ICU and You · Mnemonic No. 53
C
CardiacThe duct has closed — collapse at day 2 to 14, absent femorals, a pre- and post-ductal gap
O
ObstructionA bilious vomit is a malrotation until proven otherwise; also NEC, incarcerated hernia
L
Lactate, glucose, gasThe first three numbers. Hypoglycaemia is common, treatable, and routinely missed
L
Listen to the mother“He is not feeding like he was” precedes the observation chart changing
A
AdrenalCongenital adrenal hyperplasia: low sodium, high potassium, shock in the second week
P
ProstaglandinStart at 10 ng/kg/min — but a grey baby with a closed duct may need 50 or more. Apnoea is frequent: airway ready first
S
SepsisGBS, E. coli, Listeria; aciclovir if seizures or vesicles. Cultures, then treat — do not wait
E
Errors of metabolismEncephalopathy with acidosis. Ammonia above 100, stop feeds, run 10% dextrose
D
Deliberate harmAbusive head trauma: apnoea, seizures, and no history offered, because none will be
Challenge of the week
Which one do you most need to rule in or out first — and how would you do it?
Three in the morning. The baby is grey, eleven days old, and was discharged home feeding well. You have telephoned the retrieval service and they will call you back shortly. Before they do, you have time to settle exactly one of these nine. Tap it, tell me how you would establish it at the bedside, and why it comes ahead of the other eight. I'll publish the reasoning — including the disagreements, which are the interesting part.
Each tap opens a reply straight to me with your choice filled in — just add your reasoning and send.