Day 5: 8th Biennial Convention in Review

by Dr. Lottie A. Uy

On the last day of the PSPC Biennial Convention, the scientific committee, as the saying goes, had saved the best for last with relevant topics that we wouldn’t want to miss.

The session started off with an informative talk on Cardiac emergencies in children that would prove helpful in emergency situations where the Pediatric cardiologist is absent or is still on their way. This topic will prove useful particularly for the generalist.

The topics presented were extensive to say the least.

We have DR. MARIA RONELLA T. FRANCISCO discussing about the ins and outs of a cardiac tamponade. She insightfully mentioned that we can simply diagnose it with a thorough physical examination and a simple x-ray. Then, once confirmed, it needs to be drained ASAP.

Then, we have DR. MAGDALENA J. LAGAMAYO talking about Tachy and Bradyarrhythmias. She advises that, once it is suspected, the first thing you have to determine is whether it’s life threatening or not. We should then go on to assess hemodynamics, support circulation, airway and breathing, and terminate it with the appropriate drugs quickly. Once terminated, we proceed by identifying the cause and giving definitive treatment.

Another one of our esteemed speakers is DR. REGENTE I. LAPAK, who discussed about hypoxic spells, particularly on its prevention and treatment. He points out the importance of early detection of Hypoxic Spells and how it can save lives. A Hypoxic spell is a vicious cycle. So, it is important to halt and interrupt any part of the cycle to terminate it. He emphasized the importance of the knee chest position while still in the house or while preparing for IV insertion at the ER, because it will increase systemic resistance, promoting left to right shunting in the VSD causing more blood flow to the lungs.

In the Q and A portion, the moderator DR JONNIE BOTE – NUNEZ was very engaging. I’m sure all our attendees were enlightened after the discussion and after all their queries were answered. I hope that, through the event, they can apply what they’ve learned in cases of cardiac emergencies at the ER while awaiting for their friendly pediatric cardiologist.

The CME Educational Grant, brought to us by Philips, was very helpful and informative especially to the Pediatric Cardiologist in the provinces. The topic presented was Saline Contrast echocardiography in pediatric cardiology discussed by the much anticipated DR. JONATHAN CHOO TZE LIANG, the head of cardiology service in KK Women’s and Children Hospital located in Singapore. Additionally, it was moderated by no less than the Vilma Santos of PSPC, DR. ROSARIO P. BERNAL. Using Agitated Saline has been a known technique to detect shunting, if echocardiography alone is not so convincing, but it’s often neglected in the practice. This lecture was an excellent reminder for all of us on the proper handling of this procedure. Not to mention that it’s very relevant in places where there’s no cardiac catherization and other high end diagnostic modalities. Personally, I really appreciate this lecture because of how it is applicable in my practice here in Zamboanga Peninsula.

The last session held in this 5-day convention was about post-operative intensive care of cardiac patients with multi-organ complication. The panelists were, DR. RACHELLE ANGELI R. NIÑALGA , a Pediatric Cardiologist, DR. PAULA PILAR EVANGELISTA, a Pediatric Intensivist, DR. ANGELES G. MARBELLA, a Pediatric Nephrologist, and DR. KARYN P. LUNA, a cardiac surgeon/ ECMO specialist. Special thanks to their moderator DR. GLENDA T. TUBIANOSA for making sure that all the information are correlated and are presented in a cohesive manner.

In this session, the case presented was a 4-month old infant with TGA, S/P Arterial switch Operation.

They emphasized that post-op care is comprehensive and multidisciplinary. So, it is of good practice that the co-managing doctors assess and monitor the patient closely, so that adverse events maybe predicted and prevented through the proactive management given to the patient.

It was also noted that in giving analgesia and sedation, parameters like heart rate, blood pressure, sensorium and the like should be monitored closely. Nutrition should also be a key factor. Note that, we can give parenteral if enteral feeding is not tolerated well. It is expected that fluid and electrolytes is also vital. The fluid balance should never be neglected and of course the electrolytes should be maintained normal as much as possible especially the potassium levels, which is the most common electrolyte disturbance. Temperature is a very important post-operative parameter because hypothermia and hyperthermia can cause deleterious effects neurologically. Respiratorywise, mechanical ventilation targets to maintain homeostasis without causing barotrauma. Countermeasures to prevent ventilation associated infection are: closed suctioning, head -of -bed positioning, oral care and patient repositioning. Nephrologically-speaking, there’s a role in early peritoneal dialysis when urine output is tapering and creatinine level is increasing.

We then conclude that the infant expired despite aggressive management like peritoneal dialysis and ECMO. Since there’s failure to recover despite optimal management, the team must then meet and come up with a consensus and finally discuss the prognosis with the family. Communication is very important in situations like these.

The session was closed with a heart-warming performance of the PSPC members of the song “Don’t Stop Believing” by the band The Journey. We in PSPC believe that no one can stop us from healing the hearts of the Filipino children even in this pandemic. This 5-day journey was indeed a very exhausting journey for us but it was also quite a fulfilling experience. Although we encountered some technical difficulties, because of this virtual era we are currently living in, and we cannot see all our members and attendees personally, due to the pandemic, the silver lining in all of this is that we were able to reach out to the whole Philippines and possibly even more. Per day, our attendees reach from 1700 to 2300 participants. It’s no doubt it was a huge success, so, in honor of this victory, I would like to congratulate PSPC, the speakers and moderators, the sponsors, the delegates and everybody who in their own little way made this event possible. Congratulations to the overall chair, DR. JUAN G. REGANION, the head of the scientific committee, DR LEAH PATRICIA A. PLUCENA,  and of course to the very energetic PSPC President, DR. MARIA BERNADETTE A. AZCUETA. Kudos to all of you.

In celebration of the conclusion of this event, the virtual fellowship organized a fun-filled pajama party for its members. We had a number of fun games and my personal favorite was the TIKTOK contest, where we explored TikTok for dance challenges and fun activities for us to try. It’s as if we weren’t doctors for a night with all these festivities! It was really enjoying to see even our bosses, like DR. CASAS, DR. VILLANUEVA, DR. GAMPONIA, AND DR. MALANYAON, to name a few, showing off their dance moves. Despite the constraints laid upon us by this pandemic, we did not let that stop us from having fun and building new friendships. This event was a good opportunity for us to foster camaraderie in our members. See you all again next year!

To God be the glory!