CNA | Inside The Children's ICU | E03 - Critical Decisions | Full Episode

attention, all

children

's medical supplies for the first time we get unprecedented access to Singapore's largest

children

's intensive care unit working in the ICU, even if your feet splash furiously underwater, you should still be able to perform efficiently this week, some of these complications can be fatal parents and doctors face impossible dilemmas we have to wait for lease benefit versus risk chicken we can get really ambitious long before we can do the digging Marcus, age nine, was admitted to the children's ICU in one minute he was playing field soccer and the next he was in an ambulance with intense chest pains Marcus's heart rate is completely out of control he needs to be monitored 24 hours a day or he could collapse at any moment collapsing means he is hot basically it stops beating there is not enough blood flow to support it any of your vital organs its almost like what we call cardiac arrest.

He was dead at the time of cardiac arrest, alone in the children's ICU. Kim Marcos received the

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care he needs, so Marcus' main condition is myocarditis, which is an inflammation of the heart. muscle, this is probably a viral infection and a virus has reached the heart and caused damage and injury to the heart muscle. This contract when this flu myocarditis carries a risk of death of approximately 25 to 30 percent. I was surprised because I didn't realize it. that was so

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because of the usual pain in the chest and then in the spirit you tell me okay it's a viral infection how can a viral infection be so harmful and it attacks the heart and basically it just collapses just asking you know how did it happen, where? happened, no one can answer that question, not even doctors can answer that question and we really don't know how three year old Alia has childhood leukemia.

Four rounds of chemotherapy have left Alia Neutral Clinic with a condition where her white blood cell count is low. For the past week, CICU doctors have managed to keep a bloodstream infection at bay but now a cut on her anus threatens become another deadly infection. I don't see any flowers at this time doctors must decide whether to intensify the intervention by creating a stoma bag that collects stool from your intestines instead of your anus to keep the perianal wound clean. The decision to create Stormer for the audience was actually a very, very challenging decision. Making a new trophy was very long.

His immunity is very weak and so is his ability. Controlling his blood is also very, very, very bad, so adding this factor, the risk of performing an operation like Tama's creation actually presents a very high risk one day after being admitted to the CICU. Marcuse's plummeting blood pressure and his erratic heartbeat are warning signs. that Marcus is in danger of multiple organ failure his heart function was deteriorating in front of his eyes to the point where the hat was barely moving on the five different machines, let me have the nurses call him when the doctors say something in which his patient is clinically deteriorating. in front of you and having to process all that input and information and formulate a plan, it's a challenge to stay calm and all hell breaks loose yeah, I think other moves the doctors need to make a quick decision on whether to put Marcus on a heart bypass -lung machine that could save your life, but it is a very high risk procedure because we remove all your blood and pass it through an external device with external shots every time black comes out of your body at the same time, the clot and The problem when we have a black back is that if there is a risk of protein, the clots can also travel to the bloodstream and one of the Western requests is that we will have a stroke or you can take nine-year-old Marcus, who runs the risk of suffering a stroke. cardiac arrest and the doctors make the call to hook him up to a heart-lung machine called ECMO or extracorporeal membrane oxygenation the moment the doctors caught me he has to be moved for support ignoring what he's already telling me oh my god , there is a good chance that you will lose it moments after the doctors completed the procedure.

Boston actually told me that his heart stopped beating, so that was really scary for a mom. Yes, at that point he was totally sedated and paralyzed, so there's not much he can do. except just praying for you to come back. Marcus now relies solely on a machine to pump blood around his body. We are very grateful that we implemented the mo as soon as we did because if we had waited any longer Marcus's life would have been in danger, fortunately the machine keeps Marcus alive but no one can say when or even if Marcus's heart function return.

I mean, it's just a gambling nightmare, I hope no parent has to go through that. Olia has been receiving intravenous nutrition for the past two weeks. To prevent exacerbation of a perianal infection, it has been a while since he ate anything orally, but his wound has not yet healed. The doctors managed to overcome the infection with antibiotics, but it seems that in the battle of Meander they still leave with a fever. Otto is coming. below is: hanging down there, we really don't know where the end of all these infections is. I think to make the question easier for you is whether we should open the stoma in exchange for feeding him earlier and it's also easier if Lea's parents don't do it yet.

If he doesn't agree to surgery, Lea may have to receive intravenous nutrition for up to a month, which could lead to liver damage and more infections. She has to wait during this pregnancy facing the risk that is 20 to 30 percent chance that stolen men might have something. complications talk to your husband talk to the family and they make a decision that it is not as if the chain reaction was a cascading event, you cannot say if this is, to know if it is all country people, but that is what What happened to cancer patients. The factors will come together and you just had to make the best possible decision considering all the factors with the discussion now.

I have to make a very quick decision by tomorrow if we will open the stoma for all of you, get your three today dr. Chen is checking on Marcus, detects a weak pulse, that's good news after 48 hours of no heartbeat. Marcus's heart is slowly regaining strength. The possibilities of the tribal refugee center policy. So, like the skinless, you just feel uncomfortable. Okay? Too much. The important things on your neck. and in your mouth, okay, these are important, the one in your head and all you want to move is Rafi, today is the seventh day of ECMO, a VA ECMO, which is complicated more significantly by the rhythm problems that has underlying Harlow, his other problem is Probably hospital-acquired pneumonia for which we have not been able to isolate any microorganisms in terms of the etiology of the cause.

Every time I get good news I hear other complications and other ways they are involved, so that's the difficulty. part for me because you decide to walk one step forward and then you know you go back down side streets because there are other risks that involve other complications despite the antibiotics, Marcus's lungs are still infected by a bacteria that has caused

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-blown pneumonia, doctors now have little We had no choice but to put Marcus through an invasive procedure again. We had to do what we call a bronchoscopy, which is a surgery like a little fiber optic endoscope that we put through his breathing tube basically to look for secretions that we can help remove. to help open his lungs better, but what was supposed to be a simple procedure has uncovered complications, once again doctors are doing a bronchoscopy to treat Marcus' pneumonia, they managed to remove the mucous plugs caused by the infection, but during the procedure the doctors also found blood clots in his lungs.

Some of these complications can be fatal, for example, the formation of blood clots within the ECMO circuit. Marcus has been relying on a heart-lung machine called ECMO to pump blood through his body. The longer we keep patients on ECMO, the greater the complications associated with this when there is a clock and if the stick moves towards the palm, I basically automatically turn off the system, so you can imagine if it turns off automatically now that Marcus depends on largely on 500% of the machine that will basically work. good life people are dry, so you're not anymore. I know from you that it is just the truth and it is informative.

The doctors must make a decision about when and if they should remove the ECMO machine holding Marcus while the doctors deliberate the next course of action without Lin. The parents have to decide about their daughter's fate, listen, okay, ding Sharna, your wife wants their daughter to go home soon, for that they need to get her off a ventilator that supplies oxygen to her lungs, but no one knows if cynllun will be able to survive the process known as extubation after hers after feasible activism, if she does this on Sunday then we wish to continue dear, she will come from home and they will be inside if we delay it, sometimes also on the day of prolonged ventilation , the muscles themselves may also be deconditioned, okay, mucus secretion and sun.

The lungs are blocking the passage of air, but the three-year-old girl is too weak to clear the phlegm. She was born with spinal muscular atrophy or SMA, a genetic disease that progressively weakens her muscles and the more time she spends on the ventilator, the faster her muscles weaken. The chances of her being able to success

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y dig are about fifty-fifty, isn't it that my wife and I decided that it's painful where she sees us? Papaji's mom, okay, ding Shan and her wife now face the dilemma if Cynllun has difficulty breathing when they They took her off the ventilator in case they resuscitated her and connected her to the machine once again or let her go.

The problem was that when we tried to remove her respiratory support, she felt it that first time and with the discussion with her parents we put it back on her. respiratory support, she had a first test of extubation according to specifications on Friday, so she had a multiple D situation and after discussing it with the parents, we intubated her after about a day and a half, last Sunday there was a difficult decision for the parents: do we really use the full power of medical technology to support her, but knowing that even at this time with the scientific advances we have we have no cure for her underlying condition, dr.

Mom was saying that she looks taller here compared to last time when we did the digging, she was saying that by looking at the machine readings, she seems to require more energy to prefer the owner of her. Do I still hold? her to my invasive support being in a hospital being in the ICU having vines and tubes and things stuck in her or I say enough is enough and we should let them touch her naturally I think the parents' dilemma is really that she always looks so much better and he obviously responds Well, once we have the kids, it'll be better if we do a dig next week.

Give us some time. Yes, maybe in the meantime we can call my office to see if it's possible to let them know that this distance is a little different than the previous hospitalization. ready this afternoon they are making casts of Sin Lin's hands and feet, it would be a final moment because if the inevitable happens, in case the singing cannot keep up the count, this exhibition is not actually successful, then maybe it will be Time we have to decide. let her let her go in preparation for extubation the doctors are lined up in an isolation room to give her family privacy maybe always