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Ward rounds in PICU

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Guide for Registrars

  • A detailed but concise handover is one of the key ingredients to good and efficient intensive care.
  • Some people on the ward round will not know the child. It is never adequate to say "no major changes overnight" without some sort of introductory sentences.
  • For many children in PICU the diagnosis is clear cut and a detailed history is not necessary (e.g. most of the cardiac patients). However if the problem is acute or unclear a brief history should be presented.
  • Children in PICU fall in to two broad groups. Approximately half come and go within 12-24 hours. They do need all the relevant details presented but do not necessarily need every component of the systematic review. Use your judgement. Sicker children and those who stay longer than 12-24 hours need all components of the review covered (see below).
  • A common problem is to give too much detail on the simple patients and not enough for the sicker and more complex ones. Simple problems might include children:
    • with respiratory diseases who do not need mechanical ventilation and improve rapidly after admission
    • after "simple" cardiac surgery (e.g. ASD or VSD closure in an older infant or child) who are extubated after a few hours and need no or minimal inotropic support
    • who have had minor head injury/seizures and require intubation for CT scan but are extubated within 1-6 hours and are neurologically normal
  • There should be no interrupting of your presentation. We will try to ensure that this does not occur.

Introductory Sentence:

name, age, diagnosis, operation, ?days since admission

Overall Progress:

comment (briefly), e.g. "stable night", weaning ventilation

Details by System:

Cardiac
• Rhythm / rate
• MAPs (range)
• Atrial pressures (LAP,CVP)
• PAP (relative to MAP) e.g. ½  systemic
• Inotropes - name, dosage
• Lactate-most recent and trend
• Peripheral-core temp gradient  (infants)
• Chest drainage total over 24 hours
• Drain bubbling?
Urine Output
ml/kg/hr - averaged over last 4-12 hours
PD/CVVH
average fluid "loss" (per cycle if receiving PD, per hour if free drainage, net  removal per hour if CVVH)
Balance
for previous 24 hours (e.g.+300ml), given frusemide?
Respiratory Status
• Oxygenation: FiO2, PEEP - PaO2, SaO2
• Ventilation: TV/PIP, rate - PaCO2
• Secretions
• CXR appearances - most recent and trend
Blood Results: - as relevant
• Hb/Hct, platelets
• WCC and differential (?left shifted)
• electrolytes
• creat, LFTs
• coags
Sepsis: - evidence of sepsis?
• microbiology results
• antibiotics
Nutrition: - volume in ml/kg/day
Neurology
• paralysed?
• level of sedation
• abnormal signs
• ICP/CPP - current and trend

Other Investigations: - e.g. head US/CT, genetic assessment etc.

Primary team contacted? - especially for all direct admissions.

Plans

  • Circulation
  • Ventilation
  • Sedation/relaxants
  • Fluids / nutrition
  • Investigations
  • Drains, invasive lines ?out

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Document Control

  • Date last published: 31 October 2005
  • Document type: Other
  • Services responsible: Paediatric Intensive Care Unit
  • Editor: John Beca
  • Review frequency: 2 years