• PICU Management of Malignant Hyperthermia

  • 2024/04/14
  • 再生時間: 30 分
  • ポッドキャスト

PICU Management of Malignant Hyperthermia

  • サマリー

  • Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists.

    • Hosts:
    • Dr. Pradip Kamat: Children’s Healthcare of Atlanta/Emory University School of Medicine
    • Dr. Rahul Damania: Cleveland Clinic Children’s Hospital

    Introduction:

    • Pediatric Intensive Care Unit (PICU) physicians passionate about medical education in the acute care pediatric setting
    • Episode focus: A case of a 23-month-old ex-28 week premie presenting with sudden high fever and rapidly rising ETCO2 during surgery

    Case Presentation:

    • Presented by Dr. Rahul Damania
    • 23-month-old ex-28 week premie intubated during hernia repair surgery
    • Noticed rapidly rising ETCO2, unprovoked tachycardia, and elevated temperature
    • Transferred to PICU, exhibiting rigidity, clenched jaw, metabolic acidosis, and elevated lactate.
    • Consideration of Malignant Hyperthermia (MH) crisis

    Key Points:

    • Elevated temperature, hypercapnia, metabolic acidosis, and unprovoked tachycardia raise concern for MH
    • Organized discussion on pathophysiology, clinical signs, symptoms, and management

    Multiple Choice Question:

    • Diagnosis of MH crisis during scoliosis repair
    • Correct Answer: D) Sarcoplasmic reticulum
    • Dantrolene acts on the sarcoplasmic reticulum to inhibit calcium release, crucial in MH management

    Clinical Presentation of MH Crisis:

    • Tachycardia, acidosis, muscle stiffness, and hyperthermia are hallmark features
    • Potential life-threatening complications underscore the urgency of recognition and treatment

    Triggers and Pathophysiology of MH Crisis:

    • Triggered by inhalational agents and depolarizing neuromuscular blocking agents
    • Pathophysiology involves defective Ryanodine receptor leading to uncontrolled calcium release

    Differential Diagnosis:

    • Includes sepsis, thyroid storm, pheochromocytoma, and neuroleptic malignant syndrome
    • Differentiation from similar conditions crucial for accurate management

    Diagnostic Approach:

    • High clinical suspicion
    • Genetic testing (ryanodine...
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あらすじ・解説

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists.

  • Hosts:
  • Dr. Pradip Kamat: Children’s Healthcare of Atlanta/Emory University School of Medicine
  • Dr. Rahul Damania: Cleveland Clinic Children’s Hospital

Introduction:

  • Pediatric Intensive Care Unit (PICU) physicians passionate about medical education in the acute care pediatric setting
  • Episode focus: A case of a 23-month-old ex-28 week premie presenting with sudden high fever and rapidly rising ETCO2 during surgery

Case Presentation:

  • Presented by Dr. Rahul Damania
  • 23-month-old ex-28 week premie intubated during hernia repair surgery
  • Noticed rapidly rising ETCO2, unprovoked tachycardia, and elevated temperature
  • Transferred to PICU, exhibiting rigidity, clenched jaw, metabolic acidosis, and elevated lactate.
  • Consideration of Malignant Hyperthermia (MH) crisis

Key Points:

  • Elevated temperature, hypercapnia, metabolic acidosis, and unprovoked tachycardia raise concern for MH
  • Organized discussion on pathophysiology, clinical signs, symptoms, and management

Multiple Choice Question:

  • Diagnosis of MH crisis during scoliosis repair
  • Correct Answer: D) Sarcoplasmic reticulum
  • Dantrolene acts on the sarcoplasmic reticulum to inhibit calcium release, crucial in MH management

Clinical Presentation of MH Crisis:

  • Tachycardia, acidosis, muscle stiffness, and hyperthermia are hallmark features
  • Potential life-threatening complications underscore the urgency of recognition and treatment

Triggers and Pathophysiology of MH Crisis:

  • Triggered by inhalational agents and depolarizing neuromuscular blocking agents
  • Pathophysiology involves defective Ryanodine receptor leading to uncontrolled calcium release

Differential Diagnosis:

  • Includes sepsis, thyroid storm, pheochromocytoma, and neuroleptic malignant syndrome
  • Differentiation from similar conditions crucial for accurate management

Diagnostic Approach:

  • High clinical suspicion
  • Genetic testing (ryanodine...

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