Week 6 Jingwei Zhang

This week I spent my time among PICU, CT scanning room, MRI scanning room, and radiology reading room. This Thursday happened to be a big day for MRI in PICU. Totally 3 patients were scanned. I shadowed them all the way from PICU to MRI. One of the patients, a 7-year-old girl, had a brain tumor removal surgery that Wednesday. MRI was performed as a post-surgery checkup. Similar to many other pediatric patients, she was sedated during MRI. The drug used was propofol. Propofol is a short-acting, IV administrated hypnotic agent. It has very unique milk like appearance. Induction of anesthesia is rapid and ‘clean’, meaning fast acting upon administration and rapid recovery upon removal. These properties were well evidence in this case. The patient passed out in a few seconds after the initial bolus and recovered in less than 2 minutes upon drug removal. However, the initial compact of the drug was immense. The patient experienced pain on injection. This was not the pain from the needle insertion but the drug itself. In addition, the patient stopped breathing for about 30 second upon administration. Her oxygen saturation dropped briefly below 80. Oxygen mask was used immediately to recover the oxygen level. I talked to the nurse afterwards. She said that propofol might weaken or stop patients’ breath during initial injection. So some oxygen countermeasure must be used. In addition, propofol has no pain relief effects. So it is very good in some situations, but very limited in others.

Friday I saw an interesting case in PICU. An 11-year-old girl had an unknown viral infection. She had a fever for 3 days. Average resting heart rate was 130 bpm, almost double the normal resting heart at her age. She also experienced muscle pain through her body. Doctors had no clues what type of virus it was. However, given that she has been to the US for just 2 years there were good chances that she had viral infections that more frequently happened in younger child due to the lack of immunity. In addition, she looked uncomfortable but not toxicated. It implied that it was not life threatening at the moment. Therefore, until the test results are back, doctors only recommended supportive care.