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

[Music] attention all medical stuff for children for the first time we gain unprecedented access into Singapore's largest children's intensive care unit working in the ICU even if your feet are paddling furiously underwater you have to still be able to perform efficiently this week some of these complications can be fatal parents and doctors confront impossible dilemmas have to wait lease benefit versus the risk chicken we can really be ambitious totally well before we can actually do the excavating [Music] nine-year-old Marcus has been admitted into the children's ICU one minute he was on a soccer field and the next he was in an ambulance with intense chest pains Marcus's heart rhythm is completely out of whack he needs to be watched round-the-clock or he could collapse anytime collapse means he's hot basically stops beating there's not enough blood flow to support any of his vital organs it's almost like what we call cardiac arrest he is dead at the time of the cardiac arrest only at the Children's ICU Kim Marcos received the critical care that he needs so Marcus's main condition is myocarditis which is an inflammation of the heart muscle this is probably a viral infection and a virus has gotten to the heart and causing damage and injury to the heart muscle this contract when this flu myocarditis carries risk of the death of approximately 25 to 30 percent I was shocked because I didn't realize that was so critical from just usual chest pain and then into the spirit you tell me that okay is a viral infection how can a viral infection be so detrimental and it attacks the heart and basically he just collapse just asking you know how did it happen where did happen nobody can answer that question even the doctors can't answer that question and we really don't know how [Music] three-year-old alia has childhood leukemia four rounds of chemotherapy have left alia neutral clinic a condition where her white blood count is low over the past week the CICU doctors managed to keep a bloodstream infection at bay but now a cut in her anus is threatening to blow up into another deadly infection [Music] [Music] I don't see any flower right now the doctors must decide whether to escalate intervention by creating a stoma bag which collects stools from her intestines instead of her anus to keep the perianal wound clean the decision for audience stormer creation was actually a very very challenging decision to make a new trophy was very long her immunity is very weak and also her ability to clock her blood is also very very very bad so putting this factor together the risk of performing an operation such as Tama creation actually post very high risk [Music] one day after being admitted into the CICU Marcuse's blood pressure plummets this and his erratic heartbeat are warning signs that Marcus is in danger of multiple organ failure his heart function was deteriorating in front of the eyes to a point where the Hat was hardly moving at all five different machines allow me to nurses are calling you when doctors saying something your patient is clinically deteriorating in front of you and having to process all those inputs and information and formulating a plan it is challenging to remain calm and all hell breaks loose yeah I think other movements the doctors must make a quick decision whether to hook Marcus up to a heart-lung bypass machine that could save his life but it is an extremely high-risk procedure because we're drawing all your blood out and we're running it through an external device with external shootings any time black comes out of your body at once the clot and the problem when we return black back is if there's risk of protein the clots may also travel into the bloodstream and one of the Western petitions are that we'll get a stroke or you can take [Music] nine-year-old Marcus is at risk of a cardiac arrest and the doctors make the call to hook him on a heart-lung bypass machine called ECMO or extracorporeal membrane oxygenation the moment the doctors caught me he has to be moved to be supported by ignore what's already telling me oh my god there is a high chance that I'll lose him just moments after the doctors completed the procedure Boston actually told me that his heart stopped beating so that was really scary for a mom - yeah [Music] at that time he's totally sedated and paralyzed so there's nothing much I can do except to really just pray that you will come back Marcus is now relying solely on a machine to pump blood around his body we were very thankful that we put in the mo as early as we did because if we had waited any longer Marcus's life would have been in danger luckily the machine is keeping Marcus alive but nobody can tell when or even whether Marcus's heart function would return I mean it's just a bet nightmare that I hope no parents have to go through olia has been on intravenous nutrition for the last two weeks to avoid exacerbation of a perianal infection it's been a while since she's eaten anything orally but her wound still hasn't healed doctors has managed to overcome the infection with antibiotic but it looks like the Battle of meander they still walk away on a fever Otto coming down is - hanging down there we don't really know where is the end of all these infections I think to make the question easier for you is should we do stoma opening in exchange of earlier feeding and also easier okay if our Lea's parents still don't agree to the surgery a Lea may have to be on intravenous nutrition for up to a month which could lead to liver damage and further infections you have to wait these pregnancy versus the risk which is 20 to 30 percent chance men stolen may have some complications talk to your husband talk to the family and they make a decision that's not is all like the chain reaction is a cascade event you can't say whether this is - to tell whether the everything country people but that's what happened to oncology patients order factor will come together and you just had to make the best decision you can considering all the factors [Music] with the discussion just now I have to make a very fast decision by tomorrow whether we are opening the stoma for all you guys get your three [Applause] [Music] today dr. Chen is checking on Marcus [Music] he detects a weak pulse that's good news after 48 hours of not beating Marcus's heart is slowly regaining strength [Music] the possibilities tribal refugee center policy so as the skinless you just feel uncomfortable is it okay [Music] too much the important things in your neck and in your mouth okay these are important ones the one on your head and all that you want to move is Rafi today is day seven of ECMO a VA ECMO which is most significantly complicated by rhythm problems he has underlying Harlow his other problem is that of likely hospital acquired pneumonia for which we have not been able to isolate any microorganism in terms of the etiology of what buck is causing it every time I received a piece of good news I will hear other complications and other ways they are involved so that's the difficult part for me because decide walking one step ahead and then you know back down back streets that because there are other risk involving other complications despite the antibiotics Marcus's lungs are still infected by a bacteria which has led to a full-blown pneumonia doctors now have little choice but to put Marcus through an invasive procedure again we had to do what we call a bronchoscopy for him which is surgery as a small fiber-optic scope that we pass through his breathing tube basically to look for any secretions that we can help to clear to help open up his lungs better but what was supposed to be a straightforward procedure has uncovered complications yet again [Music] the doctors are doing a bronchoscopy to treat Marcus's pneumonia they managed to clear the mucus 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 blood clot formation within the ECMO circuit [Music] Marcus has been relying on a heart-lung bypass machine called ECMO to pump blood through his body the longer we keep patients on ECMO the higher the complications associated with it when there is a clock and if the club moves to the palm I basically auto-shutdown the system so you can imagine if it auto shuts now where Marcus is relying heavily in 500% on the machine that's going to just basically a nice life people dry so is your anymore I of you know it's just the truth [Music] and informative um the doctors need to make a decision when and should they remove the ECMO machine which is keeping Marcus while the doctors deliberate on the next course of action sin Lin's parents have to decide on their daughter's fate [Music] it's listen okay ding Sharna his wife want their daughter to go home soon to do that they need to remove her from a ventilator which delivers oxygen to her lungs but nobody knows if cynllun can survive the process known as extubation after your own after feasible activism if she's do this on Sunday then we wish to proceed my dear will come from home and they're in if we delay sometimes also on prolonged ventilation day the muscles itself also may be deconditioned okay [Music] mucus secretion and sunland's lungs are blocking her air passage but the three-year-old is too weak to cop out the phlegm she's born with spinal muscular atrophy or SMA a genetic disease that weakens her muscles progressively and the longer she is on the ventilator the faster her muscles decondition the chances of her being able to excavator successfully is about to miss fifty fifty percent don't you me and my wife decide is painful where she see us [Music] Papaji mom okay ding Shan and his wife now confronts the dilemma if cynllun struggles to breathe when they removed the ventilator should they resuscitate her and hook her on the machine yet again or do they let her go the problem was when we tried to come off our breathing support she felt that first time and with the discussion with the parents we put her back on breathing support she had a first trial of extubation to Friday spec for which she had multiple D situation and after discussion and parents we intubated her after about one and a half days there was on last last Sunday difficult decision for parents is really do we use the full might of medical technology to support her but knowing that it is still at this present moment with what scientific advancement we have have no cure for her underlying condition dr. mom was saying that this around here she looks more higher as compared to the previous time when when we do the excavation make she was saying that by looking at the machines reading she seems to require more energy to actually prefer her owner do I continue to subject her to my invasive support being in a hospital being the ICU having vines and tubes and things poked into her or do I say enough is enough and we should allow touchable naturally I think parents dilemma is really that she always looks so much better and obviously responds so well once we get the children will be better if next week then we do excavation give us some time to yes maybe meantime we can call my office to see whether when maybe to let them know that this distance is a bit different from the previous hospitalization ready this afternoon they are making molds of sin Lin's hands and feet it would be a final momento for if the inevitable happens [Music] in case singing can sustain no account this exhibition is actually not successful then we maybe time that we we have to decided to actually maybe to let let her let her go [Music] in preparation for the extubation the doctors moose in list to an isolation room to give her family privacy [Music] maybe [Music] you always [Music] [Music]

Channel: CNA

Views: 1,261,677

Keywords: Inside the children's ICU, Hospitals, Medical care, Children's illnesses, Hope

Id: rqQzmVVhGcY

Length: 22min 45sec (1365 seconds)

Published: Fri Sep 07 2018