PCC Conference, Day 2

Late this morning as well. Bad, since I'm generally a very prompt, and usually early person!

First concurrent session was Surgical and ICU Management of Head and Spinal Trauma. This was an interesting presentation. Things learned: Hypertonic saline (anything > 0.9%) doesn't dehydrate like mannitol, but shuts down the pulmonary cilia, leaving pt more vulnerable to pneumonias; in decompressive craniotomies: remove bone flap and implant in abdomen (keeps bone sterile, alive, and it won't get lost like inevitably happens in a freezer); Putting in two ICP drains ... first in ventricles, second in lumbar area to drain from both top and bottom; brain dialysis to monitor lactate levels (?); Prevention in Buffalo/Pennsylvania: reduced incidence of head trauma secondary to child abuse by having mothers watch a video on hazardous effects of shaken baby syndrome, and sign that they've watched said video and understand it (cuts down on boyfriend abuse of mother's children).

In the second session, I met up with Z. After a stint with One Legacy (federal transplant donor agency), she's now a manager at a facility in Phoenix. She says she still misses us, and that she now appreciates more than ever what a great hospital my place is. Also met up with S, who's working in Denver, and echoed Z's assessment. And really, I'd have to concur ... my hospital is pretty fan-dam-tastic (as Superman is so fond of saying).

The second session was a little out of my area. It was titled Pediatric Arhythmias: Recognition and Management from the normal newborn to the CICU. However, it dealt mostly with congenital cardiac problems, which we don't see in my PICU, since we have all the cardiac kids go to the Cardio-Thoracic ICU.

For the third session, I chose Dr. Banner's Sedation and Analgesia presentation. The take home lesson is one I've always believed ... critically ill kids deserve drugs. Things learned: using Elamax for circumcisions (not that we do this in the ICU, but for prospective parents) and suture removal, using fentanyl (instead of morphine, due to itching) for burn patients; nalbuphine as a partial agonist; some hospitals taking demerol off of their formulary due to metabolite bioaccumulation, and risk of seizures; PCA literature doesn't show that basal rate alleviates pain, and takes five half lives to reach steady state; buffering lido 9:1 with bicarb (much less painful!).

The fourth session was rather a wash for me. I started at the Going Beyong Conventional Mechanical Ventilation Modes, but there wasn't any new material, and the presenter was so dead-pan that I found myself falling asleep.

For the last session of the day, I chose to go to Hazinski's Rapid Assessment and Initial Stabilization of the Critically Ill or Injured Child. This session was mis-labelled, as it was basically a course on the differenced between the pediatric and adult critical patient, but as none of the other sessions really interested me, I stayed. It was a good review, but not a lot of new material. One thing that I learned was that generally one can prevent shivering (as in the head trauma patient) by keeping the front of the tibias warm. Sounds like an old wives' tale, but I'll try it the next time I have a hypothermic patient ... along with other things like layering blankets, and baer huggers, etc.