Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-Board Questions: Shock, Cardiopulmonary, Hematology, Immunology, Sepsis

Video Transcription

Video Summary

The transcript covers an extensive learning session involving the diagnosis and management of several critical pediatric cases. The key cases and teaching points are summarized below:<br /><br />1. <strong>Meningococcemia in a 2-year-old Boy:</strong> <br />   - Boy intubated and ventilated, unresponsive to fluid resuscitation, reliant on catecholamine infusions.<br />   - Radial arteries unavailable for arterial catheterization; the axillary artery is chosen for its collateral circulation.<br /><br />2. <strong>Intubation Strategy for a 10-month-old with Pneumonia and Sepsis:</strong><br />   - Patient stable on a high-flow nasal cannula.<br />   - The combination of atropine and ketamine for intubation is preferred over other agents due to ketamine’s hemodynamic neutrality.<br /><br />3. <strong>Acute Bacterial Endocarditis in a 6-year-old Girl:</strong><br />   - Diagnosed after fever, hip pain, and findings on echocardiogram.<br />   - Empirical antibiotic treatment involves the combination of ampicillin, gentamicin, and vancomycin.<br /><br />4. <strong>Commotio Cordis in a 12-year-old Boy:</strong><br />   - Cardiac arrest post-blow to the chest while playing baseball.<br />   - Immediate defibrillation is the recommended response.<br /><br />5. <strong>Management of Myocarditis in an 8-year-old Boy:</strong><br />   - Myocarditis leads to shock after extubation.<br />   - Cause identified as increased left ventricular afterload due to removal of positive pressure ventilation.<br /><br />6. <strong>Sepsis in a 15-month-old Boy with Pre-existing Conditions:</strong><br />   - Symptoms include hepatosplenomegaly and critical signs pointing towards Hemophagocytic Lymphohistiocytosis (HLH).<br /><br />7. <strong>Critical Post-Operative Management in Pediatric Cardiovascular Surgery:</strong><br />   - Several scenarios of post-surgical management involving HLH, pulmonary stenosis, and aortic insufficiency.<br />   - Emphasis on volume expansion and monitoring ventricular compliance.<br /><br />8. <strong>Immunosuppression and Infection in a Lung Transplant Patient:</strong><br />   - Adjustment of Tacrolimus due to Voriconazole administration for fungal infection.<br /><br />9. <strong>Pulmonary and Renal Syndromes in a 6-year-old Boy:</strong><br />   - Hemoptysis with glomerulonephritis linked to ANCA-associated vasculitis over Goodpasture’s syndrome.<br /><br />10. <strong>Pacing Management in a Post-operative Infant with Heart Block:</strong><br />    - Optimization of pacemaker settings to avoid under-sensing and ensure effective pacing.<br /><br />The session emphasizes specific diagnostic tests, empirical treatments, clinical decision-making pathways, and technical interventions for various pediatric emergencies.

Keywords

Meningococcemia

Pediatric Intubation

Bacterial Endocarditis

Commotio Cordis

Pediatric Myocarditis

Hemophagocytic Lymphohistiocytosis

Post-Operative Management

Immunosuppression

ANCA-associated Vasculitis

Pacing Management

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