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My clinical rotation this week provided me with valuable insights and unpleasant circumstances, but it proved to be a highly educational experience. This week, I had the opportunity to hear about a 13-month-old female who was diagnosed with tricuspid atresia and absent pulmonary valve syndrome before birth. She has had a balloon atrial septostomy, tricuspid valve perforation, occlusion of the MPA device, and stenting of the PDA.
On January 25th, she underwent surgical management with Dr. Mulinari, a specialist in congenital heart conditions. The procedure involved a median sternotomy to place a Central shunt and remove the PDA stent with ligation. Additionally, an existing atrial septostomy was enlarged, the MPA was dissected to widen the currently restricted RPA, and the dilated LPA was repaired. Over the course of the night, the 13-month-old kid experienced a condition called lactic acidosis, with the highest level recorded at 11.2. This necessitated an escalation in the use of ECMO (extracorporeal membrane oxygenation) and inotropic support. Extracorporeal membrane oxygenation (ECMO) is an advanced therapy used to manage critically ill patients with severe respiratory or cardiovascular dysfunction that is refractory to conventional management (Sakurai and Singhal, 2022.)
The services of vascular surgery were requested to evaluate and treat the left lower extremity. According to the vascular surgery consultation, the ultrasound revealed full blockage of the left PTA, ATA, and DPA. The visualized superficial femoral artery shows reduced blood flow due to an obstruction further upstream, although the common femoral artery was not visible in the current investigation. The vascular team’s intention was to promptly bring the 13-month-old infant to the operating room for a left lower extremity angiography, embolectomy/thrombectomy, thrombolysis, potential bypass, and any other necessary procedures. Additionally, they planned to initiate therapeutic anticoagulation by administering a heparin drip.
Managing a 13-month-old infant in a critical care/ICU environment is an exceptionally sensitive and challenging circumstance. The medical team must provide the highest level of attention and care to address the vulnerability of a child at such a young age. Every facet of the infant’s state necessitates diligent observation and prompt intervention to tackle any arising concerns.
The nurse assigned to the baby shown remarkable vigilance by instantly detecting the darkening of the left lower leg in this specific instance. This astute assessment was important, as it resulted in the prompt engagement of the vascular team. To ensure the newborn receives appropriate care and attention for the discolouration and any potential underlying concerns, it is advisable to seek guidance from the vascular team.
The parents of the infant are understandably distraught by their child’s situation. Nevertheless, the medical team, including my preceptor, is absolutely dedicated to ensuring that the parents are kept fully informed about every single aspect of their child’s care during the day, which is of utmost importance. Communication can have a positive or negative effect on their parents’ perceptions of the decision-making process (Brouwer et al, 2021.) Establishing a transparent line of communication with the parents facilitates the provision of the necessary assistance and reassurance they require throughout this arduous period.
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