Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-MCCRCPeds_BoardReviewAnswers_Part2

MCCRCPeds_BoardReviewAnswers_Part2_2024

Pdf Summary

The document deals with complex case studies and procedures frequently encountered in pediatric intensive care units (PICUs). These include various conditions such as meningococcemia, respiratory failure, acute bacterial endocarditis, commotio cordis, cardiac tamponade, viral myocarditis, mononucleosis complications, hypoplastic left heart syndrome, Fontan physiology, severe anemia likely due to sickle cell disease, sepsis linked to toxic shock syndrome, veno-venous extracorporeal membrane oxygenation (VV-ECMO), and severe acute vasculitis.<br /><br />Key highlights include:<br /><br />1. **Decision-Making in Emergency Situations**:<br />   - In children with severe hemodynamic instability from toxic shock syndrome, ketamine is preferred for increasing blood pressure during intubation without causing vasodilation.<br />   - In cases of acute bacterial endocarditis with severe symptoms, empirical antibiotic therapy with IV ampicillin/sulbactam with or without vancomycin is recommended.<br />   - For suspected commotio cordis, immediate defibrillation is advised for ventricular fibrillation.<br /><br />2. **Special Considerations in Pediatric Patients**:<br />   - For infants with conditions like hypoplastic left heart syndrome undergoing procedures like the Norwood operation or bidirectional Glenn, interventions like fluid bolus are critical to addressing preload issues.<br />   - Post-extubation worsening is often managed by identifying increased left ventricular afterload rather than administering supplemental oxygen as seen in viral myocarditis cases.<br /><br />3. **Diagnostic Approaches**:<br />   - Hemoglobin electrophoresis is crucial for diagnosing conditions leading to severe anemia such as sickle cell anemia, while other tests like the anti-glomerular basement membrane (GBM) antibody test helps diagnose vasculitis in patients with severe respiratory and kidney symptoms.<br /><br />4. **Pharmacological Management**:<br />   - Medications such as warfarin must be carefully titrated due to zero-order kinetics to prevent overdose and maintain therapeutic levels.<br />   - In managing febrile neutropenia in immunocompromised children, broad-spectrum antibiotics combined with vancomycin are essential.<br /><br />5. **Advanced Procedures and Monitoring**:<br />   - Effective management of ECMO for refractory ARDS requires addressing potential heparin resistance by supplementing antithrombin.<br />   - For children with severe cardiac failures, timely interventions such as pericardiocentesis for suspected tamponade can be lifesaving.<br /><br />Each case underscores the importance of tailored medical intervention closely aligned with dynamic monitoring and reassessment to improve pediatric patient outcomes in critically ill scenarios. The document emphasizes evidence-based practices and includes references to support clinical decisions and treatment protocols.

Keywords

pediatric intensive care

meningococcemia

respiratory failure

acute bacterial endocarditis

hypoplastic left heart syndrome

sepsis

VV-ECMO

severe acute vasculitis

emergency decision-making

pharmacological management

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