PICU Doc On Call

A clinical case of a four-month-old needing MRI sedation sparks a discussion of needle-free intranasal drug use. They explore nasal anatomy and pharmacology that enable rapid nose-to-brain delivery. Practical tips cover atomizer technique, dosing limits per nostril, and how intranasal options compare with oral and IV routes. Common pediatric intranasal drugs and monitoring considerations are reviewed.

A pediatric critical care team breaks down mean arterial pressure using a septic shock case of a six-year-old. They walk through bedside MAP calculation and pediatric reference formulas. Discussion covers physiological drivers like cardiac output, systemic vascular resistance, autonomic and endocrine regulators. Practical targets, monitoring methods, and management steps for maintaining organ perfusion are highlighted.

In this episode of "PICU Doc on Call," Drs. Pradip Kamat and Rahul Damania dive into a pediatric ICU case involving a 4-year-old girl who presents with severe anemia and bleeding, ultimately diagnosed with von Willebrand disease (VWD). They chat about the causes and different types of VWD, walk through the key clinical features, and break down how to diagnose and manage this condition. Drs. Kamat and Damania highlight the important roles of desmopressin and factor concentrates in treatment. Throughout the episode, they stress the need to recognize VWD in kids who have mucosal bleeding and offer practical tips for intensivists on lab evaluation and treatment strategies for this common inherited bleeding disorder.Show Nighlights: Clinical case discussion of a 4-year-old girl with severe anemia and bleeding symptomsDiagnosis of von Willebrand disease (VWD) and its significance in pediatric critical careEtiology and pathogenesis of von Willebrand diseaseClassification of von Willebrand disease into types (Type 1, Type 2 with subtypes, Type 3)Clinical manifestations and symptoms associated with VWDDiagnostic approach for identifying von Willebrand disease, including laboratory testsManagement strategies for VWD, including desmopressin and von Willebrand factor concentratesRole of adjunctive therapies such as antifibrinolytics and hormonal treatmentsImportance of multidisciplinary collaboration in managing complex bleeding disordersOverview of the pathophysiology of von Willebrand factor and its role in hemostasisReferences:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter ***.Reference 1: Leebeek FW, Eikenboom JC. Von Willebrand's Disease. N Engl J Med. 2016 Nov 24;375(21):2067-2080.Reference 2: Ng C, Motto DG, Di Paola J. Diagnostic approach to von Willebrand disease. Blood. 2015 Mar 26;125(13):2029-37.Platton S, Baker P, Bowyer A, et al. Guideline for laboratory diagnosis and monitoring of von Willebrand disease: A joint guideline from the United Kingdom Haemophilia Centre Doctors' Organisation and the British Society for Hematology. Br J Haematol 2024 May;204(5):1714-1731.Mohinani A, Patel S, Tan V, Kartika T, Olson S, DeLoughery TG, Shatzel J. Desmopressin as a hemostatic and blood-sparing agent in bleeding disorders. Eur J Haematol. 2023 May;110(5):470-479. doi: 10.1111/ejh.13930. Epub 2023 Feb 12. PMID: 36656570; PMCID: PMC10073345.

A dramatic pediatric case of massive rectal bleeding sparks a practical walkthrough of stabilization and resuscitation. They explore age-based causes for lower GI bleeding and when to use imaging versus endoscopy. Management of inflammatory bowel disease in acute care gets attention, including steroids, escalation to biologics, and nutritional rehabilitation with multidisciplinary planning.

A riveting discussion focuses on a 9-month-old with hypoglycemia and seizures, delving into glucose metabolism fundamentals. Learn about various causes of hypoglycemia, from metabolic disorders to endocrine issues. The hosts expertly highlight diazoxide as a key treatment for hyperinsulinemic hypoglycemia while addressing its side effects. Insightful tips on quick diagnosis and personalized treatment underscore the importance of prompt intervention in pediatric care, all wrapped in a captivating case study that brings clinical scenarios to life.

The hosts tackle a gripping case of a 10-year-old boy facing post-intubation desaturation. They introduce the DOPE mnemonic to swiftly diagnose issues like displacement and obstruction. Key discussions include the pivotal role of capnography and manual ventilation in emergencies. Techniques to prevent unplanned extubation are highlighted, alongside the importance of teamwork and simulation training. Listeners learn about critical bedside tools and the necessity for a structured approach to managing acute crises in pediatric care.

Join a thrilling discussion about a 16-year-old patient's unexpected diagnosis of paroxysmal nocturnal hemoglobinuria. The hosts break down the pathogenesis, linking mutations to clinical complications like thrombosis and hemolysis. Discover key diagnostic approaches, including flow cytometry and lab tests. Management strategies shine a light on revolutionary treatments like eculizumab. They also review this patient's recovery journey and essential PICU support principles, uncovering vital insights for recognizing this rare condition.

Dr. Neal Laxpati, an assistant professor of neurosurgery and pediatric epilepsy expert, joins the discussion on intracranial pressure (ICP) monitoring in pediatric critical care. He shares insights on external ventricular drains (EVDs) and their setup, emphasizing the risks and challenges like infections and device complications. The conversation explores the significance of cerebrospinal fluid (CSF) in brain function and management strategies tailored for young patients. Listeners will also gain practical tips for optimal bedside care and waveform interpretation.

Explore the intricacies of blood pressure management in pediatric intensive care. The hosts break down the pros and cons of invasive arterial lines versus non-invasive cuffs. They delve into blood pressure targets during critical illnesses like sepsis and traumatic brain injuries. Discover practical strategies for weaning vasoactive medications and the importance of accurate measurements. All this, backed by the latest guidelines and research, offers actionable insights for treating the most vulnerable patients.

A 13-year-old boy experiences sudden muscle weakness after a meal, leading to a diagnosis of familial hypokalemic periodic paralysis. The hosts delve into the genetic mutations involved and discuss crucial management strategies like potassium supplementation. They explore common triggers for episodes, such as carb-heavy meals and exercise, and highlight the importance of genetic testing. Key considerations for anesthesia and cardiac monitoring in these patients are also covered, offering practical insights for clinicians.