PICU Doc On Call

Dive into the urgent case of a 16-year-old girl with a pulmonary embolism, showcasing the critical role of diagnostic imaging. Discover the complexities of managing venous thromboembolism in pediatric care, highlighting risk factors and the necessity for interdisciplinary collaboration. Learn about the intricacies of heparin therapy, including potential side effects and monitoring protocols. Explore the benefits of low-molecular weight heparin and the evolving landscape of direct oral anticoagulants tailored for young patients.

Dive into the Alveolar Gas Equation with Dr. Pradip Kamat and Dr. Rahul Damania as they unravel the complexities of oxygenation, hypoxemia causes, and A-a gradient interpretation in pediatric critical care. Learn how atmospheric pressure, FiO2, PaCO2, and R influence PAO2 calculation, and explore clinical scenarios highlighting VQ mismatch, shunting, and diffusion defects.

Explore a case of Malignant Hyperthermia in a 23-month-old premature boy during surgery, discussing pathophysiology, clinical signs, symptoms, and management. Learn about Dantraline's role in inhibiting calcium release, clinical features of MH crisis, triggers, and potential complications. Understand differential diagnoses like Neuroleptic Malignant Syndrome and Serotonin Syndrome. Gain insights into managing MH crisis in pediatric patients, emphasizing the need for a coordinated team and pharmacist collaboration.

Exploring the challenging case of a 14-year-old patient with depression who ingested a large amount of medications. Discussing the crucial history and physical exam in ingestion work-up. Differentiating between Calcium Channel Blocker and Beta-Blocker overdose based on ECG findings. Detailing the approach to managing Calcium Channel Blocker overdose with resuscitation, IV calcium salts, and vasopressors. Highlighting the importance of early intervention and specific medical therapies in such overdose cases.

An 8-month-old infant with severe bronchospasm and RSV is discussed. Topics include epidemiology, pathophysiology, diagnosis, and evidence-based management of acute bronchiolitis. The podcast covers etiology, diagnosis, and management frameworks for patients requiring PICU admission. Other topics include inappropriate antibiotic use, mechanical ventilation, ECMO, nitric oxide therapy, and prevention strategies for RSV bronchiolitis in high-risk infants.

Discussion on the management of a six-year-old patient with severe pneumonia and pediatric ARDS, understanding and assessing dead space in arterial blood gas measurements, significance of dead space ratio in evaluating gas exchange, implications and management of dead space in obstructive lung disease, and the concept of dead space fraction in pediatric ARDS.

Explore a unique case of retropharyngeal abscess in a 9-month-old, including clinical manifestations, diagnostic workup, and management strategies. Learn about the dangers and potential complications of RPA in pediatric patients. Gain valuable clinical takeaways for diagnosing and treating this condition.

Dr. Matthew Kirschen, a leader in pediatric neurocritical care and one of the authors of new brain death guidelines, discusses the prerequisites for determining brain death, updates in the guidelines for pediatric neurocritical care, brain death examinations, diagnostic tests, and the importance of communication with families in brain death cases.

The podcast discusses the case of a 2-year-old girl with acute respiratory distress and the use of High-Flow Nasal Cannula (HFNC) therapy. They explore the mechanisms and advantages of HFNC, including improved oxygen efficiency and reduced upper airway resistance. The podcast also debunks the myth of PEEP theory in HFNC and emphasizes the importance of monitoring parameters for assessing its efficacy. Finally, they summarize the physiologic effects of HFNC and encourage listener feedback.

An 8-year-old boy with chest pain, fatigue, and decreased oral intake is admitted to the PICU. They discuss the pathophysiology and epidemiology of acute rheumatic fever, its manifestations and diagnostic measures. Management goals include eliminating strep infection, controlling inflammation, and preventing recurrence. They also explore the use of biomarkers for early detection and treatment of acute rheumatic fever.