Approach to RRTs | Notion

Adapted from the lecture given by Dr. Moath Alabdulsalam, PICU consultant KFSH

General Principles

VBG is a vital sign — obtain early.
Always examine your patient — never rely solely on endorsement.
Assess trends — vitals, fluids, lactate, gas exchange, CBC.
Do not treat the monitor — treat the patient.
Investigate every hypoxia — always ask: Why is this child hypoxic?
Immediate Labs: VBG, glucose, lactate, Hgb, lytes, consider cultures.
Consider upgrade Abx in RRT

⏱️ First 5-Minute Assessment (ABCDE)

Step	What to look for	What to do
Airway	Stridor, secretions, obstruction	Suction, jaw thrust, oral/nasal airway, BVM
Breathing	RR, SpO₂, WOB, chest rise, auscultation	High-flow O₂, NIPPV if tiring, intubate if GCS <8 or CO₂ narcosis
Circulation	HR, BP, CRT, pulses, skin perfusion	Fluids (if not cardiac), pressors, inotropes
Disability	GCS, pupils, tone, seizure	Dextrose bolus if hypoglycemic, anticonvulsants
Exposure	Rashes, bleeding, temp	Undress, check for shock signs, bruising, trauma

📉 Oxygen Delivery: Core Physiology

Any hypoxia is not a simple issue. Ask yourself why?

1. Hypoxia ≠ Always Hypoxemia

Almost all hypoxia causes hypoxemia, EXCEPT:
- Congenital cyanotic heart disease
  - R→L shunt bypasses lungs
  - High Hb due to compensation (can also be seen in NICU babies with CHD)
  - SpO₂ low, but no distress → beware of being misled
  - Example: Eisenmenger, Tetralogy, AVMs

2. Oxygen Delivery Equation

O₂ delivery = O2 content x cardiac output = (Hb × SaO₂) × (HR × SV)