Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-MCCRCPeds_BoardReviewAnswers_Part3

MCCRCPeds_BoardReviewAnswers_Part3_2024

Pdf Summary

The document presents several case studies of pediatric patients with critical conditions requiring specialized medical interventions in the Pediatric Intensive Care Unit (PICU).<br /><br />1. **Asthmaticus Case**: A 6-year-old girl admitted with severe status asthmaticus received multiple treatments, including albuterol and IV terbutaline, but continued to deteriorate. Ketamine was recommended for sedation due to its sedative, analgesic, and bronchodilatory effects, though it carries a risk of laryngospasm.<br /><br />2. **Trisomy 21 and Cardiac Surgery**: A 6-month-old girl with trisomy 21 recovering from cardiac surgery required sedation and anxiolysis for extubation. Dexmedetomidine was suggested for its minimal respiratory depression risks, unlike propofol, morphine, or lorazepam.<br /><br />3. **ARDS and Neuromuscular Blockade**: A boy with ARDS and multiple organ dysfunctions due to viral pneumonia needed neuromuscular blockade. Cisatracurium was chosen because it is metabolized independently of liver and kidney function, suitable for patients with hepatic and renal dysfunction.<br /><br />4. **Scoliosis Surgery**: Pancuronium was considered for a 15-year-old undergoing spinal fusion surgery. Tachycardia is a likely side effect due to its vagolytic properties.<br /><br />5. **MSSA Infection**: A 7-year-old with a subdural empyema required antibiotics. Nafcillin was the preferred choice for methicillin-sensitive Staphylococcus aureus.<br /><br />6. **Increased Intracranial Pressure**: A 3-year-old girl from Vietnam with TB meningitis showed signs of increased intracranial pressure. Emergent decompression of ventricles was recommended over conservative management or lumbar puncture.<br /><br />7. **Diabetic Ketoacidosis**: An 8-year-old girl with severe DKA and cerebral edema was to be treated with mannitol over other measures like head CT or sodium bicarbonate.<br /><br />8. **Pheochromocytoma**: An 8-year-old presented with HT and was diagnosed with pheochromocytoma. Phentolamine, an alpha-adrenergic blocker, was recommended for preoperative management.<br /><br />9. **Abdominal Compartment Syndrome**: A 3-year-old post-stem cell transplant had ACS due to VOD/SOS. Abdominal paracentesis with drain placement was advised over noninvasive ventilation or additional medications. <br /><br />Each case required specific pediatric pharmacological and therapeutic interventions based on the patient's detailed clinical presentation and underlying condition, prioritizing safety and efficacy.

Keywords

Pediatric Intensive Care Unit

PICU

critical conditions

status asthmaticus

trisomy 21

ARDS

neuromuscular blockade

increased intracranial pressure

diabetic ketoacidosis

pharmacological interventions

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