We report the case of a 13-year-old who presented with an ST-segment elevation myocardial infarction caused by a thrombotic occlusion of an aneurysmal left anterior descending coronary artery. Our patient was diagnosed and treated for multisystem inflammatory syndrome in children and underwent successful balloon angioplasty and aspiration thrombectomy.().
View Article and Find Full Text PDFIntroduction: Point-of-care ultrasound (POCUS) is ultrasound performed by the provider at the patient's bedside to answer a specific clinical question. No guidelines exist for teaching POCUS to pediatric residents, and there are currently no pediatric-specific POCUS resources on . To fill this gap, we designed an educational resource to introduce pediatric residents to POCUS during their pediatric intensive care unit (PICU) rotation.
View Article and Find Full Text PDFBackground: Fluid is central to the resuscitation of critically ill children. However, many pay limited attention to continued fluid accumulation. Fluid overload (FO) is associated with significant morbidity and mortality.
View Article and Find Full Text PDFPurpose: To determine if there is an association between mortality and admission chloride levels and/or increases in the chloride level in critically ill children.
Methods: We performed a retrospective cohort study of all patients admitted to the paediatric intensive care unit (PICU) from January 2014 to December 2015. Patients were excluded for the following reasons: (1) age < 90 days or > 18 years, (2) admission to the cardiac intensive care unit, (3) no laboratory values upon admission to the PICU, (4) history of end-stage renal disease, (5) a disorder of chloride transport, and (6) admission for diabetic ketoacidosis.
Objective: To assess whether Web-based teaching is at least as effective as traditional classroom didactic in improving the proficiency of pediatric novice learners in the image acquisition and interpretation of pneumothorax and pleural effusion using point-of-care ultrasound (POCUS).
Methods: We conducted a randomized controlled noninferiority study comparing the effectiveness of Web-based teaching to traditional classroom didactic. The participants were randomized to either group A (live classroom lecture) or group B (Web-based lecture) and completed a survey and knowledge test.
Background: The optimal fluid management in critically ill children is currently under investigation with several studies suggesting that hyperchloremia, chloride load, and the use of chloride-rich fluids contribute to worse outcomes.
Methods: This is a single-center retrospective cohort study of Pediatric Intensive Care Unit patients from 2008 to 2016 requiring continuous renal replacement therapy (CRRT). Patients were excluded if they had end-stage renal disease, a disorder of chloride transport, or concurrent provision of extracorporeal membrane oxygenation therapy.
Respiratory failure after ventricular assist device (VAD) placement may threaten transplant candidacy and can be lethal. Refractory respiratory failure may require addition of extracorporeal membrane oxygenation (ECMO) support. Providing ECMO in a VAD-supported patient is uniquely challenging, particularly in the case of LVAD inflow cannula obstruction in a pediatric patient who may be more prone to cannula obstruction.
View Article and Find Full Text PDFBackground: The enzyme extracellular superoxide dismutase (EC-SOD; SOD3) is a major antioxidant defense in lung and vasculature. A nonsynonomous single-nucleotide polymorphism in EC-SOD (rs1799895) leads to an arginine to glycine amino acid substitution at position 213 (R213G) in the heparin-binding domain. In recent human genetic association studies, this single-nucleotide polymorphism attenuates the risk of lung disease, yet paradoxically increases the risk of cardiovascular disease.
View Article and Find Full Text PDFOxidative stress has many implications in the pathogenesis of lung diseases. In this review, we provide an overview of Reactive Oxygen Species (ROS) and nitrogen (RNS) species and antioxidants, how they relate to normal physiological function and the pathophysiology of different lung diseases, and therapeutic strategies. The production of ROS/RNS from endogenous and exogenous sources is first discussed, followed by antioxidant systems that restore oxidative balance and cellular homeostasis.
View Article and Find Full Text PDFPediatr Emerg Care
March 2013
Topical anesthetics are commonly used in many health care settings and for many clinical conditions. However, there are a number of potential adverse effects associated with their use. Their widespread administration can convey a false sense of security and failure to appreciate possible complications.
View Article and Find Full Text PDFVancomycin is routinely used for empiric antibiotic therapy in children. Higher-serum-concentration targets for serious infections are now being recommended. This recommendation may result in aggressive dosing with increased potential for toxicity.
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