Mortality

Course in the PICU SubjectiveObjective -6 hours of hospital stay -With spontaneous respirations -No desaturations - T:38 - HR 174 bpm - RR: 33 bpm - BP: 106/62 mmHg - O2 sats: 100% - Intubated with the following settings: RR: 30 FiO2: 90% PIP: 15 iTime: 0.5 PEEP: 2 - No cyanosis, - (+) alar flaring - (+) OGT with bloody drain - (+) bloody secretions per nostril probably due to traumatic - Equal breath sounds, Subcostal and Intercostal retractions - Tachycardia, regular cardiac rhythm, no murmur - Full and equal radial and brachial pulses - Weak dorsalis pulses - Cold toes - GCS 3, 2-3mm pupils EBRTL

Course in the PICU AssessmentPlan Complex febrile seizure prob secondary to CNS infection -Repeat blood gas with electrolyte levels -Continue antibiotics -Fever control -Adjust Mechanical Ventilator settings accordingly

Course in the PICU SubjectiveObjective -8 hours hospital stay -Persistently febrile -ECG reading according to the ICU nurse is SVT -Repeat Potassium level is 2.5 mEq -With spontaneous respirations -With adequate urine output - T: 39 C - HR: bpm - RR:30-40 bpm - No BP appreciated - O2 sats: 100% - Intubated with the following settings: RR: 30 FiO2: 90% PIP: 15 iTime: 0.5 PEEP: 2 - (+) alar flaring - (+) OGT with bloody drain - Equal breath sounds, Subcostal and Intercostal retractions - Tachycardia, regular cardiac rhythm, no murmur - Full and equal radial and brachial pulses - Weak dorsalis pulses - GCS 3, 1-2 mm EBRTL

Course in the PICU AssessmentPlan Hypovolemic Shock-Adenosine 1.25mg/kg rapid push for SVT -Potassium correction -Calcium Gluconate 1gm for Calcium correction -Plain LR 250ml as bolus (20ml/kg) -Norepinephrine 8mg in 100ml of D5W to run at 5ml/hr (0.5mcg/kg/min), and titrated accordingly -For Cardiac enzymes level -For Eg7 and serum Albumin levels -Paracetamol 125mg/IV was given for fever -Continue Tepid sponge bath

Course in the PICU SubjectiveObjective -9 hours hospital stay -Persistently febrile -With spontaneous respirations -With adequate urine output -Cardiac enzymes CK total: 25,825 U/L CK MB: 596 U/L CK MM: 25,229 U/L - HR: bpm - RR:30-40 bpm - Bp: 114/40 mmHg, at times, BO cannot be detected - O2 sats: 100% - Intubated with the following settings: RR: 25 FiO2: 90% PIP: 15 iTime: 0.5 PEEP: 2 - (+) alar flaring - (+) OGT with bloody drain - Equal breath sounds, Subcostal and Intercostal retractions - Tachycardia, regular cardiac rhythm, no murmur - Full and equal radial and brachial pulses - Weak dorsalis pulses - GCS 3, 1-2mm pupils EBRTL

Course in the PICU AssessmentPlan Hypovolemic Shock Myocarditis -Cardio- referral was done -For Stat 2d Echo -For Stat ECG -Decrease Norepinephrine to 5ml/hr (0.5mcg/kg/min) -Start Milrinone at 0.5mg/kg/min -For Troponin I

2D Echo

2 hours prior to Cardio-Pulmonary arrest The patient is persistently febrile HR is 227 bpm BP 214/95mmHg RR: 45 bpm GCS 3, no response to pain, (+) corneal reflex, Minimal gag reflex, (+) alar flaring For stat EEG. Norepinephrine drip was adjusted accordingly.

1 hour prior to Cardio-Pulmonary arrest The patient is persistently febrile HR ranges from bpm BP is labile RR: bpm GCS 3, no response to pain, Pupils: 1-2mm briskly reactive to light, (+) alar flaring Norepinephrine drip was adjusted accordingly.

At 10:15AM,the patient was noted to have decreasing hear rate (HR: 140bpm) which gradually decreased to 103bpm. Within 2 minutes, asystole was noted. HR:0, no spontaneous breathing, no pulses and blood pressure appreciated. Cardio-Pulmonary resuscitation was started.

Chest compressions and ambubagging were started. Epinephrine doses were given every 2 minutes while during chest compressions 2 doses of 1 mg Epinephrine followed by 3 doses of 0.1 mg Epinephrine followed by 8 doses of 1.3ml Epinephrine (1mg in 10ml PNSS or 0.1mg/ml) Norepinephrine drip was increased to 20ml/hr (20mcg/kg/min)

50 minutes of resuscitation The patient remained asystole. HR:0, no spontaneous breathing, no pulses and blood pressure appreciated. Sodium Bicarbonate 25 mEqs + 250ml PNSS via IV push was given Epinephrine was given at 1mg every 2 minutes

54 mins of resuscitation Calcium carbonate 1 gram + 10ml PNSS via IV was given for 15-30minutes Chest compression and ambubagging was continued. Epinephrine 1 mg for 2 more doses HGT done = 51 mg/dl D10 water at 5 ml/kg or 62.5ml via IV given

1 hour of resuscitation The patient remained asystole HR:0, no spontaneous breathing, no pulses and blood pressure appreciated. Epinephrine 1mg was continously given every 2 minutes for 10 more doses while ongoing chest compressions and ambubagging.

1 hour and 25 mins after resuscitation the patient remained asystole HR:0, no spontaneous breathing, no pulses and blood pressure appreciated. Parents decided to stop resuscitation Patient pronounced dead at 11:43am. Post mortem care rendered.