Critical Points

It’s on, people. We’re in Scottsdale at the Omni resort. So good! Wish you were here.

Critical Points 2018 Day1: Rancho San Bernardo, Ca. Starting the day talking shock

Dr. DeBlieux: Why do we intubate? The three biggies. #CritPoints17SD

Dr. DeBlieux: When you want MAP >65 in resuscitation: post-ROSC and spinal shock patients. How much MAP? Keep it above 75 mmHg. #CritPoints17SD

It’s about to start! 10 minutes until Critical Points San Diego gets underway. #CritPoints17SD

Treat status like a code!! run on a clock 3-5 minutes and have your next drug ready before the timer is up. #CritPoints17SD

If a kid is seizing for more than 5 minutes… They will continue until you do something to break it. : Lorazepam:0.1mg/kg Diazepam: 0.1mg/kg Diazepam: 0.5mg/kg Midazolam: 0.1mg/kg IV,IN or IM seizures beget seizures #CritPoints17SD

Bronchiolitis: risk for apnea: Full term<1mo of age, born<37 and less than 48 weeks post conception, If the kid has had a single apnea episode. Needs admission: Toxic, persistent hypoxia, apnea, RR>70, Inability to feed or dehydration. #CritPoints17SD

Bronchiolitis: <2 years of age. Big risk in: Premature, younger and medically fragile. NO: dilators(Strong level B, steroids(strong level A). High risk kids… bets are off #CritPoints17SD

Pessor-resistant shock=steroids

Pressing kids: Cold shock(constricted) EPi 0.05-0.3mcg/kg/min Warm shock (dilated) Norepi: 0.05-0.3mcg/mg/min. Dr Nate Mick #CritPoints17SD

Which Fluid for kids? LR or Normosol. Saline is not normal…. Abnormal Saline can cause renal injury and worsening acidosis. Fluid bolus is 60ml/kg/1st hour. #CritPoints17SD

Acyclovir: All really sick kids <4 weeks of age get it!!! Sepsis syndrome with negative culture, skin vessicles, Hepatic failure all get it. . Dr. Nate Mick

Lactate of greater than 4 in a kid is highly suspicious for pending organ failure… Serial lactates in sick kids can give you the warning #CritPoints17SD

You won’t find the patechia if you don’t take off the diaper.

Peds Sepsis: Death increases with every hour of delay in resuscitation.. Each hour of persistent shock doubles your mortality in kids. #CritPoints17SD

Critical Points Peds Sepsis: IV/IO Fluids Antibiotics 20ml/kg. B4 ETT (If you can)

Sepsis in kids: Not easy automatic trigger: Can get sick from bacteria or virus, Most common cause of the “sick kid”. 4 beasts: Newborns, “Syndromes", Cancers & Teens. #CritPoints17SD

When to terminate: 10 minutes without heart rate and asystole. tough calls... #CritPoints17SD

The only kids we cool are hypoxic newborns. It is the only time cooling has been shown to be helpful. It can usually wait for the ICU. #CritPoints17SD