Child abuse
Pearls • Infants and children with inflicted head or other traumatic injuries often appear in emergency departments with signs and symptoms of trauma or conditions suspicious of being of medical…
Principles of drug disposition
Pearls • Studies of drug disposition in critically ill children are limited. • Effective pharmacologic therapeutic interventions should focus on choosing the right drug, right time, right dose, right duration,…
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…
Sedation and analgesia
Pearls • A wide selection of sedation and analgesia options is available in the pediatric intensive care unit. • No ideal sedative agent exists for all patients. • Most children…
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…
