Education in the Pediatric Intensive Care Unit.

This article addresses the latest data and ideas related to education in the pediatric intensive care unit, including traditional education methods with newer and technology-based methods. A review of adult learning theory is included with discussions regarding medical decision making and error prevention, bedside teaching, medical simulation, and electronic methods of education.

A 17-Year-Old Girl with a Recent History of Marijuana Use Presented with Pneumomediastinum and Pneumopericardium and Tested Positive for SARS-CoV-2 Infection on Hospital Admission.

BACKGROUND Pneumomediastinum and pneumopericardium have been reported to occur in people who regularly smoke marijuana and have also been reported in patients with COVID-19 pneumonia due to infection with SARS-CoV-2. This report is of a 17-year-old girl with a history of marijuana use who presented with pneumomediastinum and pneumopericardium and was found to be positive for SARS-CoV-2 infection on hospital admission by Abbott ID NOW testing. CASE REPORT A 17-year-old girl presented to the emergency room with a 3-day history of abdominal pain, nausea, and vomiting and a 1-day history of diarrhea.

Barriers to Aging in Place for Rural, Institutionalized Older Adults: A Qualitative Exploration.

Objectives: Although the majority of older adults wish to "age in place" in their communities, rural contexts pose challenges to maintaining long-term independence. The purpose of this study was to develop an understanding of the experiences of rural older adults who live in Skilled Nursing Facilities (SNFs) and thus have not aged in place. By retrospectively analyzing their pre-institution care situation, we aim to generate foundational knowledge on the barriers to aging in place in rural settings.

Noninvasive Determination of Blood Pressure by Heart Sound Analysis Compared With Intra-Arterial Monitoring in Critically Ill Children-A Pilot Study of a Novel Approach.

Objectives: To develop a novel device to predict systolic and diastolic blood pressure based on measured heart sound signals and evaluate its accuracy in comparison to intra-arterial blood pressure readings.

Study Design: Prospective, observational pilot study.

Setting: PICU.

Analysis of DNA Damage Response Gene Alterations and Tumor Mutational Burden Across 17,486 Tubular Gastrointestinal Carcinomas: Implications for Therapy.

Background: Alterations in the DNA damage response (DDR) pathway confer sensitivity to certain chemotherapies, radiation, and other DNA damage repair targeted therapies. are the most well-studied DDR genes, but recurrent alterations are described in other DDR pathway members across cancers. Deleterious DDR alterations may sensitize tumor cells to poly (ADP-ribose) polymerase inhibition, but there are also increasing data suggesting that there may also be synergy with immune checkpoint inhibitors.

Low thiamine levels in children with type 1 diabetes and diabetic ketoacidosis: a pilot study.

Objective: Thiamine deficiency has been documented in adults with diabetes and in a single report of reversible encephalopathy in a child with diabetic ketoacidosis. In children who present with severe diabetic ketoacidosis, one of the most serious complications is cerebral edema of which the primary symptom may be encephalopathy. Thiamine deficiency in other disease states has been clearly linked with acute encephalopathy, but there are no data on thiamine status in children with diabetic ketoacidosis.

Views of pediatric intensive care physicians on the ethics of organ donation after cardiac death.

Objective: Donation after cardiac death has been endorsed by professional organizations, including the American Academy of Pediatrics as a means of increasing the supply of transplantable organs. However, ethical concerns have been raised about donation after cardiac death, especially in children. This study explores the views of pediatric intensive care physicians on the ethics of pediatric donation after cardiac death.

Family-centered care in the pediatric intensive care unit.

Patient-centered and family-centered care (PFCC) has been endorsed by many professional health care organizations. Although variably defined, PFCC is an approach to care that is respectful of and responsive to the preferences, needs, and values of individual patients and their families. Research regarding PFCC in the pediatric intensive care unit has focused on 4 areas including (1) family visitation; (2) family-centered rounding; (3) family presence during invasive procedures and cardiopulmonary resuscitation; and (4) family conferences.

Copeptin as a marker of relative arginine vasopressin deficiency after pediatric cardiac surgery.

Purpose: Relative arginine vasopressin (AVP) deficiency after pediatric cardiac surgery has recently been described. Copeptin, a more stable and easily measured product of pro-AVP processing, may be a means of identifying these patients. We aimed to determine if copeptin was correlated with AVP in these children and whether it can be a surrogate marker of relative AVP deficiency.

Relative deficiency of arginine vasopressin in children after cardiopulmonary bypass.

Objective: To describe changes in plasma arginine vasopress in concentration in children following cardiopulmonary bypass and determine whether, in some patients, plasma arginine vasopressin remains relatively low despite hemodynamic instability.

Design: Prospective observational study.

Setting: Pediatric intensive care unit at a tertiary care university hospital.

Integrative basic sciences: change in mental status.

This case discussion is part of the Integrating Basic Science Into Clinical Teaching Initiative. It examines the presentation of altered mental status and describes the underlying physiology, which explains the basic laboratory findings in an attempt to reach a diagnosis. This article describes a 13-year-old boy who presented to the emergency department with altered mental status after being found unconscious and alone in an abandoned building.

Arginine vasopressin to manage hypoxemic infants after stage I palliation of single ventricle lesions.

Objective: Management of patients with single ventricle physiology following stage I palliation procedures is often challenging, with optimization of the ratio of pulmonary-to-systemic blood flow as an important goal. Persistent hypoxemia may be a manifestation of elevated pulmonary vascular resistance and therefore decreased blood flow to the lungs. In such situations, the use of arginine vasopressin to increase systemic vascular resistance may be an effective strategy to improve pulmonary blood flow and maintain adequate pulmonary-to-systemic blood flow ratio.

Metabolic acidosis as an underlying mechanism of respiratory distress in children with severe acute asthma.

Objective: 1) To alert the clinician that increasing rate and depth of breathing during treatment of acute asthma may be a manifestation of metabolic acidosis with hyperventilation rather than worsening airway obstruction; and 2) to describe the frequency of metabolic acidosis with hyperventilation in children with severe acute asthma admitted to our pediatric intensive care unit.

Design: Retrospective medical record review.

Setting: University-affiliated children's hospital.

Wheezing child.

This case discussion is part of the Integrating Basic Science into Clinical Teaching Initiative. It is intended to examine wheezing as a symptom and to describe the underlying physiology that explains the physical findings and blood gas features in an attempt to localize the site of obstruction. The information contained in this case is a compilation and derived from 2 similar patients.

Acute thiamine deficiency in diabetic ketoacidosis: Diagnosis and management.

Objective: Persistent encephalopathy in a patient with diabetic ketoacidosis is often feared as a sign of cerebral edema. Although thiamine deficiency is a rare diagnosis in children, marginal nutritional status and osmotic diuresis may be risk factors. The objective was to describe a heretofore unreported cause of encephalopathy in a child with diabetic ketoacidosis and review the mechanisms and pathophysiology of thiamine deficiency in this clinical scenario.

Epidermal growth factor receptor kinase domain mutations in esophageal and pancreatic adenocarcinomas.

Purpose: Specific activating mutations within the epidermal growth factor receptor (EGFR) identify a subset of non-small cell lung cancers with dramatic sensitivity to the specific tyrosine kinase inhibitors (TKI), gefitinib and erlotinib. Despite the abundant expression of EGFR protein in a broad range of epithelial cancers, EGFR mutations have not been reported in a substantial fraction of other cancers. Given recent reports of TKI-responsive cases of esophageal and pancreatic cancer, this study was designed to determine the prevalence of EGFR mutations in these gastrointestinal cancers.

Comparison of traditional and plethysmographic methods for measuring pulsus paradoxus.

Background: In the evaluation of patients with acute asthma, pulsus paradoxus (PP) is an objective and noninvasive indicator of the severity of airway obstruction. However, in children PP may be difficult or impossible to measure. Indwelling arterial catheters facilitate the measurement of PP, but they are invasive and generally reserved for critically ill patients.

Assessing Web site usability: construction zone.

The research community is just beginning to take notice of the need to cut through the subjective, vendor-driven clutter and provide objectively verifiable support for making Web assessment choices. The value of an effective Web site is rarely debated--but what is an effective Web site?