Mark C. Bugnitz

Use of the esophageal stethoscope in pediatric transports

INTRODUCTION Monitoring cardiac and respiratory function during helicopter transports can be difficult, so the authors devised a study of the esophageal stethoscope for pediatric patients. SETTING The study was conducted at Pediflite in Tennessee, which transports between 250 to 300 pediatric patients every year. MATERIALS AND METHODS A disposable esophageal stethoscope was used as an adjunct to other monitoring systems in intubated patients. Prior to transport, the stethoscope was placed orally by the respiratory therapist and advanced to the point where heart sounds are heard best, at which point breath sounds can also be heard clearly. The devices ear piece easily fit under the crew members headphones, which block helicopter noise. Three sizes of stethoscope are available: a 6 French for patients 1 day to 4 years old, a 9 French for those 4 to 12 years old, and an 18 French for patients 12 years of age or older. RESULTS The esophageal stethoscope was used in 55 patients ranging in age from newborn to 18 years. Eighteen of 55 (33%) had multiple trauma or closed head injury, and 14 of 55 (25%) suffered respiratory failure. The esophageal stethoscope proved to be easy to place, had a low risk of complications and allowed continuous access to breath sounds. In addition, the ability to hear heart tones was minimally affected by noise or vibration. CONCLUSION Due to its ability to continuously monitor breath sounds, endotracheal tube obstruction or displacement can be rapidly detected by the esophageal stethoscope. Also, if there is failure of the cardiopulmonary monitor, heart sounds can be continuously monitored. The esophageal stethoscope is a simple but potentially valuable tool in pediatric and neonatal transports for monitoring respiratory and cardiac status.

Pamidronate treatment for hypercalcemia in an infant receiving parenteral nutrition.

A 17‐day‐old infant who was delivered 8 weeks premature underwent small bowel resection for necrotizing enterocolitis. During treatment with continuous infusions of furosemide and hydrocortisone, his total calcium concentration had increased. The calcium dose in his parenteral nutrition solution was decreased and then finally withheld. At 7 weeks of age and after 10 days of calcium‐free parenteral nutrition, pamidronate 3 mg (1.1 mg/kg) in 60 ml of normal saline was infused over 6 hours. The infants total serum calcium concentration decreased, but then 6 days later it had increased again; pamidronate 2 mg (0.7 mg/kg) in 40 ml of normal saline over 4 hours was administered. The patient demonstrated no signs or symptoms of adverse reactions to pamidronate. His serum calcium concentration returned to normal, and calcium‐containing parenteral nutrition was tolerated. The use of pamidronate for treatment of hypercalcemia and chronic conditions that affect normal bone growth is increasing in children. Clinical trials in pediatric patients are necessary to determine how best to use bisphosphonates in this patient population.

Evolution of traumatically acquired infracristal ventricular septal defect

SummaryNonpenetrating traumatic rupture of the ventricular septum is rare. This case report describes the evolution of such a lesion documented by echocardiography and color flow Doppler. Included is a brief discussion of postulated mechanisms for this rare phenomenon.

Evaluation of gastric pH and guaiac measurements in neonates receiving acid suppression therapy during extracorporeal membrane oxygenation.

Study Objectives. To assess gastric pH measurements, evaluate the frequency of guaiac‐positive gastric aspirates, and characterize the appearance of gastric aspirates in neonates receiving acid suppression therapy during extracorporeal membrane oxygenation (ECMO).