- Praegender Schweregrund
- Condition aggravated
- Hospital-Tage
- 11,0
- Labordaten
- First Hospitalization Sept 29 to Oct 3: Assessment/Plan Pt. is a 6 month old girl with Scimitar variant (pulmonary artery hypertension associated with a moderate ventricular septal defect, right congenital diaphragmatic hernia (small), RML and RLL pulmonary sequestration and R lung hypoplasia), s/p collateral coiling of vessels feeding sequestered lung segments (RML/RLL) on 4/20, and slide tracheoplasty 4/21, trach/vent dependence, and Gtube dependence admitted for viral gastroenteritis. Symptoms resolving, tolerating feeds. CV: - Continue home digoxin, amlodipine, sildenafil, Lasix, Aldactone RESP: - trach: Peds Bivona flextend 3.0 cuffed (deflated), - Continue home vent settings for chronic resp failure: SIMV PCPS 24/7 x18 PS 12 iT 0.65 FiO2 30%- - Continue home pulmonary clearance: budesonide nebs BID, atrovent nebs TID, albuterol PRN FEN/GI - Continue home feeds - Holding home NaCl -- > do not resume post discharge, will need follow up chemistry to monitor electrolytes 1 week post discharge - Start Pepcid for reflux -- > continue post discharge 10/3 ID: -Off antibiotics, likely contaminated blood culture on 9/29, 2 subsequent cultures NGTD NEURO: - Resume home bethanechol 1. Scimitar syndrome 2. Fever 3. Vomiting 4. Chronic respiratory failure 5. Congenital stenosis of trachea due to complete tracheal rings Orders: famotidine, 3 mg, Liquid, PO, BID, First Dose Priority: Routine, First Dose: 10/03/23 22:00:00, (Greater than or equal to 3 months of age. Max: 40 mg/day) famotidine, 0.37 mL, PO, BID, (Greater than or equal to 3 months of age. Max: 40 mg/day), # 30 mL, 11 Refill(s), Pharmacy:, 63, cm, 10/02/23 8:11:00, Height, 6.1, kg, 09/29/23 22:04:00 nystatin topical, 1 app, TOP, TID, PRN Other (see comment), (mucocutaneous candidal infection), 6.1 simethicone, 0.3 mL, PO, BID, PRN gas, (less than 2 years), 6.1 Attending Attestation I saw and evaluated the patient. I have verified and agree with the findings and plan of care as edited above. Agree with comprehensive discharge summary above. Stable exam, tolerating feeds. All home meds reviewed. Echo this admission showed lower RVp which is reassuring. f/u with PCP in 2-3 days. Second Hospitalization Oct 6 to Current (10/11/2023): - Blood tests, CT scan, ultrasound of abdomen, CT and MRI of the brain, spinal tap. No significant findings other than rhinovirus.
- Aktuelle Erkrankungen
- >4/14: Cardiac catheterization > 4/20: cath for coiling of AP collaterals > 4/21: slide tracheoplasty, pexy of the innominate vein > 4/30: ECMO cannulation after aspiration event, requiring 1 hour of CPR > 5/3: ECMO decannulation > 5/23: DLB > 5/24: Cardiac Catheterization > 5/31: Tracheostomy (Neo Shiley 3.0), G-tube placement , first trach change 6/6 > 6/16: Trach changed to Bivona 3.0 Flextend, no tracheomalacia on scope > 8/8: Bedside scope showing grad 3 severe subglottic stenosis
- Vorgeschichte
- Chronic Problems Ongoing Hyponatremia Oxygen desaturation Pulmonary artery hypoplasia Pulmonary vein atresia 1. Scimitar syndrome (Possible) 1. Scimitar syndrome 2. Hypoplasia of right lung 3. Paramembranous VSD 4. Chronic respiratory failure 5. Tracheostomy dependent 6. Partial anomalous pulmonary venous return (PAPVR) 7. Lung sequestration 8. CDH (congenital diaphragmatic hernia) 9. Pulmonary hypertension 10. Congenital stenosis of trachea due to complete tracheal rings 11. Respiratory failure in newborn 12. Pulmonary artery hypoplasia 13. Dysphagia 14. At risk for seizures 15. Personal history of ECMO 16. Hyponatremia 17. Oropharyngeal dysphagia 18. Bilateral sensorineural hearing loss (Rule out) Pt is a 5-month-old female with Scimitar variant (pulmonary artery hypertension associated with a moderate ventricular septal defect, right congenital diaphragmatic hernia (small), RML and RLL pulmonary sequestration and R lung hypoplasia), L bronchomalacia ,s/p cardiac catheterization (4/14), collateral coiling of vessels feeding sequestered lung segments (RML/RLL) on 4/20, and slide tracheoplasty 4/21, s/p ECMO following cardiac arrest following likely aspiration event. Residual cardiac disease is VSD with L-to-R shunt contributes slightly to excess pulmonary blood flow, the large majority is from PAPVR. Long-term goals are weight gain as surgical intervention on PAPVR to relieve right ventricle is planned, likely Warden procedure. Tolerated wean of ventilator to home settings. She will benefit from as much growth and tracheal healing as possible prior to cardiac repair +/- congenital diaphragmatic hernia repair. CV: -Unrestricted moderate VSD, Partial anomalous pulmonary venous return, small ASD, Abdominal aortic collateral to R lung, s/p coiling 4/20; Qp:Qs 3:1 driven essentially entirely from anomalous pulmonary venous drainage - Furosemide 1.5 mg/kg PO q8h - Amlodipine daily for HTN 0.2 mg/kg - Digoxin 20 mcg PO BID - Sildenafil 1 mg/kg TID on 6/17 for pulmonary hypertension - Spironolactone 3.5mg BID - Most recent echocardiogram 8/31: Normal right ventricular systolic function Normal left ventricular systolic function Hypoplastic right pulmonary artery Large left pulmonary artery Prominent left pulmonary venous return consistent with preferential left lung perfusion Mild acceleration of left-sided pulmonary vein velocities, suspect flow related Anomalous right pulmonary vein drainage into the superior vena cava (not well seen today) High muscular ventricular septal defect, small (3mm), adjacent to the perimembranous septum. Vmax 4m/s across the VSD. Posterior deviation of the atrial septum with at least 2 defects--not well seen today. High muscular ventricular septal defect, moderate size, adjacent to the perimembranous septum NEURO: - Subdural fluid collections: spoke with neuro consult 7/25 re:timing and specifics of MRI. They agree that coordinating brain MRI (w/o contrast) with timing of future cardiac imaging is ok; even if she goes home before returning for cardiac imaging and intervention. (due to history of SIADH there was discussion of thin slices of the pituitary, but this is not needed as SIADH resolved with removal of inciting factor) - Head US 8/3 - right subdural collection resolved, interval decreasing prominence of the extra-axial CSF space
- Andere Medikamente
- Amlodipine, Furosemide, Spironolactone, Bethanechol, Ipratropium Bromide, Budesonide Inhalation, Sodium Choloride, Digoxin, Sildenafil
- Allergien
- bactrim
- Vorherige Impfungen
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