12 ปี 65.7 kg
5937568
Admit 22/9
Dx#Hypertrophic obstructive cardiomyopathy with SubAo Stenosis, mild MR(SAM), mild AR
#Obesity, OSA, Allergic rhinitis, ATH
Admit for MRI cardiac 22/9
FENGIreg diet
Npo ตาม anes
5%DNSS rate 80 6.00น.
Planแก้ใบเปลี่ยนprotocolการตรวจจาก full night เป็น split night pap
titration
Initial CPAP 4-15cmH20 ถ้า
RDI>10
+ Monitor TcCO2
18 ปี BW 50 kg
70969/69
Admit 23/9
Dx# DORV subpulmonic VSDwith PHT clinical-dTGA
S/P cath hemodynamic +acute vasoreactivity test(neg) 24/9
RSRA> on canular 2 LPM
Keep spo2>70
CVSL 0.4>1.6
A 1
Cavedilo ½*1
D(0.25) 0.5x1
Sildenafil(50) 3/4x3 > off24/9
Hemato23/9
Hb 17.1 Hct 56.0
ฝากเวร⭕️คลำpulse ขาขวา
⭕️observe RS
10 yr 43 kg
6668269
Admit 7/9/69
ระบบบริการพิเศษ
Cline RtIJV
Dx# Truncus arteriosus with residual aortic valve regurgitation
S/p VSD closure with homograft from RV to PA (10yrpta)
S/P
Bentall’s hemiarch+replace RV to PA conduit 9/9/69
#PVC(hypoK,Mg,Ca)
#hypoNa asymptomatic (diuretic induced)
#thrombocytopenia>solved
RSExtube 11/9 9.00
HF 30/0.3
>>
RA
16/9
Keep sat>=95
CVSMilrinone 3.5=0.3 >off 20/9
Lasix 5mg iv q12(10,22)
Keep BP 100-130
Off Nicar (1:5) 6=0.5 (13-15/9)
Med
-L 2 9,18
-Al 1.3 12,24
-Di 3.2
-amlo 0.12>>off
-Enalapril 0.06
-NaCl 0.8
FENGIregular diet
16/9
20/0.5
127/3.7/84/22
Ca 9.8 mg 0.8 P2.9
AST/ALT/ALP 57/33/185
T/D 2.9/2.2
21/9
15/0.31
125/4.2/85/28
ca 9.8 mg 0.79 p 3.7
Hemato21/9
12/37
16830 78/11
421k
Last LPRC 10/9
Last FFP 9/9
FF1x2
Warfarin 16>19/wk (INR2-3)
INR 21/9 (1.49)
IDfree atb
ceftri (9/9-14/9)
Cloxa (9/9-14/9)
16/9 10.30 BT38.3
Procal 2.22
hs-CRP 73
Planambulate+Triflo
-CXR tmr
DC soon+บันทึกข้อความ
ฝากเวร⭕️I/O clinical (L5=0.1)
⭕️obs RS
2 ปี 8 kg
HN 5003767
Admit 23/9
Dx# Severe coarctation of aorta with hypoplastic aortic arch
with flap with mild MS
S/P coarctectomy with arc reconstruction with PDA ligation
- Admit for CT cardiac 24/9
CVSMed
- L 0.8
- A 1.5
- Digox 7
- Ferdek, MTV
4 mo, 3.6 kg
45114/69
Refer 16/8
T38+6, 2.5
ACP: no CPR, full med, no PD
C-line
ID Nephro Neuro
Dx# Supracardiac type TAPVR with restricted ASD
S/P reroute TAPVR 8/9
# Post cardiac arrest from hyperkalemia with pulmonary hypertension (23/9)
# Steno. VAP (11/9)
RSPCAC (23/9) 16/4/50/FiO2 1.0
Keep SpO2 80%
-
Iloprost 2.5 mcg + NSS upto 4 ml NB q 6 hr (23/9)
NIPPV PC above PEEP8, PEEP5, RR30,FiO2 0.3
CVSAdrenaline 3=0.3
Levophed 3=0.3
Dobu 1=10
Hydrocort 25 mg (100 mg/m2/day) iv q 6 hr
Keep SBP>65
-
Milri 0.3=0.3 off23/9
- L 6=1.2 q 6 hr
FENGIAbsolute NPO
50%glucose 2 ml/hr (GIR 4.6)
DTX (13.09) 50
Erythro (prokinetic) 22/9
23/9
134/7.3/106/19
Lac 4.6
Hemato22/9
11.3/34.7
Plt 298K
WBC 8770
23/9
8.2/24.7
Plt 34K
WBC 9780
N 76% L 14%
IDMero 23/9
Mero 1-21/9
Levo 14-22/9
Bactrim 14-22/9
11/9
TSC Steno malto
H/C NG
23/9 H/C
NeuroKeppra 30 mkday IV q 8 hr
Fen 0,4=1
Mo 0.5=55
chloral prn q 6
Off 10.00 Fen 0.8=0.8
PlanClamp LA line 20/9
Med-Absolute npo
-
Sildenafil 7/9
- Bosetan 18/9
- Lasix 2.8
- Aldactone 2.8
ฝากเวร⭕️Iloprost 2.55mcg + NSS up to 4 ml NB q 6 hr (18,24)
⭕️
If dyspnea , drip Mo 10 mg + 5%DW up to 50 ml Iv rate 0.8 ml/hr (44 mcg/kg/hr)
อายุ 6 ปี 14.2 kg
7654263
Admit 22/9
Dx# Large high muscular VSD
s/p PA banding with PDA ligation (11/11/63)
s/p VSD closure(Dacron patch) with demanding PA with MPA plasty(autologous pericardium) 18/10/65
Admit for CT cardiac 22/9
FENGIreg diet
Npo ตาม anes
5%DNSS rate 50(M) 6.00
3 เดือน BW 5.8 kg
4945369
Dx# PA/IVS s/p PBPV , PDA stent 17/6/69
Admit for cath 22/9
CVSL 1.5>2.5
A 1.5>2.5
Lanoxin 6.4
MTV drop
FENGI21/9
BUN 7, Cr 0.36
Na135/K4.8/Cl 96/ 27
Plancath 22/9
Hold ASA 3.5
Tmr cxr
ฝากเวร⭕️คลำ pulse ขาขวา
⭕️I/O clinical
5 ปี 24 kg
514764
Admit 22/9
Dx# Moderate Pm VSD, PDA, tiny ASD secundum, PAPVR (RUPV drain to SVC)
S/P PDA device closure (16/2/64
S/P Reroute PAPVR+VSD closure +SVC patch(16/3/64)
# Subglottic stenosis,
CLD on O2 canula 1 LPM at home
> RA
# Epilepsy
รักษา ฉะเชิงเทรา
FENGIregular diet
22/9
BUN 10, Cr 0.48
137/4.1/103/24
14 ปี 49 kg
HN 25901868
Admit 18/9
Dx# LVVT
s/p RFA of Lt posterior fascicular VT and typical AVNRT 23/3/69
รอบนี้ admit for RFA 21/9
#septal hematoma (plan MRI2mo)
If off heparin plan start warfarin
#hypoMg
CVSDobu 6=3
Milrinone 4=0.3
Amiodarone10=5
Keep BP>90/60
Medication
-verapamil 3.7
-ASA 3.3
-cordarone(200)
FENGIregular diet
Mg 2/3
21/9
8/0.58
143/2.9/108/17
Ca7.6 Mg0.69 P3.5
22/9
137/4.2/102/22
Ca9.6 alb4.6
Hemato21/9
11/36
16330 87/6
157k
PlanDC tmr
F/U echo 1 m+lab
MRI cardiac___
ฝากเวร⭕️keep UO>100ml/4hr
⭕️if VT plan
If stable VT
- diltiazem 10 mg iv slowly push in 5-10 min
- ไม่หาย amoiodarone 150 mg iv load in 1 hr
Unstable
- sedate cardioversion
15 ปี , 50 kg
10009/68
Admit 23/8
notify psychi 15/9
0898153064 psychi แพทย์ธัญมน
HF
Ado
Dx# DCM c CHF
# Adjustment+Anxiety disorder
#Hx cardioembolic stroke (3/68)
#HypoCa - improve
RSHFNC Flow 40 FiO2 0.3
>>
25/8 RA
KeepSpO2 > 95
4/9 น้ำเกิน พอเดิม
7/9 congestเดิม
CVSDobu max3=5OFF 29/8 milrinone 4.5=0.3 >>
7/9 off
Milrinone 4.5=0.3 (8-16/9)
OFF
Levosimendan drip 24 hr 18/9 ครบ
Med
A 1.5x2 (1.5)
Cordarone 2>1
W 11 mg/wk
L 1x3 (2.6) 8/9
E 1x1 26/8
FENGIRegular diet
Restrict fluid <1.2 L
23/8 Ca 8.1 >10%Ca iv
26/8 16/0.88
7/9 NTproBNP 2400
14/9 NTproBNP 3300
18/9 NTproBNP 3390
Cr 1.13(0.9) Na133, K 3.7, Cl 97, HCO3 22, Ca9, mg0.81
Hemato23/8 INR3.74
31/8 INR 1.49
7/9 INR 1.65
14/9 INR2.04
Neurono sedative
Lora 1x1
Sertraline 1.5*1
PlanMRI cardiac 9/12/69
21/9 cbc bun cr elyte ca mg phos lft pt ptt inr NT pro BNP + CXR
ฝากเวร⭕️I/O clinical (L10=0.2)
⭕️observe sign low flow
12 yr 51 kg
8336867
Admit 10/9
Dx# bigem PVC
- admit for start flecanide
CVSMed
- Flecanide (100) 1-0-0.5
adjust 15/9
(102 mg/m2/day)
- atenolol(25)1x1
FENGI10/9
137/4.1/101/26
Ca 9.8 Phos 5.4 Mg 0.92
Hemato10/9
13/39, WBC6590
Plt 421K
PlanEKG จันทร์ คุณกุ้ง (QRS>20%)
DC tmr
+-นัด RFA
-ติดต่อสังคมสค.
ฝากเวร⭕️BP>90/60
⭕️HR 50-120
If<50 stable ปลุกตื่น observe
⭕️If short run VT >> ส่ง BUN Cr Elyte Ca Mg Phos LFT (keep Ca 10 Mg 1 K 4)
2 y BW 10 kg
8947768
Admit 14/9
Dx# DORV, Tricuspid atresia, inlet VSD, ASD secundum s/p PA banding, suspected subaortic ridge obstruction 10/67
Admit for cath hemodynamic 15/9
CVSMed
- Lasix 2
- Aldac 2.5
15 Y 42 kg
HN 6323254
Admit 16/9
Dx# Complete heart block S/P pacemaker
# Vagovagal syncope
FENGI16/9 รพอื่น
139.5/3.95/106/25.9
BUN 7.5 Cr 0.59
Hemato16/9 รพอื่น
12.9/39.2
8200 57/32
240K
ฝากเวร⭕️observe HR keep >40
7 months 7 kg
988569
Admit 15/9/69
DxTOF, flap PFO ,small PDA
S/P PBPV 16/9
RSETT no 4 with cuff depth 10
RA 16.30
CVSHeparin 48 hr
Med
- propranolol 1.2 mkday
IDCefazolin post cath 48 hr
DOL 15, 2.6 kg
75403/69
Term 37+6
C/S 3/9/69 9.21
UVC 3-15/9
Dx# TOF with severe PS with PDA
S/P PBPV with PDA stent 8/9
RS9/9 RA
keep sat 80-95%
8/9 ใส่ ETT 3.5/ 8 ก่อนไป OR SIMV 10/8/5/40/1:2/0.2
CXR 16/9 hypoaerate
CVSHeparin 1 via UVC d3/3
PGE1 0.4=0.04 7/9
Med
- Lasix 1.5
- Aldac 1.5
- ASA 4.6 mkday
FENGIBM/IF(20) 45x8 (TF137)
Hemato8/9
Hct 25 🩸
Plt 152K
9/9
Hct 29.9 🩸
Plt 130K
15/9
Hct 41
Plt 133k
Plan✅5/9 screening+Mb/Hct
If tachy +-lanoxin
Add FF
17/9 MVD
Plan D/C 2-3 days
16 yr
9091154
Admit 16/9/69
DxSingle ventricle (unbalanced AVCD) with severe PS with AVV regur with supracardiac PAPVR S/P LMBTS ‘54 # S/P heart Tx with reroute PAPVR 3/69
Admit for heart biopsy 17/9
FENGI16/9
Prograf level 14.1
11/0.8 138/4/104/25
Ca9 Mg 0.51 P3.6
ลด prograf 3-0-3
Mg adult dose d1/3
Hemato16/9
15/49
27800 80/18
467k
5 ปี
463264
Admit 15/9
DxDORV, PA, rt aortic arch, PDA from aortic arch to RPA
s/p PDA stent 2/2/64
s/p RMBTs
s/p PTA PDA stent, PTA LPA 27/9/65
#HbE trait
Admit for CT cardiac
CVSMed
L 1.2
A 0.8
Digox 4
hold ASA
Eurofer
5Y 14 kg
4848765
Admit 6/9/69
C-line 7/9
Dx# Marfan syndrome, MV prolapse with moderate to severe MR
S/P MV repair 7/9/69
#post op
RUL atelectasis
#aortic root dilatation
#PVC
RS9/9 extube
HHHFNC 15/0.3
12/9 RA
Keep SpO2>95
Vent 1nb prn q8
CXR
8/9 RUL atelec
14/9 atelec improve
CVSdobu off10/9
dopa max 6.9>off8/9
Med
L 1.4
Cordarone 6.9 E(5)1/2x1
FENGIregular diet
9/9 143/3.1/110/27
Minobolus K x1 >>K 3.5🔺
10/9 135/3.4🔺/97/25, Mg0.71🔺
14/9 mg 0.79🔺
Hemato10/9
10.5/31.8
10490 72/20
164k
14/9
10.6/32.9
9600 55/34
449k
Last LPRC 7/9
Last FFP 7/9
FF 1x1
IDfree atb
cef3(7/9-9/9)
Cloxa(7/9-9/9)
7/9 sputum c/s ng
8/9
H/C c NG
H/C a NG
Sputum c/s normal flora
9 Y 20 kg
65052/60
Admit 7/9/69
C-line8/9
Dx#Absent RPA (RPA feeding by closing PDA from Rt subclavian artery), S/P balloon dilate PDA 68, S/P stent PDA 68, S/P PTA at PDA stent and RPA ‘60
S/P median sternotomy with interposition graft MPA to RPA 8/9
RSRA 12/9
Keep Sat>95%
Cxr: Rt pleural eff
CVSlast lasix 10=0.5 14.00 11/9
Dopa 1.5=3 off 10/9
NE 1=0.016
off 10/9
Med
Hold
ASA 4
- Silde 1.2
- Lasix 1.5
- Aldac 1.2
- Digox 6
FENGIRegular diet
9/9
Elyte 142/4/106/26
Mg 0.79 >> D 3/3
Hemato8/9
Hct 28 🩸
9/9 39.4
25,650
N85 L22
Plt 182k
IDFree ATB
Ceftri 8-11/9
Cloxa 8-11/9
(Last fever 8/9 T38)
8/9
H/C NG
UC NG
Neurofen 20mcg. Iv q4h
Para prn
DOL 20, 2.4 kg
Lt 48 cm, BSA
104766/45
T39+5, 2.4
Refer 26/8/69
คลอด 25/8/69
HN 72462/69
C-line
foley
ID
Endo
เบอร์หมอชลประทาน
0888271734
Dx#PA/IVS, PDA
S/P PDA 4 mm stent#2, PBPV(fail) 28/8
Inactive
#Post arrest suspected from metabolic acidosis (septic shock, poor heart pumping) 28/8
#KP septicemia 28/8 >solved
#Rt hemothorax
#r/o CIRCI
#UGIB 29/8
#KP ESBL pneumonia26/8>>solved
#hematoma Lt groin
#infection induce Thrombocytopenia
RSOFF ETT 30/8
8/9 ร้องกลั้น
NIV IP5 above PEEP5 RR30 Ti0.5 FiO2 0.25
9/9 RA
Keep SpO2 > 80
VBG: 7.252/50.4/22.2/
22.4/-5
CXR8/9 mild congest
CVSL 2
A 1.6
ASA 5
D 8.3
Hydrocortisone 4 mg q 6 day3 (9.4CPR)
(Off 31/8)
FENGILF(24) 45x8
(TVรวมยา 144 TC115)
AC 36 cm
7/9 Mg 0.62🔺
8/9 137/4.5/98/23
12/9 137/5.3/101/27
Hemato12/9 14/44
Plt 160k
Last
LDPPC 3/9
LDPRC 5/9
IDfree ATB
mero 60>120 mkday 28/8 > ปรับdose 3/9-9/9
25/8
H/C ng
,
KP ESBL(colo)
28/8
H/C KP ESBL
30/8 H/C NG
TSC
p.aero
(colonize)
7/9 CSF NG
bact-neg
PlanBCG
screen 27/8
FU echo 15/10/69
Dc tmr
ถ่ายรูป
1 yr, 9.2 kg
104875/67
- Nutri
- ID
- GD
- Eye (dry eye)
C-line 7/8
Foley 8/8
NG
Dx#AVCD
(unbalance= Single ventricle)
with PDA
S/P bilateral PA banding (inadequate) with PDA ligation
(3/1/68)
PA banding c RPA plasty 9/68
Selective PA banding 10/68
S/P
AVV valve reair, LPA debanding, MPA banding
(12/5/69)
#RS failure (hypoxia) 8/8
#AFI
8/8, 10/8, 13/8
#Hypernat
#AKI
prerenal
#Postop: JET, HyperNa, HypoK
#Lung with difficult intubation with airway edema
#Severe PEM, GDD
RSNIV IP15 PEEP6 RR30 F0.3
ETT 8/8
PCV: IP18 above PEEP 6 RR 35 Ti 0.7 Fi 0.35
Monitor ETCO2
(= pCO2)
(Keep SpO2 >
80%)
13/8 VBG
7.516/24.5/20/-3.1 K 4.14 lac 1.4
CXR 14/8congest
CXR 17/8
CVSDobu 1.6=8 8/8
Dopa 1.6=5.2 8/8
Milrinone
1.7=0.5
11/8-14/8
Isoprel 1.5=0.05 13/8
L 10 mg IV q 8 hr (10/18/2)
1.3 mkdo
Med
Lasix 2
Aldactone 1.5
HCTZ 2.2
Hold8/8
Enalapril 0.15
- off 31/7
FENGILF (43/oz) 110 ml*6 feed (TV71, TC105)
-
Panen36
50x6
TV33
- onsia 1 mg iv prn q 8
TVรวมยา 55M
5DN/3 keep total 20(74M)
Diamox2.7mkdose q12(8/8)
Med
Vitakiddy 5 ml
OTE
Zinc paste, cold cream
Trancel
Ac55
15/8
13/0.32 141/3.8/100/21
9.2/1.3/5 alb 3.9
0.68/0.42 50/39/128
17/8
10/0.26 140/2.9🔺/98/26
9.3/0.89🔺/3.6
18/8 140/4.9/101/29
Hemato8/8
12.2/41.5🩸
16870 (76/12) 199k
10/8
13.3/43.8🩸 14240 (69/20) 131k
15/8
14.7/47.6
14510(67/23) 209k
17/8
14/45.7
10950(57/31) 240k
14.9/1.35/30
IDTazo
8-10/8
Mero d9 10/8
Van
13-16/8
8/8
H/C NG
UC NG
10/8
TSG GPB, co
TSC normal flora
H/C NG
13/8
hs 54.8
PCT 0.56
Swab neg
H/C x3 NG
TSG GPB, co
TSC NG
NeuroFen 0.5=0.5
Dormicum prn q6
Chloral prn q 6
PlanBefore DC
Ear,
MMR เดือนหน้า
MUAC q 2 wk, Lab q wk
Plan CVT ตัด PA, central shunt, change AV valve 18/8
F/U
10/8 GD
ฝากเวร⭕️I/O clinical (L10=1.2)
⭕Ob RS, feed
4 months
3714569
Admit 10/9
Dx# PA/IVS with ASD S/P PBPV + PDA stent (6/69)
-
S/P cath + PBPV 11/9
CVSMed
- Aldac 1.3
- Lasix 1.6
- Digox 8.5
Plan✅EKG, CXR
Tmr cxr,echo
Tmr ASA
1Y 8.4 kg
7260368
Admit 8/9/69
Dx# PA/IVS with PDA s/p PDA stent s/p RMTBS
S/P balloon LPA, PDA 9/9
CVSHeparin 1=10 9/9 (48 hr)
Med (hold asa)
- Lasix 1.6
- Aldac 1.6
- Digox 9
IDCefazolin 9/9
(post cath)
Plantmr start asa (81) 0.5 tab
DOL 31, 2.5 kg
BSA 0.18
71375/69
T38+2, 2470
Refer 24/8
คลอด 10/8
C-line
A-line
Endo
Genetic
Plastic Sx
GNAS
Dx#Large PDA c PFO
(S/P Lt thoracotomy with PDAligation 31/8) BL 2ml
#fail extubation due to cord edema 3/9
#fail extubation due to secretion 7/9
#steroid induceHT
# PTH resistance
(
Symptomatic HypoCa
with hyperPO4)
#2AI, primary hypothyroid
21/8 FT4 0.92 TSH 31
ACTH 1 mcg : cortisol 13.68%
#Complete bilateral cleft lip and palate,
46XY
#Micropenis
1.5 cm
RSfail extube 3/9
Fail Extube 7/9
DislodgeETT 9/9
ETT 3.5/8
Setting: SIMV IP10 PS8 PEEP5 RR40 Ti0.35 Fi 0.3
keep SpO2 >95
CXR 7/9
no congest
Ven1/2NB+3%Naclnb q 8 hr (7,14,22)
CVS- L1.6
- A1.6
- D 8
Hydralazine 0.25 mg iv prn q 6h(0.1 mkdose)
off Dobu 1=5 31/8-4/9
FENGIBM/IF 40>45x8 (TV144, TC96)
NPO หลังมื้อ6.00
10%dn/5 iv 10ml/h(TV96)
Med
- Hydrocort 3.3>2 CPR
- Calcitriol 0.5(50) 30/8
- Levothy 10mcg/kg/day
- CaCO3 40mkgday eCa40mkday
5/9
Ca 9.3 p5 mg0.8
7/9
Ca 10.3
Hemato7/9 12/35
Plt 643k
Last LDPRC 30/8
FF 5mkday
IDFree atb
บ่าย BT37.9
Observe
TSC 20/8 KP ESBL
NeuroU/S brain bedside 20/8 : no holoprosencephal
Fen prn 1(0.5)
Chloral 25mkd prn
ฝากเวร⭕️I/O clini (L1=0.4)
⭕️Ven1/2NB+3%NaCl NB (22)
⭕️if SBP>117 (P95+12) hydralazine(0.25=0.1) prn q 6
⭕️if brady try suction+PPV+-sedate
⭕️observe fever if>38 septic w/u, TSC,TSG
1 y 8 kg
8783467
Admit 8/9/69
Dx# DORV, subaortic VSD, MAPCAs
S/P MAPCA stent 9/9
CVSHeparin 1=10 9/9 (24 hr)
Med
- Digox 6
FENGIMed
- Vita kiddy
- OTE
- Eurofer
IDCefazolin 9/9
(post cath)
PlanFlu vaccine ก่อนกลับบ้าน
Tmr ASA,plavix
L1.2 A0.8
ฝากเวร⭕️คลำpulse Rt
⭕️ฝากดู CXR post cath
5 yr
15.3 kg
396864
Admit 7/9
Dx# PA/VSD S/P PDA stent, S/P RMBTS, S/P stent RMBTS, S/P LMBTS
- S/P cath hemodynamic 8/9
FENGIregular diet
Med
- Eurofer 2.7
PlanFlu vaccine ก่อนกลับบ้าน
ASA 5 (start 9/9)
8 Y 25 kg
4575/62
Admit 8/9/69
Dx# Truncus arteriosus type IV
# Absent LPA, Lt MAPCA, Rt sided arch
S/P RPA banding 62
S/P Left unifocalizing with LMBTS
S/P Rastelli, PA recon 6/69
Admit for CTPA 9/9
CVSMed
-
Lasix 0.9
- Aldac
- Digox 5
ฝากเวร⭕️Order anes
⭕️bun cr elyte
9 Y 22 kg
45514/69
Admit 7/9/69
Dx#ASD secundum, moderate to severe TR
- S/P TEE 8/9
#ATH on avamys, montelukast
CVSMed
- Lasix 1
- Aldac 1.2
ฝากเวร⭕️ตื่นดีกินได้ >> ย้ายพิเศษ
18Y 51 kg
5488069
Admit 6/9/69
Dx# Ebstein anomaly
S/P Cath EP study 7/9
CVSMed
- Lasix(40) 1 tab
- Aldac(25) 1 tab
PlanEKG เช้า 8/9
MRI cardiac 8/9
2yr 8mo, 11 kg
111017/66
Admit 17/8
At SK6 25/8
C-line
NeuroMed 0823326123
Neuroped
ID
PM&R OT
eye
Dx#Myocarditis with cardiogenic shock s/p va
Ecmo 17-21/8
IVIG 17-18/8, methylpred 5 day
#Complete heart block with hx of VT
last echo 23/8 : EF 65-70%
#Acute ischemic stroke rt PCA 23/8 >>
BP < 118/71
CT brain 24/8 : gyri petechial hemor
26/8 : hemor ลดลง
31/8 : bleed มากขึ้น
2/9: lacunar necrosis, bleedลดลง
RSOFF ETT 23/8
HF 10/0.3
RA 25/8
CVSKeep BP <118/71 (P95+12)
FENGIBD(1:1) 200x4+น้ำ50 iva NG
TV รวมยา MT
Try โจ๊กปั่นละเอียด 3 มื้อ
Hemato24/8
11/34
17250 40/52 247k
25/8
11/35
13800 41/53
326k
IDOsel
Azithro
Meropenem 17-23/8
H/C 25/8 NG
CRP1.04 PCT0.49
NeuroE4V5M6
rt lt
IV III
IV III
2/9 ASA 3mkday
PlanCardiac mri feb/70 congen
ASA 2/9CT
Cardi f/u opd 3mo
Off NG 4/9
6 yr 34 kg
77151/63
Dx#MA, SV(RV morphology), VSD, restrict ASD
S/P PA banding S/P ASD Stent
S/P cath hemodynamic 4/9
FENGIK 3.2 >> po 2 dose >>4.1
ฝากเวร⭕️คลำpulseขาสองข้าง
18 yr 77 kg
9854151
Admit 1/9/69
Dx#VSD closure post-op CHB 52 on pacemaker DDD mode
S/P pacemaker battery change 2/9/69
NeuroMo 3 mg prn IV q 4 hr
Para q4 oral
Planนัด check pace 3 mo
9/12/69
CVT 17/9/69
DOL 21, 2.4 kg
PT 34+1, 2352
Refer 24/8
คลอด 14/8
PICC off 24/8
Dx# TOF
# RDS s/p surfactant,on ETT 1 วัน
S/P PBPV + PDA STENT 25/8/69
ระวัง NEC
RS28/8 RA
keep SpO2 >85
CXR28/8 : ดำมากขึ้น
CVSPGE1 1 (0.001) >
OFF 24/8
hep1.5 =15 28/8
L2(0.9)28/8 10.00
Med
25/8
L1.6
A1.6>1 31/8, off 2/9
D8.3
ASA5
FENGIBM/LF (24) 50x8 (TV160, TC107) + adlib
AC 36
7/1.1 20/9/149 alb 3.7
Ca 10 P 6.9 Mg 0.79
31/8 K 5.8
2/9 K 6.6 >Kalimate 1g/kg
Hemato24/8
18/54
13340 55/36
411k
13/1.2/36.7
31/8 Hct 41
IDTazo 3 days
off (25-28/8)
Post cath
Planvac แล้ว
screen 3/9✅
ABR
If DC F/U echo 2 mo
Tmr Elyte หลัง off Ald
ฝากเวร⭕️I/O clinical
ไม่ฝาก
16 yr 35 kg
4504666
Admit 2/9/69
Dx# Non-compaction LV s/p Heart Tx
.
- cath for biopsy 3/9/69
DOL27 2.5 kg
66282/69
Refer 7/8
คลอด 6/8
T38+2, 2.49
UVC
,
UAC
6/8
Dx#TAPVR (intracardiac, supracar)
#AFI 14/8
#LBW
#HBsAg pos - false pos from vac
RSHF 3, 0.21
off 8/8
RA
Keep SpO2 >=80
7/8
ABG: pH 7.399/28.4/36.9/17.7/-7.3/lac5.8
14/8CXR congest
17/8CXR congest
24/8CXR good
1/8CXR good
CVSlasix 3 IV 20/8
Med
-L,A 2
-D 8
- ferdek
FENGI-FBM(27kcal) 50 ml x 4
-Infratini(30kcal) 40 ml x 4
(TV 144, TC 136)
AC BL 27
14/8
23/0.68 135/4.6/83/30
11.3/0.86/9.5 Alb 4.3 49/26/204 13.2/1.39
18/8
TFT normal, K 3.3🔺
11.6/1.25 34/29/226
26/8
136/4.7/96/27 TB3.18
1/9 elyte normal
Hemato⅞ DTX 59
14/8
13.6/39.4🩸
14520 (50/33)463k
18/8
15/46.5
12440 22/61
487k
26/8 Hct39
1/9 Hct33
IDAmpi
6-14/8
Genta
6-14/8
Tazo
15-18/8
Tazo 26/8
14/8
H/C S.aereus
15/8 H/C NG
CSF WBC13, C/S NG
26/8 feverx2 peak
H/C-
NG
CSF C/S NG
Planscreening 10/8
CT cardiac 20/8 ASD 3 mm
U/SWA 21/8 N
tmr D/C
BCG, ABR
ฝากเวร⭕️I/O clinical (L3)
⭕️Obs fever
DOL26, 3.11 kg
6785669
Refer 12/8
คลอด 7/8
T39+3, 3.1
PICC periพัง 20/8
Dx#AVCD, PA, PDA, mod to sev AVVR
S/P cath for hemodynamic 18/8
S/P PDA stent 28/8
#Jaundice on SPT 17/8
#LUL atelectasis - improve
RSCPAP 5,0.21 >> RA
keep SpO2 >80%
CXR18/8 LUL atelec, ดำ
CXR28/8 ateดีขึ้น
CXR29/8 พอเดิม
CVSon PGE1
off 13/8
18/8 Re-start
PGE1 1.5 = 0.003 (off 28/8)
Hep 1.5=15
Med
29/8
L 1.3
A 1.3
D 9.3
ASA 5, 30/8
FENGIBM/IF(20) 40>50x8 +adlib (TV129)
Dtx 81
AC BL 33.5 cm
17/8
2/0.31 139/4.8/102/21
alb 3.5
18.5/
1.5 33/43/152
TG 115 >>
SPT 1 day
18/8
3/0.3 140/3.5🔺/102/25
11.8/2.1 30/30/127
28/8 K 3.2🔺
Hemato15/8
13/38.4
15450 (41/48) 284k
18/8
13/36.8 🩸
7750 50/45
254k
28/8 at cath
Hct 26 🩸
Hct 36
IDTazo 28-31/8
13/8
H/C NG
TSC NG
Planlab screen 15/8
BCG, HBV
ABR
D/C 3/8
ฝากเวร⭕️I/O clinical
⭕️observe feed
13 yr 53 kg
1214757
Admit 1/9/69
Dx#DILV (SV) s/p LMBTS s/p RMBTS s/p stent RMBTS s/p stent LMBTS
Plan Cath evaluate shunt 2/9
Plan CVT conference for shunt (redo RMBTs or redo LMBTS or central shunt)
CVSmed
L 1/2x2 (2.1)
A 1x2 (0.9)
E 1/2x2 (0.08)
Sil 1x2 (0.7)
D 1/2x1 (2.8)
ASA 2x1 , FF
FENGI2/9 K3.4 แก้กิน 1 dose
9 yr 28 kg
30141759
Admit 1/9/69
Dx#TOF s/p total correction 10/63
Plan MRI under GA
CVSmed
L 1/2 x1 (0.8)
A 1x1 (1)
D 3/4x1 (7.8)
16 yr 39 kg
5906053
Admit 31/8/69
Dx#TOF s/p total correction s/p TPVR ,residual LPA stenosis
Plan Cath for evaluate LPA +/- LPA stent
1 yr 7 kg
2308768
Admit 31/8/69
Dx#PA/VSD,MAPCAs
S/P MAPCA stent, PTA at PDA 22/5/68
Cath for evaluate MAPCAs
1
/9
Plan CVT con for RMBTs + rt unifocalization
Ao sat 82%
CVSHep 1=10
med
holdASA1/4x1(3.3)
MTV 0.6x1
FF
ฝากเวร⭕️คลำ pulse ขา2 ข้าง
DOL 15, 3.3 kg
70068/69
Refer 19/8
คลอด 18/8 15.30
T 37+3, 3.25 kg
UVC 20/8
Dx#Trunchus arteriosus type 1
Plan Rastelli operation with repair truncal 1/9
#neonatal jaundice suspected breast feeding
> SPT 21/8-22/8 , 27/8
มารดา A+
G6pd
normal
U/s : normal
GGT 84
RS>CPAP 5 Fio2 0.21
> RA 20/8
>
HF 7, 0.21
28/8
> NIPPV IP10 PEEP5 RR30 Ti0.67 FiO2 0.21
Keep SpO2 >=85
CXR31/8 bowelดี, lung เดิม
CVSL3 (0.9) q 6 (14,18,24,6)
med
L2>2.6 27/8 , A2>1.2 25/8
D8.3
FENGIIF(20) 40x8 (TV97 TC 64)
NPO AMN, 10%dn/5 rate16 (80%MT)
AC 37>36
25/8
122🔺/6/77/29 17/0.85
27/8 130/5.2/85/28
30/8 130/5.4/84/26 Mg 0.75 🔺TB/DB 12.6/2.31
31/8
130/5/83/30 Mg 1.16
Hemato19/8 18/51
13490 88/6
166000
15.6/1.4/35.7
21/8
Hct62MB14.4
SPT 21-22/8
25/8 17.2/2.2
27/8 18/2.4>SPT
31/8 Hct 41
IDTazocin 31/8
H/C18/8 ng
รพ.บางจาก
H/C19/8 ng
hscrp1.24
31/8 BT 38.2
H/C -
UC_
Planscreen 24./8
Vaccineเหลือ
BCG
หู
ฝากเวร⭕️I/O neg (L3)
⭕️Obs RS
⭕️Order post-op
8 yr 47 kg
HN 54532/68
Dx#AVNRT with mild TR
cath RFA 31/8
PlanEKG tmr
F/U อ.ธวัชชัยที่รพ.สิริกิตต์ 1mo
งดออกกำลังกาย1wk
1mo, 3.8 kg
Term 38+5
70838/69
Admit 21/8/69
Dx#unbalanced AVSD with DORV with pulmonary atresia with PDA with infracardiac PAPVR with cotriatrium
With hypoxic spell
#suspect rt isomerism
ระวัง SVT
Palliative : no ETT no Cpr
RSNIV PC 10 PEEP 5 RR 30 Ti 0.67 FiO2 0.21
>
CPAP5 fio2 0.21
Ra 25/8
Keep SpO2 > 70%
CXR22/8 ดี
CVSPGE1 0.6=0.008>0.005 24/8
Off 25/8
FENGIIF 50x8 tv 105
5%DN/3 IV 10
(TV65, GIR2.2)
กินดี off iv
21/8
8/0.22 137/4.3/102/21
10.3/1.08/7
31/16/245/0.48/0.32/4.3/2
Hemato21/8
6680/32%/62%/18.1/55.9/388k
12/22.5/1.08
Neuromo 2 ml q 4 , 2 ml prn q 2
Chloral prn q 6
PlanU/S upper abd 26/8/69
7mo
26027468
Admit 25/8
OT, nutrition
Dx#Hypoplastic Lt.Heart variant ,VSD ,PDA s/p selective PA banding s/p balloon COAT s/p atrial septation with resection suppra Mitral valve membrane
Plan CT under GA 26/8
CVSmed
L2, A2, HCTZ2
ASA 5.3
Ferdek 2.8
MTV 0.5mlx2
OTE 1mlx2
FENGI- โจ๊กhigh calories ปั่น 3 มื้อ
- Modular(50) 80 ml × 6 feeds (TV 86, TC 144, TP 1.95) (CPF 47:7:46)
25/8 0.2 136/3.7/95/25
Hemato25/8
17.5/52
9000 52/38
445k
PlanNutri 31/8 >> เลื่อน 2mo จัน พร้อม cardio
Gene14/1/70
คุยแม่ NG
24 yr, 38 kg
10476645
Admit 24/8
Dx#VSD, Coarctation of aorta
S/P VSD closure and coarctectomy ปี 45
Residual subaortic ridge with severe subvalvular AS, severe valvular AS and moderate AR, no residual CoA
S/P subaortic ridge resection with aortic valve replacement (SJM Regent mechanical valve, valve ring 23 mm)
Echo 24/8/69 : LVEF 29.9% (52% 8/67)
CVSMed
E (5) 1×1 PO pc
L (40) 1×1 PO pc
A(25) 1x1
Cordarone(200)0.5x1
Warfarin (5) 1×1 hs Mon–Sat
Warfarin (3) 1×1 hs Sun
[31 mg/week]>33
OFF digoxin
PlanLFT TFT Elyte coag 27/8
CT coronary 8/9
พรุ่งนี้ cxr
DOL20, 3.6 kg
6680369
Refer 8/8
คลอด 5/8
T37+4, 3.66
UVC 20/8
Dx#AS, PDA (Lt to Rt), ASD (Lt to Rt), MR
S/P balloon AV, PDA device closure 14/8
#Neonatal hypogly, TTNB
#Cong pneumonia
Loss Lt rib 9th ??
RSETT 14-15/8
NIVPC
17/8
CPAP PEEP 5,FiO2 0.21
>>
RA 18/8
Keep SpO2>95
CXR18/8 พอเดิม
CVSDopa
7-11/8, 12-13/8
Milri
0.5 = 0.3 (13-16/8)
Hep 1=10
Para
d5/5 9-13/8
Lasix 1 (0.27) 12/8
Keep MAP>40
Med
- L1 A0.5 D8.3 (21/8)
FENGIBM/IF
50 x8 + ad libs
(TV111)
AC 36
13/8
130/5.3/89/20 Alb 3.3 5.3🔺/0.76🔺/4.8
15/8
5/0.37 139/4.5/99/26 Ca 8
17/8
6/0.44 133/4.6/90/22
8.4/0.88/3.8 ALP124 PTH86
21/8
K 5
Hemato8/8
18.3/53
13610 (57/31)
97k
PT 14.5 INR 1.32 PTT 38
10/8
Hct62 MB11.7
11/8
16.9/50.3 9480 (71/20) 128k
IDAmpi
7-13/8
Cefo
8-13/8
Tazo
14-17/8
8/8
H/C NG
TSG no
TSC NG
PlanScreening 11/8
FISH for digorge 14/8 _
Vac, ABR
มีนัด US KUB?
BUN Cr elyte CBC tmr
ฝากเวร⭕️IO clinical (L4)
⭕️Ob feed
3 yr 10.5 kg
5888266
Admit 10/8
Dx#PA/IVS, PDA, nonrestrictive flap PFO, RVDCC (SV)
S/P PDA stent 7/66, 9/66
balloon RPA and PDA stent 4/67
Last cath 5/69: mild LPA stenosis functioning PDA stent
S/P RMBTs 11/8
RSO2 1 LPM
>> now RA 14/8
Keep SpO2 >85
Off ICD 14/8
CXR16/8 congest
CXR18/8 congest
CVS- lasix 10
18/8
Med
- L, A2 adj
13/8
- ASA 4 (restart 12/8)
- Ferdek hold
- MTV hold
FENGIRegular diet
5%DN/2 rate 30
(80M)
12/8 141/4.1/108/17
13/8 hs 81.6
15/8 139/3.4/97/24
Hemato12/8
16/50.4 12k 73/23 172k
IDCef, clox
11-13/8
Tazo
13-15/8
13/8
H/C NG
PlanCar 30/9
Eye 3/11
Nutri 16/11
ENT 21/4/70
Tmr ; cxr,lab cbc,bun,cr,elyte
9yr , 12.1 kg
8783864
Admit 19/8
G&D
Dx#DORV ,subaortic VSD with infundibular PS s/p LMBTS
Plan CT cardiac under GA
# delayed development
CVSMed
- A ½-0-1/4 (1.6)
- L 1/4x2 (1.7)
- ASA 1/2x1 (3.4)
- Eu 5ml
17 yr , 46 kg
8843752
Admit 18/8
Dx#situs solitus ,dextrocardia ,TA,PS,Rudimentary RV,SV s/p RMBTS s/p PDA stent s/p PTA LPA
S/P balloon PDA stent , RMBTS stent 19/8
CVShep 4=10 unit
Med
L 1x1
D 1/2x1
E 1x2
ASA 2x1
Plancxr tmr
ตัดไหม 2 groin
ฝากเวร⭕️io neg
⭕️คลำ pulse
⭕️Cxr
⭕️lft uric serum iron
Tibc ferritin
11 yr
6591359
Admit 18/8
Dx#DILV ,AP relation great artery s/p Extracardiac Fontan, ligate RMBTS 9/4/68, MPA ligate 3/9/68
Plan cath for evaluate PAP, Fontan circuit 19/8
CVSMed
W(2) 1hs จ-ศ
L 1/2x1 (0.8)
A 1x1 (1)
Sidenafil1-½-½(1.7)
4mo
2993769
Admit 19/8
Dx#ASD secundum with mild PPS ,persistent LSVC
Plan CT cardiac under GA
CVSMed
- A 1/4x1 (2.3)
- L 1/4x1 (0.9)
- F, MTV
14 yr 28 kg
8026555
Admit 17/8
Dx#DORV,remote VSD ,hypoplastic aortic arch s/p VSD closure s/p arch reconstruction and subaortic ridge resection s/p redo Ross-konno
Cath for hemodynamic+CAG 18/8
CVSHep 1=10 18/8
Med
- L 1 A 0.4
- D 2.1
- E 1/2x2(0.17)
-Ivabradine 1.5-0-1
Plancardio 16/9/69
CMR adrenosine stress test 28/8
16 yr 65 kg
26245568
Admit 14/8
Dx#RVOT PVC
S/P RFA , Ajmaline test 17/8/69
CVSMed
OFFmetoprolol, OFFflecainide
PlanEKG tmrเขียนใบแล้ว
F/U 3 mo opd cardio + ekg
6 yr .. kg
6771062
Admit 17/8
Dx#d-TGA, VSD, PS, PDA
s/p BAS s/p PBPV
Plan Rastelli operation + enlarge VSD จอง decellulized no.24
CVSMed
- L 1/4x1 (1)
- A 1/4x1 (0.63)
- Ferdek1.5x2(3.8)
2 yr 12 kg
6544167
Admit 9/8
Drain
C
Dx#TOF c forward flow in PA, DA with PAC, Rt side arch
S/P
total correction
(ASD, VSD closure, infundibulec., commisurotomy c MPA plasty 10/8
#JET
#AUR 15/8
RSOff ETT 10/8
RA 13/8
CXR 16/8
CVSDopa max 6
Now 0.3=3
15/8
Lasix 6 (14/8)
NE max 0.02
10/8
Med
- L1.7, A1.6, D8.3
FENGIReg diet
Restict <900/day (80M)
Mg
d3
13/8
18/0.25 135/3.9/95/17 9.8/3.8/0.81 33/20/132 0.53/0.23
14/8
137/4.1/96/25
Hemato13/8
14.1/42.4 15460 N61 L34 Plt 191k
IDCef3
d5 16 12 น.
Cloxa
d5 17 6 น.
10/8
Neurofen prn q 8
Para oral prn q 6
ฝากเวร⭕️
IO ba + insen 150 ml/day (L6)
⭕️
ย้ายสก.17A + ตามแลป cbc bun cr elyte mg cxr อังคาร
3 yr 15 kg
Dx#Recurrent VF arrest 3 times
> CPVT !!!!
#Bidirectional VT
CVSEsmolol 16-20/7 max 100 mcg/kg/min
Lidocaine 16-20/7
max 50 mcg/kg/min
Baseline HR 60-70
Med
Propanolol 3
(2-2-0.5)
Flecainide 87
HematoHb 10 Hct 31 Plt 140,000
IDTazo+Mero toal 7 days
// Free ATB
NeuroMO off24/7
Clinidine
off 24/7
Planคุย family consuling จันทร์
Ekg คุณกุ้งจันทร์
ฝากเวร⭕️Observe VT >> Lidocaine 1 mgkdose then 10 mcg/kg/min
⭕️If HR<50, evaluate HD
Bed 6: 67664/61
7 ปี, BW 16 kg
Chest, nutri, ID
PICC
Dx#
biventricular HF,
LVEF 20% จาก AVV regur and shunt overflow
# Situs solitus, dextrocardia,
DORV
, VSD,
PA,
PDA, AV discordance s/p PTA, LPA, PDA stent, RMBTS
Cath 14/5 :
post cardiac arrest 30 sec at 10.15 น (intraop cath) S/P cpr 2min and adrenaline 1mg iv 10.17 - SVT with abberancy 30 sec then PEA —> ROSC 10.17
CVSMilrinone 1.8=0.3
>> off 27/7/69
Ivabradine 0.1 mkdose q 12 hr
Aldactone ½ x2
Enalapril (5) ½ *1
Lasix ½ -0-¼
ASA 5.4
FENGIRegular diet
+ BD สูตร nutrition
Plan🩵Con dental if off milinone
🩵Heart transplant
Repeat echo wk หน้า
2810969
10 yr 47 kg
Admit 3/8
Dx#SVT
- Dx 4/69: Adenosine *3, sync *2, cordarone*1 then dc c digoxin
S/P RFA 3/8/69
CVSMed
-
Atenolol (25) 1*1 (plan inc 1.5*1)
hold 28/7
- ASA start 4/8
PlanF/U
-
Car 7/10
- ระยอง 1 M
ASA 2 M
EKG คุณกุ้ง TMR
5 yr 15.5 kg
4848365
Admit 4/8
Dx#Marfan
#MV prolapse c mod to severe MR
#Ao root dilat, PVC
MRI heart 5/8
CVSMed
E ½ x1 (0.15)
L 1/2x1 (1.2)
Plan4/9 ฟัน, car
4/12 gene
22/12
5 yr 12 kg
9363063
Admit 4/8
Dx#PA/VSD, MAPCA
S/P RMBT 3/64, LMBT 7/66, stent MBT, PTA at LPA 5/68
CT cardiac, coro 5/8
8896467
14 yr 39 kg
Admit 3/8
Dx#Severe TS, PS, RV hypoplasia (SV, LV morpho)
S/P RMBTs 1/55, Glenn 2/56, Fontan 7/62 (failed,
PHT
, plan heart transplant)
S/P cath for
RPA stent 4/8
#Protein loosing enteropathy
#Hepatic congestion
CVSHeparin 4=10
Med
Lasix, Aldact, digox, silde, ena, carvediolol, bosen
Vitd, mtv, ote, ff, an
Restart WFR
PlanEcho
Off stitch
PT, INR next 2 d + 2 wk
HF 9/9
GI 8/10
Nutri 2/11
12 yr 56 kg
2666962
Admit 3/8
Dx#PA/VSD, MAPCA
S/P RMBTs 9/56, LMBTs 3/61, stent RMBTs/LMBTs 10/62, aortic valve repair +
Rastelli
+ LPA, RPA plasty, ligate MBTs 10/68
S/P cath for balloon RPA 4/8
CVSHeparin 4=10 24 hr
Med
- L 1x1
- E 1x1 (0.1)
- Digoxin
PlanEcho
Off stitch
CVT 11/5/70
Term 37+5 wk
1M 3 kg
PedSx
Dx#PA/VSD
S/P PDA stent 14/7
#Fever suspected Viral
#Scalp wound with subgaleal collection
#Prerenal AKI
#Umbilical hernia
RSoff ETT 17/7
RA
Keep SpO2 >80
CVSMed
Lasix 3>1.4
(adj 4/8)
Aldac 3>1.4
Lanox 6.67
ASA 4
FENGIBM 50x8 = TV 138
adlibs
28/7 ดูดนมไม่ดี
AC 32.5 cm, active BS
>> on OG feed
2/8 กินดี off OG
HematoHb 10.3 Hct 32.3%
(28/7)
🩸LDPRC
(29/7)
ID20/7 Fever 38.1 H/C GPB >> NG
off Cline 21/7
25/7 fever 38 >> septic wu lab ดี
26/7 Tazocin
27/7 fever 37.9 ,H/C NG
Now Tazocin day 7/7 ( 26/7-2/8)
>> off 2/8
DC TMR
6/8 US brain+abd wall ศัล
1 ปี 1 เดือน
BW 11.7 kg
Admit 4/8
Dx#
PA/IVS ,small tripartite RV RV s/p PBPV s/p PDA stent
Cath for PBPV 5/8
CVSHep 1=10 24 hr
Med
HCTZ 1 start 5/8
Asa 3.7
Aldactone 0.9
Lasix 1.8
Lanoxin 5.7
MTV
Ferdex 2.2
9 yr 5 mo
30067260
Admit 4/8
Dx#Closed ASD secundum, Mild valvular PS, PAPVR (LUPV to vertical V)
Cath for hemodynamic 5/8
1 yr 9.5 kg
9894167
Admit 5/8
Dx#TOF, LPA ste S/P balloon LPA 9/68
CT car, coro 6/8
3 Mo 4.4 kg
Admit 5/8
Dx#R/O PAPVR c Scimitar syndrome
Echo 4/69: small PDA, VSD, flap PFO
CT car 4/69: dextrocar, Rt lung hypoplasia
CT car, coro 6/8
#Cholestasis
#Sym SGA
#Hemolytic anemia Last blood transfusion 17/7
- Gene มี plan ES
CVSMed
- vit D, E, K
- Ursolin
- Ferdek
PlanGI 8/10
Gene 26/11
ENT 3/9/70
ค้าง hema
5 yr 15.5 kg
4671369
Admit 3/8
Dx#PDA, ASD
S/P cath for device closure
4/8
14 yr 55 kg
9578054
Admit 5/8
Dx#CA, SV, unba AVCD, CoA
S/P coarctec, PDA ligat, PA band 11/54, Fontan 12/63 c residual mod AVVR, mild AS
Cath hemo., NSS loading test 6/8
#Bradycardia, PVC
#Asplenia
#Epilepsy
CVSkeep HR>50
Hep 4=10 24 hr
Med
- Keppra
- dilantin
- L 0.7, A 0.5
- ASA 3
(Restart 7/8)
- Start E
FENGIMg
d2
5/8
142/3.7🔺/108/22
8.7🔺/0.84🔺
PlanUS upper ab 9/11
Car 6 mo + lab
ฝากเวร⭕️คลำ pulse ขาขวา
⭕️ob HR, arrhythmia
1 yr 1 mo
BW 5.7 kg
Dx#Perimembranous VSD
S/P VSD closure 27/7
CVSMed
Furosemide 1.7
Spironolactone 1.7
Digoxin 8.7
IDCeftriaxone + Cloxa post-op 5 days off
27/7-1/8
PlanD/C TMR
Car 2 wk
Lab
TMR + CXR อาจลด diure
EKG TMR + scan EMR
10 yr 39 kg
Refer 7/8
Dx#Truncus arteriosus
S/P Rastelli
C residual AVR, mod PS, PR
#URI, AGE DOI8
#Compensated hypovolumic shock
CVSMilrinone 4=0.34
Med
ASA
D
Hold L 0.5, E 0.1
FENGIReg diet
5DN/2 IV keep total rate 30 (38MT)
off IV
Restrict vol 1.2L/day(65MT)
Mg
d3
7/8
15/0.45 135/4.7/102/17
9.1/0.76🔺/4.6
Alb 4.1 29/15/250 0.96/0.6
UA blood?
Hemato7/8
16.1/48.1
12230 (67/25.3) 259k
IDCef3
d3
7/8
7/8
Stool C/S _
My IgM, G _
H/C _
ฝากเวร⭕️IO cli (L15)
⭕️Ob HR
DOL15 BW 2.7 kg
Dx#Coarctation of aorta c PDA (nonductal dependent)
#Neonatal jx s/p photo
W/U G6PD WNL, B+ (แม่ AB)
RSRA 28/7
Keep Preductal SpO2>95%
CVSPGE1
off 31/7/69
Para 4-8/8
Monitor BP pre/post duct q 8
FENGITV 158
-BM/IF (20 kcal/oz) 50x8 (TV148) adlibs
Hemato27/7
Hb 13.3 Hct 40.2 Plt 188,000
30/7/
Hct 54
MB 13.6
On photo
1/8/ hct 46 mb 10.4 delta 8
3/8/ hct 43.4
Mb 12.8
(Delta 5.4)
DOL22 3.2 kg
Term 38 wk
Endo
C-line
Dx#Severe PS with small pda
PDA 1.6 mm (31/7/69)
S/P cath for PBPV 6/8
#Fever
unknown
source
DDx
PGE1
#Bifid scrotum suspected undervirillized male
RSETT 6-7/8
RA 7/8
Keep sat >=80%
FENGIFBM/IF(24) 50x8 + adlib
TV 133 TC 106
31/7 BUN 6 Cr 0.4
140/4.3/102/26
Hs <0.15 PCT 0.07
HematoHb 13.6 Hct 41 WBC 11810 N 39 L 49 Plt 475k (31/7)
🩸LDPRC
(31/7)
ID31/7 fever 38.3
H/C NG
Tazocin d6
(31/7-5/8)
Tazo
6-9/8
Free ATB
PlanNext lab
chromosome
(
OPD
)
F/U endo 1 mo + chro, T DHT androstene ช่วง minipuberty
Vac, ABR
ฝากเวร⭕️I/O clinical (L3)
3 yr 13 kg
3194266
Admit 10/8
Dx#PA/IVS, rudiment RV, PDA, TVD, ASD S/P
PBPV, PBTV 4/66
PDA stent 6/66
PTA PDA stent c PTA PV c PTA atrial septum 11/66
PTA Rt FA, BAS 12/66
Echo 5/69: small TV inflow, mild TRm functioning PDA stent, ASD Rt to Lt
CXR dec PBF
Cath
for HD 11/8
#Hx ALI from FA occlusion
CVSHep 1=10
Med
- L, A, D
Hold ASA
Plan28/1/70 hem
F/U 2 wk car (28/10)
Admit 13/10
MRI car 14/10
2M 3.3 kg
4714469
Admit 12/8
Dx#PA/VSD, subaortic DORV, ASD sec c PDA
S/P PDA stent, ASD stent 6/69
Plan CT car 13/8
#Hx of Lt ax inj c ALI
#Hyponat
11M 8.5 kg
6719169
Admit 10/8
Dx#Severe valvular PS
คลอด รพ ตำรวจ พบ murmur
Echo 6/8/69: severe valv PS, PG 90-100
Cath
for PBPV 11/8
2 yr 13 kg
9525566
Admit 10/8
Dx#PA, VSD
S/P PDA stent 10/66, RMBTs 1/68
CXR inc PBF Rt lung
Cath
evaluate LPA +
balloon LPA
11/8
#Erb’s palsy Lt arm
#Snoring - ATH
CVSHep 1=10
Med
- L, A 1.2
-
D 6
, off 11/8
- Ferdek, avamys
Hold ASA
Plan10/8 rehab**
21/9 chest
Car 6 mo
Off stitch, echo, CXR, EKG TMR
10 yr 69 kg
IBW 39,
ABW 49
7195758
Admit 6/8
C-line 7/8
A-line 7/8
Dx#Small perimem VSD, RCC prolapsed c subaortic ridge c ob
>> no LVOT
S/P
VSD closure
(minimal invasive)
7/8
**Obesity (1st dx)
RSHF 40, 0.3
RA 11/8
Keep sat >=95
CXR 14/8
CVS-
Dobu 3=5
10-11/8
-
Lasix 40 mg q 12 hr (0.8 mg/kg of ABW) 10/20
-
nicardipine 0.24
off 8/8
Med
- lasix 1
- aldactone 1
- digoxin 3
FENGI- regular diet
-
Restrict fluid 1.5L/day (74%Mt)
10/8
14/0.58 136/3.7/94/28
11/8
14/0.44/136/3.6/94/25
hs 66.1 PCT 0.15
12/8
hs 35.6 Ca 9.6 Mg 0.85
16/0.5 135/3.7/95/26
Hemato11/8
11.4/35.1 15540 (83/9.7)336k
12/8
12/36.8
16530 (80/11) 448k
IDcefazolin 1 gm q 6 (7-12/8)
Tazo d3/3 13-15/8
12/8
Tip C NG
H/C NG
ฝากเวร⭕️IO clini (L40)
⭕️d/c 14.00 if no fever
Term 38+5
, 3.32
DOL14 BW 3.2
6508769
Refer 4/8
คลอด 3/8
ID
UVC 3/8
Dx#TOF c severe PS (infun, valv)
C PDA, MAPCA c hypoxic spell
S/P PBPV 4/8
#HBsAg pos - false pos from vac
#Simple hyperglycemia (stress)
RSOff ETT 5/8
RA 6/8
Keep SpO2 >85
CXR 8/8 good
CXR 19/8_
5/8 VBG 7.298/39.6/19.6/-7
CVSPGE1 2=0.04
off 4/8
Levophed 2=0.1
Off 6/8
Keep MAP >40
FENGIBM/IF20 60x8 (TV150) + ad lips
AC BL 33 cm
4/8 11/0.75 137/4.1/104/20
8/5.3/0.72 alb 3.5 90/9/126 2.83/0.62 hs 0.3
7/8
8/0.8 144/3.2🔺/111/19
10/8
6/0.57 139/4.1/107/19
Hemato4/8 Hb 14.1/41.6 🩸29120 (79/8) 324k
5/8 15.7/45.2 34150 (85/5) 263k
7/8
14.8/42.9 15750
(59/20) 210k
Hct 43 MB 9.2 (ก16.4)
Keep hct40
IDAmpi 4/8
Cefo 4/8
Tazo 4-11/8
Free ATB
4/8
H/C NG, NG
6/8
UC NG
Planscreening 7/8
BCG 19/8
ABR
ฝากเวร⭕️IO cli (L3)
⭕️ob feed
2 yr 12 kg
6811369
Admit 16/8
ทันตกรรม
Dx#TOF
S/P RMBTs 17/8
On rt ICD 17-19/8
#multiple dental caries
RSHFNC 12 L,fio2 0.5>0.21>0.3 17/8-19/8
RA
CXR21/8 rt pleural eff ลดลง
CVSHep 1 (10) 17/8
L 10 19/8
Med
Off propra
- L2 A2 D10(18/8)
- ASA 1/2x1(18/8)
- MTV, Ferdek
FENGIregular diet
restrict fluid < 900/day
5%DN/2 IV 40 (85M)
16/8
13/0.38 137/4.3/101/22
Hemato16/8
26/79
5380(35/54)
140k
Planทำฟัน
CBC, Elyte, BUN, Cr tmr
ฝากเวร⭕️I/O clinical (L10)
4 mo, 3.9 kg
6489169
Refer 12/8
PT35+3
Dx#Perimembranous VSD 6.7 mm
#PDA 4.3 mm
S/P
PDA device closure
6/8 mm
14/8
#AFI 14/8
RSHF 4 LPM, FiO2 0.21
on RA 17/8
12/8
7.401/35/21.9/-3.1 lac 2
CXR18/8 congest
CVSDopa 0ff 15/8
Hep 1.5=15.4 off บ่าย
Lasix 4 (1) 17/8
Med
Furosemide 3
Spironolactone 2
Digoxin 10
- NaCl, FF
FENGIInfatrini (30/oz) 60 ml x 8 feeds (TF 123, TC 123) +adlibs
12/8
26/0.31 138/4.5/102/22
10.4/6/0.95 Alb 4.8 63/64/331 0.44/0.26
Hemato12/8
10/31.6 10610 (30/61) 518k
11.9/1.07/26
14/8 🩸
16/8
9.5/30.3
17630 (39/55)248k
IDCefazolin14-18
16/8
H/C NG
CRP17 PCT0.15
NeuroChloral prn
Para prn
Fentanyl 4 mcg iv q6
Plan⭕️OFF เส้น
D/C ส-อา
F/U 2wk+CXR
CBC, Elyte, BUN, Cr tmr