Explore the harrowing tale of a toddler who ingested concentrated bleach, showcasing alarming symptoms like stridor and drooling. Delve into effective strategies for managing caustic ingestions, emphasizing the need for airway management and diagnostic measures like endoscopy. Learn about the long-term risks associated with such ingestions, including potential esophageal complications. The discussion also highlights essential prevention strategies and vital insights for healthcare providers dealing with pediatric emergencies.
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Cardiac Output Basics
Cardiac output equals stroke volume multiplied by heart rate and depends on heart contractility and preload.
Positive pressure ventilation alters preload by changing pressure around the heart, affecting the blood returning to the heart.
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Positive Pressure Ventilation Effects
Positive pressure ventilation increases intrathoracic pressure, reducing venous return and preload affecting right heart function.
It decreases left ventricular afterload by reducing transmural pressure, creating a complex balance in cardiac output.
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Spontaneous vs Positive Pressure Breathing
Spontaneous breathing creates negative intrathoracic pressure enhancing venous return and increasing right ventricle preload.
Positive pressure ventilation reverses this, reducing preload and increasing pulmonary vascular resistance, which strains right ventricular function.
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Have you ever wondered what happens when a toddler gets into something they definitely shouldn’t? Today, Dr. Monica Gray, Dr. Pradip Kamat, and Dr. Rahul Damania discuss the case of an 18-month-old boy who accidentally ingested concentrated bleach, presenting with stridor, drooling, and vomiting. They review the clinical approach to caustic ingestions in children, including airway management, diagnostic workup, and the roles of endoscopy, steroids, and multidisciplinary care. The episode also highlights potential complications such as esophageal strictures and cancer, emphasizes prevention strategies, and provides key takeaways for intensivists managing similar pediatric emergencies. If you’re an intensivist or just want to know what to do in a pediatric emergency, don’t miss these essential takeaways for managing one of the scariest situations in the ER.
Show Highlights:
Case study of an 18-month-old boy who ingested concentrated bleach
Clinical presentation including symptoms like stridor, drooling, and vomiting
Management strategies for caustic ingestions in children
Importance of airway management and monitoring in cases of caustic ingestion
Diagnostic workup including imaging and endoscopy
Differential diagnosis considerations for similar presentations (e.g., button batteries, laundry detergent pods)
Mechanism of injury caused by alkaline substances like bleach
Long-term complications associated with caustic ingestions, such as esophageal strictures and cancer
Multidisciplinary approach to treatment involving various medical specialties
Prevention strategies to reduce the incidence of accidental caustic ingestions in children
References:
American Academy of Pediatrics – Pediatric Care Online: Esophageal Caustic Injury (AAP clinical guidance on caustic ingestions).
Fuhrman & Zimmerman’s Pediatric Critical Care textbook – Chapters on toxicology and gastrointestinal emergencies (covering caustic injury management and critical care approach).
Hoffman RS, et al. “Ingestion of Caustic Substances.” New England Journal of Medicine. 2020; 382(18):1739-1748. A comprehensive review of caustic ingestion injuries and management.
Arnold M, Numanoglu A. “Caustic ingestion in children – a review.” Semin Pediatr Surg. 2017;26(2):95-104. Review of epidemiology, pathophysiology, and treatment of caustic injuries in kids.
Johnson CM, Brigger MT. “The public health impact of pediatric caustic ingestion injuries.” Arch Otolaryngol Head Neck Surg. 2012;138(12):1111-1115. (Epidemiology study showing declining incidence).
Pediatric Critical Care Medicine (PCCM) Journal – various case reports and series on caustic ingestion (for case-based insights), and annual National Poison Data System reports (for statistics on pediatric poisonings).
Tringali A, et al. ESGE/ESPGHAN Pediatric GI Endoscopy Guidelines (Endoscopy, 2017) – Includes recommendations for endoscopy timing and steroid use in caustic ingestions.
Usta M, et al. “High doses of methylprednisolone in the management of caustic esophageal burns.” Pediatrics. 2014;133(6):E1518-24. (Key study demonstrating steroids benefit in grade 2b injuries).
Royal Children’s Hospital Melbourne – Clinical Practice Guidelines: Caustic Ingestions (2019) – Practical hospital guidelines emphasizing early intubation for airway threat, endoscopy within 24h, IV PPI, and supportive care.
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