Approach to Sick Child

Praveen  Khilnani

IAP Textbook of Pediatric ICU Protocols Praveen Khilnani, Soonu Udani, Deepak Ugra, Bala Ramachandran, Suchita Khadse

CHAPTER 1:Approach to Sick Child
CHAPTER 2:Approach to Collapsed Child
CHAPTER 3:Approach to Respiratory Distress
CHAPTER 4:Airway Management Protocol
- Laryngeal Mask Airway
- Predictors of Difficult Intubation
- Algorithm for Difficult Airway
  - Contents of Cricothyrotomy Kit
CHAPTER 5:Rapid Sequence Intubation
- Steps in Rapid Sequence Intubation
- Conclusion
CHAPTER 6:Respiratory Failure
- Definition
- Etiology of Acute Respiratory Failure
- Classification of Respiratory Failure
  - Hypoxemic Respiratory Failure (Type I)
  - Hypercapnic Respiratory Failure (Type II)
- Approach to a Child with Acute Respiratory Failure
- Summary
- Respiratory Failure: Mechanical Ventilation Algorithm
CHAPTER 7:Basic and Disease Specific Mechanical Ventilation
- Case Scenario 1
  - Ventilation for Acute Respiratory Distress Syndrome
    - Goals of Ventilation in Acute Respiratory Distress Syndrome
- Case Scenario 2
- Case Scenario 3
CHAPTER 8:Weaning from Mechanical Ventilation
- Weaning Strategy
- Suggested Weaning Strategy from Mechanical Ventilation
CHAPTER 9:Noninvasive Ventilation
CHAPTER 10:High Frequency Ventilation
CHAPTER 11:Management of Pediatric Status Asthmaticus
- Case Scenario
- Steps in Management of Pediatric Status Asthmaticus
CHAPTER 12:Brief Protocol of Treatment of Bronchial Asthma in PICU
CHAPTER 13:Brief Protocol for Managing Shock
- Introduction
- Step 1
- Step 2
- What Does Early Goal Directed Therapy Try To Do (Egdt)?
  - Early Goal Directed Therapy
- First Hour Antibiotics and Source Control
- Mechanical Ventilation and Sedation
- Steroids When and At What Dose?
- Glucose Control
- Summary
- Shock
  - Antibiotic
  - Consider Endotracheal Intubation and Ventilation with RSI and Lung Protective Strategies
CHAPTER 14:IAP Sepsis Guidelines Summary
- Shock Not Reversed?
  - 40–60 Min
- Shock Not Reversed?
  - 60 Min
    - Recognize catecholamine resistant shock
- Beyond 60 Min
CHAPTER 15:Dengue Fever and Shock Syndromes: WHO Guidelines
- Classification and Clinical Course of Dengue
  - Clinical Manifestations and Phases
  - Clinical Phases of Dengue
- Diagnosis
  - Laboratory Confirmation of Dengue
- Management of Patients with Dengue
CHAPTER 16:New Fever in PICU: Nosocomial Infection
CHAPTER 17:Pediatric HIV Algorithm
CHAPTER 18:Empyema Algorithm
CHAPTER 19:Comatose Child
CHAPTER 20:Raised Intracranial Pressure Algorithm
CHAPTER 21:Pediatric Head Trauma
- Clinical Signs of Herniation
CHAPTER 22:Status Epilepticus
- IAP Convulsive Status Epilepticus Management Algorithm (2008)
- IAP Algorithm for the Management of Neonatal Seizure (2008)
CHAPTER 23:Cardiovascular Drug Protocol
- Inotropes and Vasopressors
- Common Notes
CHAPTER 24:Arrhythmias
- Tachyarrhythmia (Also see Chapter 66)
  - Two Types
- Management
- Rhythm Disturbances Algorithm
CHAPTER 25:Diabetic Ketoacidosis Protocol
- Diabetic Ketoacidosis: Management
  - Notes
CHAPTER 26:Trauma in Children
- Anatomic and Physiologic Differences
  - General Considerations
- Primary Survey
- Breathing
  - Assessment
  - Management
- Circulation
- Secondary Survey
- Pediatric Multiple Trauma Algorithm
CHAPTER 27:Approach to Gastrointestinal Bleeding
- Approach to Upper Gastrointestinal Bleed
- Approach to Lower Gastrointestinal Bleed
- Role of Endoscopy in Lower Gastrointestinal Bleed
CHAPTER 28:Acute Gastrointestinal Bleeding Algorithm
CHAPTER 29:Pediatric Multiorgan Failure (Renal and Hepatic) and Support
- Pediatric Multiorgan Failure (Liver and Kidney)
  - Case Scenario
  - Definitions
- Acute Kidney Injury in Multiple Organ Dysfunction
- Hepatic Dysfunction in Pediatric Multiorgan Dysfunction
  - Laboratory Evaluation
  - Principles of Treatment
CHAPTER 30:Acute Renal Failure Algorithm
CHAPTER 31:Fulminant Hepatic Failure Algorithm
CHAPTER 32:Hyperammonemia
- Clinical Approach to a Newborn Infant with Symptomatic Hyperammonemia
- Treatment of Acute Hyperammonemia in an Infant
CHAPTER 33:Interpretation of Arterial Blood Gas
- Importance of Arterial Blood Gas in PICU
- Basics of Arterial Blood Gas
- Interpretation of Arterial Blood Gas
- Five Steps for ABG Analysis
- Some Important Equations and Principles
CHAPTER 34:Inborn Errors of Metabolism (Iem) Algorithm
- Principles of Treatment
- Metabolic Acidosis with Increased Anion Gap in Young Infant
CHAPTER 35:Acidosis
- Metabolic Acidosis
  - Causes of Metabolic Acidosis
  - Distinguishing Features of Hyperchloremic Acidosis
- Treatment
  - Forms of Alkali Replacement
- Approach to Child with Acidosis
CHAPTER 36:Alkalosis
CHAPTER 37:Hyponatremia
CHAPTER 38:Hypernatremia
- Causes of Hypernatremia
- Diagnostic Approach to Hypernatremia
- Treatment
- Hypernatremia Algorithm
CHAPTER 39:Hyperkalemia
CHAPTER 40:Hypokalemia
CHAPTER 41:Hypocalcemia
- Definition
CHAPTER 42:Hypercalcemia
CHAPTER 43:Hypomagnesemia
- Signs and Symptoms
  - Common Symptoms
  - Uncommon Symptoms
- Treatment
  - Complications of Parenteral Magnesium Therapy
CHAPTER 44:Bleeding Child in the PICU
- Medical History
- Family History
- Types of Bleeding Manifestations
- Physical Examination
- Investigations
  - Complete Blood Count and Peripheral Blood Smear
- Coagulation Studies
- Platelet Disorders in PICU
- Management of Bleeding Child
CHAPTER 45:Bleeding Child Algorithm
CHAPTER 46:Approach to a Child with Poisoning
CHAPTER 47:Paracetamol Poisoning
- Dose and Pattern of Paracetamol Ingestion
- Pathophysiology of Paracetamol Toxicity
- Clinical and Laboratory Manifestations
- Management
CHAPTER 48:Paracetamol Poisoning Algorithm
CHAPTER 49:Iron Toxicity
- Treatment
  - Iron Poisoning
CHAPTER 50:Iron Poisoning Algorithm
CHAPTER 51:Organophosphorus Poisoning
- Pathophysiology
- Diagnosis
- Treatment
- Algorithm
CHAPTER 52:Salicylate Poisoning
- Pathophysiology
- Clinical Presentation
  - Laboratory Studies
- Treatment
  - Criteria for Admission or Observation
    - Methods to Prevent Absorption
- Algorithm
CHAPTER 53:Hydrocarbon Ingestion
- Treatment
CHAPTER 54:Scorpion Sting Poisoning
- Pathophysiology and Clinical Features
- Investigations
- Treatment
- Pharmacotherapy
  - Doses of Medications
- Algorithm
CHAPTER 55:Mammalian Bites
- Management
CHAPTER 56:Snake Bite Management Algorithm
- Antivenom Treatment of Snake Bite Cases Algorithm
- Classification of Envenomation Severity
- Antivenin
CHAPTER 57:Approach to Pediatric Hypertension
CHAPTER 58:Hypertensive Crisis in the PICU
- Hypertensive Crisis: Management Protocol
  - Definitions
  - Protocol of Management
    - Clinical Evaluation: Goals
    - Treatment
CHAPTER 59:Hypertensive Crisis Algorithm
CHAPTER 60:Management of the Postoperative Pediatric Cardiac Surgical Patient
- Pulmonary Hypertension
CHAPTER 61:Lesion Specific Management of Pediatric Cardiac Patients
- Approach to Acyanotic Heart Defects
- Approach to Cyanotic Heart Defects
- Postoperative Low Cardiac Output
- Left Ventricular Dysfunction
- RV Dysfunction
- Pulmonary Hypertensive Crises
- Arrhythmias
- Interpretation of Various Invasive Pressures in a Postoperative Cardiac Patient with Low Cardiac Output
- Algorithm for the Management of Low Cardiac Output after Fontan Procedure
CHAPTER 62:PICU Rounds and Documentation
- General Admitting Orders
- Admission Notes
- Progress Notes
  - SOAP Note—Subjective
- SOAP note—Objective
- Example
- Important Points to Remember
- Summary
- Appendix
  - Glossary
CHAPTER 63:Transport Protocol
- Who Should Be Transported Out?
- Classification
- Mode of Transport
- Skills Needed by Physician, Nurse and Technician
- Counseling the Family
- Ambulance Equipment
- Do's and Don'ts
  - Do's
  - Don'ts
- Documentation of Vital Signs and Physical Examination
CHAPTER 64:Sedation in PICU
- Introduction
- Main Goals of Sedation
- Procedures Requiring Sedation
  - Noninvasive Procedures
  - Invasive and Painful Procedures
- Preprocedure Fasting and Risk of Aspiration
  - Sedation Eqipment
- Physician Qualifications
- Monitoring and Care of Child after Sedation
- Documentation
CHAPTER 65:Admission, Transfer and Discharge Criteria for Pediatric Intensive Care Unit (PICU)
- Admission Criteria
- Admission Criteria to Level 2 Care (Unventilated)
- Criteria for Transfer/Discharge from the PICU (Level 3 or Level 2)
  - Minimum Criteria
CHAPTER 66:Pediatric Advanced Life Support 2010 Guidelines
- Pediatric Advanced Life Support
- BLS Considerations During PALS
- Monitoring
- Emergency Fluids and Medications
  - Estimating Weight
  - Medication Dose Calculation
- Medications
- Pulseless Arrest
  - Nonshockable Rhythm: Asystole/PEA (Step 9)
  - Shockable Rhythm: VF/Pulseless VT (Step 2)
- Defibrillators
- AEDs
- Special Resuscitation Situations
- Children with Special Healthcare Needs
- Postresuscitation Stabilization (Post-Cardiac Arrest Care)
- Interhospital Transport
- Family Presence During Resuscitation
- Termination of Resuscitative Efforts
- Sudden Unexplained Deaths
  - Class of Evidence
  - Levels of Evidence (LOE)
CHAPTER 67:Procedures in PICU
- Intubation
- Central Line Placement
- Arterial Line Placement
  - Introduction
- Intracranial Pressure Monitoring
  - Introduction
- Chest Tube Placement
  - Introduction
- Intra-abdominal Pressure Monitoring
  - Introduction
CHAPTER 68:Useful Information and Equations in the PICU
- Alveolar Air Equation
- Alveolar Arterial Oxygen Gradient
- Airway Resistance Equation
- Oxygen Content (CaO2)
- Oxygen Delivery (DO2)
- Oxygen Consumption (VO2)
- Oxygen Extraction
- Shunt Equation (Qs/Qt)
- Systemic to Pulmonary Shunt (Qp/Qs)
- Systemic Vascular Resistance Index (SVRI)
- Pulmonary Vascular Resistance Index (PVRI)
- Pharmacokinetics
  - Drip Calculation
- Acid-Base/Renal/Fluids
- Temperature Conversion
  - Body Surface Area (BSA)
- Biostatistics
CHAPTER 69:PICU Drug List

INDEX

TOC
Index

Chapter Notes

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Approach to Sick ChildCHAPTER 1

Praveen Khilnani

Abbreviations: ABC, airway, breathing and circulation; GCS, Glasgow Coma Scale; ET, endotracheal; IV, intravenous; BP, blood pressure; SpO₂, saturation of oxygen; PICU, pediatric intensive care unit