeding in critically ill children. We found that the use of feeding guidelines improved calorie delivery and so units should be encouraged to develop their own guidelines based on the best evidence available. © 2010 The Authors. Nursing in Critical Care © 2010 British Association of Critical Care Nurses.
Naseem F.,Paediatric Unit II |
Mahar I.A.,PICU |
Arif F.,Dow University of Health Sciences
Pakistan Journal of Medical Sciences | Year: 2016
Objective: To study the demographic and clinical features, outcome, complications and treatment cost of tetanus patients admitted in Paediatirc Intensive Care Unit (PICU) of Civil Hospital Karachi (CHK). Methods: It is a descriptive observational study conducted at Civil Hospital Karachi from July 2013 to June 2015. Patients of tetanus admitted in PICU during the study period were enrolled. Data was collected from the file records of patients and included the demographic profile, clinical presentation, grade of severity, length of stay, complications and outcome. It also included the cost of treatment. Descriptive statistics were applied to describe the results. Results: During the study period, 23 cases of tetanus were admitted in P.I.C.U. twelve were male and 11 female. Majority of cases (13) belonged to age group 2-6 years. Seventeen cases were unvaccinated and 6 had received only BCG & OPV. None was appropriately vaccinated for age. There were 9 cases of post injury tetanus, 6 of them were males, 5 cases of otogenic tetanus and 9 cases had no clinically identifiable portal of entry. Eleven cases belonged to grade III severity of Ablett classification and 6 had grade IV severity. Mortality in our case series was 26%. Autonomic instability was seen in 17 patients and all of them needed ionotropic support. The estimated cost of per day treatment of a tetanus patient with mechanical ventilation was approximatly 31, 979/Pak Rs and without mechanical ventilation was 20,000/Pak Rs. Conclusion: Tetanus is an entirely preventable disease with a high mortality. Treatment is very costly as compared to vaccination which is free of cost. Complete vaccination and proper wound care is the only option to reduce the ongoing burden of tetanus. © 2016, Professional Medical Publications. All Rights Reserved.
Indian Journal of Practical Pediatrics | Year: 2012
Minimal change nephrotic syndrome (MCNS) is often associated with frequent relapses and complications such as hypovolemia, massive edema, infections and thromboembolism. Initial steroid therapy for 3 months or more is associated with reduction in the risk of relapses at 12 to 24 months. In frequently relapsing nephrotic syndrome (FRNS) Steroid dependent nephrotic syndrome (SDNS) maintenance of remission is achieved with alternate day steroid therapy. Steroid sparing agents currently in use include levamisole, cyclophosphamide, chlorambucil, cyclosporine, tacrolimus and mycophenolate. No drug has been proved superior to another. Cyclophosphamide is inexpensive and may give more sustained remission when compared to other drugs. Rituximab has been used as rescue therapy in some children. Diuretics and albumin infusions need to be used judiciously. Pneumococcal vaccine is recommended for prevention of invasive pneumococcal infections. Some children with SDNS may continue to relapse in adulthood.
Pediatric nursing | Year: 2011
In 2005, a protocol for patients with bronchiolitis in the pediatric unit was created, but compliance was less than desired. Therefore, revisions based on staff feedback and current literature were implemented in 2007. A pre- and post-implementation design was used. Descriptive statistics were used to measure the following variables: use of protocol, frequency of suctioning, use of beta2 agonist medication, length of stay, and charges per case. A chart review was used. After implementing the revised protocol, improvement in all areas was demonstrated. Protocol use went from 20% to 68%; suctioning per protocol went from 9% to 66%, beta2-agonist medication use dropped from 70% to 48% (desired change). Financial measures also showed improvement; a decrease in length of stay (2.23 from 3.25 days), and a decrease in charges of $1000/case were demonstrated.