Pediatric delirium
Pearls • Delirium is a frequent complication of pediatric critical illness and is associated with substantial morbidity. • Refractory agitation in the pediatric intensive care unit is often a manifestation…
CRITICAL CARE
Evaluation, stabilization, and initial management after trauma
Pearls • The primary survey, as defined by Advanced Trauma Life Support, is a prioritized evaluation and management protocol focused on identifying and treating the most life-threatening injuries first. This…
Malignant hyperthermia
• Risk factors for malignant hyperthermia (MH) include a family history of severe hyperthermia or sudden hypermetabolic state during anesthesia with exposure to succinylcholine and/or potent inhalation anesthetics, and ryanodine…
Toxidromes and their treatment
• Flumazenil, when used for benzodiazepine overdose, may unmask seizures caused by a coingested substance or precipitate acute withdrawal in the patient who habitually uses benzodiazepines. • β-Adrenergic antagonists, when…
Procedural sedation for the pediatric intensivist
In the last 2 decades, there has been a robust demand for outpatient pediatric procedural sedation, now provided by myriad pediatric subspecialists, including pediatric intensivists. , The intensivist who is…
Tolerance, dependency, and withdrawal
• Physical dependency and withdrawal have been documented in all agents used for sedation and analgesia in the pediatric intensive care unit, including benzodiazepines, barbiturates, opioids, dexmedetomidine, propofol, and the…
Neuromuscular blocking agents
• Through the blockade of skeletal muscle function, neuromuscular blocking agents (NMBAs) cause cessation of respiratory function, mandating airway control and the institution of mechanical ventilation. NMBAs should not be…
Burn and inhalation injury
Pearls • The accurate estimation of burn severity is crucial both for appropriate resuscitation and for maintenance of adequate urine output and hemodynamics, including blood pressure and cardiac output. The…
Bites and stings
• Snakebite-related morbidity and mortality are reduced most effectively by rapid transport, intensive care support, and the administration of antivenin. • Pit viper envenomation may produce both painful local tissue…
Anesthesia principles and operating room anesthesia regimens
• The preoperative evaluation, which is performed prior to any anesthetic intervention, includes a history of present illness; past medical problems, including medication allergies; a past surgical and anesthetic history;…
