Increase rate to 10nanograms/kg/min

You increase the infusion rate to 10ng/kg/min as part of the management plan suggested by the cardiology team. However, Bella’s hypoxia continues to worsen and the consultant is called by the senior nursing staff. The consultant arrives shortly afterwards to review baby. Together you check that baby is being ventilated effectively, and that drugs have been prescribed correctly and have been administered. 

The consultant picks up that prostacyclin was prescribed on the drug chart, and not prostaglandin. Prostacyclin (also known as Epoprostenol or Flolan) is used as a pulmonary vasodilator, NOT to maintain ductal patency. The infusion is stopped and the baby is started on prostaglandin infusion. 

The consultant comments that there has been a prolonged period of critical hypoxaemia, as a result of the delay in starting prostaglandin infusion from initial misdiagnosis and failing to pick up on the prescription error. 

Bella is transferred to the cardiac referral centre, where she is a diagnosed with Fallot’s tetralogy with critical pulmonary stenosis. She undergoes an emergency balloon valvotomy, before having a modified Blalock-Taussig shunt. 

Bella is reviewed in the local developmental clinic at 12 months of age.

She has severely delayed gross motor milestones. Her mother had been told that this may have been due to brain damage as a result of low oxygen levels. However, she is well from a cardiac perspective. 

Outcome: severe learning difficulties

Map: TAME case 6- Bella (Tutorial 1) (328)
Node: 8150
Score:

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OpenLabyrinth
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  • Él juega con sus amigos.
  • Explain the procedure and ask for his consensus
  • new node
  • Επίσκεψη επανελέγχου
  • Presentation at Accident and Emergency
  • De la 5nm până la 100μm
  • Κουκουνάρι πεύκου
  • Άκρη ρίζας κρεμμυδιού
  • Option 3
  • Put on gloves
  • surfactant – diuretics – bili and discharge
  • Allow the woman with the umbrella to decide how she can best help
  • У мого знайомого була ФП, і йому дали ліки, які відновили ритм за кілька годин. Мені потрібно попросити таке ж лікування.
  • Tell the neighbour in short sentences and in a confident tone (without being too harsh or dismissive). “Take a few steps. Walk to the left (or right)” to prompt her to take action.
  • Hojas maduras de roble
  • Interphase, prophase, prometaphase, metaphase, anaphase, telophase
  • Αύξηση των mAs από 50 σε 80.
  • Proteínas incrustadas
  • steroids – diuretics – split bili and other tests
  • Permeabilidad selectiva
  • Μείωση του δυναμικού λυχνίας στα 100 kV.
  • De la 50nm până la 1mm
  • Prefiere sentarse solo.
  • ICM
  • Start by selecting the pipette appropriate for your volume.
  • new node
  • Prefere sentar-se sozinho.
  • Prophase, prometaphase, metaphase, anaphase, telophase
  • Start gluten free diet
  • Refer to gastroenterologist
  • Αρχίζει να γυμνάζεται σε γυμναστήριο
  • Αποφασίσαμε να κάνουμε ένα φιλανθρωπικό μπαζάρ.
  • Stop the infusion and change prescription
  • You suggest that we ask for money from the bank.
  • Node 6: Proceed with a demonstration
  • Interphase, prophase, prometaphase, metaphase, anaphase, telophase
  • Clotting screen
  • Examine him in the air
  • Increase rate to 10nanograms/kg/min

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