Navigating Intubation in Cardiac Dysfunction

Learn how to sharpen your pediatric intubation skills and make evidence-based decisions at the bedside. Today, Dr. Pradip Kamat, Dr. Monica Gray, and Dr. Rahul Damania expertly dissect the nuances of selecting optimal induction agents for critically ill children in the PICU. Through engaging, real-world case scenarios, our hosts guide you through drug choices in complex situations such as cardiogenic shock, septic shock, and elevated intracranial pressure—always prioritizing hemodynamic stability and patient safety. Gain valuable insights into the advantages, limitations, and clinical pearls of agents like propofol, fentanyl, ketamine, and midazolam, along with practical strategies for rapid sequence intubation, neuromuscular blockade, and individualized patient care. Don’t miss this high-yield discussion, packed with actionable knowledge!

Show Highlights:

• Induction agents for endotracheal intubation in critically ill children
• Clinical scenarios highlighting optimal choices of induction agents and neuromuscular blockers
• Importance of maintaining hemodynamic stability during intubation
• Pharmacology and clinical considerations of various induction agents (e.g., propofol, ketamine, fentanyl, etomidate)
• Use of neuromuscular blocking agents (NMBAs) in pediatric intubation
• Differences between depolarizing and non-depolarizing neuromuscular blockers
• Risks associated with specific induction agents in patients with cardiac dysfunction or septic shock
• Modified rapid sequence intubation (RSI) techniques for unstable patients
• Key takeaways for managing critically ill pediatric patients requiring intubation
• Practical tips for optimizing intubation conditions and minimizing complications

References:

1. Fuhrman & Zimmerman - Textbook of Pediatric Critical Care 6th Edition. Chapters 127 - 135, Pages 1510 - 1610
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3. Agrawal, Dewesh. Rapid sequence intubation (RSI) in children for emergency medicine: Medications for sedation and paralysis. UpToDate. Last updated Dec 4, 2024.
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