Cardiopulmonary Interactions (basics) in the PICU

PICU Doc On Call

#Science #Fitness #Biology #Podcasting Education #Medicine #Dr. Pradip Kamat, Dr. Rahul Damania #Dr. Pradip Kamat #Dr. Rahul Damania

21:04

Step into the mysterious and visually stunning world of The Electric State as host Francesca Amiker takes you behind the scenes with the creative masterminds who brought Simon Stålenhag’s dystopian vision to life. In this premiere episode, directors Joe and Anthony Russo, stars Millie Bobby Brown and Chris Pratt, writers Christopher Markus and Stephen McFeely, and producers Angela Russo-Otstot and Chris Castaldi reveal how they transformed a haunting graphic novel into an epic cinematic experience. Watch The Electric State coming to Netflix on March 14th. Check out more from Netflix Podcasts . State Secrets: Inside the Making of The Electric State is produced by Netflix and Treefort Media.…

大约1年之前 20:37

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In this episode of PICU DOC on Call, Dr. Rahul Damania and Dr. Pradip Kamat chat about a challenging case involving a 15-year-old girl dealing with acute myocarditis and worsening respiratory failure. They explore the intricate dance between the heart and lungs, especially how positive pressure ventilation can affect heart function. They cover important topics like cardiac output, preload, and afterload, and discuss the delicate balance needed to manage myocarditis effectively. The episode offers practical tips for optimizing care for critically ill children, underscoring the importance of personalized treatment plans and teamwork in pediatric critical care. Tune in!

Show Highlights:

Clinical case of a 15-year-old girl with acute myocarditis and respiratory failure
Importance of understanding cardiopulmonary interactions in pediatric critical care
Effects of positive pressure ventilation on cardiac function
Key concepts of cardiac output, preload, and afterload in the context of myocarditis
Challenges of managing hemodynamic instability in critically ill pediatric patients
Differences between spontaneous breathing and positive pressure ventilation
Strategies for optimizing preload and fluid management in myocarditis patients
Tailoring ventilatory support and transitioning to invasive mechanical ventilation
Monitoring for arrhythmias and managing myocardial function with inotropic support
Importance of frequent assessments and collaboration with cardiac ICU teams for patient care

Management Strategies

Optimizing Preload:

Volume depletion is common in patients with hypotension and tachycardia. A careful fluid challenge is important to restore circulatory volume, but fluid overload should be avoided, especially with impaired left ventricular function.

Tailoring Ventilatory Support:

Adjust BiPAP settings to improve oxygenation without overloading the heart with excessive positive pressures.
Use the optimal level of PEEP to recruit alveoli while maintaining adequate venous return to the heart.

Supporting Myocardial Function:

Inotropic support (e.g., milrinone) may be necessary to improve myocardial contractility. Milrinone also provides vasodilation, which can reduce afterload but must be used cautiously due to its potential to lower blood pressure.

Frequent Reassessments:

Bedside echocardiography and regular monitoring of biomarkers (lactate, BNP) and clinical status are essential for ongoing evaluation.
In severe cases, advanced therapies like ECMO may be required if the patient’s hemodynamic status continues to deteriorate.

99集单集

Cardiopulmonary Interactions (basics) in the PICU

PICU Doc On Call

16 subscribers

published 大约1年之前

MP3•单集首页

Show Highlights:

Clinical case of a 15-year-old girl with acute myocarditis and respiratory failure
Importance of understanding cardiopulmonary interactions in pediatric critical care
Effects of positive pressure ventilation on cardiac function
Key concepts of cardiac output, preload, and afterload in the context of myocarditis
Challenges of managing hemodynamic instability in critically ill pediatric patients
Differences between spontaneous breathing and positive pressure ventilation
Strategies for optimizing preload and fluid management in myocarditis patients
Tailoring ventilatory support and transitioning to invasive mechanical ventilation
Monitoring for arrhythmias and managing myocardial function with inotropic support
Importance of frequent assessments and collaboration with cardiac ICU teams for patient care

Management Strategies

Optimizing Preload:

Volume depletion is common in patients with hypotension and tachycardia. A careful fluid challenge is important to restore circulatory volume, but fluid overload should be avoided, especially with impaired left ventricular function.

Tailoring Ventilatory Support:

Adjust BiPAP settings to improve oxygenation without overloading the heart with excessive positive pressures.
Use the optimal level of PEEP to recruit alveoli while maintaining adequate venous return to the heart.

Supporting Myocardial Function:

Inotropic support (e.g., milrinone) may be necessary to improve myocardial contractility. Milrinone also provides vasodilation, which can reduce afterload but must be used cautiously due to its potential to lower blood pressure.

Frequent Reassessments:

Bedside echocardiography and regular monitoring of biomarkers (lactate, BNP) and clinical status are essential for ongoing evaluation.
In severe cases, advanced therapies like ECMO may be required if the patient’s hemodynamic status continues to deteriorate.

99集单集

#Science #Fitness #Biology #Podcasting Education #Medicine #Dr. Pradip Kamat, Dr. Rahul Damania #Dr. Pradip Kamat #Dr. Rahul Damania

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2 years之前26:14

26:14

PICU Doc On Call

1
Integrated PICU Journal Club: An Intubated, Febrile Toddler 19:55

2 years之前19:55

19:55

Today’s episode of "PICU Doc On Call," with Dr. Pradip Kamat and Dr. Rahul Damania, pediatric ICU physicians, delves into intriguing case and management strategies within the acute care pediatric setting. This episode focuses on a 2-year-old child transferred to the PICU due to pneumonia-induced respiratory distress. As the child's condition deteriorates, intubation becomes necessary to address acute hypoxemic respiratory failure. We discuss the significance of minimizing unnecessary blood cultures in febrile patients with central lines in the PICU. A study implementing a quality improvement program is referenced, which successfully reduces blood culture rates, broad-spectrum antibiotic usage, and CLABSI rates without impacting mortality or length of stay. Next, we’ll explore the comparison between a high-flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) in pediatric patients experiencing respiratory distress. Findings from a randomized controlled trial revealed that HFNC is non-inferior to CPAP in terms of time required for liberation from respiratory support. We further investigate the application of pediatric early warning scores (PEWS) and automated clinical prediction models to identify patients at risk of deterioration and transfer to the PICU. The importance of employing clinical judgment and a combination of assessment tools to determine the need for transfer is emphasized. Lastly, we’ll highlight the significance of screening for social determinants of health in critically ill children and their families. A study demonstrates that a substantial number of participants had unmet social needs, underscoring the importance of screening to provide appropriate interventions and resources. To summarize, this podcast episode covers key topics such as reducing unnecessary blood cultures, comparing HFNC and CPAP in respiratory distress, utilizing PEWS and clinical prediction models for patient identification, and the importance of screening for social determinants of health. Be sure to listen in entirety as we discuss the case.…

PICU Doc On Call

1
Post-Operative Care in the PICU 25:12

2 years之前25:12