PICU Doc On Call

Ready for a deep dive into a real-life pediatric ICU situation? Today,  Dr. Pradip Kamat, Dr. Monica Gray, and Dr. Rahul Damania will walk you through the case of a seven-year-old girl with Hemoglobin SC (HbSC) disease, who presents with abdominal swelling, pneumonia, low oxygen, and pain.In this episode, our team unpacks the spleen’s anatomy and its crucial role in immunity, then zooms in on how sickle cell disease can throw a wrench in splenic function. You’ll hear how they approach the diagnosis and management of acute splenic sequestration crisis, sharing clinical pearls along the way. Plus, they’ll break down why quick recognition is so important and discuss strategies for both immediate and long-term care in pediatric sickle cell patients. Don’t miss these practical insights from the frontlines of pediatric critical care!Show Highlights:Case study of a seven-year-old girl with hemoglobin SC diseasePresentation of symptoms: abdominal distension, pneumonia, hypoxia, and body painDiscussion of acute splenic sequestration crisis as a complication of sickle cell diseaseAnatomy and physiology of the spleenThe role of the spleen in sickle cell disease and how sickled cells affect splenic functionAcute splenic sequestration crisis, including clinical features and laboratory evaluationsManagement strategies for acute splenic sequestration crisis in the ICUImportance of blood transfusions and supportive care in treatmentProphylactic measures to prevent recurrence of splenic sequestrationEducational emphasis on recognizing clinical signs and the need for timely interventionReferences:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 88. Hemoglobinopathies. Baender, MA, Marsh Anne. Pages: 1457-1470Rogers' textbook of pediatric intensive care: Hematologic Emergencies. McCory MC, Bhar S, and Blaine E. Pages 2003-2005Brousse V, Buffet P, Rees D. The spleen and sickle cell disease: the sick(led) spleen. Br J Haematol. 2014 Jul;166(2):165-76. doi: 10.1111/bjh 12950. Epub 2014 May 26. PMID: 24862308.Waleed S, Aldabsa M, Gouher S. Splenic Sequestration Induced by Parvovirus B19: A Case Report. Cureus. 2024 May 23;16(5):e60937. doi: 10.7759/cureus. 60937. PMID: 38915956; PMCID: PMC11195323.Solanki DL, Kletter GG, Castro O. Acute splenic sequestration crises in adults with sickle cell disease. Am J Med. 1986 May;80(5):985-90. doi: 10.1016/0002-9343(86)90649-2. PMID: 3706382.Karna B, Jha SK, Al Zaabi E. Hemoglobin C Disease. [Updated 2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559043/

A young girl presents with seizures and respiratory failure, prompting a deep dive into Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. The discussion highlights the complexities of diagnosing this challenging autoimmune disorder in pediatric care. Experts emphasize the critical need for early immunosuppressive therapy and a multidisciplinary approach. Through real case analysis, listeners gain insights into effective management strategies, including airway control and collaboration with specialists, enhancing patient outcomes in acute neuroimmunological emergencies.

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.

In a gripping discussion, experts analyze a case of an 18-month-old who ingested concentrated bleach, leading to severe symptoms like stridor and drooling. They delve into emergency management strategies, emphasizing airway safety and the critical role of endoscopy in treatment. The podcast outlines the long-term risks associated with caustic substances, including esophageal strictures and cancer. Preventive measures and the importance of educating families about household hazards are also highlighted, making this a vital resource for pediatric care.

Today, Dr. Monica Gray, Dr. Pradip Kamat, and Dr. Rahul Damania discuss two real-life pediatric cases of hyponatremia in the PICU. They talk through a case of a six-month-old baby with severe sodium depletion and a teenager dealing with cancer-related hyponatremia. The team breaks down the pathophysiology, walks us through the diagnostic workups, and discusses the careful management needed for these cases. They emphasize the importance of correcting sodium levels gradually and addressing the root cause of the problem. They share practical tips for intensivists and highlight why staying vigilant and following evidence-based care is so crucial when managing critically ill kids with electrolyte disturbances. Tune in to hear more!Show Highlights:Discussion of hyponatremia in pediatric patients, particularly in the PICUPresentation of two case studies illustrating different presentations of hyponatremiaExamination of the pathophysiology of hyponatremia, including its classification into hypovolemic, euvolemic, and hypervolemic typesOverview of diagnostic investigations for hyponatremia, including volume status assessment and serum/urine electrolyte measurementsManagement strategies for hyponatremia, emphasizing the importance of gradual correction of sodium levelsRisks associated with rapid correction of hyponatremiaImportance of fluid management in different types of hyponatremiaRole of pharmacological interventions in specific cases, such as SIADHClinical presentation and symptoms associated with hyponatremia in pediatric patientsEmphasis on continuous monitoring of sodium levels and clinical status during treatmentReferences:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 71. Fluid and electrolyte issues in pediatric critical illness. Evans I, Joyce E. Page 866-872Rogers' textbook of Pediatric Intensive Care Chapter 108: Disorders of Water, Sodium and Potassium homeostasis: Schneider J & Glater-Welt L. Pages 1868-1880Harrison’s Principles of Internal Medicine Volume 1. Chapter 53: Fluid and Electrolyte Disturbances. Mount D. Pages 338-347

The hosts discuss a critical case involving a one-month-old infant with respiratory distress and fever, linked to viral myocarditis. They explore the complexities of its diagnosis, symptoms, and management strategies in pediatric care. Key topics include the role of echocardiography, the significance of recognizing atypical symptoms, and various treatment options like IVIG and steroids. The conversation emphasizes the importance of a multidisciplinary team approach and the impact of timely intervention on outcomes.

A gripping case unfolds as a 16-year-old battles severe carbon monoxide poisoning after being found unresponsive. The discussion dives into the pathophysiology behind this toxic exposure and its alarming effects on hemoglobin. Key insights include the urgency of early oxygen administration and the potential for neurological complications. Experts outline essential diagnostic methods and management strategies while emphasizing the need for a multidisciplinary approach. The impact on cardiac health is also highlighted, making this a must-listen for pediatric care.

Explore the oxygen extraction ratio (O2ER) and its significance in pediatric critical care. Discover how this crucial metric impacts the management of cases like severe pneumonia and ARDS. The hosts delve into calculating O2ER and the importance of central venous oxygen saturation (ScvO2) for optimizing oxygen delivery. Learn strategies to enhance oxygen supply while minimizing demand in critically ill young patients. This engaging conversation highlights vital clinical insights that can lead to improved outcomes for the most vulnerable.

Dive into a gripping case of a five-week-old baby suffering from acute respiratory failure due to pertussis. The experts dissect the disease's stages, early symptoms, and critical management strategies needed for infants. They discuss the alarming public health implications, emphasizing vaccination to prevent outbreaks. Additionally, the podcast unpacks severe complications associated with pertussis and urges the importance of early recognition and support in pediatric care. Get ready for an insightful exploration of this potentially life-threatening disease!

Join the experts as they tackle upper airway obstruction in children, starting with a compelling case of a 12-month-old girl with stridor and fever. Key insights include the crucial role of calming the child and positioning for optimal treatment. They explain the significance of dexamethasone and racemic epinephrine in managing croup, while also discussing serious infections like epiglottitis. The hosts highlight essential diagnostic signs and emphasize the importance of timely interventions, making it a must-listen for healthcare professionals!