PICU Doc On Call

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.

Discover the complexities of Multi-Organ Dysfunction Syndrome (MODS) in pediatric patients. Learn how different organs interact during failure and the non-linear progression of organ damage. The case of a 15-year-old girl with septic shock illustrates critical management strategies involving broad-spectrum antibiotics and mechanical ventilation. Explore the therapeutic potential of plasma exchange in treating sepsis-related complications and the importance of collaborative care in the ICU.

A riveting case of a 15-year-old girl grappling with progressive headaches and severe hydrocephalus takes center stage. The discussion delves into the urgency of evaluation and the critical symptoms to watch for. Insightful insights on managing acute hydrocephalus, including both temporary and permanent CSF diversion techniques, are unveiled. The complexities of differential diagnoses between obstructive and non-obstructive hydrocephalus are thoroughly explored, alongside the implications of various causes and the significance of timely intervention.

IntroductionHosts: Dr. Pradip Kamat (Children’s Healthcare of Atlanta/Emory University) and Dr. Rahul Damania (Cleveland Clinic Children’s Hospital)Mission: A podcast dedicated to current and aspiring pediatric intensivists, exploring intriguing PICU cases and acute care pediatric managementFocus of the Episode: Managing toxic alcohol ingestion in the PICU with emphasis on ethanol, methanol, ethylene glycol, propylene glycol, and isopropyl alcoholCase PresentationPatient Details: A 7-month-old male presented with accidental ethanol ingestion after his formula was mixed with vodkaKey Symptoms: Lethargy, uncoordinated movements, decreased activity, and ethanol odorInitial Labs & Findings:EtOH level: 420 mg/dL.Glucose: 50 mg/dL.Normal CXR and EKG.PICU Presentation: Tachycardic, normotensive, lethargic, with signs of CNS depressionInitial Management: Dextrose infusion, glucose monitoring, neurological observation, and ruling out complicationsKey Learning Points from the CaseToxic alcohol ingestion in pediatrics requires rapid stabilization and targeted interventionsHypoglycemia and CNS depression are common features of ethanol toxicity in infantsManagement prioritizes glucose correction, airway support, and close neurological monitoringDeep Dive: Toxic Alcohols in the PICU1. EthanolTypical Presentation in Infants/Toddlers: Hypotonia, ataxia, coma, hypoglycemia, hypotension, and hypothermiaDiagnostic Workup:Focus on CNS and metabolic effectsLabs: Glucose, electrolytes, bicarbonate, anion gap, ketones, toxicology screenImaging (head CT) if indicatedManagement: Stabilization, IV dextrose for hypoglycemia, NPO status until alert, and consultation with poison control and social work2. MethanolSources: Windshield fluids, cleaning agents, moonshineClinical Stages:Early: Dizziness, nausea, vomiting (0–6 hours)Latent: Asymptomatic (6–30 hours)Late: Vision disturbances, seizures, respiratory failure (6–72 hours)Key Symptoms: “Snowstorm blindness” from retinal toxicityManagement: Fomepizole, correction of metabolic acidosis, and hemodialysis in severe cases3. Ethylene GlycolSources: Antifreeze, brake fluids, household cleanersPathophysiology: Metabolism to glycolic acid (acidosis) and oxalic acid (renal failure due to calcium oxalate crystals)Red Flags: Hypocalcemia, renal failure, QT prolongationManagement: Fomepizole, supportive care, and hemodialysis for severe toxicity4. Propylene GlycolSources: Medications like lorazepam and pentobarbitalPresentation: High anion gap metabolic acidosis at high doses, with renal and liver dysfunctionManagement: Discontinue offending agent, supportive care, and hemodialysis if severe5. Isopropyl AlcoholSources: Disinfectants, hand sanitizersPresentation: CNS depression, GI irritation, fruity acetone breath, but no metabolic acidosisManagement: Supportive care; fomepizole and ethanol are ineffectiveKey Laboratory InsightsOsmolar Gap Formula:Measured Osmolality - Calculated OsmolalityA high osmolar gap indicates unmeasured osmoles like toxic alcohols.Lactate Gap in Ethylene Glycol: Discrepancy between bedside and lab lactate levels due to glycolate interferenceManagement PearlsEthanol and Ethylene Glycol: Fomepizole as first-line treatment; hemodialysis for severe casesMethanol: Similar approach with additional focus on preventing blindnessPropylene Glycol: Monitor lactate and renal function, discontinue offending medicationsIsopropyl Alcohol: Supportive care, no acidosis presentMnemonics for Toxic AlcoholsMEGA GAP:Methanol and Ethylene Glycol: Anion Gap Acidosis with elevated Osmolar GapIsopropyl Alcohol: Isolated Osmolar Gap (no acidosis)Propylene Glycol: Mimics ethylene glycol with HAGMA at high dosesTakeaway MessagesEarly recognition of toxic alcohol ingestion is critical for successful managementDifferentiate between toxic alcohols using anion gap, osmolar gap, and clinical presentationEngage poison control and social work early in the processConclusionPediatric toxic alcohol ingestions are rare but potentially life-threateningFomepizole is a cornerstone therapy for methanol and ethylene glycol toxicitySupportive care remains essential across all toxic alcohol ingestionsConnect with US!Twitter: @PICUDocOnCallEmail: contact@picudoconcall.com

In this enlightening discussion, Dr. Jordan Dent, a second-year fellow from Children’s Healthcare of Atlanta, dives into a critical case of a 15-year-old male suffering from exertional heat stroke during football practice. They explore the pathophysiology of heat stroke, emphasizing the failure of thermoregulation and the severe complications that can arise, such as multiorgan dysfunction. Dent and the hosts discuss vital management strategies, including rapid cooling techniques and the importance of early recognition to minimize risks in young athletes.