Index

Practical Approach to Pediatric Intensive Care Praveen Khilnani

SECTION ONE: BASIC PRACTICAL ISSUES
CHAPTER 1:Managing Any Pediatric Emergency: A Practical Approach
- CLINICAL ASSESSMENT
- STABILIZATION
- SUMMARY
  - Stabilizing the Pediatric Patient (Flow chart 1.1)
- TAKE HOME MESSAGE
CHAPTER 2:Pediatric Basic Life Support
- INTRODUCTION
- SPECIAL RESUSCITATION SITUATIONS
- SUMMARY
CHAPTER 3:Pediatric and Neonatal Cardiopulmonary Resuscitation
- PEDIATRIC ADVANCED LIFE SUPPORT
- RESPIRATORY FAILURE
- SHOCK
- AIRWAY
  - Oropharyngeal and Nasopharyngeal Airways
  - Laryngeal Mask Airway
- OXYGENATION AND ASSISTED VENTILATION
  - Oxygen
  - Pulse Oximetry
  - Bag-Mask Ventilation
  - Two-Person Bag-Mask Ventilation
  - Gastric Inflation
  - Ventilation through an Endotracheal Tube
  - Exhaled or End-Tidal CO2 Monitoring
  - Esophageal Detector Devices
  - Transtracheal Catheter Ventilation
  - Suction Devices
  - Circulation
  - Backboard
  - CPR: Techniques and Adjuncts
  - Extracorporeal Membrane Oxygenation
  - Cardiovascular Monitoring
  - Vascular Access
  - Intraosseous Access
  - Venous Access
  - Endotracheal Drug Administration
- EMERGENCY FLUIDS AND MEDICATIONS
  - Estimating Weight
  - Fluids
  - Medications for Pediatric Resuscitation and Arrhythmias
- PULSELESS ARREST (FIG. 3.1)
  - “Shockable Rhythm”: VF/Pulseless VT
  - Torsades de Pointes
    - Treatment
- BRADYCARDIA (FIG. 3.2)
- TACHYCARDIA AND HEMODYNAMIC INSTABILITY (FIG. 3.3)
  - Narrow-Complex (0.08 Second) Tachycardia
    - Probable Supraventricular Tachycardia
  - Wide-Complex (> 0.08 Second) Tachycardia
  - Tachycardia with Hemodynamic Stability
- SPECIAL RESUSCITATION SITUATIONS
  - Trauma
  - Children with Special Health Care Needs
    - Ventilation with a Tracheostomy or Stoma
- POSTRESUSCITATION STABILIZATION
  - Respiratory System
  - Cardiovascular System
  - Neurologic System
  - Renal System
  - Interhospital Transport
  - Family Presence during Resuscitation
  - Termination of Resuscitative Efforts Family Presence during Resuscitation
- ANTICIPATION OF RESUSCITATION NEED
- INITIAL STEPS
  - Temperature Control
  - Clearing the Airway of Meconium
  - Periodic Evaluation at 30-Second Intervals
  - Administration of Oxygen
  - Positive-Pressure Ventilation
- CHEST COMPRESSIONS
- MEDICATIONS
  - Route and Dose of Epinephrine Administration
  - Volume Expansion
  - Naloxone
- POSTRESUSCITATION CARE
  - Glucose
  - Induced Hypothermia and Avoidance of Hyperthermia
- WITHHOLDING AND DISCONTINUING RESUSCITATION
  - Withholding Resuscitation
  - Discontinuing Resuscitative Efforts
- A. HEALTH CARE PROVIDER (HCP)
  - 1. Activate
  - 2. Airway
  - 3. Breathing
  - 4. Circulation
  - 5. Foreign Body Airway Obstruction
- B. LAY RESCUER
  - No Jaw Thrust in Trauma Victim (use head tilt chin lift to open airway)
  - 30:2 Ratio of Compression to Ventilation (for all ages except newborn)
- FOREIGN BODY OBSTRUCTION
- MAJOR BLS CHANGES FOR ALL RESCUERS
- MAJOR PALS CHANGES
- RHYTHM DISTURBANCES AND DEFIBRILLATION
- POSTRESUSCITATION CARE
- NEONATAL RESUSCITATION
CHAPTER 4:Airway Management
- AIRWAY MANAGEMENT TECHNIQUES
- DIFFICULT INTUBATION
- MANAGEMENT OF DIFFICULT INTUBATION
- SUMMARY
CHAPTER 5:Transport of a Critically Ill Child
- ORGANIZATION OF A CRITICAL CARE TRANSPORT SYSTEM
  - Ground Transport
  - Air Transport
- COMPONENTS OF A NEONATAL AND PEDIATRIC CRITICAL CARE TRANSPORT PROGRAM
  - Transport Dispatch System
  - Communication with Neonatal or Pediatric Intensivist (The Intensivist)
  - Response Time
  - Critical Care Transport Team
- TRAINING AND SKILLS FOR TRANSPORT TEAMS
  - Pediatric Critical Care Transport Team
  - Neonatal Critical Care Transport Team
  - Transport Process
  - Transport Equipment and Medications
  - Aeromedical Transport
    - Boyle's Law
    - Daltons Law
  - Cabin Altitude
- PREVENTION OF COMPLICATIONS DURING AIR TRANSPORT OF PEDIATRIC AND NEONATAL PATIENTS
  - Gas Expansion
  - Decreased Partial Pressure of Oxygen
  - Stresses of Flight
- FURTHER READING
- CARDIAC ARREST
  - Epinephrine
  - Newborn
  - Child
  - Adult
  - Atropine
  - Dextrose
  - Defibrillate
  - Cardioversion
- ENDOTRACHEAL (ET) INTUBATION
  - GLASGOW Coma Scale
- ANALGESIA AND SEDATION
- REVERSAL AGENTS
- ANTIBIOTICS
- ASTHMA, ANAPHYLAXIS, STRIDOR
- CARDIAC MEDICATION AND DRIPS
- ENDOCRINE
- HYPERKALEMIA
- MALIGNANT HYPERTENSION
- SEIZURES
- INCREASED INTRACRANIAL PRESSURE
- RAPID SEQUENCE INTUBATION
- HEAD INJURY
- MISCELLANEOUS DRUGS
CHAPTER 6:Consensus Guidelines for Pediatric Intensive Care Units in India
- INTRODUCTION
- UNIT DESIGN
- ORGANIZATION AND STAFFING
  - Medical Director/Intensivist Incharge5
  - Staffing Requirements
    - Medical Staff
    - Nursing Staff
- ANCILLARY SUPPORT STAFF
- LEVELS OF PICU CARE AND ADMISSION AND DISCHARGE CRITERIA6–8
  - Levels of PICU Care
  - Level 3 Care (tertiary level PICU)
    - Admission Criteria to Level 3 Care PICU 6,7
    - Admission Criteria to Level 2 Care (stepdown/high dependency PICU)
- REFERENCES
CHAPTER 7:Monitoring in the Pediatric ICU
- CARDIOVASCULAR MONITORING
- NON-INVASIVE ESTIMATION OF CARDIAC OUTPUT (CO)
- RESPIRATORY MONITORING
- NEUROLOGIC MONITORING
CHAPTER 8:Capnography
CHAPTER 9:Pediatric Intensive Care Working Rounds and Documentation
- GENERAL ADMITTING ORDERS
- IMPORTANT POINTS TO REMEMBER
- SUMMARY
CHAPTER 10:Nursing Care in the PICU
- BRADYCARDIA ALGORITHM (FIG. 10.2)
- TACHYCARDIA ALGORITHM (FIG. 10.3)
  - Narrow-Complex (0.08 Second) Tachycardia
    - Probable Supraventricular Tachycardia
  - Wide-Complex (> 0.08 Second) Tachycardia
  - Tachycardia with Hemodynamic Stability
- PULSELESS ARREST
  - “Shockable Rhythm”: VF/Pulseless VT
- CARE OF THE HEMODYNAMICALLY UNSTABLE VENTILATED PEDIATRIC PATIENT
  - Cardiorespiratory Monitors
  - Hemodynamic Monitoring
  - Automated Non-invasive Blood Pressure (NIBP) Monitoring
    - Doppler Ultrasonic Technique
  - Care of Ventilatory Issues Related to Nursing
- USE : D O P E
  - D Displacement, O Obstruction, P Pneumothorax, E Equipment failure
  - Routine Ventilator Management Protocol
- PULSE OXIMETRY
  - Capnography
  - Position Changes
  - Mouth Care
  - Eye Care
  - Respiratory Care During Ventilation
  - General
  - Chest Physiotherapy (CPT)
  - Humidification
  - Aerosol Therapy
  - Endotracheal Suctioning
  - Minimizing Drug Errors
  - Accurate Intake and Output Chart
  - Intracranial Pressure (ICP) Monitoring
  - Dealing with Visitation and Families
  - Communication with the Families
  - Informed Consent
  - In the United states
  - Do Not Attempt Resuscitation (DNR)
    - Medical Futility
    - Assisted Suicide
    - Euthanasia
  - In India
  - Breaking Bad News: The Nurse's Role (for Pediatrics)
  - Helping Parents Face the Death of their Child
    - Communication
    - Facilitate Family Grieving
  - Team Approach
- SUMMARY
- 1. OXYGEN THERAPY
  - Definition
  - Purpose
  - Articles
  - Methods of Oxygen Administration
  - Special Points to Remember
  - Humidification
  - Advantages of Humidification
  - Procedure
- 2. BLOOD TRANSFUSION
  - Definition
  - Purpose
  - General Instructions
  - Articles Required
  - Special Points to Remember
- 3. ELECTROCARDIOGRAM (ECG)
  - Placement of Chest Leads
    - Objectives
  - Nursing Intervention
- 4. SECURING AND CARE OF ENDOTRACHEAL TUBES (ETT'S)
  - Standards
  - Outcomes
  - Equipment
  - Procedure
  - Post Procedure
  - Special Precautions
- 5. DRAWING ABG'S FOR BLOOD GAS ANALYSIS
  - Policy
  - Outcomes
  - Procedure
  - Special Considerations
- 6. GUIDELINES FOR BLOOD CULTURE COLLECTION
  - Indications
  - Timing
  - Volume of Blood Per Set
  - Number of Sets of Blood Cultures
  - Site of Blood Culture
  - Labeling
- PREPARATION OF THE SITE FOR CULTURE
- 7. CARE OF A PATIENT WITH CENTRAL LINE
  - A. Procedure: Central Venous Catheters
- B. HEPARIN LOCK FOR CENTRAL VENOUS CATHETER LINES
  - Policy
  - Outcomes
  - Equipment
- C. CENTRAL VENOUS CATHETER SITE DRESSING
  - Policy
  - Outcomes
  - Special Considerations
  - Equipment
  - Procedure
- D. DRAWING BLOOD FROM A CENTRAL VENOUS CATHETER
  - Policy
  - Outcomes
  - Equipment
  - Procedures
- E. REMOVAL OF CENTRAL VENOUS LINE STANDARDS
  - Policy
  - Outcomes
  - Equipment
  - Procedure
- 8. ARTERIAL PRESSURE MONITORING
- A. ARTERIAL LINE PLACEMENT
  - Procedure
  - Procedure: Insertion of an Arterial Line
  - Policy
  - Outcomes
  - Equipment
- B. SETTING UP A TRANSDUCER FOR INVASIVE PRESSURE MANAGEMENT
  - Procedure
- C. DRESSING CHANGES TO RADIAL/FEMORAL ARTERIAL LINES
  - Policy
  - Outcomes
  - Equipment
  - Procedure
- D. REMOVAL OF ARTERIAL LINE
  - Policy
  - Outcomes
  - Equipment
  - Procedure
  - Alert
- 9. PROCEDURE: PERICARDIOCENTESIS
- 10. PROCEDURE THORACOCENTESIS AND CHEST TUBE PLACEMENT (FIG. 10.6)
  - Procedure
- 11. CARE OF THE PATIENT WITH CHEST TUBE
  - Water Seal Drainage
    - Definition
  - Purpose
  - Methods of Water Seal Drainage System
  - General Instructions
- 12. URINARY CATHETERIZATION
- 13. SUCTIONING A PATIENT WITH A TRACHEOSTOMY TUBE
  - Policy
  - Outcomes
  - Post Procedure
- 14. SUCTIONING A PATIENT WITH AN ENDOTRACHEAL TUBE
  - Standards
  - Outcomes
  - Post Procedure
- 15. TRACHEOSTOMY CARE
  - Definition
  - Purpose
  - General Instructions
  - Articles Required
  - Procedure
- 16. TRACHEOSTOMY DRESSING
  - Policy
  - Outcomes
  - Equipment
  - Procedure
- 17. INSERTION OF PERITONEAL DIALYSIS CATHETER
  - Purpose
  - Articles Required
  - Procedure
  - Care of PD Catheters
  - General Instructions
  - Basic Peritoneal Dialysis Regime
  - PD Cycles
  - Comments
CHAPTER 11:Procedures in Pediatric Intensive Care Unit
- ABDOMINAL PARACENTESIS
- TRANSURETHRAL BLADDER CATHETERIZATION FOR INTRA-ABDOMINAL COMPARTMENT PRESSURE MEASUREMENT AND URINARY DRAINAGE
CHAPTER 12:Flexible Bronchoscopy in Infants and Children
- INDICATIONS
  - Contraindications
  - Bronchoscopic Equipment
- THE PHYSICS OF FLEXIBLE FIBEROPTIC ENDOSCOPES
- BASIC ANATOMY OF A BRONCHOFIBERSCOPE
- COMPARISON OF AVAILABLE FIBERSCOPES
- ACCESSORY INSTRUMENTS
- CLEANING AND STERILIZATION
- THE FIBEROPTIC CART
- SUGGESTIONS FOR FIBERSCOPE USAGE
CHAPTER 13:Pediatric Thoracoscopy
- HISTORY
- INDICATIONS FOR PEDIATRIC THORACOSCOPY
- OTHER USES28–33
  - Pleural Effusion
  - Pneumothorax
CHAPTER 14:Radiology for the Pediatric Intensivist
SECTION TWO: RESPIRATORY SYSTEM
CHAPTER 15:Respiratory Physiology
- APPLIED RESPIRATORY PHYSIOLOGY FOR MECHANICAL VENTILATION
- SUMMARY
CHAPTER 16:Oxygen Therapy in Pediatrics
- CONCLUSION
CHAPTER 17:Blood Gas and Acid-Base Interpretation
- ACIDOSIS
- ALKALOSIS
- BUFFERING SYSTEM
- HOMEOSTASIS
- PATHOPHYSIOLOGY
- METABOLIC ACIDOSIS (FLOW CHART 17.1)
  - Effects of Metabolic Acidosis
- TREATMENT
- METABOLIC ALKALOSIS (pH > 7.44 BLOOD BICARBONATE > 26 mEq/L) (FLOW CHART 17.2)
  - Treatment
- RESPIRATORY ACIDOSIS (pH < 7.35 WITH PRIMARY PaCO2 > 45 mmHg)
- RESPIRATORY ALKALOSIS (PRIMARY DECREASE IN PaCO2 < 35 mmHg AND pH > 7.44)
  - Practical Tips to Approach Acid-Base Disorders
- MIXED ACID-BASE DISORDERS
- REFERENCES
CHAPTER 18:Upper Airway Obstruction in Children
- PEDIATRIC AIRWAY
- SPECIFIC DISEASES
- CONGENITAL MALFORMATIONS
- INFECTIOUS DISEASES
- SUPRAGLOTTITIS (EPIGLOTTITIS)
- LARYNGOTRACHEOBRONCHITIS
  - Clinical Presentation
  - Management
- BACTERIAL TRACHEITIS
  - Clinical Presentation
- FOREIGN BODIES
  - Clinical Presentation
  - Management
- TRAUMATIC INJURY
- BURN INJURY
- ANGIOEDEMA
- TRACHEAL STENOSIS
- TRACHEOMALACIA
  - Clinical Presentation
- MEDIASTINAL MASSES
CHAPTER 19:Meconium Aspiration Syndrome and PPHN
- INTRODUCTION
CHAPTER 20:Acute Respiratory Failure
- GENERAL CONSIDERATIONS
- SPECIFIC DISORDERS LEADING TO ARF: IMPORTANT ISSUES IN DIAGNOSIS AND MANAGEMENT
CHAPTER 21:Pediatric Tracheostomy
- HISTORY (FIG. 21.1)
  - Indications
- TYPES OF TRACHEOSTOMY TUBES (FIGS 21.2 AND 21.3)
  - Specific Indications for a Tracheostomy9
  - Tracheostomy Tubes Available in India
- CHOICE OF A TUBE
- TECHNIQUE
  - Percutaneous Technique (PT)5
  - Technique of Insertion of Percutaneous Tracheostomy
- POSTOPERATIVE CARE
- ROUTINE CARE
- PARENT TEACHING AND HOME CARE
  - Monitoring
- DECANNULATION
- COMPLICATIONS
  - Early Complications
  - Late Complications
CHAPTER 22:Acute Severe Asthma Management in Pediatric Intensive Care Unit
- REFERENCES
- FURTHER READING
- DIAGNOSIS OF ASTHMA IN CHILDREN
- PROGNOSIS OF CHILDHOOD ASTHMA
- A. FAMILY HISTORY OF ATOPY
- B. CO-EXISTENCE OF ATOPIC DISEASE
- C. EFFECT OF SEX
- D. BRONCHIOLITIS IN INFANCY
- E. PARENTAL SMOKING
- F. BIRTH WEIGHT AND PREMATURITY
- G. AGE AT PRESENTATION
- H. SEVERITY AND FREQUENCY OF EPISODES
- I. LUNG FUNCTION MEASUREMENTS
- ACUTE ASTHMA IN CHILDREN AGED OVER 2 YEARS
  - Initial Assessment
- TREATMENT OF ACUTE ASTHMA IN CHILDREN AGED OVER 2 YEARS
- A. OXYGEN
- B. BETA 2 AGONIST BRONCHODILATORS
- C. IV SALBUTAMOL
- D. STEROID THERAPY
  - Inhaled steroids
- E. IPRATROPIUM BROMIDE
- F. IV AMINOPHYLLINE
- G. OTHER THERAPIES
- H. INTRAVENOUS FLUIDS
- I. IV MAGNESIUM SULPHATE
- FURTHER INVESTIGATION AND MONITORING
- ASSESSMENT OF ACUTE ASTHMA IN CHILDREN AGED LESS THAN 2 YEARS
- TREATMENT OF ACUTE ASTHMA IN CHILDREN AGED LESS THAN 2 YEARS
  - A. beta 2 Agonist Bronchodilators
  - B. Steroid Therapy
  - C. Ipratropium Bromide
- FURTHER INVESTIGATION AND MONITORING
CHAPTER 23:Viral Pneumonias: Common Pneumonias and Recent Advances
- INTRODUCTION
- SPECIFIC VIRAL PATHOGENS AND THEIR CLINICAL SYNDROMES
- SPECIFIC ATYPICAL PATHOGENS AND THEIR CLINICAL SYNDROMES
  - Mycoplasma Pneumoniae and Ureaplasma Urealyticum
  - Chlamydia Trachomatis, Chlamydia Pneumoniae
- SUMMARY
- REFERENCES
  - Section 1: Common viral pneumonias
- COMMON VIRUSES PRODUCING PNEUMONIA
- REFERENCES
  - Section 2: Recent advances in viral pneumonias in children
CHAPTER 24:Persistent and Recurrent Pneumonias
- SUMMARY
CHAPTER 25:Recent Advances in the Rapid Diagnosis of Respiratory Tract Infection
- CONCLUSIONS
CHAPTER 26:HIV Disease and Respiratory Infection in Children
- SUMMARY (FLOW CHART 26.1)
CHAPTER 27:Acute Respiratory Distress Syndrome (ARDS) in Children
- INTRODUCTION
- OTHER ADJUNCTIVE THERAPIES
- REFERENCES
CHAPTER 28:Empyema Thoracic in Children: A Current Perspective
- SUMMARY (FLOW CHART 28.1)
CHAPTER 29:Air Leak Syndromes
- PNEUMOTHORAX
- PULMONARY INTERSTITIAL EMPHYSEMA
- PNEUMOMEDIASTINUM
- PNEUMOPERICARDIUM (FIG. 29.4)
CHAPTER 30:Cystic Fibrosis: Clinical Manifestations and Treatment
CHAPTER 31:Neonatal Congenital Lung Lesions
- CONGENITAL DIAPHRAGMATIC HERNIA (CDH)
- REFERENCES
- PULMONARY SEQUESTRATION
- REFERENCES
- CONGENITAL LOBAR EMPHYSEMA
- REFERENCES
- BRONCHOGENIC CYSTS1–4
  - Clinical Features
  - Surgical Management
- REFERENCES
- CONGENITAL CYSTIC ADENOMATOID MALFORMATION
- REFERENCES
- ESOPHAGEAL ATRESIA AND TRACHEO-ESOPHAGEAL FISTULA (TEF)
CHAPTER 32:Bronchodilator Therapy in Mechanically Ventilated Children
CHAPTER 33:Basic Mechanical Ventilation
- INTRODUCTION
- BASIC FUNDAMENTALS OF VENTILATION
- CASE SCENARIO 1
  - Ventilation for Acute Respiratory Distress Syndrome (ARDS)
    - Goals of Ventilation in ARDS
- CASE SCENARIO 2
  - Airleak Syndrome
  - Postoperative Ventilation following Open Heart Surgery
    - General Principles
- CASE SCENARIO 3
- CASE SCENARIO 4
  - Alternative Modes of Neonatal Ventilation
  - Rescue Strategies for Management of Neonatal Ventilatory Failure
- CASE SCENARIO 5
  - Inhaled Nitric Oxide (INO)
  - Summary
CHAPTER 34:Structure and Function of a Conventional Ventilator
CHAPTER 35:Commonly Available Ventilators
- VELA VENTILATOR: VIASYS HEALTH CARE (USA)
  - Features (as listed by the manufacturer)
- NEONATAL VENTILATOR MODEL BEARCUB 750 PSV–VIASYS HEALTH CARE (USA)
  - Listed Features (from the manufacturer)
- VENTILATOR MODEL AVEA- VIASYS HEALTH CARE (USA)
CHAPTER 36:Advanced Mechanical Ventilation: Newer Modes and Modalities
CHAPTER 37:Ventilator Graphics and Clinical Applications
- LOOPS
- ABNORMAL WAVEFORMS
- REFERENCES
- FURTHER READING
CHAPTER 38:Care of the Ventilated Patient
CHAPTER 39:Weaning from Mechanical Ventilation
- EXTUBATION
CHAPTER 40:Complications of Mechanical Ventilation
- COMPLICATIONS RELATED TO ADJUNCTIVE THERAPIES
  - Mechanical Misadventures
- SUMMARY
CHAPTER 41:Noninvasive Ventilation
- MECHANISM OF IMPROVEMENT WITH NONINVASIVE VENTILATION
- CONCLUSIONS
- REFERENCES
CHAPTER 42:High Frequency Ventilation
- VENTILATOR INDUCED LUNG INJURY
- PROTECTIVE STRATEGIES OF CONVENTIONAL MECHANICAL VENTILATION
- BASIC CONCEPTS OF HFV (HIGH FREQUENCY VENTILATION)
- TYPES OF HIGH FREQUENCY VENTILATION
- CLINICAL APPLICATION (FLOW CHART 42.1)
- SUMMARY
- REFERENCES
- WHERE IS THE EVIDENCE?
  - Initiation of High Frequency Oscillation
- WHY IS THIS IMPORTANT?
- CONCLUSION
- REFERENCES
- FURTHER READING
- I. INITIAL SETTINGS
- II. MANAGEMENT STRATEGIES FOR THE SENSORMEDICS 3100
- III. WEANING
- IV. COMPLICATIONS ASSOCIATED WITH HFOV
CHAPTER 43:Inhaled Nitric Oxide (INO)
CHAPTER 44:Neonatal Ventilation
CHAPTER 45:Surfactant Therapy in the Newborn
- CONCLUSION
CHAPTER 46:Extracorporeal Membrane Oxygenation (ECMO)
- CONCLUSIONS
- ACKNOWLEDGEMENT
CHAPTER 47:Pediatric Heart and Lung Transplantation
- HEART TRANSPLANTATION
- LUNG AND HEART-LUNG TRANSPLANTATION
  - Indications
  - Selection of Candidates and Waiting List
    - Surgical Considerations
- PHYSIOLOGY OF THE TRANSPLANTED HEART
  - Hemodynamics
- PHYSIOLOGY OF THE TRANSPLANTED LUNG
- CHRONIC REJECTION AND PROBLEMS AFTER TRANSPLANTATION
  - Common to all Transplants
- PROBLEMS SPECIFIC TO EACH ORGAN TRANSPLANT
SECTION THREE: CIRCULATORY SYSTEM
CHAPTER 48:Shock: Management of Shock in PICU
- DEFINITIONS
- PATHOPHYSIOLOGY
- PHASES OF SHOCK
  - Compensatory Mechanisms
  - Clinical Presentation
- CLASSIFICATION OF SHOCK
- ASSESSMENT AND RECOGNITION OF SHOCK
  - Laboratory Investigations
- MONITORING OF SHOCK
- TREATMENT OF SHOCK
- MYOCARDIAL CONTRACTILITY
  - Inotropic and Vasoactive Agents
  - Afterload Reduction
- SUPPORTIVE THERAPY
- SUMMARY
CHAPTER 49:Inotropes and Vasopressors in the Pediatric Intensive Care Unit
- DIGOXIN
- THE CHOICE OF INOTROPES AND VASOPRESSORS
- DOPAMINE
- DOBUTAMINE
- EPINEPHRINE
- MILRINONE
- NOREPINEPHRINE
- VASOPRESSIN
- SUMMARY
  - Guideline
- REFERENCES
CHAPTER 50:Cardiogenic Shock
- CLINICAL FINDINGS
- INITIAL TREATMENT
- SPECIFIC CONDITIONS
- SUMMARY
CHAPTER 51:Pediatric Septic Shock
- INTRODUCTION
- DEFINITIONS
- DISCUSSION OF FLOW CHART 51.1
- THERAPEUTIC END-POINTS
- CONCLUSIONS
- ACKNOWLEDGEMENTS
CHAPTER 52:Multiorgan Failure in Critically Ill Children
- CONCLUSIONS
CHAPTER 53:Viral Hemorrhagic Fever: Management in Pediatric Intensive Care Unit
- SUMMARY
- REFERENCES
- INTRODUCTION
- RISK FACTORS REPORTED FOR DHF
- PATHOGENESIS OF DENGUE AND DHF (FIG. 53.2)
  - Mechanism of Thrombocytopenia
- CLINICAL CLASSIFICATION
- DENGUE FEVER
- DENGUE HEMORRHAGIC FEVER (DHF)
- DENGUE SHOCK SYNDROME (DSS) (FLOW CHART 53.2)
- DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS
- LABORATORY METHODS FOR DIAGNOSIS
- MANAGEMENT: FEBRILE PHASE
  - High Risk Dengue Patients that Need Special Attention
  - Indication for Admission
- MANAGEMENT: CRITICAL PHASE
- SIGNS OF RECOVERY
- CRITERIA FOR DISCHARGING PATIENTS
- WHAT NOT TO DO
- PREVENTION AND CONTROL OF DENGUE FEVER
  - Dengue Vaccine
  - Acknowledgement
CHAPTER 54:Role of Echocardiography in the Pediatric Intensive Care Unit
- SUMMARY
CHAPTER 55:Cardiac Failure
- DEFINITION
- PROCESSES CAUSING CARDIAC FAILURE
- CLINICAL PRESENTATION
- THE ELECTROCARDIOGRAM
  - Echocardiography (See Chapter on Pediatric Echocardiography)
  - Management
- FLUID MANAGEMENT
- DIGOXIN
- MODULATORS OF RENIN-ANGIOTENSIN-ALDOSTERONE AXES
- CONCLUSION
CHAPTER 56:Cardiac Dysrhythmias in Pediatric Intensive Care
- REFERENCES
CHAPTER 57:Hypertension in Children
CHAPTER 58:Postoperative Management of Pediatric Cardiac Patients after Open Heart Surgery
- INTRODUCTION
- BASIC PHYSIOLOGIC PRINCIPLES FACTORS AFFECTING CARDIAC OUTPUT
CHAPTER 59:Pediatric Pacemaker and Implantable Cardioverter Defibrillator (ICD) Therapy
CHAPTER 60:Interventional Pediatric Cardiology: An Overview
- VASCULAR ANGIOPLASTIES
- DILATION OF VALVULAR LESIONS
- CLOSURE OF EXTRACARDIAC AND INTRACARDIAC COMMUNICATIONS
- PROCEDURES
- COMPLICATIONS
- SUMMARY
SECTION FOUR: METABOLIC RENAL ISSUES
CHAPTER 61:Electrolyte Abnormalities in Critically Ill Children
- DISORDERS OF WATER HOMEOSTASIS
- POTASSIUM DISORDERS
- CALCIUM DISORDERS
- MAGNESIUM
- SUMMARY
CHAPTER 62:Inborn Errors of Metabolism
- PATHOPHYSIOLOGY
- LABORATORY INVESTIGATIONS
- TREATMENT
CHAPTER 63:Diabetic Ketoacidosis
- CLASSIFICATION
- DEFINITION OF DIABETIC KETOACIDOSIS(DKA)
- SUMMARY
CHAPTER 64:Acute Renal Failure in Pediatric Intensive Care Unit
CHAPTER 65:Renal Replacement Therapy in the Pediatric Intensive Care Unit
- PHYSIOLOGICAL PRINCIPLES OF DIALYSIS
- SELECTION OF MODALITY
- INDICATIONS OF DIALYSIS
- PERITONEAL DIALYSIS (FIG. 65.2)
- CONTINUOUS VENOVENOUS HEMOFILTRATION AND HEMODIAFILTRATION (CVVH/CVVHD)
  - Advantages and Disadvantages of CVVH/CVVHD
CHAPTER 66:Pediatric Renal Transplantation
SECTION FIVE: GASTROENTEROLOGICAL ISSUES
CHAPTER 67:Gastrointestinal Bleeding: Diagnosis and Management
- LOWER GI BLEEDING
  - Further Diagnostic Evaluation
- MANAGEMENT
  - Stabilization in the PICU
  - Therapeutic Modalities
- SUMMARY
CHAPTER 68:Nutrition in the Pediatric Intensive Care Unit
- MODES OF NUTRITIONAL REPLETION
- NUTRITIONAL SUPPORT
- NUTRITION IN SPECIAL CIRCUMSTANCES
- CONCLUSION
- SUMMARY
CHAPTER 69:Parenteral Nutrition for the Pediatrician
CHAPTER 70:Fulminant Hepatic Failure
- CLINICAL FEATURES
- SUMMARY
CHAPTER 71:Liver Transplantation
- INDICATIONS
- EXTRAHEPATIC COMPLICATIONS
  - Post-transplant Lymphoproliferative Disease (PTLD)
- OUTCOME OF LIVER TRANSPLANTATION
CHAPTER 72:Liver Transplantation in Children: Indian Scenario
- INDICATIONS
SECTION SIX: HEMATOLOGICAL ISSUES
CHAPTER 73:Disseminated Intravascular Coagulation
CHAPTER 74:Blood Transfusion in Neonatal and Pediatric Intensive Care
- INTRODUCTION
  - Physiological Principles
- ANEMIA IN THE INTENSIVE CARE UNIT
- WEIGHT IN KG × BLOOD VOLUME PER KG × (DESIRED HEMATOCRIT – OBSERVED HEMATOCRIT)
- SUMMARY
- REFERENCES
- FURTHER READING
SECTION SEVEN: PEDIATRIC SURGICAL ISSUES
CHAPTER 75:Postoperative Care in Pediatric Surgical Patients
- SUMMARY
CHAPTER 76:Multiple Trauma: Stabilization and Management in Pediatric Intensive Care Unit
- INTRODUCTION
CHAPTER 77:Child Abuse and Shake Injuries
- DEFINITION AND ETIOLOGY
- DIAGNOSIS
- EXAMINATION
- HEAD INJURIES
- ABDOMINAL INJURIES
- LABORATORY AND DIAGNOSTIC IMAGING STUDIES
- DIAGNOSTIC IMAGING EVALUATION
- MANAGEMENT
- LEGAL IMPLICATIONS
CHAPTER 78:Pediatric Anesthesia—for the Pediatrician
- TRIAD OF ANESTHETIC RISK
SECTION EIGHT: TOXIC INGESTION
CHAPTER 79:Poisoning and Bites
- TOXICITY OF SPECIFIC AGENTS
- HYDROCARBONS EXPOSURE
- CLINICAL FEATURES
- ORGANOPHOSPHATES
  - Clinical Features
- TREATMENT (FLOW CHART 79.3)
  - Specific Treatment
- CARBAMATES
- PARACETAMOL
  - Clinical Features
  - Laboratory Features
- TREATMENT (FLOW CHART 79.4)
  - Gastrointestinal Decontamination
  - N-Acetyl Cysteine (NAC)
- IRON
- SALICYLATE POISONING
- METHANOL AND ETHYLENE GLYCOL
  - Treatment
- CALCIUM CHANNEL BLOCKERS
  - Treatment
- ANTIDEPRESSANTS
- CARBON MONOXIDE POISONING
- SMOKE INHALATIONAL INJURY AND CARBON MONOXIDE POISONING
- SUMMARY
- ALUMINIUM PHOSPHIDE POISONING
- POISONING BITES
- SCORPION STING
CHAPTER 80:Methemoglobinemia
SECTION NINE: INFECTIONS AND INFECTION CONTROL
CHAPTER 81:Antibiotic Therapy in the Pediatric Intensive Care Unit
- CARBAPENEM
- LINEZOLID
- TEICOPLANIN
- TIGECYCLINE
- SUMMARY RECOMMENDATIONS
- SUMMARY
CHAPTER 82:Nosocomial Infection and its Management
CHAPTER 83:The Immunocompromised Child in the Pediatric Intensive Care Unit
CHAPTER 84:Pediatric HIV Infections
- AIDS
- MONITORING PEDIATRIC HIV INFECTION
- NUCLEOSIDE/NUCLEOTIDE ANALOGUE REVERSE TRANSCRIPTASE INHIBITORS (NRTIS/NNRTIS)*†
- NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIS)*
SECTION TEN: NEUROLOGICAL ISSUES
CHAPTER 85:Pediatric Head Injury
- CLINICAL EVALUATION AND MANAGEMENT IN EMERGENCY
- NONSURGICAL MANAGEMENT
- SUMMARY
- GUIDELINES FOR ACUTE MEDICAL MANAGEMENT OF SEVERE TRAUMATIC BRAIN INJURY IN INFANTS AND CHILDREN1
  - Evidence Highlights
- CONCLUSION
CHAPTER 86:Coma: Encephalitis and Cerebral Malaria
- ENCEPHALITIS
  - Herpes Encephalitis
  - Japanese Encephalitis
CHAPTER 87:Bacterial, Viral and Fungal Meningitis
- BACTERIAL MENINGITIS
- FUNGAL MENINGITIS
- INTRODUCTION AND INCIDENCE
- HERPES SIMPLEX ENCEPHALITIS
- TUBERCULAR MENINGITIS
CHAPTER 88:Sedation, Analgesia and Neuromuscular Blockade
- CLINICAL PHARMACOLOGY OF COMMONLY USED SEDATIVES AND ANALGESICS
- PRACTICAL APPROACH TO SEDATION IN THE PICU
- SUMMARY
- NEUROMUSCULAR BLOCKADE
- NON-DEPOLARIZING AGENTS
CHAPTER 89:Hydrocephalus
- SUMMARY
CHAPTER 90:Status Epilepticus
- TREATMENT OF STATUS EPILEPTICUS
- SUMMARY
CHAPTER 91:Near-drowning
- ASSESSMENT AND MANAGEMENT
- RESPIRATORY MANAGEMENT
- PROGNOSIS
- CONCLUSION
CHAPTER 92:Brain Death in Children
- HISTORY
- CONCLUSION
CHAPTER 93:Care of Terminally Ill Children
- INTRODUCTION
  - A Child's Reaction to Illness and Hospitalization
  - Stress in PICU Team Members
- ISSUES RELATED TO A CRITICALLY ILL CHILD DYING (OR LIKELY TO DIE) IN PICU AND END OF LIFE CARE
- ENDSTAGE PALLIATIVE CARE9
- INTERVENTIONS
- HELPING PARENTS FACE THE DEATH OF THEIR CHILD17,18
- SUPPORTING GRIEVING FAMILIES19,20
- SUMMARY
CHAPTER 94:Limitation of Life Support in the Pediatric Intensive Care Unit: Ethical Issues Relating to End of Life Care
- CONCLUSIONS
- ABSTRACT
  - Guidelines
- INTRODUCTION
  - Ethical Principles
- GUIDELINES FOR LIMITING LIFE-SUPPORT INTERVENTIONS
- CONCLUSIONS
CHAPTER 95:Psychological Issues in PICU
- CHILD'S REACTION TO HOSPITALIZATION
- EFFECTS OF HOSPITALIZATION ON THE FAMILY OF THE CHILD
- SOURCES OF STRESS IN A HOSPITAL SETTING
- ROLE OF NURSE IN HELPING CHILD AND FAMILY IN COPING WITH STRESS OF HOSPITALIZATION AND ILLNESS
- CONCLUSION
SECTION ELEVEN: ENVIROMENTAL INJURIES
CHAPTER 96:Thermal Burns
CHAPTER 97:Heat Disorders
- THERMOREGULATION
- ENVIRONMENTAL HYPERTHERMIA
- MINOR HEAT ILLNESSES
- HEATSTROKE
  - Management
- MALIGNANT HYPERTHERMIA
- SUDDEN UNEXPECTED CARDIAC ARREST IN CHILDREN
  - Postacute Phase
CHAPTER 98:Electrical Shock
- SUMMARY
SECTION TWELVE: MISCELLANEOUS
CHAPTER 99:Research in the Pediatric Intensive Care Unit
CHAPTER 100:Quality in Pediatric Intensive Care Unit
- SUMMARY
CHAPTER 101:Training in Pediatric Critical Care Medicine
- SKILLS
- SYLLABUS
CHAPTER 102:Medicolegal Aspects in Intensive Care
CHAPTER 103:Useful Information and Equations in the PICU
CHAPTER 104:Drugs Used in the Pediatric Intensive Care Unit

INDEX

TOC
Index

Chapter Notes