PICU Doc On Call

By: Dr. Pradip Kamat Dr. Rahul Damania
  • Summary

  • 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
    Show More Show Less
activate_Holiday_promo_in_buybox_DT_T2
Episodes
  • Approach Toxic Alcohol Ingestion in the PICU
    Oct 15 2024

    Introduction

    • Hosts: Dr. Pradip Kamat (Children’s Healthcare of Atlanta/Emory University) and Dr. Rahul Damania (Cleveland Clinic Children’s Hospital)
    • Mission: A podcast dedicated to current and aspiring pediatric intensivists, exploring intriguing PICU cases and acute care pediatric management
    • Focus of the Episode: Managing toxic alcohol ingestion in the PICU with emphasis on ethanol, methanol, ethylene glycol, propylene glycol, and isopropyl alcohol

    Case Presentation

    • Patient Details: A 7-month-old male presented with accidental ethanol ingestion after his formula was mixed with vodka
    • Key Symptoms: Lethargy, uncoordinated movements, decreased activity, and ethanol odor
    • Initial Labs & Findings:
    • EtOH level: 420 mg/dL.
    • Glucose: 50 mg/dL.
    • Normal CXR and EKG.
    • PICU Presentation: Tachycardic, normotensive, lethargic, with signs of CNS depression
    • Initial Management: Dextrose infusion, glucose monitoring, neurological observation, and ruling out complications

    Key Learning Points from the Case

    • Toxic alcohol ingestion in pediatrics requires rapid stabilization and targeted interventions
    • Hypoglycemia and CNS depression are common features of ethanol toxicity in infants
    • Management prioritizes glucose correction, airway support, and close neurological monitoring

    Deep Dive: Toxic Alcohols in the PICU

    1. Ethanol

    • Typical Presentation in Infants/Toddlers: Hypotonia, ataxia, coma, hypoglycemia, hypotension, and hypothermia
    • Diagnostic Workup:
    • Focus on CNS and metabolic effects
    • Labs: Glucose, electrolytes, bicarbonate, anion gap, ketones, toxicology screen
    • Imaging (head CT) if indicated
    • Management: Stabilization, IV dextrose for hypoglycemia, NPO status until alert, and consultation with poison control and social work

    2. Methanol

    • Sources: Windshield fluids, cleaning agents, moonshine
    • Clinical Stages:

    1. Early:...
    Show More Show Less
    30 mins
  • Multisystem Organ Dysfunction Syndrome (MODS) in the PICU
    Nov 24 2024

    Did you know that Multi-Organ Dysfunction Syndrome (MODS) can result from both infectious and non-infectious causes? In our latest episode, we delve deep into the pathophysiology of MODS, exploring how different organs interact and fail in sequence. We discuss key concepts like organ functional reserve and the kinetics of organ injury, which aren’t as straightforward as they seem. Tune in to learn about the non-linear progression of organ damage and how it impacts management strategies in pediatric critical care.

    We break down the case into key elements:

    1. Patient Background: A 15-year-old girl with chronic TPN dependence and a PICC line presented with septic shock and respiratory failure.
    2. Initial Presentation: Blood cultures confirmed Gram-negative rod bacteremia. She developed multi-system complications, including acute kidney injury (AKI), thrombocytopenia, and cardiac dysfunction.
    3. Management: Broad-spectrum antibiotics, mechanical ventilation, vasoactive agents, and supportive care for MODS.

    Key Case Highlights:
    • Clinical case of a 15-year-old girl with sepsis from a gram-negative rod
    • Dependence on total parenteral nutrition (TPN) and prolonged PICC line use
    • Discussion of septic shock, acute respiratory failure, and acute kidney injury
    • Overview of multiple organ dysfunction syndrome (MODS) and its definitions
    • Pathophysiology of MODS, including organ functional reserve and kinetics of organ injury
    • Molecular mechanisms involved in MODS, such as mitochondrial dysfunction and immune responses
    • Specific phenotypes of sepsis-induced MODS, including TAMOF and IPMOF
    • Management strategies for MODS, emphasizing multidisciplinary approaches
    • Role and complications of therapeutic plasma exchange (TPE) in treating MODS
    • Importance of recognizing signs of MODS and timely intervention in pediatric patients

    Segment 1: MODS Definitions and Phenotypes

    • Key Definition: MODS is the progressive failure of two or more organ systems due to systemic insults (infectious or non-infectious).
    • Phenotypes:
    • TAMOF (Thrombocytopenia-Associated Multi-Organ Failure): Characterized by thrombocytopenia, hemolysis, and decreased ADAMTS13 activity.
    • Immunoparalysis: Persistent immunosuppression and risk of secondary infections.
    • Sequential Liver Failure: Often associated with viral triggers.

    Segment 2: Pathophysiology of MODS

    Molecular Insights:

    • Mitochondrial dysfunction and damage-associated molecular patterns (DAMPs)
    • Innate and adaptive immune dysregulation
    • Microcirculatory dysfunction and ischemia-reperfusion injury
    • Organ Interactions: MODS evolves through complex multi-organ interdependencies

    Segment 3: Diagnosis and Evidence-Based Management

    • Key Diagnostic Pearls:
    • MODS is not solely infection-driven; it requires a shared mechanism and predictable outcomes.
    • Use biomarkers like ADAMTS13 and TNF-α response for phenotypic classification.
    • Management Highlights:
    • Supportive Care: Multisystem approach including lung-protective ventilation, renal replacement therapy, and hemodynamic support.
    • Therapeutic Plasma Exchange (TPE): Especially effective in TAMOF by restoring ADAMTS13 and removing inflammatory mediators.

    Segment 4: Practical Tips for Intensivists

    • Early recognition of MODS phenotypes for targeted therapy
    • Importance of multidisciplinary teamwork in critical care settings
    • Monitoring for complications like TMA and immunoparalysis during prolonged ICU stays

    Follow Us:

    • Twitter: @PICUDocOnCall
    • Email:
    Show More Show Less
    32 mins
  • Acute Hydrocephalus in the PICU
    Nov 17 2024

    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
    • Email:
    Show More Show Less
    36 mins

What listeners say about PICU Doc On Call

Average customer ratings

Reviews - Please select the tabs below to change the source of reviews.