Pediatric Critical Care: A Primer for All Clinicians


Jason Kane, M.D. (Editor)
Associate Professor of Pediatrics, University of Chicago, Comer Children’s Hospital, Interim Chief, Section of Pediatric Critical Care, Director of Quality and Outcomes, Pediatric ICU, Chicago, IL., US

Rachel Wolfson, M.D. (Editor)
Associate Professor of Pediatrics, University of Chicago, Comer Children’s Hospital, Pediatric Critical Care Medicine, Pritzker School of Medicine, University of Chicago Medical Center, Chicago, IL, US

Stuart Berger, M.D. (Editor)
Vice Chair for Clinical Affairs, Department of Pediatrics, Chief of Cardiology in the Department of Pediatrics, Professor of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL., US

Joseph R. Hageman, M.D. (Editor)
Director NICU Quality Improvement, Comer Children’s Hospital, Senior Clinician Educator, Pritzker School of Medicine, University of Chicago, Chicago, IL., US

Series: Emergency and Intensive Care Medicine
BISAC: MED094000

Pediatric critical care is an emotionally and intellectually demanding field of medicine; however, it is at its core the discipline focused on saving and improving the lives of children affected by acute and chronic illnesses, injuries, and toxicities. The heart of any successful pediatric critical care program is the multidisciplinary and interdisciplinary care provided by pediatric intensivists and their team of specialized co-workers including pediatric critical care nurses, respiratory therapists, pharmacists, social workers, and nutritionists working in concert with the pediatric ICU (PICU). It is this interplay between clinical specialists that ensures children are afforded cutting-edge, technologically complex, holistic, and age-appropriate care, while at the same time ensuring that the needs of both the child and the family are addressed. Additionally, critical care medicine encompasses the extremes of all pediatric medicine and as such, those charged with caring for children in the PICU must be well-versed in all areas of pediatric medicine, as well as prepared for any contingency or emergency.

Caring for sick children both within and outside of the pediatric intensive care unit (PICU) requires an understanding of how pediatric physiology differs from that of adults. Recognizing a deteriorating child and stabilizing that patient rapidly is a requisite skill that every clinician charged with caring for a child must master. This practical handbook is written for all clinicians who care for children with acute illness, and who may need to assess and stabilize a deteriorating child before transfer to the PICU. Specifically, chapters provide helpful insights for all levels of pediatric providers including pediatric critical care and general care nurses, advanced practice nurses, medical students, pediatric residents, and residents from other disciplines who rotate through the PICU, pediatric hospitalists, and emergency physicians who care for children. In addition to covering PICU-specific topics such as mechanical ventilation and procedural sedation, this handbook also includes guidance in the initial resuscitation, management and stabilization of children with impending critical illnesses or those at risk for acute deterioration. Management of life-threatening situations that are specifically included in this book include respiratory failure, cardiovascular failure, electrolyte derangements, diabetic ketoacidosis, burn injuries, status epilepticus, status asthmaticus, toxic ingestions, and sepsis, among many others. (Imprint: Nova Medicine and Health)



Table of Contents

Chapter 1. Preface

General Procedures and Administration

Chapter 2. Rapid Assessment of the Critically Ill Pediatric Patient
(Edward E. Conway, Jr.)

Chapter. 3 Basic Concepts of Pediatric Transport
(Paul Severin)

Chapter 4. Cardiopulmonary Resuscitation
(Priti Jani)

5. Procedural Sedation
(Julie Williamson)

6. Invasive Vascular Access
(Whitney Kopp, Chelsey A. Willie and Tara L. Petersen)

Cardiovascular Conditions

7. Shock
(Nathan Thompson, Martin Wakeham and Timothy E. Corden)

8. Neonatal Cyanotic Heart Disease
(Jeremy T. Affolter)

9. Common Pediatric Arrhythmias
(Fei Fei Z. Williams)

10. Hyper-Cyanotic Spells in Tetralogy of Fallot
(Ahmeneh Ghavan)

11. Single Ventricle Physiology
(Jeremy T. Affolter)

12. Pediatric Cardiomyopathy and Myocarditis
(Jeremy T. Affolter)

Respiratory Conditions

13. Acute Status Asthmaticus
(Toni Petrillo)

14. Foreign Body Aspiration
(Madeline Charlson and Andrea M. Kline-Tilford)

15. Mechanical Ventilation
(Jason M. Kane)

16. Acute Respiratory Distress Syndrome (ARDS)
(Jaime Braverman)

17. Pneumonia
(B. Louise Giles and Maria L. Dowell)

18. Pediatric Tracheostomy
(Andrea M. Kline-Tilford and Madeline Charlson )

19. Transfusion Related Acute Lung Injury
(Ahmeneh Ghavan)

Hematologic Conditions

20. Anemia
(Walter Palmer, Aamne Shalabi and Joseph R. Hageman)

21. Disseminated Intravascular Coagulation
(Miki Nishitani and Joseph R. Hageman)

22. Hemophilia
(Rhukmi Bhat)

23. Pediatric Febrile Neutropenia
(Muayad Alali, Amir Bari Siddiqui and Jennifer L. McNeer)

24. Complications of Sickle Cell Disease
(Josephine Misun Jung, Gabriela Villanueva and Radhika Peddinti)

25. Oncologic Emergencies
(Elizabeth Sokol)

Infection and Immunology

26. Anaphylaxis
(Leena V. Padhye and Christina E. Ciaccio)

27. Fever in the Immunocompromised Patient
(Priscila Badia and Christopher E. Dandoy)

28. Fungal Infections
(Allison H. Bartlett)

29. Sepsis
(Philip A. Verhoef)

Gastrointestinal Disorders

30. Acute Abdominal Pain in Children
(Anna F. Tyson and Nikunj K. Chokshi)

31. Gastrointestinal (GI) Bleeding
(Manish Tushar Raiji and Lindsey Zhang

32. Bowel Obstruction
(Grace Mak, MD, and Jared Emolo, MD)

33. Refeeding Syndrome
(Joseph Runde and Timothy Sentongo)

34. Acute Liver Failure
(Joseph Runde and Ruba Azzam)

Endocrine Emergencies and Metabolic Disorders

35. Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Syndrome (HHS)
(Rachel Stork Poeppelman, Michelle Lemelman Elizabeth Littlejoh and Stephen Duck)

36. Adrenal Crisis
(Harini Kolluri and Dianne Deplewski)

37. Salt Syndromes
(Casey W. Stulce)

38. Hypoglycemia
(Juan J. Lado)

39. Thyroid Emergencies
(Dianne Deplewski)

40. Hyperammonemia
(Vincent Dimaggio and Stephanie Sacchrow)

Neurologic Conditions
41. Status Epilepticus
(Jason L. Adler)

42. Pediatric Traumatic Brain Injury
(Jason L. Adler)

43. Coma in Children
(Jason L. Adler)

44. Guillian Barre Syndrome and Other Neuropathologies
(Janet L. Rossi)

45. Acute Spinal Cord Injury
(Casey W. Stulce)

46. Evaluation & Management of New-Onset Seizures
(Bridget M. Wild and Leah Finkel)

47. Acute Paresis
(Afsaneh Talai)

48. Encephaliitis
(Casey W. Stulce)

49. Delirium and Psychosis
(Afsaneh Talai)

50. Analgesia and Sedation in Pediatric Critical Care
(Julie Williamson)

Renal and Electrolyte Disorders

51. Acute Kidney Injury
(Reem Itani and Shireen Hashmat)

52. Hemolytic Uremic Syndrome (HUS)
(Anna Rodenbough, Eltsa Nicolaou and Christopher Clardy)

53. Hypertensive Emergencies
(Juan R. Barron-Alemany and L. Nelson Sanchez-Pinto)

54. Evaluation and Management of Dehydration
(Sadie LaPonsie)

55. Electrolyte Derangements and Emergencies
(Reem Nubani)

56. Acute Acid Base Disorders
(Cesar Menchaca, B. Louis Giles and Shireen Hashmat


57. Hanging Injuries in Children
(Tracy Koogler)

58. The Acute Pediatric Trauma Patient
(Leslie Hueschen)

59. Drowning and Submersion Injury
(Jana A. Stockwell)

60. Toxidromes and Poisonings
(Meral M. Patel)

61. Bites and Stings
(Leslie Hueschen)

62. Burns, Smoke Inhalation, Chemical and Electrical Injuries
(Tracy Koogler)

63. Child Maltreatment
(Norell Rosado)

Frequently Used Medications

64. Pharmacology for Pediatric Patients
(Allison Nelson)

Additional information