PICU Doc On Call

著者: Dr. Pradip Kamat Dr. Rahul Damania
  • サマリー

  • PICU Doc On Call is the podcast for current and aspiring Intensivists. This podcast will provide protocols that any Critical Care Physician would use to treat common emergencies and the sudden onset of acute symptoms. Brought to you by Emory University School of Medicine, in conjunction with Dr. Rahul Damania and under the supervision of Dr. Pradip Kamat.
    Copyright 2024 Dr. Pradip Kamat, Dr. Rahul Damania
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あらすじ・解説

PICU Doc On Call is the podcast for current and aspiring Intensivists. This podcast will provide protocols that any Critical Care Physician would use to treat common emergencies and the sudden onset of acute symptoms. Brought to you by Emory University School of Medicine, in conjunction with Dr. Rahul Damania and under the supervision of Dr. Pradip Kamat.
Copyright 2024 Dr. Pradip Kamat, Dr. Rahul Damania
エピソード
  • Acute Hydrocephalus in the PICU
    2024/11/17

    In this episode, we discuss the case of a 15-year-old girl who presents with progressive headache, nausea, vomiting, and difficulty ambulating. Her condition rapidly evolves into altered mental status and severe hydrocephalus, leading to a compelling discussion about the evaluation, diagnosis, and management of hydrocephalus in pediatric patients.

    We break down the case into key elements:

    • A comprehensive look at acute hydrocephalus, including its pathophysiology and causes
    • Epidemiological insights, clinical presentation, and diagnostic approaches
    • Management strategies, including temporary and permanent CSF diversion techniques
    • A review of complications related to shunts and endoscopic third ventriculostomy

    Key Case Highlights:
    • Patient Presentation:
    • A 15-year-old girl with a 3-day history of worsening headaches, nausea, vomiting, and difficulty walking
    • Altered mental status and bradycardia upon PICU admission
    • CT scan revealed severe hydrocephalus without a clear mass lesion
    • Management Steps in the PICU:
    • Hypertonic saline bolus improved her mental status and pupillary reactions
    • Neurosurgery consultation recommended MRI and close neuro checks
    • Initial management included dexamethasone, keeping the patient NPO, and hourly neuro assessments
    • Differential Diagnosis:
    • Obstructive (non-communicating) vs. non-obstructive (communicating) hydrocephalus
    • Consideration of alternative diagnoses like intracranial hemorrhage and idiopathic intracranial hypertension

    Episode Learning Points:
    • Hydrocephalus Overview:
    • Abnormal CSF buildup in the ventricles leading to increased intracranial pressure (ICP)
    • Key distinctions between obstructive and non-obstructive types

    Epidemiology and Risk Factors:

    • Congenital causes include genetic syndromes, neural tube defects, and Chiari malformations
    • Acquired causes: post-hemorrhagic hydrocephalus (e.g., from IVH in preemies), infections like TB meningitis, and brain tumors

    Clinical Presentation:

    • Infants: Bulging fontanelles, sunsetting eyes, irritability
    • Older children: Headaches, vomiting, papilledema, and gait disturbances

    Management Framework:

    • Temporary CSF diversion via external ventricular drains (EVD) or lumbar catheters
    • Permanent interventions include VP shunts and endoscopic third ventriculostomy (ETV)

    Complications of Shunts and ETV:

    • Shunt infections, malfunctions, over-drainage, and migration
    • ETV-specific risks, including delayed failure years post-procedure

    Clinical Pearl:

    • Communicating hydrocephalus involves symmetric ventricular enlargement and is often linked to inflammatory or post-treatment changes affecting CSF reabsorption.

    Hosts’ Takeaway Points:

    • Dr. Pradip Kamat emphasizes the importance of timely recognition and intervention in hydrocephalus to prevent complications like brain herniation.
    • Dr. Rahul Damania highlights the need for meticulous neurological checks in PICU patients and an individualized approach to treatment.

    Resources Mentioned:
    • Hydrocephalus Clinical Research Network guidelines.
    • Recent studies on ETV outcomes in pediatric populations.

    Call to Action:

    If you enjoyed this discussion, please subscribe to PICU Doc On Call and leave a review. Have a topic you’d like us to cover? Reach out to us via email or on social media!

    Follow Us:

    • Twitter: @PICUDocOnCall
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    36 分
  • It’s Getting Hot in Here | Heat Stroke in the PICU
    2024/10/13
    Introduction:

    Today, Dr. Rahul Damania, Dr. Pradip Kamat, and their guest, Dr. Jordan Dent, discuss a critical case involving a 15-year-old male who collapsed during football practice due to exertional heat stroke. The discussion emphasizes the clinical presentation, risk factors, pathophysiology, and evidence-based management of heat stroke and other heat-related illnesses in pediatric patients. The episode also delves into the role of rapid cooling interventions and long-term care to minimize mortality and morbidity.

    Case Summary: A 15-year-old male with ADHD collapsed during football practice on a hot, humid day. He presented with:

    • Normotension (BP: 101/67 mmHg)
    • Tachycardia (HR: 157 bpm)
    • Tachypnea (RR: 40 breaths/min)
    • Febrile (Rectal temp: 41.8°C/107.2°F)
    • Dry, hot skin, GCS of 9
    • Lab abnormalities: hyponatremia, hypokalemia, hypoglycemia, elevated creatinine, liver enzymes, lactate, CK, and troponin

    After suffering cardiac arrest and undergoing resuscitation, the patient developed multiorgan dysfunction, including seizures, encephalopathy, and cerebral edema. Despite severe initial complications, the patient demonstrated neurological improvement with left-side hemiparesis before discharge.

    Key Discussion Points:

    1. Etiology and Pathophysiology of Heat Stroke:

    • Heat stroke occurs when the body’s thermoregulatory mechanisms fail, leading to dangerous elevations in core body temperature. Exertional heat stroke is common during strenuous physical activity in hot, humid environments.
    • Key physiological breakdowns include inadequate sweating, vasodilation dysfunction, and subsequent cellular damage due to hyperthermia.

    1. Risk Factors for Exertional Heat Stroke:

    • Environmental factors: High temperature, humidity, lack of hydration, and breaks.
    • Athlete-related factors: Hypohidrosis, dehydration, medical conditions, and medications (e.g., Adderall).
    • Heat illness is the third leading cause of death in high school athletics, with American football players particularly at risk.

    1. Spectrum of Heat-Related Illness:

    • Heat Cramps: Involuntary muscle contractions due to dehydration and electrolyte imbalance.
    • Heat Syncope: Transient loss of consciousness due to heat exposure.
    • Heat Exhaustion: Milder heat illness with core temperature < 104°F, potentially progressing to heat stroke if untreated.
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    30 分
  • Hemostatis and Coagulation in the PICU
    2024/08/04
    Introduction

    Welcome to PICU Doc On Call, a podcast dedicated to current and aspiring pediatric intensivists. I'm Dr. Pradip Kamat from Children’s Healthcare of Atlanta/Emory University School of Medicine, and I’m Dr. Rahul Damania from Cleveland Clinic Children’s Hospital. We are two Pediatric ICU physicians passionate about medical education in the PICU. This podcast focuses on interesting PICU cases and their management in the acute care pediatric setting.

    Episode Overview

    In today’s episode, we are excited to welcome Dr. Karen Zimowski, Assistant Professor of Pediatrics at Emory University School of Medicine and a practicing pediatric hematologist at Children’s Healthcare of Atlanta at the Aflac Blood & Cancer Center. Dr. Zimowski specializes in pediatric bleeding and clotting disorders.

    Case Presentation

    A 16-year-old female with a complex medical history, including autoimmune thyroiditis and prior cerebral infarcts, was admitted to the PICU with acute chest pain and difficulty breathing. Despite being on low-dose aspirin, her oxygen saturation was 86% on room air. A CT angiography revealed a pulmonary embolism (PE) in the left lower lobe and signs of right heart strain. The patient was hemodynamically stable, and thrombolytic therapy was deferred in favor of anticoagulation. She was placed on BiPAP to improve her respiratory status. Her social history was negative for smoking, illicit drug use, or oral contraceptive use.

    Key Case Points
    • Diagnosis: Pulmonary embolism (PE)
    • Hemodynamics: Stable with no right ventricular (RV) strain on echocardiogram
    • Management Focus: Anticoagulation and consultation with the hematology/thrombosis team

    Expert Discussion with Dr. Karen ZimowskiRisk Factors and Epidemiology of VTE in Pediatrics
    • Pathophysiology: Venous thromboembolism (VTE) in children involves components of Virchow’s triad: stasis of blood flow, endothelial injury, and hypercoagulability.
    • Incidence: VTE is rare in the general pediatric population but increases significantly in hospitalized children.
    • Age Distribution: Bimodal peaks in infants and adolescents aged 15-17 years.
    • Risk Factors: Central venous lines, infections, congenital heart disease, cancer, and autoimmune disorders.

    Clinical Manifestations of DVT
    • Symptoms: Swelling, pain, warmth, and skin discoloration in the affected extremity.
    • Specific Presentations:
    • SVC syndrome from superior vena cava thrombosis
    • Abdominal pain from portal vein thrombosis
    • Hematuria from renal vein thrombosis
    • Neurological symptoms...
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    50 分

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