🏥 IPCCU Handover

# AVCD
(unbalance= Single ventricle)
with PDA
S/P bilateral PA banding (inadequate) with PDA ligation
(3/1/68)
S/P
AVV valve repeir, LPA debanding, MPA banding
(12/5/69)
#AKI
prerenal
#Postop: JET, HyperNa, HypoK
# Lung with difficult intubation with airway edema

NIV IP10 PEEP5 RR30 F0.21>0.3
(Keep SpO2 >
80%) (12/7)
off ETT 22/5 (เดิม 3.5/11 Microcuff 0.6=2)

Furo 12 mg IV q 12 hr (10/22)
Med
Lasix 2.5
Aldactone 1.5
HCTZ 1.5
Enalapril 0.15

LF (44/oz) 120 ml*6 feed (TV80, TC114)
-onsia 1mg iv prn q 8
Med
Vitakiddy 5 ml
OTE
Losec

Free ATB

Chloral prn

Before DC
Ear, Vaccine
MUAC q 2 wk
Plan CVT banding

⭕️I/O clinical (L10=1.2)

#PA/VSD
PDA 3.8 mm (29/7/69)
#Birth asphyxia s/p cooling 2-4/7
#Anemia from abruptio placenta
Picc 15/7

HHHFNC 4
Fi 0.21-0.25
Keep SpO2 80-90%

PGE rate
1.8 = 0.018
Furo 2 mg IV (1 mg/kg/dose)

LF/BM (24kcal/oz)สลับ Infantini (30kcal/oz)
35x8
TVรวม 160
แหวะนม
10 ml
AC 32 cm

Hct 43%
(23/7)
🩸LDPRC
(24/7)

ไข้ 37.8
>> Septic w/u: H/C NG, U/C NG
Tazocin d 5
(Start 26/7)

Chloral 0.5 ml prn q 6

⭕️I/O clinical
⭕️Lab septic w/u
(CBC,BUN,Cr,Elyte,hs CRP,H/C)
⭕️Film Chest +Abd
⭕️Observe แหวะนม abdominal signs

#Severe PS with small pda
#Fever unknown source DDx from PGE1

RA Keep SpO2 >=80%

PGE1 1 = 0.002 >> 0.5 = 0.001

BM/IF(20) 50x8 + adlib
TV 133

free atb
27/7 fever 37.8 no OSS

Chloral 1 ml prn q 6

ส่ง LH FSH chromosome หลังผ่าน mini puberty

⭕️I/O Cli (L=1)
⭕️Keep BT<38.5

#Perimembranous VSD
S/P VSD closure 27/7 POD2

HFNC flow 10, FiO2 0.3
Keep SpO2 >95

Adre 0.4= 0.05
Dobu 1 = 3
Furosemide 5 mg IV q 8 hr (14,22,6)
Med
Furosemide 1.7
Spironolactone 1.7
Digoxin 8.7

LF 30 ml q 4 hr
5%DN/5 rate 9
TV75

Ceftriaxone + Cloxa post-op 5 days
start 27/7

Fentanyl prn

⭕️I/O negative (L5)

#Coarctation of aorta

O2 box 10 >> wean RA 28/7
Keep Preductal SpO2>95%

PGE1 1 = 0.01 (TV 9)

TV 88
-BM/IF (20 kcal/oz) 10>>25x8 (TV74)
-0.45%NaCl 50 ml + heparin via UAC rate 0.5 (TV 4.5)

Hb 13.3 Hct 40.2 Plt 188,000
Hct,MB

FA

⭕️I/O clinical
⭕️Observe signs low flow
⭕️Obs diff SpO2/BP

#Recurrent VF arrest 3 times
> CPVT !!!!
#Bidirectional VT

off ETT 20/7/69
on RA

Esmolol 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

Regular diet

Hb 10 Hct 31 Plt 140,000

Tazo+Mero toal 7 days
// Free ATB

MO off24/7
Clinidine
off 24/7

🧪

⭕️Observe VT >> Lidocaine 1 mkdose then 10 mcg/kg/min
⭕️If HR<50, evaluate HD

#PA/VSD
S/P PDA stent 14/7
#Fever suspected Viral
#Scalp wound with subgaleal collection
#Pulmonary congestion
#Prerenal AKI

off ETT 17/7
RA d 5
Keep SpO2 >80

Med
Lasix 3
Aldac 3
Lanox 6.67
ASA 4

BM 50x8 = TV 138
28/7 ดูดนมไม่ดี
AC 32.5 cm, active BS
>> on OG feed

Hb 10.3 Hct 32.3%
(28/7)
🩸LDPRC
(29/7)

20/7 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 4

⭕️I/O Clinical
⭕️Obs Fever s/s

#DCM with MR CHF ขาดยา
EF 23
#RAD on flixotide
#RSV pneumonia (23/7/69)

RA ตั้งแต่ 27/7/69
Salbutamol 1nb prn q 8 hr

Milrinone off 21/7
Med
Lasix 2
Aldac 2
Lanox 6 - hold
Enalapril 0.1
Carve 0.2

soft diet

off warfarin

Tazo start 21-24/7
Free atb

⭕️I/O cli (L10)

#TOF s/p total correction 18/5/69
#Chylothorax
PICC 3/7

RA
Keep >= 95
on Rt ICD 2bottle
(baseline ประมาณ 50-100 mL/day)

Off fat 20/7
กินน้ำมันถั่วเหลือง
Off Octreotide 15/7

22q11 neg
-USG KUB 4/8
-CXR 31/7

⭕️I/O clinical (L10)
⭕️Obs RS

#
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

RA keep SPO2≥75

Milrinone 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

Regular diet
+ BD สูตร nutrition

🩵Con dental if off milinone
🩵Heart transplant

⭕️I/O Clinical
⭕️Obs NV signs low flow

#dTGA with VSD with ASD with PDA
S/P arterial switch operation with ASD, VSD closure with PDA ligation 10/6
#LPA stenosis (1.5 mm)
S/P balloon 14/7/69
#R/O LONS 29/6/69 (PBS Hemolysis + fever)

RA
keep SpO2 > 95%

Med
Lanoxin (10)
FF (5) ½ tab
Ferdek 4 MKD
Hold
Lasix 1
Aldactone 0.5 (restart 24/6)

Infatrini (30) 45 ml x 8 feeds (TV130 TC 130)

🩸LPRC 3/7 7/7 13/7
Intravas shearing force

H/C NG
CSF C/S NG

⭕️ l/0 clinical
L3=0.9
*** DC 20/7/69

#TAPVR s/p reroute TAPVR with ASD closure

lasix
Aldactone
Med
- Sildenafil 1.67 mkday
- Lanoxin 3 mcg/kg/dose

post cath

⭕️คลำ pulse Rt.

#severe TS , severe PS
#AFI (4/7)

cannula 3 L
Keep Sp02 > 75

sildenaril
Digoxin

cefa day 1

Post cath

⭕️Obs fever + sepsis

severe TOF with ASd
S/p infundibulectomy with asd closure 30/6
#fever unknown source >improved
#lll atelectesis improved

cannula 2lpm > off RA
Keep >95

med
Lasix (40)½ x2 (0.8)
Aldac 1-0-0.5 (0.8)

regular diet
No Restrict

-

tazo 3-6/7/69
Cef3,cloxa 30/6-3/7

-

free ATB
H/c 6/7
Tip c/s 6/7

- Observe fever > CBC UA hs-CRP PCT and start tazocin

#
DORV , VSD, PA
s/p RMBTS s/p Rt. BDG,ยังมี persistent LSVC s/p Extracardiac Fontan s/p Azygous vien  occlusion
S/P take down Fontan ,VSD closure ,Rastelli ) 23/6
#Lt pneumothorax (Improved)

RA
keep SpO2 >=95
CXR 1/7 improved

Med
Lasix 1.8
Aldactone 1.7
Lanoxin 5.9

Regular

Hct 36.7 (30/6)

Tazocinครบ  d5 off

fen prn q 4 hr

⭕️ I/O clinical (Lasix 10)

DILV, large inlet VSD,PS
S/P LMBTS s/p Coil occlusion of MAPCA
Hx of Definite IE
Admit for cath evaluate before fontan 2/7/69

on RA

Med
-Lasix 0.3
-Aldactone 0.4
Hold
-ASA Warfarin

heparin 24 hr

severe PR
TOF s/p total correction
Down syndrom
Tinea capitis
Hyperthyroid
รับยาสปร

RA
Keep
spo2 >95%

Med
hctz 0.6
Lanoxin (0.25) ¼ tab
Sidenfil0.7 mkday
Mmi (5) 0.5 tab

regular diet

⭕️admit ct cardiac
⭕️order anes

Truncus arteriosus
with absent LPA with Lt MAPCA
S/P RPA banding PTFE graft 18/2/62
S/P Lt unifocalization 18/5/69
S/P Rastelli operation 22/6
Pericardial effusion 29/6

RA
Keep Spo> 95%
CXR congest Lt

No inotrope
Med
Lasix 1.8
Aldac 2.2
Lanoxin 5.6

Regular
Restrict oral 1000/d
29/6
K2.9 -> K oral x 2 doses

(29/6)
Hct 33.5

Free ATB
Ceftri +
Cloxa post 22/6-26/6

CT cardiac under GA 9/9/69
elyte 1/7/69

⭕️ I/O negative (L10=0.4)
⭕️ if fever ระวัง post pericardiotomy syndrome

#TGA with VSD with coarctation of aorta
#NEC 3B S/P Explore lap small bowel resection + Sepsis DIC 24/5/69 >> tissue c/s KP CRE
#Direct hyperbilirubinemia suspected from PNALD +/- sepsis
#Portal vein thrombosis (from U/S upper abdomen 9/6)
#A.baum CRAB,Steno tracheitis , A.baum CRAB intrabdominal infection
OG No.8 depth 17, foley No.6
C-line Rt IJV.
Double end jejunostomy Rt.

PC IP 16  PEEP 6 RR 40 Fio2 0.21
Keep preduct 80-95%
23/6
pH7.56 pCO2 30 pO2 40 HCO3 27.4 lactate 3.2

off PGE 20/6

50%glucose rate
1 (GIR 2.6)
NPO

(23/6) CBC : Hct32.4 WBC 10800 plt 4000
🩸
Plt 31/5,3/6, 6/6, 7/6,9/6, 11/6
PRC 29/5,5/6,9/6, 15/6
FFP 6/6

Meropenem 23/5-24/6
Colistin 8/6-25/6
Sulbactam 8/6-25/6
Tissue c/s (24/5): KP CRE (sense Mero)
TSG (15/6) : A.baum CRAB , steno
Penrose (15/6) : A.baum CRAB

Fentanyl 1 =1
Dom 0.5=0.05

O USG KUB นัดหลังผ่าอีกที
BP 4 ext weekly
✅IEM screening

⭕️I/O clinical  (lasix 5)
⭕️if fever ไม่ w/u ใหม่
⭕️if clinical แย่ update ผปค อีกที