Rapid Response Teams with Dr. Nada Mallick and the Cribsiders -- Part 1
Nov 8, 2023
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Dr. Nada Mallick, a pediatric intensivist at Children's National Hospital, discusses pediatric rapid response teams, patient safety, and managing undifferentiated shock. The podcast also explores the evaluation and escalation of patient care, procedures in a surgical care unit, and the importance of gathering input from medical providers and nurses.
Thorough physical examination is crucial before listening to the patient's story to avoid bias.
Consider differential diagnoses beyond the primary complaint.
Knowing the patient's baseline and medications is essential to avoid potential complications.
Deep dives
Pediatric rapper response
In this two-part episode, the podcast explores pediatric rapper response, which is the collaboration between pediatric ICU and hospital medicine. They discuss the importance of evaluating patients for escalation of care from acute care to the intensive care unit (ICU). They highlight the significance of a thorough physical examination before listening to the patient's story to avoid bias. The podcast emphasizes the need to consider differential diagnoses beyond the primary complaint. They also emphasize the importance of knowing the patient's baseline and medications to avoid potential complications.
Respiratory distress in a bronchiolitis patient
The podcast discusses a rapid response scenario involving a six-month-old with bronchiolitis. The speaker emphasizes the need to assess the patient's respiratory distress, including retractions, grunting, and tachypnea. They suggest considering an escalation of respiratory support, such as high flow oxygen or bipap. Additionally, they highlight the importance of ordering a chest x-ray and checking labs to evaluate for possible pneumonia or other complications. The speaker mentions the need for fluid repletion, CBC, and coagulation studies.
Posterior spinal fusion patient with hypotension
In this scenario, the podcast addresses a rapid response in a post-operative patient with neuromuscular scoliosis and chronic kidney disease. The speaker emphasizes the need to assess the patient's perfusion, surgical site, and drain functionality. They recommend checking for infections, administering fluids, and performing relevant labs, including CBC and coagulation studies. The speaker also highlights the importance of considering the patient's baseline conditions, such as adrenally insufficiency, and checking medications to avoid potential complications.
Prioritizing Interventions in Acute Care
In this podcast episode, the speaker emphasizes the challenge of managing patients on acute care floors and the need to prioritize interventions based on the time it takes to implement them. They highlight the importance of understanding the time differences between acute care floors and ICU floors to set realistic expectations for patient care. The speaker suggests creating a list of common interventions and their time requirements to help guide decision-making. They discuss how patients in between levels of care should be evaluated based on the reason for their condition, such as procedural needs or changes in respiratory support. The speaker also advises healthcare providers to call the ICU when they feel the need for assistance, stressing that judgment and skepticism should be avoided.
Considerations for Patient Escalation
The podcast episode delves into the decision-making process when deciding to escalate a patient's care to the ICU. The speaker emphasizes the importance of assessing chest X-rays and the presence of a pleural effusion, as it can significantly impact patient management. They suggest that if respiratory distress is integrated with increased respiratory support, a chest X-ray should be obtained. The speaker also highlights the need for close monitoring and evaluations, particularly for patients with undifferentiated shock and potential abdominal catastrophes. Collaboration with surgical colleagues and prioritizing tasks, such as delegating responsibilities and ensuring prompt interventions, are essential in managing patients with acute abdominal pathologies. Additionally, the speaker recommends considering ICU admission for patients with complex conditions to facilitate a comprehensive workup and invasive monitoring.
Dr. Nada Mallick is a pediatric intensivist at Children's National Hospital in Washington, DC. She has a master’s in Biochemistry and Molecular Biology from the Johns Hopkins University School of Public Health, after which she did her medical residency and chief resident year at Virginia Commonwealth University and her critical care fellowship at Children's National Hospital. Nada now serves as the physician chair for both the Pediatric Early Recognition and Resuscitation Committee and the Late Rescue Collaborative at Children’s National.
The Cribsiders is a pediatric medicine podcast composed of a national network of students, residents and clinician educators from across the country and multiple institutions. On the show we “curbside” the experts to deconstruct various topics in the world of medicine to provide listeners with clinical pearls, practice-changing knowledge and a weight-based dosing of fun.
Learning Objectives: By the end of this series, listeners should be able to: 1) Describe techniques for diagnosis of historically oppressed groups 2) Describe acute stabilization of impending hypoxemic respiratory failure from a complicated pneumonia. 3) Discuss workup for a patient with undifferentiated shock. 4) Describe options for ICU support for a patient who does not meet ICU criteria.
References
Jones DA, DeVita MA, Bellomo R. Rapid-response teams. N Engl J Med. 2011;365(2):139-146. doi:10.1056/NEJMra0910926
Levin AB, Brady P, Duncan HP, Davis AB. Pediatric Rapid Response Systems: Identification and Treatment of Deteriorating Children. Curr Treat Options Pediatr. 2015;1(1):76-89. doi:10.1007/S40746-014-0005-1/TABLES/1
Gold DL, Mihalov LK, Cohen DM. Evaluating the Pediatric Early Warning Score (PEWS) system for admitted patients in the pediatric emergency department. Acad Emerg Med. 2014;21(11):1249-1256. doi:10.1111/acem.12514
Tews MC, Liu JM, Treat R. Situation-Background-Assessment-Recommendation (SBAR) and Emergency Medicine Residents’ Learning of Case Presentation Skills. J Grad Med Educ. 2012;4(3):370-373. doi:10.4300/JGME-D-11-00194.1
Gross CJ, Porter JJ, Lipsett SC, Monuteaux MC, Hirsch AW, Neuman MI. Variation in Management and Outcomes of Children With Complicated Pneumonia. Hosp Pediatr. 2021;11(3):207-214. doi:10.1542/hpeds.2020-001800
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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