February 2012
8 posts
2 tags
Vascular access with ultrasound
When you use ultrasound for difficult IV access, ask someone else to watch for the flashback in the needle so you can concentrate on the picture on the screen.
4 tags
Not Always Top 5 - Cleft Palate
Difficult airway and other associated abnormalities
South RAE tube and throat pack
Nasal airways post op - Repair can cause upper airway obstruction in patients who were breathing though the cleft. Plus tongue can swell with gag
Arm splints and respiratory monitoring post op
PS - For cleft lip use infraorbital nerve blocks via the mouth: Approach at the intersection of the mucobuccal fold and...
1 tag
LMA Insertion Trick
Remove the plunger from a syringe attached to the LMA pilot balloon so it’s open to atmospheric pressure. The LMA cuff deforms as needed on insertion making it easier to place.
2 tags
Local Anaesthetic Dose
An easy way to remember the maximum dose of local anaesthetic in mililitres is: 1mL/kg of 0.25% bupivacaine/levobupivacaine/ropivacaine.
Surgeons often ask how much they can infiltrate safely and it’s easier to calculate this volume in your head, rather than calculate mg/kg and then convert to volume.
For example, a 15kg child could have up to 15mL of 0.25% bupivacaine, or 7.5mL 0.5%...
3 tags
Not Always Top 5 - Laryngospasm
100% O2
Laryngospasm notch pressure
CPAP or positive pressure ventilation
Lignocaine on the cords
Induction dose of propofol
Suxamethonium IV (1 to 2mg/kg) or IM (4mg/kg)
PS - Laryngeal notch pressure: Firm pressure to the notch behind the earlobe, bounded by the mastoid process, base of skull and condyle of mandible. Pressure on both sides in a cephalad and medial direction can terminate...
3 tags
Not Always Top 5 - Emergence Agitation
Occurs in about 10% of children
Lasts about 20 minutes
Characterised by crying, lack of eye contact, non purposeful actions/verbalisations
Exclude other causes (pain, hypoxia, hypercarbia, hypotension, raised ICP, full bladder)
Clonidine 1mcg/kg IV works well
PS - Getting parents in to calm a child with emergence agitation is not helpful, as the child is in a dissociated state and will not...
3 tags
Ultrasound for Vascular Access Tricks
Ultrasound for vascular access in paediatrics can be really useful. The problem is that the distance between the probe and your target might be so small that you can’t see the needle on the screen before it has gone through the target!
To increase this distance put a thick layer of gel on the probe and use a clear dressing to keep it in place. You can almost get an extra 1cm to play...