RCP: 421 Narrative Summary of Physician Interaction

Autumn Cooley

3/7/2017. Shantaveer Gangu, MD. General Practice. Review of Content. 1720. 5 minutes.

I had questions regarding the production of free radicals in regard to prolonged

administration of 100% supplemental oxygen therapy in potential donor patients and the use of

inhaled nitric oxide. Dr. Gangu explained that free radicals are highly reactive molecular

fragments that can damage cell membranes and the internal organelles of the cell. The primary

source is from our body during the energy production process within the cells. Most of the

oxygen we breathe is used within our cells in the production of energy. The resultant effect of

this energy producing activity is that a very small amount of oxygen that was not used losses

electrons creating free radicals. The free radicals created burn holes in our cellular membranes

that weaken tissues and organs in our body.

3/13/2017. Jennifer Freeman, MD. General Surgery Fellow. Patient Centered. 1801. 5 minutes.

A two-day old patient with a diaphragmatic hernia was being ventilated by way of HFOV

and was awaiting possible ECMO. We discussed the criteria for infants with diaphragmatic

hernia included OI >35 for 30 minutes or >30 for two hours. The CBG was used for the

calculation of OI=MAPx FiO2x100/PaO2. The patient was maxed out with HFOV: FiO2 100%,

with iNO at 20ppm. The patients OI was continuously on the rise at 36 and the surgeon and

ECMO team were waiting on hand. The patient was placed on ECMO shortly after our shift was

over.