Browsing by Author "Ward, Chad"
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- A Case of Childhood Severe Paroxysmal Cold Hemoglobinuria with Acute Renal Failure Successfully Treated with Plasma Exchange and EculizumabPelletier, Jessica; Ward, Chad; Borloz, Matthew; Ickes, Anne; Guelich, Susan; Edwards, Erwood (Hindawi, 2022-04-22)We describe the case of a 4-year-old female who presented with sepsis and disseminated intravascular coagulation (DIC), developed ongoing intravascular hemolysis with acute renal failure from suspected pigment-induced acute tubular necrosis necessitating continuous renal replacement therapy (CRRT) for five days followed by four episodes of intermittent hemodialysis (iHD), and was subsequently diagnosed with paroxysmal cold hemoglobinuria (PCH). She was successfully treated with plasma exchange and eculizumab, a humanized monoclonal antibody targeting complement protein C5, and demonstrated significant improvement of hemolysis and recovery of renal function.
- Enhancing Inpatient Team Communication Among Pediatric Nurses and ResidentsHayes, Andrew; Washofsky, Anne; Boggs, Lia; Ward, Chad (2022-04-28)Background: Nurse and physician collaboration is important in patient care satisfaction. Improving communication among the inpatient nurses and residents was identified as a top priority within our Pediatric Quality Improvement Committee at Carilion Children's Hospital for 2021. Methods: Communication committee formed (inpatient pediatric residents and nurses). Communication survey administered. Interventions were identified through survey results and committee planning: - Nurse-Intern Mentor Program - Human Factor Engineers audit of rounding which led to addition of a clinical lead nurse on rounds - Communication Guidelines for nurses and residents PDSA cycles carried out following interventions. Post-intervention survey administered 1 year from start of project. Summary and Conclusion: Communication deficiencies among nurses and residents decreased following the initiation of Nurse-Intern Mentor program, addition of Clinical Lead Nurse on rounds, and implementing communication guidelines for nurses and residents. There was NO improvement in the communication deficiency responses involving the “delays of care”. Face-to-face communication also did not significantly improve post-intervention. More intervention planning is required to promote improvement in face-to-face communication among nurses and residents.
- High-Dose Dexmedetomidine for Severe Hyperactive Delirium Secondary to Intravenous Levetiracetam on Two Separate Occasions in the Same PatientWard, Chad; Khalid, Kiran; Rozette, Nicole (Hindawi, 2022-07-02)We describe the case of a 5-year-old male who developed severe hyperactive delirium with aggressive violent behavior following the administration of IV levetiracetam for the treatment of status epilepticus on two occasions. The child’s symptoms ranged from attacking his parents and the intensive care staff. Risperidone was given without any improvement in symptoms. A high-dose continuous infusion of IV dexmedetomidine was administered, and his violent behavior and delirium significantly improved. The two episodes of hyperactive delirium following IV levetiracetam administration occurred at ages 3 and 5, resulting in extensive work up including laboratory testing and cranial imaging, along with cerebral spinal fluid analysis and were normal. IV dexmedetomidine provided rapid symptom relief to prevent harm for the child, staff, and family on both occasions.
- Preventing Severe Hypoglycemia with a Continuous Glucose Monitor Device in an Infant with Glycogen Storage Disease 1a undergoing a Gastrostomy Tube Placement: Case ReportWard, Chad; Washofsky, Anne; Nguyen, Emily; Fortune, Laura; Wattsman, Terri-Ann (2022-11-12)We describe a case in which a continuous glucose monitor (CGM) was used during hospitalization to safely prevent severe hypoglycemia in a 10-month-old male with glycogen storage disease 1a undergoing placement of a gastrostomy tube. The child was admitted to the hospital for placement of a gastrostomy tube given increased severe hypoglycemic episodes at home secondary to worsening feeding aversion. During hospitalization, the CGM was monitored before, during and after surgery. Severe hypoglycemic episodes were avoided while hospitalized. The CGM device assisted with the management and titration of continuous dextrose infusion while the child was fasting. The CGM device improved patient and family centered outcomes by reducing the need for frequent finger stick point-of-care glucose checks and allowed the family and anesthesiologist to carefully monitor the child’s blood glucose continuously during the procedure.