Last week’s summer series was an excellent session on lumbar punctures, suturing, and pediatric resuscitation.
Lumbar Puncture and Suturing
Dr. Eric Mutter and Dr. Karen Graham walked us through how to perform a lumbar puncture, both with and without ultrasound guided landmarking prior to the procedure – an especially useful skill in those patients whose anatomy or body habitus makes external landmarking more difficult. Dr. Sharleen Hoffe led a parallel session on suturing – reminding us of the basic principles of wound management and showing us some spiffy new techniques. It turns out that pigs feet are excellent models to practice skin and tendon repairs! Check out the infographic below for a summary of some important tidbits or click here to download the pdf: LP & Suturing.
For a more in depth look at extensor tendon repair, Sharleen directs us to this acep article.
We spent the afternoon in the SIM lab working through a series of pediatric resuscitation cases with Sharleen and Tim. This topic is a scary one for many of us and I found it very helpful to go over a few potential pediatric patients. Some take home points from the day were as follows:
- Use the broselow tape! Yell out the colour and estimated weight so that everyone is on the same page. If the child looks heavy for their age, increase the medication doses but keep the equipment sizes the same.
- Sepsis response is age related! Kids will often get hypocalcemic + hypoglycemic so watch out for those. In general, treat septic shock with norepinephrine if there is no response to 2 boluses of fluid. (Epinephrine is suggested instead of norepi in cases of “cold shock”)
- Remember to initiate CPR in the bradycardic kid with a pulse <60bpm.
- Intubation should be a last resort in asthmatics – just like in our adult population!
- Treat DKA with judicious fluids + skip the insulin bolus – we want to avoid cerebral edema if we can!
- Delegate math/dose calculations. You will have too many other things to think about running a resuscitation.
- Refer to the Canadian Pediatric Society Guidelines for a great overview of the most up to date expert recommendations.