PICU Doc On Call

Today’s episode is dedicated to acute management of laryngospasm. Join us as we discuss the patient case, symptoms, and treatment. Joining us is Dr. Tom Austin, director of General Pediatric Anesthesiology at Children’s Healthcare of Atlanta-Egleston. He’s also an associate professor of anesthesia and pediatrics at Emory University School of Medicine. >>Click here to download the PICU card for this episode<<Show Highlights:Our case: a two-year-old male with a history of Wilms’ tumor presents in a sedation suite for post-surveillance MRIHistory, symptoms, and treatment: One-week history of nasal congestion with no active nasal discharge and clear lung sounds. Patient was placed on continuous pulse ox symmetry and CO2 monitoring. With sedation for the MRI, the patient had a sudden cough, which progressed to perioral cyanosis and loss of end-tidal CO2.How this case illustrates laryngospasmDefinition of laryngospasm: complete or partial closure of the larynx due to some manner of external stimulationWhy laryngospasm leads to acute respiratory failure in childrenHow laryngospasm differs from airway obstructionCharacteristic breathing pattern with laryngospasmAcute management of laryngospasm includes a bag-mask and positive pressure ventilation, followed by deepened sedation, and a breathing tubeWhy early recognition of laryngospasm is the key

Welcome to the first episode of our podcast for current and aspiring intensivists. Our panel of medical professionals and students will examine specific patient cases, symptoms, and treatments. Today’s episode focuses on anaphylaxis. Join us!>>Click here to download the PICU card for this episode<< Show Highlights:Our case: a four-year-old is admitted to PICU, and TPN has been administered.Symptoms: dyspnea, wheezing, strider, and urticariaVitals: hypotensive, tachycardic, with stats dropping rapidlyWhat is anaphylaxis? An acute, life-threatening, systemic allergic reaction that can lead to death by airway obstruction or cardiovascular collapse.Anaphylaxis symptoms include skin, mucosal, respiratory, cardiovascular, and gastrointestinal symptoms that develop within one hour of exposure to the allergen.Anaphylaxis triggers can include allergens, biologics, immunotherapy, and radio-contrast media.The anaphylaxis reaction ends with distributive shock, manifested by low cardiovascular output, low systemic vascular resistance, and high pulmonary vascular resistance.Acute management of an anaphylaxis reaction includes airway, circulation, and breathing management, and epinephrine (the dosing is different from code dose).Watch out for hypotension and lower airway obstruction as possible complications, which can be managed with fluids and nebulized albuterol.Adjunctive therapies include histamine blockers and steroids.Post-anaphylaxis care:Focus on observation of the patient for 10-24 hours.Watch for a biphasic reaction.At discharge, provide two prescriptions for epinephrine, education for the patient and family, and a medical alert bracelet for the patient to wear.