Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-MCCRCPeds_BoardReviewAnswers_Part1

MCCRCPeds_BoardReviewAnswers_Part1_2024

Pdf Summary

In this document, various clinical case vignettes explore different pediatric critical care situations and their associated management and diagnostic steps.<br /><br />1. **Venous and Arterial Catheter Confirmation**: An 18-month-old girl suffers from acute respiratory distress and systemic inflammatory response syndrome (SIRS). The correct method to confirm venous access of a central venous line (CVL) is pressure transduction to differentiate between venous and arterial placement.<br /><br />2. **Management of Cardiac Tamponade**: Another case involves an 18-month-old girl with pericardial effusion suggestive of cardiac tamponade due to underlying pneumonia. Here, immediate administration of a crystalloid bolus to ensure adequate stroke volume is recommended.<br /><br />3. **Improving Oxygenation in ARDS**: For a 12-year-old with acute respiratory distress syndrome (ARDS), management using airway pressure release ventilation (APRV) suggests increasing Phigh to improve oxygenation.<br /><br />4. **Extending Detection of Dead Space**: Another scenario involves calculating the dead space fraction using blood gas values in a 12-year-old girl, indicating the importance of understanding dead space ventilation in assessing respiratory distress.<br /><br />5. **Ventilator Management in Asthmatic Crisis**: For a 17-year-old boy with severe asthma, pressure control ventilation with a lower rate but ensuring plateau pressure below 30 cm H2O is optimal to prevent complications.<br /><br />6. **Hemodynamics During Mechanical Ventilation**: The cause of reduced right atrial filling during mechanical ventilation is attributed to positive pressure ventilation creating positive intrathoracic pressures.<br /><br />7. **Tracheomalacia Post-TEF Repair**: A 6-month-old boy with a repaired tracheoesophageal fistula develops respiratory distress during PEEP weaning, suggesting the need for optimal PEEP settings to manage tracheomalacia.<br /><br />8. **Management of Hyperleukocytic Crisis in AML**: A summary case discusses the management of a 10-year-old with acute myeloid leukemia and hyperleukocytosis, emphasizing the use of leukapheresis over packed RBC transfusion.<br /><br />9. **Pulmonary Embolism Post-Surgery**: In discussing differential diagnosis for a post-surgical acute decompensation, pulmonary embolism is suggested based on the presence of a significant end-tidal CO2 gradient.<br /><br />10. **Chiari Malformation and Respiratory Distress**: The best diagnostic approach for a 2-month-old with Chiari malformation and respiratory distress is fiberoptic laryngoscopy to assess for vocal cord paralysis and aspiration risks.<br /><br />11. **Diagnosing Fat Embolism Syndrome**: A 16-year-old girl's post-orthopedic surgery complication with sudden mental status change and a petechial rash likely indicates fat embolism syndrome.<br /><br />12. **Ventilation Strategy in ARDS**: A case study calls for reducing PEEP in a patient with ARDS and a high minute ventilation but CO2 retention, underlining the need to optimize PEEP to manage lung overdistention.<br /><br />13. **Sample Size Determination**: Discussing statistical planning for an ICU study, it's highlighted that determining the smallest clinically significant difference expected between groups is key for sample size estimation.<br /><br />14. **Pediatric ARDS Definition**: Various case scenarios reiterate key diagnostic and management criteria for pediatric ARDS, highlighting non-cardiac, bilateral infiltrates on new or worsening oxygenation issues, typically within 7 days of onset.<br /><br />This comprehensive review underlines the importance of tailored diagnostic and management strategies in pediatric critical care, ensuring optimal patient outcomes based on specific clinical scenarios and guidelines.

Keywords

pediatric critical care

venous catheter confirmation

cardiac tamponade management

ARDS oxygenation

dead space ventilation

asthmatic crisis ventilation

mechanical ventilation hemodynamics

tracheomalacia management

hyperleukocytic crisis AML

pulmonary embolism diagnosis

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