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Видео добавленное пользователем “OPENPediatrics”
"Fetal Circulation" by Lisa McCabe, RN for OPENPediatrics
 
06:12
Learn about the anatomy and physiology of fetal and post-natal circulation. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 31565 OPENPediatrics
"Interpreting Central Venous Pressure Waveforms" by James DiNardo, MD, for OPENPediatrics
 
08:52
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. Interpreting Central Venous Pressure Waveforms, by Dr. James DiNardo. Hi. My name is Jim DiNardo. I'm a Professor of Anesthesia at Harvard Medical School and one of the Cardiac ICU attendings here at Children's Hospital Boston. I'm going to talk now about our central venous pressure trace and the kind of information that we can get from a central venous pressure trace, and also about how a central venous pressure trace is generated and what implications that has. So again, it's important to remember that when we're measuring a CVP, we are in fact measuring a pressure in the central circulation, so in the superior vena cava or in the right atrium, depending on where the tip of the catheter is. But in fact, what's happening is this pressure is a consequence physiologically of volume changes in the superior vena cava or the right atrium in the setting of the compliance of those two systems. What we see here when we look at a CVP trace, we see a volume moving in and out of the right atrium or the superior vena cava being represented as a pressure here. This pressure -- we're going to talk about this trace as one bead of the central venous pressure. You can see that there's a couple of waves here. So this first wave on the upstroke here is known as the A wave. And you can see that is actually occurring - we can see with the simultaneous A line trace - as a late event in diastole. So here is end diastole in the arterial blood pressure traced right before the onset of systole. And if we look up here at the EKG, that same interval corresponds with the atrial contraction of the EKG. So this is an end diastolic event. And what this represents-- this is the pressure generated in the right atrium or the superior vena cava when the atrium contracts in a late diastole. And that is the pressure that's generated. And that pressure is a consequence of the volume of blood that's moving into the atrium and the compliance of the atrium. So you can imagine a circumstance where, if you have a very compliant right atrium, even if you have a lot of volume moving in with the atrial contraction, the A wave is not going to be very big. By the same token, if I have a very non-compliant right atrium, a very young patient, and I have a lot of volume moving - and let's say they've been given a big volume infusion - and I have a very forceful atrial contraction, I'm going to see a big A wave here. The next part of this CVP waveform is a C wave. You can see with a simultaneous A line trace that the C wave of occurs during the onset of ventricular systole. And if we look up here at the EKG, that same time interval corresponds to the R wave. What the C wave represents is bowing of the tricuspid valve back into the right atrium during systole such that there is a transient decrease in the atrial compliance and an increase in atrial pressure. During tachycardia, the C wave commonly becomes merged with the A wave. And under those circumstances, it's almost impossible to differentiate the A and the C waves. This little down slope is known as the x descent. And the x descent actually represents-- we're going to be talking about systole now here. See, now we're under the systolic portion of the arterial line trace and we're into the QRS of the EKG. And it also represents a combination of factors. It represents the atrium relaxing. And as a consequence of that, the tricuspid valve apparatus is descending towards the apex of the ventricle. And that, in turn, results in the formation of this x descent. Now, the next thing we see here is the V wave. And every human being that has a CVP line in has a V wave. The V wave is a late systolic event. You can see with the simultaneous A line trace that the V wave is occurring during late systole. And again, if we look up here at the EKG, this interval corresponds to the T wave of the EKG.
Просмотров: 29024 OPENPediatrics
"Oculocephalic Reflex Testing During Brain Death Examination" by David Urion for OPENPediatrics
 
01:50
Quick Concepts are short videos that describe a key physiological or theoretical concept, or demonstrate a brief procedure. In this video, Dr. David Urion demonstrates how to test a patient's oculocephalic reflex, and how it can help contribute to a patient's brain death examination. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 8064 OPENPediatrics
"Cardiac Development' by Lisa McCabe for OPENPediatrics
 
09:42
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. Hello, my name is Lisa McCabe. I’m a clinical nurse specialist at Children’s Hospital Boston in the cardiovascular program. I will be discussing with you today Cardiac development. The information I swill share is consistent with our practice here at Children’s Hospital Boston. You may want to adapt this information to your own institutional practice. Fetal Development During the first week of fetal life, the fertilized egg develops into a blastocyte and implants in the mother’s uterus. During the second week of fetal life, the blastocyte implants deeper into the uterine wall, and a primitive placenta begins to form. During the third week of fetal life, the primitive umbilical cord develops. Also at this time, the blastocyte develops into a three-layered disk. The three layers are: the endoderm, mesoderm and ectoderm. Specific body systems will develop from each layer. The endoderm, or inner layer, gives rise to the primitive intestinal tube, mucous membranes, glands, lung buds, urinary tract, and yolk sac. The mesoderm, of middle layer, gives rise to the heart and vascular system, the dermis, subcutaneous tissue, muscles, skeleton, sex glands, lymph glands, kidneys, connective tissue, and blood cells. And finally the ectoderm, or outer layer, gives rises to the epidermis, hair, sebaceous glands, sweat glands, and nervous system. Cardiogenesis Early in the development, the primitive heart develops two tubes that merge into one tube. The single tube begins to swell, and develops into various anatomic features of the heart. The heart begins o beat by week three. In normal cardiac development, the cardiac tube will twist and turns on itself in a rightward direction. This is called dextral-looping. This results in the right ventricle developing on the right side of the heart and the left ventricle developing on the left side of the heart. Abnormal looping in a leftward direction is called leval-looping. This results in the right ventricle developing on the left side of the heart and the left ventricle developing on the right side of the heart.
Просмотров: 65222 OPENPediatrics
"Case Study: Congenital Heart Defects" by Patricia Lincoln, RN, MS, CCRN, CNS-BC, for OPENPediatrics
 
05:11
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. Question 1: James is a four week old diagnosed at birth with Tetralogy of Fallot. He was scheduled for surgery in 2 weeks, but because of hypercyanotic spells he is admitted to the intensive care unit from the emergency room. As James’ nurse, you know that Tetralogy of Fallot is a combination of which four defects? The correct answer is: Ventricular septal defect, pulmonary stenosis, overriding aorta, right ventricular hypertrophy. Question 2: The hypercyanotic spells that James is experiencing are primarily related to: The correct answer is: Pulmonary stenosis. The greater the amount of obstruction in the pulmonary outflow tract or the greater the degree of pulmonary stenosis the more cyanotic the patient will be. Because blood is unable to flow from the right side of the heart to the lungs to receive oxygenation the blood will shunt right to left across the Ventricular Septal Defect and return to body without being oxygenated. Question 3 What causes hypercyanotic spells? The correct answer is: an increased oxygen requirement together with increased resistance to pulmonary flow. Question 4: If James were to experience a hypercyanotic spell while in your care, your first intervention would be to: The correct answer is: Place James in a knee-chest position and administer oxygen. Question 5: Other clinical signs and symptoms of Tetralogy of Fallot include: The correct answer is: Chest radiograph showing decreased pulmonary markings, electrocardiogram with right ventricular hypertrophy, systolic ejection murmur. Question 6: James undergoes surgical correction of his Tetralogy of Fallot, including a ventricular septal defect closure and right ventricular outflow tract patch. Intraoperatively, a transthoracic pulmonary artery catheter is placed. Before James had his pulmonary artery line removed, right atrial and pulmonary artery saturations were measured. The right atrial saturation = 72, and the pulmonary artery saturation = 95. What might this indicate? The correct answer is: A residual ventricular septal defect.
Просмотров: 23440 OPENPediatrics
"How to Test for Newborn Hip Dysplasia" by Nina Gold for OPENPediatrics
 
01:00
Quick Concepts are short videos that describe a key physiological or theoretical concept, or demonstrate a brief procedure. In this video, the viewer will learn to assess for hip dysplasia in a newborn, using the Barlow and Ortolani maneuvers. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 8004 OPENPediatrics
"Respiratory Distress in the Newborn" by Megan Connelly for OPENPediatrics
 
09:54
In this video, the viewer will learn the differential diagnosis for newborn respiratory distress, and the epidemiology, pathophysiology, presentation, diagnosis, and management of its most common etiologies. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 19200 OPENPediatrics
"Newborn Exam" by Nina Gold for OPENPediatrics
 
16:41
In this video, the viewer will learn the key aspects of the newborn physical exam, and how to distinguish between normal and abnormal findings. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 16162 OPENPediatrics
"Accessing a Port" by Pamela Dockx for OPENPediatrics
 
06:18
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 19069 OPENPediatrics
"Neonatal Chest Tube Placement" by E. Doherty, MD and P. Fleck, PhD, NNP-BC, for OPENPediatrics
 
06:09
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. We will review indications, contraindications, equipment, procedure-- including preparation and placement, complications, assessment and monitoring, and documentation. Indications and Contraindications. Indications. Tension pneumothorax not resolved with needle thoracentesis. Pleural effusion. Hemothorax. Chylothorax. Epyema. Contraindications. There are no true contraindications to neonatal chest tube placement when indicated. Correction of preexisting severe thrombocytopenia, or coagulopathy, should occur prior to or concurrently with chest tube insertion. Equipment. Surgical chest tube, antimicrobial scrub, scalpel, sterile gauze, Kelly clamp, sutures, needle driver, suction source, chest tube collection device, male-to-male connector, shoulder roll, systemic and local pain medications, dressing materials, monitoring equipment. Pre-procedure and Positioning. Obtain parental consent if non-emergent. Ensure secure airway. Pre-medicate for pain control. Position the infant supine with the affected side elevated with shoulder roll and arm on the affected side restrained superiorly over the head.
Просмотров: 13179 OPENPediatrics
"Tetralogy of Fallot: Basic Anatomy and Pathophysiology," by Peter Lang, MD, for OPENPediatrics
 
18:30
Tetralogy of Fallot: Basic Anatomy and Pathophysiology Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. I hope to show you the approach that has worked for us. Different strategies develop in different institutions, but this will give you an idea of one set of ideas that has been effective over the years. Anatomy. Tetrology of Fallot-- what most of you will hear in text books is the four parts that make up Tetrology of Fallot, or four pieces of pathology. And the four are that there is a ventricular septal defect, that there is pulmonary stenosis, that there is an overriding aorta, and the fourth is that there is right ventricular hypertrophy. And the first thing that I want to do is show you that these four points are actually one. But let's talk a little bit about the four things that tetralogy described. He described a ventricular septal defect, which, in truth is one type of ventricular septal defect. It's an anterior malalignment type. It's a VSD that's always in the same position. That doesn't close spontaneously. There's pulmonary stenosis, which is obstruction to blood flow from the right ventricle to the pulmonary artery. It's usually under the pulmonary valve, but it's very, very variable. Overriding aorta, and this is based on the malalignment of the ventricular septal defect. The aorta overrides the ventricular septum, and then because of the obstruction for blood leaving the right ventricle and the big VSD, the right ventricle works at high pressure. So there's right ventricular hypertrophy. Point of clarification. Pulmonary stenosis in Tetrology of Fallot may involve stenosis of the pulmonary valve, but it can also potentially involve stenosis of the distal pulmonary artery. The degree of stenosis varies in patients based on their individual anatomy. Now the first thing I want to do is say that conceptually there really aren't four parts of Tetrology of Fallot, but there is one part. I learned from Richard van Praagh, who's a cardiologist and a terrific cardiac pathologist. Let me draw you a very simple heart. And this is oversimplified. We've got a right ventricle. Coming into the right ventricle is a tricuspid valve. Leaving it is a pulmonary artery which branches into a right and left side. The muscular part of the ventricular septum, the outflow portion of the ventricular septum. A left ventricle. Mitral valve coming into the left ventricle, and the aorta. So let me tell you that this portion up here of the ventricular septum we're going to call the conal septum. And the first concept I want to make is that there's really one thing that makes Tetrology of Fallot. And that is when there is a alignment between the conal septum, and the rest of the ventricular septum, everything else follows. So the conal septum, instead of coming in here we're going to get rid of it, and I'm just going to remove the pulmonary artery for a moment. And remove the lower part of the aorta for a moment, and I'm going to take the conal septum, and I'm going to bring it over here. And so it is malaligned with the rest of the ventricular septum. And this is going to be rightward, and it's going to be anterior, and it's going to be superior. And when this happens there is a ventricular septal defect. It's big, and it's not going to close spontaneously. What happens then is the pulmonary artery, and the pulmonary outflow tract, is squeezed between this conal septum and what's going to be the right ventricle free wall. And so we're going to have the VSD, which is our first part of Tetrology of Fallot. And we're going to have the subpulmonary narrowing, which is the second part of Tetrology of Fallot. And the aorta is going to override the septum because it's going to be coming over this way, and instead of being closed by a ventricular septum in the normal position, it's going to appear to override the ventricular septum.
Просмотров: 45879 OPENPediatrics
"Ventricular Septal Defects" by Dr. David Bailly for OPENPediatrics
 
12:24
Listen to Dr. David Bailly discuss the anatomy and physiology, presentation, diagnosis, and management of ventricular septal defects. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 41035 OPENPediatrics
"Insertion of a Neonatal Chest Tube" by Elizabeth Doherty & Patricia Fleck for OPENPediatrics
 
03:17
Quick Concepts are short videos that describe a key physiological or theoretical concept, or demonstrate a brief procedure. In this video, Elizabeth Doherty demonstrates how to insert a neonatal chest tube into a patient. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 2868 OPENPediatrics
"The High Frequency Oscillatory Ventilator" by John Arnold, MD for OPENPediatrics
 
06:04
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. The purpose of this video to provide general information and education about the care of a critically ill child. It is in no way a substitute for the independent decision making and judgment by a qualified health care professional. The information contained in this video should not be used to make a diagnosis or to overrule the advice of a qualified health care provider, nor should it be used to provide advice for emergency medical treatment. The High Frequency Oscillatory Ventilator, by Dr. John Arnold. Please note that, in this video, we will be following the guidelines used at Boston Children's Hospital. Some of this information may need to be modified based on the equipment, guidelines, and practices in place in your institution. I'd like to take several minutes to demystify this device. This is a high-frequency oscillatory ventilator, as you know. This is the Sensormedics 3100A. And, when initially confronted with this device in the ICU setting, many people are confused. Let me help. This is simple. This is the mean airway pressure. And you're familiar with that number from conventional ventilation. And this is the amplitude. This is the delta pressure, measured proximately in the ventilator circuit. These are really the only two numbers you need to concern yourself with. When we transition to high frequency, almost all patients are on 100% oxygen. We typically will pick a frequency based on the patient's size. In Samantha-- a 13 month old, roughly eight-kilogram child-- we're going to pick a frequency of 10 Hertz. We rarely adjust that. And virtually all of our patients are managed with an I:E ratio of 1:2, giving a percent inspiratory time of 33%. So we're going to ignore these two numbers and focus on these two. So as you know, when we transition to high frequency, we'll typically transition at a mean airway pressure five to eight sonometers higher than we were on conventional. And one typically sets up the ventilator prior to transition. Now, you can increase the mean airway pressure knob in one of two ways. You can adjust mean airway pressure by manipulating the size of the orafice on the expiratory limb, which is what I do when I manipulate this knob. So I'm increasing mean airway pressure. And I'm decreasing mean airway pressure. And the other way to manipulate mean airway pressure is to increase the flow through the circuit through that fixed orafice. And that's called the bias flow. And we can do that by manipulating this knob. All patients need to start with a bias flow of 20 liters per minute. Occasionally, when you've increased mean airway pressure maximally by closing the orifice, you will need to increase the bias flow to further increase the mean. So I'm going to now increase the bias flow from 20 to 25 to 30 liters per minute. And look what it's done to the mean airway pressure. It's increased it dramatically. Let me go back to 20, and you'll see that in reverse-- 25 and 20. So that's mean airway pressure. Now the delta pressure is displayed here. It turns out we adjust the delta pressure by turning the power knob. So you actually increase power. And that generates a higher delta pressure, which is a measured variable. And we increase power simply by turning this knob. So I'm now aiming to increase the Delta P to 60 by increasing power. The Delta P is the peak-to-trough pressure, again measured proximally in the ventilator circuit. And to increase it further to 65, we simply increase power in another increment. So, it's a very simple device. The conventional ventilator is complicated, this is not. We focus on mean airway pressure and delta pressure. I hope that was helpful. That concludes our video on the high frequency oscillatory ventilator. Thank you. Please help us improve the content by providing us with some feedback. What did or didn't you like about this video? Was the content too simple, just right, or too difficult? Was the length too short, just right, or too long?
Просмотров: 16858 OPENPediatrics
"Transducers in Invasive Pressure Monitoring" by James DiNardo, MD for OPENPediatrics
 
08:42
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. Transducers in Invasive Pressure Monitoring, by Dr. James DiNardo. Hi, my name is Jim DiNardo. I'm a Professor of Anesthesia at Harvard Medical School, and one of the cardiac ICU attendings here at Children's Hospital Boston. Today I'm going to be talking about invasive monitoring, specifically arterial pressure monitoring and central venous pressure monitoring. We're going to spend a little bit of time talking about transducers and how they work. Transducers. Transducers are a system that converts a mechanical signal, which in this case-- in the case of pressure monitoring-- both for arterial lines and central venous pressure lines, is a pulsatile signal, and it's converted through the transducer, and then through this cable converted to a digital signal pressure waveform, which is what you see on the monitor. And we're not going to spend a lot of time talking about electronically how that works, but suffice it to say that in order for a transducer to work, it has to be connected by a continuous column of fluid to the fluid in the patient's body in the system that your monitoring, ideally with no bubbles in it. Because as we'll talk about the presence of bubbles in the transducer system degrades the conversion of the pressure signal to the electronic signal that we see on the monitor by damping out the pulses in the system. So, we have this continuous volume of fluid and we have the transducer generally hooked to a flush system. In this case, this is normal saline with a little bit of Heparin added running in about three mLs an hour, which is pretty typical, And that may vary from institution to institution. And that's just the volume of fluid necessary to keep the system free of clot and to prevent any thrombus forming on the ends of the catheters, which will also degrade the quality of the system and obviously creates a potential risk to the patient.
Просмотров: 19252 OPENPediatrics
"Pericardiocentesis During Cardiopulmonary Resuscitation" by Traci Wolbrink for OPENPediatrics
 
07:26
In this video, Dr. Traci Wolbrink reviews the procedural steps to performing Pericardiocentesis as well as reviewing indications, contraindications and risk factors for patients experiencing pericardial effusion. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 15046 OPENPediatrics
"Basic Cardiac Anatomy and Physiology" by Nancy Braudis for OPENPediatrics
 
06:43
Learn about normal cardiac anatomy, basic components of an ECG, and how to interpret cardiac saturations and intra-atrial pressures. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 17775 OPENPediatrics
"Status Epilepticus Algorithm" by Sally Vitali, MD for OPENPediatrics
 
09:00
Learn an algorithm for the acute management of status epilepticus. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 10322 OPENPediatrics
"Atrial Septal Defects" by Dr. David Bailly for OPENPediatrics
 
13:35
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. My name is David Bailly. I am a fellow here at Boston Children’s Hospital in the Department of Anesthesia and Critical Care. I am also a boarded Pediatrician and a boarded Pediatric Cardiologist. And I’m going to speak with you today about atrial septal defects. Atrial septal defects are very common overall and they’re common seen with other cardiac lesions. Up to 50% of all cardiac constellations include an atrial septal defect.] We’re going to talk initially about the anatomy and the physiology of the different types of atrial septal defects, followed by the usual presentations, including some of the unusual presentations, followed by the imaging and diagnostic modalities used to help us treat and diagnose atrial septal defects, followed by initial management strategies for patients with atrial septal defects and the sequel of that lesion. Anatomy and Physiology. So we’ll start out with the anatomy and physiology. Atrial septal defects are simply and defect in the atrial septum; they can be large, they can be small, they can be single, there can be many defects anywhere within the atrial septum. The three broad categories that we typically divide them out into are secundum atrial septal defects, which account for about 70% of the defects we see, and those are actually a defect in the primum portion of the septum from an embryologic standpoint. The second most common type is primum defects, which are defects in the atrial septum that occur in the inferior level of the atrial septum. They’re often associated with AV canal defects, but they don’t always have to be. The last type are the sinus venosus atrial septal defects, and they broadly fan out into two categories: those involving the superior vena cava, which are the most common type, and those involving the inferior vena cava, which are the least common type. Those are essentially a defect in the lumen of the SVC and the lumen of a pulmonary vein, so it’s just that there a communication. The entrance to the pulmonary veins is actually normal back into the left atrium, but because there’s a communication between the wall of the pulmonary vein and the wall of the superior vena cava, a left to right shunt occurs. So the physiology of all atrial septal defects is essentially a left to right shunt at the atrial level that evokes a volume burden on the right side of the heart. And we can use box diagrams to illustrate this quite clearly. The box diagram here shows that we have the right atrium, the right ventricle, into the pulmonary arteries, the blood will return to the left side of the heart in to the left atrium, the left ventricle, and into the aorta. So if we draw blood flowing through the heart in the usual pathway, you’ll see, denoted here as simply an arrow, blood going to the RA, the RV, the PAs, and then back to the left side of the heart. This is the usual course of blood flow, as you all know. Now, if there is an atrial septal defect, once the blood returns to the left atrium, it essentially has a decision to make. Is it going to shunt to the right side of the heart or continue on to the left side of the heart? The definitive point of where the blood shunts is determined by the relative compliance of the two ventricles. Now, at birth, the right ventricle is less compliant because it has essentially been behaving as a left ventricle in utero by providing systemic circulation through the ductus arteriosus. However, after birth, the placenta is detached, the lungs are inflated, the pulmonary vascular resistance drops, and the systemic vascular resistance rises over time, as the LV supports the systemic circulation. And as we go through life and have coronary artery disease and other reasons to have hypertension, the LV becomes less compliant, the RV becomes more compliant.
Просмотров: 7691 OPENPediatrics
"Interpreting Arterial Pressure Waveforms" by Jim DiNardo, MD, FAAP for OPENPediatrics
 
10:51
Learn principles of invasive and non-invasive arterial pressure monitoring, including factors that influence the appearance of the pressure waveform in arterial circulation. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 13787 OPENPediatrics
"Medications for Rapid Sequence Induction" by Robert Pascucci, MD for OPENPediatrics
 
06:55
Learn the indications, contraindications, and specific steps in performing rapid sequence induction for emergent intubation. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 14297 OPENPediatrics
"The Iron Lung and Polio" by Mark Rockoff, MD  for OPENPediatrics
 
08:36
In this video, Dr. Rockoff talks about the history, development, and use of the iron lung in response to polio. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for physicians and nurses sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between physicians and nurses around the world caring for critically ill children in all resource settings. The content includes internationally recognized physician and nursing experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. Poliomyelitis, commonly referred to as polio, is a frightening, contagious viral disease that can have devastating effects on the central nervous system. Children are most often affected, but adults can also be vulnerable as scene when future president, Franklin Delano Roosevelt, became infected in 1921 at the age of 39. Though this illness has likely been around for millennia, it became more prevalent in the early to mid 1900s, as large epidemics occurred around the world. Ironically, these often happened in developed nations, including the United States, as improved sanitation led to reduced naturally acquired immunity. Many children who were infected developed a fever and soon were unable to move their limbs. Some had such extensive involvement of their spinal chord that they also could not breathe effectively. When this occurred, death often resulted from respiratory failure. For many, little other than comfort measures were available for treatment. However, Philip Drinker, an engineer at the Harvard School of Public Health, developed a simple, mechanical ventilator that could be used to provide effective respirations for individuals who were too weak to breathe on their own. This large device, which because of its construction became known as an iron lung, was first used to treat an eight-year-old girl with polio in 1928 at Boston Children's Hospital adjacent to the Harvard School of Public Health. Soon thereafter, iron lungs were being mass produced and used to treat polio patients around the world. In the early 1950s, during the last large polio epidemics that occurred, much of Boston Children's Hospital was devoted to treating polio victims. However, due to the pioneering research work of John Enders, a microbiologist at Boston Children's Hospital, and his colleagues at the hospital, techniques were developed to culture the polio virus in the laboratory. This enabled Dr. Salk and Sabin to develop vaccines that rapidly led to the eradication of this deadly disease. And in 1954, Drs. Enders, Weller, and Robbins received the Nobel Prize in medicine for their work. By the 1980s, iron lungs were virtually obsolete, having been replaced by much smaller and less cumbersome mechanical ventilators that are now used to treat patients with respiratory failure from other causes. In order to appreciate how an iron lung functions, the archives program at Boston Children's Hospital has restored an old lung and created this short video.
Просмотров: 113546 OPENPediatrics
"Monro-Kellie Doctrine" by Lisa DelSignore for OPENPediatrics
 
02:47
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 4493 OPENPediatrics
"Neonatal Tracheal Intubation" by Lindsay Johnston for OPENPediatrics
 
15:55
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 28574 OPENPediatrics
"Anesthesia Workstation Turnover" by McArthur Kitchen for OPENPediatrics
 
05:35
In this video, McArthur "Skip" Kitchen, Chief Anesthesia Technician at Boston Children's Hospital, will demonstrate and describe the key components of an appropriate anesthesia workstation turnover. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 7996 OPENPediatrics
"Chest Tube Placement" by Chris Weldon for OPENPediatrics
 
11:46
Learn about how to perform a chest tube placement. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 137129 OPENPediatrics
"Persistent Pulmonary Hypertension of the Newborn: Pathophysiology" by Andrea Moscatelli
 
15:13
In this video, Dr. Andrea Moscatelli discusses the pathophysiology of persistent pulmonary hypertension of the newborn, PPHN. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 2267 OPENPediatrics
"Clinical Pearls: Choosing a Urinary Catheter," by Vivian Williams for OPENPediatrics
 
03:39
Nurse Practitioner Vivian Williams explains the different types of urinary catheters and when each one should be used. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for physicians and nurses sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between physicians and nurses around the world caring for critically ill children in all resource settings. The content includes internationally recognized physician and nursing experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. Hi, my name is Vivian Williams, and I am the Inpatient Nurse Practitioner for the Department of Urology at Boston Children's Hospital. Today, we will be discussing Clinical Pearls: Choosing a Urinary Catheter. Types of Catheters. There are many types of urinary catheters to choose from. Foley catheters contain a port for drainage as well as a port used to blow up a balloon. The balloon, itself, is located on the end of the catheter. When a balloon is inflated, it will look as such. If you're going to leave the catheter in place, please choose one with a balloon as opposed to the mentor or a straight catheter which is used for single-use only. Straight catheters are catheters without balloons such as this one. These are typically used for obtaining a single urine specimen and are not left in place. Lastly, there are coude catheters. These have a very small curve on the end of the catheter, and these are use for very specific reasons such as patients with difficult anatomy. Insertion of the coude catheter should be done by a medical professional who specializes in your urology as the tip must be facing upwards. Catheter Sizing. Catheter sizes are chosen based on the age of the patient. An infant may use a 6 French Foley catheter. Toddler and preschool children will use an 8 French to 10 French size catheter. School-aged children can use anywhere from an 8 French to a 10 French catheter. Adolescents can use anywhere from a 12-14 French catheter. Adults can use anywhere from a 16-18 French catheter. Thank you for watching Clinical Pearls: Choosing a Urinary Catheter. Please help us improve the content by providing us with some feedback.
Просмотров: 19310 OPENPediatrics
"Conventional Mechanical Ventilation: Initial Settings" by Barry Grenier for OPENPediatrics
 
20:06
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. Conventional Mechanical Ventilation: Initial Settings by Barry Grenier. Hello. My name's Barry Grenier. I'm the education coordinator in the Respiratory Care Department at Boston Children's Hospital. And today, I'd like to outline a practical approach for choosing initial ventilator settings for a range of pediatric patients being ventilated with a conventional mechanical ventilator. Now, this discussion assumes that you've got a ventilator that's set up with a circuit and accessories appropriate for your patient's size, and that you put the ventilator through a pre-use check as per the manufacturer's recommendations. And we'll do an overview of a choice of mode of ventilation, choosing ventilator settings that define the mandatory breath type that you're using in that mode of ventilation, choosing the other ventilator settings applicable in that mode, and finally we'll talk a little bit about using pressure support and modes of ventilation that allow spontaneous breaths. Determining Appropriate Mode of Ventilation. Now choosing the mode of ventilation may seem daunting due to the proliferation of modes and mode names that have appeared on mechanical ventilators. But it may help to try to simplify the process a little bit by stating that all modes of ventilation can be fit into three main mode families-- Continuous Mandatory Ventilation, Intermittent Mandatory Ventilation, and Continuous Spontaneous Ventilation. And that these modes contain breaths that are either volume-controlled or pressure-controlled. With Continuous Mandatory Ventilation, all breaths are mandatory. And these would include the so-called assist-control modes that we have traditionally used. The Intermittent Mandatory Ventilation modes offer a combination of mandatory and spontaneous breaths, and Continuous Spontaneous Ventilation would include those modes of ventilation where all breaths are spontaneous. With volume-controlled breaths, the tidal volume and the flow rate are set and delivered consistently from breath to breath to breath. And to do that, the ventilator will vary the pressure as needed. With pressure-controlled breaths, the ventilator pressure is predetermined and volumes and flows are, to some degree, variable. With pressure-controlled, the target pressure can be set but sometimes-- in some of the newer modes of ventilation-- the pressure's controlled by the ventilator to achieve a target tidal volume. So in modes such as Pressure Regulated Volume Control, if you dig into what's happening with that breath, the breath is volume targeted but it is delivered as a pressure-controlled breath.
Просмотров: 7077 OPENPediatrics
"Cardiac History and Exam" by Christina Ronai for OPENPediatrics
 
13:01
In this video, Dr. Chris Ronai outlines the approach to obtaining a cardiac history and physical exam when evaluating children for possible cardiac disease. Dr. Ronai describes features including the clinical history, clinical exam and auscultation of abnormal heart sounds. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. Hi, my name is Christina Ronai. I'm one of the Cardiology Fellows at Boston Children's Hospital and I'll be talking to you today about the cardiac history and physical exam when evaluating children for possible cardiac disease. Our objectives today are to understand the clinical history relevant to heart disease in children, recognize the features of the clinical exam in heart disease, understand the basics of auscultation and characterization of cardiac murmurs, and understand the features of pathologic versus benign murmurs. Clinical History. From a history standpoint, there are three important categories: gestational and perinatal history, especially if evaluating an infant, postnatal and present history, and then family history. We're going to go through each of these. The gestational and perinatal history is really important when evaluating an infant. Specifically, you're going to want to ask about the maternal history. Were they healthy while they were pregnant? Did they receive prenatal care? And did they have regular ultrasounds during pregnancy? And if so, did those show anything of concern? When you're asking about maternal infections, you're referring mostly to the TORCH infections, but any infection is also important to note. Finally, you're going to ask if mom took any medications. Specifically, phenytoin, lithium, retinoic acid, and warfarin have all been associated with cardiac malformations. The postnatal and present history is our next category. Most importantly for infants and young children is are they growing along their growth curve? And if they're not growing along their growth curve, have they at least continued to consistently gain weight or have they been losing weight? Are they meeting their developmental milestones? Have there been any feeding problems? Is there any cyanosis? Decreased exercise tolerance. Specifically for young children, you're going to want to ask, as they run around on the playground, are they able to keep up with their peers or are they falling back? Have they ever fainted or felt as if they were about to faint? Have they ever experienced chest pain or palpitations? When you're asking about palpitations, I usually pose the question to children have they had any extra beats or skipped beats? The most important thing to remember when evaluating an infant is that feeding is really an exercise test for them. And if they are able to feed and grow, there's usually not a major cardiac issue. Family history. You're going to want to ask if anyone has ever been born with a heart problem. And that'll be your screening for family history of congenital heart disease. Has anyone passed away suddenly or from an unexplained cause? Often I will also ask about unexplained car accidents or drownings, because those can be indicative of electrical problems with the heart. Does anyone have hypertrophic or dilated cardiomyopathy? And does anyone in the family require a pacemaker or an implanted defibrillator?
Просмотров: 14151 OPENPediatrics
"Basic Airway Equipment for Intubation" by Traci Wolbrink, MD, MPH, for OPENPediatrics
 
12:56
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. Basic Airway Equipment for Intubation, by Dr. Traci Wolbrink. Health care workers in all health care settings should always adhere to the latest World Health Organization guidelines on hand hygiene and barrier precautions before and after contact with a patient, bodily fluids, or patient surroundings. For more information, please watch our video entitled "Hand Hygiene." Hi, my name is Traci Wolbrink, and I'm a pediatric intensivist at Children's Hospital Boston. In this video, I'll be talking to you about the equipment and supplies that you'll need to get yourself ready to intubate a patient. Oxygen and Suction. So the first thing you'll want to make sure is that you have an oxygen source and a bag for your patient. So here, I have a self-inflating or self-refilling, or Ambu bag, whatever you want to call it. And it's connected to my oxygen source which I'll turn on here. You also want to make sure that you have suction available and that you've turned it on. And you check to make sure that it's working. And I'll leave both of these near the top of my bed so that when we get ready to perform laryngoscopy, those are readily available. The next thing you want to make sure is that you have a mask that's an appropriate size for your patient. So you'll want to choose a mask that will cover around the nose and mouth, which is not too big-- in which you have a lot of leaking, either from around your eyes or your chin. Or that's too small-- in that it doesn't adequately cover your nose and mouth. So for this patient, this size mask is probably appropriate. You can see it covers the entire nose and mouth of the patient without going much beyond the chin or the eyes. If I were to get a mask that was too large for the patient, you would see that I'd have a difficult time creating a seal because if I make sure that it fits on the chin. There's going to be a lot of leaking near the eyes and vice versa. If I make it so that it fits near the eyes, there's a lot of leaking here around the chin. It's always better to go with a smaller mask rather than a larger mask. And with this very small mask, you can see, even though it's a bit on the small side, it still mostly covers the mouth and the nose. So if you have the choice, always go smaller rather than bigger. But this mask would be appropriate for this patient here, and I'm going to connect it to my bag.
Просмотров: 10543 OPENPediatrics
"Arterial Line Placement" by James DiNardo, MD, FAAP for OPENPediatrics
 
21:29
Learn about placing arterial pressure monitoring catheters, including indications, contraindications, equipment, and procedural techniques. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. Hi, my name is Jim DiNardo. I am an associate professor of anesthesia at Harvard Medical School and I’m one of the cardiac anesthesiologists and cardiac ICU attendings here at Children's Hospital Boston. We are going to be talking about arterial pressure monitoring today, specifically placement of arterial pressure monitoring catheters. Indications: The indications for placing an arterial line include patients who require continuous blood pressure monitoring, such as those who: are hemodynamically unstable, require vasoactive agents or active volume resuscitation, or in whom non-invasive blood pressure monitoring is unreliable or unobtainable. Patients who require significant respiratory support and need frequent lab sampling, including regular arterial blood gases. But these indications must be weighed against the potential risks: infection, trauma to the artery, potential thrombosis, hematoma. Contraindications: Some healthcare providers would refrain from performing this procedure in patients with: infection at the insertion site, traumatic injury proximal to the insertion site, inadequate collateral circulation of the extremity indicated by a failed Allen’s test. Complications: The complications that you may observe include: infection, trauma to the artery, thrombosis. Equipment: You will need the following equipment to perform the procedure: arm board, tape, chlorhexadine prep solution, arterial catheter, guidewire (we must make sure that the guidewire fits through the catheter), T-connector, sterile occlusive dressing, sterile gloves, sterile towels, transducer system, saline flush.
Просмотров: 55988 OPENPediatrics
"Intraventricular Hemorrhage" by Anne Hansen, MD, MPH for OPENPediatrics
 
20:34
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. Intraventricular Hemorrhage, by Dr. Anne Hansen. My name is Anne Hansen, and I'm going to talk to you today about the most common neurologic complication of prematurity-- namely, interventricular hemorrhage. I'm going to use the abbreviation IVH. You may be asking yourself, why do I need to know much about IVH when, compared to other conditions in newborn medicine, there's relatively little that we can do to either prevent it or to treat it? One thought that might influence how much you want to know about IVH is that of answering parents' questions about their preterm baby. During this lesson, we are going to discuss the incidence, risk factors, management, diagnosis, neuropathic consequences, and outcome of patients who develop an intraventricular hemorrhage. Incidence of IVH First, let's talk about incidence. Germinal matrix and intraventricular hemorrhage is the most common neurologic complication of prematurity. It occurs in somewhere between 10% and 25% of preterm infants. If you spend time working in a neonatal intensive care unit, it won't be long before you take care of a baby with a germinal matrix intraventricular hemorrhage. The germinal matrix is a neuronal and glial cell precursor site that's located in the subependymal, subventricular region. It's extremely vascular and friable, and it's the most common site of intracranial hemorrhages in the preterm infant. Bleeding within the germinal matrix is called a germinal matrix or a subependymal hemorrhage. The blood in the germinal matrix can extend into the lateral ventricles, causing an intraventricular hemorrhage. The germinal matrix is a fetal structure that spontaneously involutes, starting at about 24 weeks gestation. It's pretty much gone by about 34 weeks gestation. Term babies don't have a germinal matrix. That's why germinal matrix and intraventricular hemorrhages are almost exclusively a complication of preterm infants.
Просмотров: 16740 OPENPediatrics
"Complications of Peritoneal Dialysis" by Sharon Su for OPENPediatrics
 
09:23
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 16718 OPENPediatrics
"Sedatives and Analgesics for Intubation" by Robert Pascucci, MD for OPENPediatrics
 
18:56
Learn about medication options for providing sedation and analgesia before endotracheal intubation. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 4000 OPENPediatrics
"Tracheostomy Primer" by Steven D. Rosenblatt and Nikolaus E. Wolter for OPENPediatrics
 
08:23
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 12818 OPENPediatrics
"Cardiovascular Assessment" by Brienne Johnson, RN, BSN, CPON, CCRN
 
18:43
Learn to assess a pediatric patient’s cardiovascular status and perform a detailed physical exam with a focus on cardiovascular status. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 8379 OPENPediatrics
"Tetralogy of Fallot: Management Strategies," by Peter Lang, MD, for OPENPediatrics
 
22:53
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. I'm Peter Lang. I'm a cardiologist at the Children's Hospital in Boston, and we're talking about Tetralogy of Fallot. What we're going to do now is speak about what I'm going to call a garden variety Tetralogy of Fallot. That is, we're in the midst of discussing different management strategies, and they depend a bit upon how kids present and what their individual anatomy and physiology is. And we're going to take a couple of examples. Review of Basic Anatomy and Physiology. And what we're going to do right now is talk about a child with Tetralogy of Fallot who I'm going to say is plain old Tetralogy of Fallot, no bells and whistles. And as we have learned over the years, Tetralogy of Fallot does have Fallot's Four Components. A ventricular septal defect. Pulmonary stenosis. In this drawing, sub-pulmonary stenosis. An overriding aorta, so it's a bit over the ventricular septum. And right ventricular-- increased right ventricular muscle mass, or right ventricular hypertrophy, because the pressure in the right ventricle is high. There's transmission of high pressure from the left ventricle, and there is the outflow tract obstruction. We know that, really, this is all because there is a malalignment of the conal septum with the ventricular septum, which creates the VSD, crowds the right ventricular outflow tract between the conal septum and the free wall of the right ventricle, leading to the overriding of the aorta. And as a consequence of that, there is right ventricular muscle hypertrophy. In what I'm going to call the usual or more typical form of Tetralogy of Fallot, we've got our ventricular septal defect and have a modest amount of right ventricular outflow tract obstruction. In this situation, systemic venous return comes to the right atrium, goes across the tricuspid valve to the right ventricle. And the way I've drawn it, a fair amount of it, if not all, can go out to the pulmonary artery while pulmonary venous return from the lungs and the left atrium goes across the mitral valve and then out the aorta. And this would be a balanced circulation. The blood in the aorta is fully saturated. There's no admixture of systemic venous blood. Nor is there a lot of, or any-- the way I've drawn it, so far-- of blood going from the left ventricle to the pulmonary artery. So normal pulmonary blood flow, normal systemic blood flow.
Просмотров: 16889 OPENPediatrics
"Status Epilepticus on the Pediatric Ward" by Nadeen Abujaber for OPENPediatrics
 
10:40
Learn to recognize and manage status epilepticus on the pediatric ward. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 2072 OPENPediatrics
"Basic Pediatric Airway Anatomy" by Steven Rosenblatt and Nikolaus Wolter for OPENPediatrics
 
02:04
Quick Concepts are short videos that describe a key physiological or theoretical concept, or demonstrate a brief procedure. In this video, Dr. Steven Rosenblatt discusses basic pediatric airway anatomy. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 1235 OPENPediatrics
"Oculovestibular Reflex Testing During Brain Death Examination" by David Urion for OPENPediatrics
 
05:30
Quick Concepts are short videos that describe a key physiological or theoretical concept, or demonstrate a brief procedure. In this video, Dr. David Urion demonstrates how to test a patient's oculovestibular reflex, and how it can help to determine whether your patient is in a coma. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 3535 OPENPediatrics
"Respiratory Assessment" by Brienne Leary for OPENPediatrics
 
28:22
In this video, Brienne Leary, RN, demonstrates how to perform a pediatric respiratory exam, reviews respiratory considerations for the intubated patient, and explains how to monitor a patient's respiratory status. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 33568 OPENPediatrics
"Periventricular Leukomalacia" by Anne Hansen, MD, MPH for OPENPediatrics
 
08:49
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. Periventricular Leukomalacia, by Dr. Anne Hansen. Hello. My name is Anne Hansen, and I'm going to talk to you today about a common neurologic complication of preterm babies-- namely periventricular leukomalacia. I will refer to it by its abbreviation, PVL. In this lesson, we're going to cover incidence, pathology, risk factors, diagnosis, presentation, and outcome of babies who develop PVL. Incidence. First, we'll start with the incidence of PVL. PVL occurs in the patient population of newborns with birth weight less than 1,500 grams or gestational age less than 32 weeks. If you look at patients who are diagnosed with PVL by autopsy, about one quarter of patients in this population will be diagnosed with PVL. However, if you look at survivors, who are typically diagnosed by head ultrasound, 15% will have the early presentation of echodensities on head ultrasound, and about a third of those, or 5%, will develop echolucencies by head ultrasound. The discrepancy between the autopsy numbers of 25% and the head ultrasound numbers of 5-15%, are, of course, partially explained by the fact that the patients diagnosed by autopsy had a higher severity of illness than the survivors. But there also has been a large number of head ultrasounds that have missed the diagnosis of PVL, especially in earlier machines that were less sensitive. Now that machines are more sensitive to diagnose PVL, the number of cases that are missed and would need an MRI for diagnosis is becoming smaller. Looking at Vermont Oxford data from 2009, patients less than 1,500 grams, 3% developed cystic PVL. That's the echolucent form.
Просмотров: 11661 OPENPediatrics
"Surfactant Replacement in Neonates" by Brian Walsh for OPENPediatrics
 
11:22
In this video, Dr. Brian Walsh discusses the use of surfactant replacement therapy in the treatment of pre-term and term neonates suffering from respiratory distress syndrome (RDS). Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 3395 OPENPediatrics
"Management of the Patient with a Bidirectional Glenn" by Melissa B Jones for OPENPediatrics
 
10:08
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 3129 OPENPediatrics
"Ventilator Waveforms" by Craig Smallwood, RT for OPENPediatrics
 
23:09
Respiratory therapist Craig Smallwood discusses the pressure, volume and flow of waveforms. He explains how to use these waveforms in troubleshooting mechanical ventilation issues. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 5322 OPENPediatrics
"Recognizing Respiratory Distress" by Monica Kleinman, MD for OPENPediatrics
 
17:24
Learn how to identify clinical signs and symptoms of respiratory distress in the pediatric patient. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 347685 OPENPediatrics
"Pain Assessment" by Catherine Dowling, RN for OPENPediatrics
 
07:07
Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. Hi. My name is Catherine Dowling. I'm a nurse at Children's Hospital Boston in the cardiac ICU. The objective of this presentation is to discuss pain assessment tools. Introduction. There are many ways institutions evaluate and categorize pain. The most quantitative way is by using a scale. Some of the scale options include the FLACC, Wong-Baker, numeric rating scale, the individualized numeric rating scale, and the evaluation of physiological parameters in the chemically paralyzed patient. Patient assessment includes the evaluation of pain and should be considered with as much importance as a vital sign. Frequency of Pain Assessment. Pain should be scored using an evidence-based scale at a minimum of every four hours, and before and after the treatment of pain. Scoring pain at these intervals allows for assessment and the effectiveness of pain treatment. Pain Scales, FLACC. The appropriate pain scale is chosen based on the developing age and neurological status of the patient. The FLACC stands for face, legs, activity, crying, and consolability. It is an observer rated pain scale performed by a health care provider, such as a doctor or a nurse. The FLACC pain scale was designed for newborns up to the age of 7. It provides a pain management assessment scale between zero and ten, with zero representing no pain. The scale has five criteria, which are each assigned a score: one, two, or zero. Pain Scales, Wong-Baker FACES Scale. The Wong-Baker FACES scale is recommended for a patient who is 3 years and older. In this scale, the result is determined by the patient. Explain to the patient that each face is for a person who feels happy because he has no pain or sad because he has some or a lot of pain. The zero is very happy because he does not hurt at all. Face one hurts just a little, face two hurts a little bit more, face three hurts even more, and face four hurts a whole lot. Face five hurts as much as you can imagine, although you don't have to be crying to feel this bad. Ask your patient to choose the face that best describes how he or she is feeling. Pain Scales, The Numeric Scale. The numeric scale is designed to be used by patients over the age of 9. In the numeric scale, the user has the option to verbally rate their scale from zero to ten, or to place a mark on a line indicating their level of pain. Zero indicates the absence of pain, while ten represents the most intense pain possible. Pain Scales, The Individualized Numeric Rating Scale. The individualized numeric rating scale is an adaptation of the numeric rating scale that asks a parent or caregiver to identify an individual patient's typical behavior, and ask them to qualify that behavior on a scale from zero to ten. It was developed at Children's Hospital Boston to help intensive care nurses observe, consistently document, and communicate the unique pain behaviors of intubated and non-verbal critically ill children after major surgical procedures. On this scale, the mother of the patient has identified talking, smiling, and giggling as no pain and screaming loudly as the most pain her child will exhibit.
Просмотров: 4326 OPENPediatrics
"Introduction to Transcutaneous Pacing" by Dr. Mjaye Mazwi for OPENPediatrics
 
17:38
Learn about the indications and necessary equipment for transcutaneous pacing, and view a case demonstration of the procedure. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 7181 OPENPediatrics
"Clinical Exam Findings in Asthma" by Traci Wolbrink, MD, MPH for OPENPediatrics
 
12:53
Learn how to generally assess an asthmatic patient, including how to clinically assess a patient in status asthmaticus. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.
Просмотров: 2934 OPENPediatrics