PedsCrit

This podcast explores communication strategies and palliative care in the PICU. Topics include the R-E-M-A-P framework for discussing difficult medical situations, using nurse statements to build rapport, developing communication skills in the ICU, and navigating difficult scenarios in palliative care.

Pediatric palliative care specialists discuss the definition of palliative care, the importance of early involvement, and debunk misconceptions about hospice care. They share their approach to communicating with families in challenging cases, emphasizing listening, humility, and being forthright. The chapter also covers general principles and guidelines for involving palliative care in seriously ill patients, and provides tips for communicating with families in different clinical scenarios.

Dr. Greg Yurasek, a CICU attending and the director of critical care simulation at Children’s National Hospital, discusses d-TGA physiology & repair, including preoperative considerations, intubation in newborns, levels of mixing, prostaglandin, early repair, and the arterial switch operation. The average length of hospital stay and potential long-term complications are also explored.

Dr. Yurasek is a graduate of the Columbia University College of Physicians and Surgeons. He completed his pediatric residency at Children’s Hospital of Boston followed by a pediatric cardiology fellowship also at Boston Children’s and a PICU fellowship at Massachusetts General Hospital. He is now a CICU attending and the director of critical care simulation at Children’s National Hospital in Washington, DC. How to support PedsCrit:Please rate and review on Spotify or Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Objectives for this series:1. Understand the preoperative anatomy that influences surgical plan and postoperative care in the cardiac intensive care unit (CICU).2. Recall the goals and general steps of operative repair.3. Recognize the key information provided in post-op handoff that will affect management.4. Recognize important postoperative complications and develop an approach to their management.5. Develop a mental framework of the expected postoperative CICU course with a focus on barriers to ICU discharge.Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. 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.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Dr. Yehya is a graduate of the University of California at Berkeley and the University of California at Los Angeles School of Medicine. After completing pediatrics training at Children’s Hospital of Los Angeles, he completed his pediatric critical care fellowship at Children’s Hospital of Philadelphia (CHOP), and joined the faculty after graduation in 2011. He is currently an Assistant Professor of Anesthesiology and Critical Care and Pediatrics at the Perelman School of Medicine at the University of Pennsylvania and an attending physician in the pediatric intensive care unit at CHOP.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.Objectives for this series:By the end of listening to this three-part series, learners should be able to:Recall the diagnostic criteria for pediatric acute respiratory distress syndrome (PARDS). Recall many of different direct and indirect causes of PARDS.Recall the methods used to stratify the severity of PARDS.Recognize the limitations of P/F ratios and the clinical utility of instead using oxygenation index (OI).Describe the rationale and limitations of adjunctive therapies for moderate to severe PARDS.CitationsPediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16(5):428-439. doi:10.1097/PCC.0000000000000350 Acute Respiratory Distress syndrome Incidence and Epidemiology (PARDIE) Investigators, & Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network (2019). Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study. The Lancet. Respiratory medicine, 7(2), 115–128. https://doi.org/10.1016/S2213-2600(18)30344-8Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. 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.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Dr. Yehya is a graduate of the University of California at Berkeley and the University of California at Los Angeles School of Medicine. After completing pediatrics training at Children’s Hospital of Los Angeles, he completed his pediatric critical care fellowship at Children’s Hospital of Philadelphia (CHOP), and joined the faculty after graduation in 2011. He is currently an Assistant Professor of Anesthesiology and Critical Care and Pediatrics at the Perelman School of Medicine at the University of Pennsylvania and an attending physician in the pediatric intensive care unit at CHOP.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.Objectives for this series:By the end of listening to this three-part series, learners should be able to:Recall the diagnostic criteria for pediatric acute respiratory distress syndrome (PARDS). Recall many of different direct and indirect causes of PARDS.Recall the methods used to stratify the severity of PARDS.Recognize the limitations of P/F ratios and the clinical utility of instead using oxygenation index (OI).Describe the rationale and limitations of adjunctive therapies for moderate to severe PARDS.CitationsPediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16(5):428-439. doi:10.1097/PCC.0000000000000350 Acute Respiratory Distress syndrome Incidence and Epidemiology (PARDIE) Investigators, & Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network (2019). Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study. The Lancet. Respiratory medicine, 7(2), 115–128. https://doi.org/10.1016/S2213-2600(18)30344-8Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. 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.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Dr. Yehya is a graduate of the University of California at Berkeley and the University of California at Los Angeles School of Medicine. After completing pediatrics training at Children’s Hospital of Los Angeles, he completed his pediatric critical care fellowship at Children’s Hospital of Philadelphia (CHOP), and joined the faculty after graduation in 2011. He is currently an Assistant Professor of Anesthesiology and Critical Care and Pediatrics at the Perelman School of Medicine at the University of Pennsylvania and an attending physician in the pediatric intensive care unit at CHOP.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.Objectives for this series:By the end of listening to this three-part series, learners should be able to:Recall the diagnostic criteria for pediatric acute respiratory distress syndrome (PARDS). Recall many of different direct and indirect causes of PARDS.Recall the methods used to stratify the severity of PARDS.Recognize the limitations of P/F ratios and the clinical utility of instead using oxygenation index (OI).Describe the rationale and limitations of adjunctive therapies for moderate to severe PARDS.CitationsPediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16(5):428-439. doi:10.1097/PCC.0000000000000350 Acute Respiratory Distress syndrome Incidence and Epidemiology (PARDIE) Investigators, & Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network (2019). Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study. The Lancet. Respiratory medicine, 7(2), 115–128. https://doi.org/10.1016/S2213-2600(18)30344-8Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. 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.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Samuel Mandell, M.D., M.P.H., is an Associate Professor in the Department of Surgery at UT Southwestern Medical Center. He specializes in trauma surgery, surgical critical care, and comprehensive care of burn-injured patients. Dr. Mandell also serves as Burn Section Chief and Director of the Parkland Regional Burn Center in Dallas, Texas.Objectives for this series:By the end of listening to this two-part series, learners should be able to:1. Describe the key elements of the initial evaluation and resuscitation of the burn injured pediatric patient.2. Recognize risk factors and clinical features of inhalation injury.3. Recognize risk factors and clinical features of carbon monoxide and cyanide poisoning.4. Estimate the total body surface area (TBSA) burned.5. Recall general indications for transfer to a specialty burn center.Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. 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.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Samuel Mandell, M.D., M.P.H., is an Associate Professor in the Department of Surgery at UT Southwestern Medical Center. He specializes in trauma surgery, surgical critical care, and comprehensive care of burn-injured patients. Dr. Mandell also serves as Burn Section Chief and Director of the Parkland Regional Burn Center in Dallas, Texas.Objectives for this series:By the end of listening to this two-part series, learners should be able to:1. Describe the key elements of the initial evaluation and resuscitation of the burn injured pediatric patient.2. Recognize risk factors and clinical features of inhalation injury.3. Recognize risk factors and clinical features of carbon monoxide and cyanide poisoning.4. Estimate the total body surface area (TBSA) burned.5. Recall general indications for transfer to a specialty burn center.Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. 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.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Dr. Bortcosh is an Assistant Professor in the Division of Pediatric Critical Care and a practicing pediatric intensivist at the University of Florida. Learning Objectives for this series:Discuss unique physiology of the neuromuscular patient and how it relates to work of breathingDefine obstacles to effective ventilation in patients with neuromuscular diseaseDescribe ventilation strategies to utilize in patients with neuromuscular diseaseReferences1.Bushby K, Finkel R, Birnkrant DJ, Case LE, Clemens PR, Cripe L, et al. Diagnosis and management of Duchenne muscular dystrophy, part 2: implementation of multidisciplinary care. Lancet Neurol. 2010;9(2):177-89.2.Mercuri E, Finkel RS, Muntoni F, Wirth B, Montes J, Main M, et al. Diagnosis and management of spinal muscular atrophy: Part 1: Recommendations for diagnosis, rehabilitation, orthopedic and nutritional care. Neuromuscul Disord. 2018;28(2):103-15.3.Finkel RS, Mercuri E, Meyer OH, Simonds AK, Schroth MK, Graham RJ, et al. Diagnosis and management of spinal muscular atrophy: Part 2: Pulmonary and acute care; medications, supplements and immunizations; other organ systems; and ethics. Neuromuscul Disord. 2018;28(3):197-207.4.Marino PL SK. The ICU Book. Wilkins LW, editor. Philadelphia: Lippincott Williams & Wilkins; 2007.5.Machado DL, Silva EC, Resende MB, Carvalho CR, Zanoteli E, Reed UC. Lung function monitoring in patients with duchenne muscular dystrophy on steroid therapy. BMC Res Notes. 2012;5:435.6.Wheeler DS, Wong HR, Zingarelli B. Pediatric Sepsis - Part I: "Children are not small adults!". Open Inflamm J. 2011;4:4-15.7.Lo Mauro A, Aliverti A. Physiology of respiratory disturbances in muscular dystrophies. Breathe (Sheff). 2016;12(4):318-27.8.Diaz CE, Deoras KS, Allen JL. Chest wall motion before and during mechanical ventilation in children with neuromuscular disease. Pediatr Pulmonol. 1993.9.Perez A, Mulot R, Vardon G, Barois A, Gallego J. Thoracoabdominal pattern of breathing in neuromuscular disorders. Chest. 1996;110(2):454-61.10.Testa MB, Pavone M, Bertini E, Petrone A, Pagani M, Cutrera R. Sleep-disordered breathing in spinal muscular atrophy types 1 and 2. Am J Phys Med Rehabil. 2005;84(9):666-70.Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. 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.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.