PICU Doc On Call

In this episode of "PICU Doc on Call," pediatric intensivists Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Monica Gray discuss a critical case involving a 16-year-old male who experienced severe carbon monoxide poisoning after being found unresponsive in a garage. They chat about the pathophysiology, clinical manifestations, diagnostic workup, and management of carbon monoxide toxicity. Furthermore, they cover the importance of early oxygen administration, recognizing potential delayed neurological sequelae, and keeping an eye out for cardiac complications. Tune in and hear more about a comprehensive approach to treatment and the significance of multidisciplinary support for achieving the best patient outcomes.Show Highlights:Case presentation of a 16-year-old male with severe carbon monoxide poisoningPathophysiology of carbon monoxide toxicity and its effects on hemoglobinClinical manifestations and symptoms associated with carbon monoxide poisoningDiagnostic workup for suspected carbon monoxide exposureManagement principles for treating carbon monoxide poisoning in pediatric patientsSources and scenarios leading to carbon monoxide poisoningComplications arising from carbon monoxide exposure including neurological injuriesImportance of early oxygen administration and monitoring in treatmentDiscussion of hyperbaric oxygen therapy and its indicationsKey takeaways for clinicians regarding the management and follow-up of carbon monoxide poisoning casesWe welcome you to share your feedback, subscribe & place a review on our podcast! Please visit our website picudoconcall.org.References:Tapking, C., et al. (2021). Burn and inhalation injury. In J. J. Zimmerman & A. T. Rotta (Eds.), Fuhrman and Zimmerman’s Pediatric Critical Care (6th ed., pp. 1347–1362). Elsevier.Nañagas KA, Penfound SJ, Kao LW. Carbon Monoxide Toxicity. Emerg Med Clin North Am. 2022 May;40(2):283-312. doi: 10.1016/j.emc.2022.01.005. Epub 2022 Apr 5. PMID: 35461624.Smollin C, Olson K. Carbon monoxide poisoning (acute). BMJ Clin Evid. 2010 Oct 12;2010:2103. PMID: 21418677; PMCID: PMC3217756.Palmeri R, Gupta V. Carboxyhemoglobin Toxicity. [Updated 2023 Apr 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.

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!

Measles is making a comeback in the U.S., with recent outbreaks highlighting critical public health challenges. Experts discuss the virus's clinical features, complications, and the essential role of vaccinations in preventing spread. They delve into vaccine hesitancy, linking it to historical outbreaks and stressing the necessity of strong immunization efforts. Listeners will also learn about the immune response to measles and the importance of public advocacy for childhood vaccinations to protect vulnerable populations.

Dive into a fascinating case of a 15-year-old girl battling acute myocarditis and respiratory distress. Discover how positive pressure ventilation intricately affects heart function. Learn about the crucial interplay between cardiac output, preload, and afterload in managing the condition. Explore strategies for optimizing fluid management and enhancing myocardial performance. This discussion underscores the importance of teamwork and continuous monitoring to improve outcomes for critically ill pediatric patients.

The discussion highlights a critical case of a 12-year-old girl with a ruptured aneurysm and subarachnoid hemorrhage. The podcast delves into the complex interplay between traumatic brain injury and various non-neurological organ dysfunctions, including cardiovascular and pulmonary complications. It emphasizes the significance of understanding these interactions for effective management. Interventions for renal and hepatic impacts are explored, along with innovative treatments for hematologic issues, illustrating the need for comprehensive and skilled care in pediatric patients.

Discover the intricate challenges of managing pneumonia in pediatric patients through a gripping clinical case. A 10-year-old girl with respiratory distress highlights the importance of recognizing symptoms and risk factors, such as incomplete vaccinations and young age. The hosts break down the diagnostic process, emphasizing the role of imaging and lab tests. Learn about the serious complications that can arise, like pleural effusions, and how timely intervention can make all the difference in the ICU.

A gripping account unfolds as a 15-year-old girl confronts tragedy during a house fire while heroically saving loved ones. The discussion delves into the complexities of inhalation injuries, highlighting the importance of recognizing signs of airway compromise. Medical experts detail management strategies and the crucial distinctions between carbon monoxide and cyanide poisoning. The urgency of immediate treatment in pediatric emergencies is stressed, offering valuable insights into the complications of such devastating incidents.

This discussion dives into the urgent management of toxic alcohol ingestion in infants. A critical case involving a 7-month-old highlights symptoms like lethargy and CNS depression following accidental ethanol consumption. The podcast covers the challenges posed by methanol and ethylene glycol poisoning, emphasizing early recognition and treatment. Notably, Fomipazole is spotlighted as a key treatment, along with the role of hemodialysis in severe cases. Overall, it underscores the vital importance of timely interventions in pediatric critical care.