PCC Conference Day 1

Arrived late this morning ... late start plus exceptionally bad traffic are a bad combo when one is new to a city and having someplace to be.

Walked in late to Mary Fran Hazinsky's prsentation on the new Pediatric BLS and PALS Guidelines. I'd recertified in PALS earlier this year, and will be recert-ing in BLS next month. Really sweeping changes. Codes need to be more coordinated to give continuous compressions after med administration, with fewer rhythm checks. After I'd heard her lecture, I wished I had signed up for the simulator mannikin sessions. However, it was too late, as they'd had a cap on 25 participants per session, so I'll have to push for more hands-on training back at the hospital.

Next came a lecture on Cerebral Oximetry and BIS monitoring. Didn't seem worth the effort for the results that were described.

A lecture on Pulmonary Arterial Hypertension followed. I honestly can't remember much of the lecturer, but I found the material very applicable. It brought to mind one patient we were going to get back from the cath lab, wherein they were going to do he cath, insert a broviac, start on flolan, then transition to remodulin. They were able to do everything but the transition. Anyway, it was very exciting. I wish we could transition all of our patients on flolan to remodulin. Remodulin is so low maintenance when compared to flolan, and since the half-life is four hours instead of two to five minutes, it gives a considerable window of safety to get to a hospital, should something happen to the infusion. I thought of ML and hoped that it would happen for her sometime soon. Things learned in this session: When using nistric oxide, NO and O2 lines need to be purged prior to use, MetHg accumulate faster in native American Indians; and Iloprost is an inhaled prostonoid that may figure strongly in the future (although it can't be given with ventilator therapy).

Dr. William Banner, Jr. was probably my favorite presenter of the conference. From the south, he has an ironic sense of humor, and a lazy drawling voice that made his pressentations seem less like a lecture, than an interesting discussion. His first presentation was on Street and Recreational Drugs: Overdoses and Management in the PICU. Talking with teens to assess intent ... both as parents and health care providers. Alcohol, MJ, SSRI's, Cocaine (involved in 26% of fatal injuries in NYC from ages 15-44, and to give benzo's), Rope, GHB, meth (increased use, easy to make, lasts 8-24 hours), XTC, and resversing narcotics, but not benzo's because of seizure potential .. plus, it's just nice to keep these patients sedated.

Next was a study on XIGRIS and severe pediatric sepsis. Xigris is recombinant activated Protein C, and the mechanisms of action are: promote fibrinolysis, ionhibit thrombosis, and decrease inflammation. The presenter (who is a pharmacist) ran through a bunch of studies that had somewhat ambivalent results. The end shot is that it can be used, but only under very special circumstances.

Laura M. Criddle next presented on blood transfusions: history (first blood bank in Russia in the 1930's), blood typing, blood products, giving transfusions, etc. Interesting historical presentation, but not much new info.

Hung out around 16th Street, then out to the airport to pick up Perky. Put down the top at the park and call area. Very cold that last half mile. Got her back home, then went to the Mercury Cafe for dancing sponsored by 23 Skidoo. Hmmm ... it was okay. A few very good dancers, very tango-inspired, who were not very friendly. Danced with an intermediate, puppy-dog friendly kid, and a couple of really beginner guys. Then Mike came. We've danced together before, but disagree on where. He thinks it was at Camp Hollywood, I think it was in Golden Gate Park in San Francisco. Anyway, it was fantastic to dance with him again. And then some other intermediate-type guys asked me to dance. The same old story. More on this for tomorrow.