Tag Archive for: Pediatrics

Approach to the Critically Ill Child: Shock

15 Oct
October 15, 2018

If you mainly treat adults or both adults and children like me, then you have probably heard the (very annoying) quote, “kids are not just small adults”, and so I won’t say it again. Well, I guess I just did, but at least I wont stop at this quote, but attempt to explain how kids are not small adults, and how this may impact their care in the emergency department and the intensive care unit.

Nearly all organ systems of young children are immature and developing throughout childhood and on into adulthood, including the cardiovascular system. Without a basic understanding of the key physiologic differences, the emergency and intensive care physicians will be ill equipped to care for the critical ill child.

To understand how kids with shock present differently than adults, it’s important to discuss a few basic differences regarding intravascular volume and cardiovascular system in children especially neonates and infants (1-24 months of age). Also remember shock is defined the exact same way as it would be in adults even though the presentation and underlying physiology may differ. Shock is simply a state where tissue/organ blood flow is inadequate to meet tissue/organ metabolic demands. Read more →

Pediatric Push Dose Epinephrine: Getting the Epi Dose Right During Pediatric Resuscitation

13 Sep
September 13, 2018

Warning: Limited Published Evidence on this Topic

You have just intubated a 4 year old with sepsis from a bad pneumonia. Post intubation BP is 70 systolic, while waiting for the epinephrine (adrenaline) infusion to come up from pharmacy you watch the BP decline into the 60 systolic range and start to use fluids to resuscitate. You are an accomplished adult resuscitationist, and are comfortable mixing, and pushing push dose epi in your adult patients.

The following questions arise as you consider mixing a batch of push dose epi:

  • How much push dose epinephrine should you give this septic 4 year old?
  • Do pediatric patients need more or less epi when given in push dose format?
  • How do some pediatric intensivists and pediatric emergency physicians manage this problem?

Read more →

IV and/or Nebulized MgSO4 in Pediatric Asthma Exacerbations?

09 Aug
August 9, 2018

Background: Acute asthma exacerbations are a common presentation to pediatric emergency departments (EDs). Standard treatment with inhaled beta agonists and corticosteroids are often sufficient in mild asthma but can fall short in the treatment of moderate to severe exacerbations. Magnesium sulfate (MgSO4) has long been touted as an adjunct treatment due to its bronchodilatory properties (both in its intravenous (IV) and nebulized form). Despite its routine use, the evidence for its benefit is inconsistent, particularly in the adult population where the most recent large RCT demonstrated modest benefits (Goodacre 2013). Read more →

Pediatric DKA: Do Fluids Really Matter?

11 Jul
July 11, 2018

Background: The most feared complication in the clinical course of children with diabetic ketoacidosis (DKA) is the development of cerebral edema. Cerebral edema is rare (<1%) but is the leading cause of death in pediatric DKA. Many of the details about the risk factors as well as the mechanisms leading to DKA related cerebral edema are not well understood. Before we review the recent, groundbreaking study by Kupperman et al (1), examining the relationship between intravenous fluid content and rate of fluid administration in the development of DKA related cerebral edema, it’s important that we review the associated risk factors as well as the proposed mechanisms. It is important to know that the available data we are about to review comes from retrospective studies as well as case reports and case series and not from randomized control trials. Read more →

Button Battery Ingestion

04 Sep
September 4, 2017

Button Batteries: Small, disc shaped battery cells which are designed for use in small electronic devices. Common sources are kids toys, watches, calculators and hearing aids. Most batteries use lithium as a power source

Button Battery Ingestion Danger:

  • Contact with mucosal surfaces (oropharynx, esophagus, nasal passage) results in transmission of current
  • Current transmission causes chemical burns and necrosis via alkaline injury (sodium hydroxide)
  • Tissue damage can progress rapidly and result in devastating injuries
  • Nasal passage and esophagus are most susceptible to injury (narrow places for battery to become lodged)
  • Injury Patterns
    • Viscous perforation
    • Fistula formation
    • Erosion into blood vessels and resultant bleeding and possible catastrophic bleeding with erosion into aorta

Read more →