IAP Textbook of Pediatric ICU Protocols Praveen Khilnani, Kundan Mittal, Santosh T Soans, Vinayak Patki, Bakul Parekh, Mahesh Mohite, Arun Bansal, Rakshay Shetty
INDEX
Page numbers followed by b, f and t indicate boxes, figures and tables respectively.
A
Abdomen 594, 603
in children 471
injuries 597
Abdominal
aortic aneurysm 472
compartment syndrome 461, 472, 480, 702
distension 99, 105, 106
and regurgitation 100
injuries 596
pain 204, 212, 489
age of the child 470t
upper
perfusion pressure 701
tenderness 603
thrusts 18
trauma 603, 605
USG 458
Abetalipoproteinemia 295
Ablation therapy 504
ABO compatible 388
ACE inhibitor 503
Acetaminophen 460
Acetazolamide 721
Acetylcholine, synaptic levels of 420
Acid-base
abnormalities, correction of 426
disturbances 303
Acid suppression therapy 448
Acidosis, hypocalcemia 76
Acinetobacter species 225, 228
Acquired methicillin resistant Staphylococcus aureus 550
Activated partial thromboplastin time 371, 372, 376, 379, 384
Activated protein C 615
Acyanotic heart defects, approach to 519
Acyclovir 535, 715
Addison's disease 347
Adenosine 717
triphosphate 361, 424
Adherent clot 451
Adipose tissue water content 320
Adipsia, primary 336
Adolescent 320
cricothyroid membrane 31
Adrenal
hyperplasia, congenital 344
suppression 631
synthesis 281
Adrenaline 516, 517, 556, 643, 716, 720, 739
Adrenergic receptors 516
Adrenocortical insufficiency 289
Adrenocorticotropic hormone 280, 283
Adult female 320
Adult male 320
Agenesis 354
Air leak syndrome 154, 570
Air leaks, like pneumothorax 115
Airborne
precautions 623
transmission 621
Airway
and breathing 647
conductance 102
management plan in emergency 35t
management, advance 56
obstruction 394
lower 15
severe croup, trauma 28
upper 13, 15, 18
of secretion, clearing of 20
patency 583
pressure release ventilation 114, 138
protection 144
resistance, increased 154
suctioning 144, 155
toileting 144
trauma 103
with cervical spine
control 185
stabilization 598
Alanine aminotransferase 413, 613
Albuterol inhalation 351
Aldosterone antagonist therapy 503
Algid malaria 199
Alkalosis 315
Allen test 303
Allergic
interstitial nephritis 480
reactions, severe 394
Alloderm 587
Alloimmunization 391
Alprostadil 517
Alveolar-capillary membrane 154
Amblyopia 724
American College of Critical Care Medicine 83
American College of Critical Medicine guidelines 2017 83
American Heart Association 60
American Society for Parenteral and Enteral Nutrition 633
American Society of Anesthesiologists 629
Amikacin 535, 711
Amino acid preparations 636
Aminoglycosides, calcineurin inhibitors
Amiodarone 54, 663
Amlodipine 509
Ammonia 465
Amniotic membrane 587
Amoxicillin 213, 711
Amphotericin B 716
Ampicillin 235, 711
Amylase 457
Analgesia 473
ladder 531
Analgesic 412, 725
Analgesic, used in PICU 630t
Analyzing acid-base disorder 306
Anaphylactic shock in children 87
Anaphylaxis 76, 88, 394, 480, 643, 716
formulations of 89t
in children. 89
signs and symptoms of 87t
Ancillary investigations 78
Anemia 212, 482, 500
severe 81, 211
Anesthetic therapy, use of 190
Angioedema 393, 509, 558
Angiotensin-converting enzyme inhibitors 347, 483, 502
receptor blockers 502
Angle with skin 667, 668
Anion gap 271
Anomalous origin of coronary artery 56
Anorexia 327
Anorexianervosa 344
Antiarrhythmic agents 503
Antiarrhythmics 54
Antibiotics 711
combinations, treatment with 225
duration of 552
in pediatric intensive care unit 222
including azithromycin 557
prophylaxis 461
stewardship, practical approach to 238
Anticipation and troubleshooting 644
Anticoagulant 503
protein 371
therapy 381
Anticonvulsant 722
Anti-diphtheritic serum 15
Antidotes in poisoning 732
Anti-epileptic drugs 190
Antifibrinolytic treatment 382
Antifungals in pediatric intensive care unit 241, 243
Antihypertensive medications 512t
Antimicrobial stewardship program 248
Antimicrobial therapy 213
duration of 264
Antimicrobial-impregnated catheters 664
Antiplasmin levels 379
Anti-reflux therapy 559
Antisnake venom 436, 732
Antitubercular drugs 198
Antivenin 437
treatment of snake bite cases algorithm 439
Antivirals 557, 715
Anxiety, nervousness 277
Anxiolysis 587
Aortic aneurysm 447
Aortic stenosis 521
Aortoenteric fistula 447
Aplastic anemia 723
Apnea 185
cyanosis 355
recurrent 551
ventilation alarm 119
Apneic
child 34
episodes 555
Appendicitis 470
Arginine vasopressin 284
Argininosuccinic acid lyase 296
Arrhythmia 76, 355, 363, 540, 720
Artemether 715
Arterial
and central venous pressures 608
ascending aorta 164
blood gas 105, 155, 166, 168, 186, 271, 301, 431, 603
blood pressure 536
cannula 164t, 172
catheter maintenance 680
diffusion gradient 304
femoral artery 164
line cannulation 676
line placement 673
pressure waveform 679f
pressure, increased 172
waveform 677f, 678, 679f
Arteriovenous malformations 446
Artesunate 715
Ascites 702
Ascorbic acid 295
Aseptic non-touch technique 692
Aseptic technique 666
Aspergillus 242
Aspirin 535
Asthma 99, 550, 570, 716
acute severe 15, 112, 545, 547, 549
Atlanto-occipital joint extension and cervical flexion 39
Atracurium 38
Atrial
fibrillation 578
flutter 42, 43, 44f, 66
Atrioventricular block 51, 342
type of 52t
Atrioventricular septal defect 521
Atropine 37, 643, 717
Atrus 370
Atypical pneumonia 197
Automated external defibrillator 56, 63, 63f
anterolateral placement of 64f
Autonomic disease 52
Autovalve 703f
Auxiliary muscles, use of 105
Azithromycin 213
Azotemia 168
B
Bacitracin 586
Bacteria 378
Bacterial
pneumonia 15
sepsis 197, 198
tracheitis 558
Bag and mask ventilation 24, 25t, 31, 34
Balloon
assisted enteroscopy 454
blood transfusions 346
dilatation 521
tamponade 452
Barbiturates 628
Barometric pressure 303
Barotrauma in children 28
Barter's syndrome 289, 344
Beer potomania syndrome 330
Behavior 555
changes 277
Benazepril 508
Benzodiazepine 217, 628, 643
for nonhypoxic anxiety 186
withdrawal 732
Benztropine antidote. 727
Beta-adrenergic blockers 54
Beta-blockers 450, 502
Bicarbonate 350, 354
gap 305
overload from transfusions
therapy 272
Bi-level positive airway pressure 95, 96, 566
Biobrane 587
Biotin 295
Biphasic defibrillator 66
Birth asphyxia 378
Bishop classification for tumor lysis syndrome 399b
Bismuth containing 445
Biventricular assist device 505
Bizarre behavior 327
Bladder pressure 703
Bleeding
child 369, 371, 375, 384
diathesis 158
disorders 159
congenital 369
from gastrointestinal 445
manifestations, types of 369
pelvic fractures 702
Blood
administration 672
component therapy 381, 381t, 383
culture 84, 392
gas 337, 534
measurements 78
monitoring 167
glucose level 279
grouping 603
lactate 78
leaking 171
loss 371
oxygen saturation 111
pressure 25, 77, 85, 506, 699
measurement 5
systolic 77, 472, 602
products administration 247
sampling 672
sugar 6
tests 457, 556
transfusion 490
indications for 384
urea nitrogen 448, 483, 515
volume 320
Blood-brain barrier 216
Bloodstream infections, primary 247
Blunt
head injury 603
trauma 603
Body cooling unit 579
Body water, normal distribution of 320t
Bone marrow failure syndromes 371
Bordetella pertussis 623
Bowel obstruction 76
Bradyarrhythmias 51
Bradycardia 36, 50, 51, 53, 55, 328, 631, 719
primary 50
secondary 50, 51
symptomatic 51, 53
Brain
hemorrhage 336
injury 69, 320
metastasis 398
neoplasms 288
tumors 182
volume 335
Brainstem injury
Breath termination 117
Breathlessness and cough 545
British Thoracic Society 570
Broad-spectrum antibiotics 233
Bronchial asthma 13
Bronchiectasis 99
Bronchiolitis 161, 554
Bronchoalveolar lavage 403
Bronchodilator therapy 545
Bronchopleural fistula 139
Bronchopneumonia 111
Bronchopulmonary dysplasia 550
Bronchoscopy 103, 570
Bronchospasm 36, 87, 355
Bubble detector 163
Bulbar palsy 144
Burkitt's lymphoma 399
Burn
major 702
wound depth assesment 582
Burn-related hospital admissions 582
Burns management 589
Burns patient care 585
C
Calcitonin 354
Calcium
and magnesium 168
channel blocker 51, 53, 512
chloride 499
dyshomeostasis 612
sensing receptor mutation 357
Calculate alveolar oxygen pressure 303
Caloric goal 635
Candesartan 508
Candida glabrata 242, 264
Candida species 263, 264
Cannula
interface and flow selection 104t
size of 163, 166, 420
Capillary
leak syndrome 173
refill time 77
Capsule endoscopy 454
Captopril 502, 508
Carbamoylphosphate synthetas 296, 299
Carbapenem-resistant enterobacteriaceae 237
Carbohydrate 636
Cardiac
arrest 34, 56, 58t, 59, 69, 716
cause of 14
management 56
medications 643
arrhythmias 434, 643
sudden death 399
complications 590
disease 564
drugs 716
dysfunction 108
dysrhythmias 509
failure 433
reversible 161
indications 108
load 126
medication protocol 516
monitor 29, 37
output 42, 517, 527
increased 43
low 533
syndrome, low 161
resynchronization therapy 504
surgery 158, 374
tamponade 76
Cardio-depressant drugs and toxins 76
Cardiogenic 77
pulmonary edema 15, 99
shock 5, 75, 76, 497, 517
Cardiomyopathies 76
Cardiopulmonary
arrest in infants 60
compromise such as hypotension 51
resuscitation 10, 12, 60, 62
resuscitation, high quality 56
stabilization 426
Cardiorespiratory
compromise 50
failure, reversible 162
Cardiovascular
collapse 281
dysfunction 614
parameters, return of 106
system 495, 591, 592
Cardioversion and defibrillation 63
Carotid artery 164, 166, 670
Carvedilol 502
Catastrophic external hemorrhage 185
Catheter
associated urinary tract infection 247, 257
dressing 672
drugs 289
over a guidewire 676
related blood stream infection 680
related infections 263
Cationic proteins 289
Cat-scratch disease 357
Cefdinir 445
Cefixime 213, 214
Cefotaxime 213, 712, 535
Cefuroxime axetil 712
Cell culture-derived inactivated vaccines 218
Cell lysis 346
Cellulitis 404
Central cannulation 164
Central cyanosis 545
Central line placement 663
Central nervous system 177, 421, 425, 427, 428, 431, 578, 598, 722
infections, acute 229
injury, severe 162
Central pontine 336, 343
myelinolysis 578
Central vein cannulation 663, 666f
Central venous pressure 84, 536, 538
Cephalosporin 252
Cerebral blood flow 28, 182, 183, 278
Cerebral blood volume 182
Cerebral dehydration 335
Cerebral edema 272, 328, 464, 467, 578
considerations 466
Cerebral folate transporter deficiency 295
Cerebral infarction 182
Cerebral malaria 179
Cerebral metabolism, higher 183
Cerebral perfusion pressure 182, 680, 686
Cerebral salt wasting 287, 290, 329
in children 287
Cerebral thromboembolism 272
Cerebrospinal fluid 82, 273
Cervical spine 603
and neurologic system 591, 592
Cervical spine stabilization 599
Chemoprophylaxis 441
Chest
discomfort 406
retractions 105
syndrome, acute 161
trauma 604
tube
care of 699
insertion 693f
placement 689
wall
deformities 99
movement 600
movements and tidal volume 5
trauma 600
X-ray 168, 396, 429, 537, 556
Child
psychiatrist counseling 588
with anaphylaxis 87
Chimeric live-attenuated vaccines 218
Chlamydia pneumoniae 551
Chloral hydrate 630
Chloramphenicol 213, 236
Chlorhexidine 691
Chlorothiazide 509
Choanal atresia 103
bilateral 144
Cholecystitis testicular torsion trauma 470
Cholestasis 637
Cholestatic jaundice 509
Cholinesterase levels correlate 421
Chvostek's signs 363
Chylothorax 689, 690
Ciprofloxacin 213, 712
Circulatory
failure 269
support 642
support, mechanical 499
Clavulanic acid 711
Clindamycin 712
Clonazepam 628
Clonidine 513, 630, 632
Closed-space bleeding 374
Clostridium difficile 620, 622
Clots in oxygenator 171
Clotting factor concentrates 373
Coagulation studies and creatine kinase 607
Coagulopathy 466
uncontrolled 675
Co-amoxiclav 535
Cobalamin 295
Colistin 535
Colloids 672
Coma 179, 181, 211, 252, 358
etiology of 179t
management of 179
Community-acquired pneumonia 226, 550
Complete blood count 166, 190, 376, 436, 607
hemoglobin 167
Condom catheters 257
Congestive cardiac failure 81, 42, 103, 343, 433
Conjunctival absorption 421
Conjunctival edema 394, 406
Conjunctival suffusion 219
Connective tissue disorder 570
Consumer Protection Act 655, 658
Contact
precautions 621
transmission 621
Continuous ambulatory peritoneal dialysis 702
Continuous cardiac output monitoring 674
Continuous distending pressure 153
Continuous mandatory ventilation 109
Continuous positive airway pressure 15, 95, 124, 127, 139, 254, 429, 556
Continuous renal replacement therapy 491, 466, 491492
Continuous veno-venous hemofiltration 491
Cooling, methods of 579t
Corneal ulceration 136
Corrosive injury 144
Corticosterone 508
Corticotropin releasing hormone 280
Cortisol breakdown 281
Cortisol metabolism, alteration of 281
Corynebacterium diphtheriae
Cotrimoxazole 535
Cough 394, 395
Counter-regulatory hormones 278
Cow's milk protein allergy 446
Cranial irradiation 280
Craniofacial anomalies 144
Creatinine clearance 255, 534
Cricoid
cartilage 31
pressure 34, 39
applied to occlude esophagus 39
during rapid sequence induction 39
Cricoid ring 143
Cricothyroid membrane 31
anatomy of 32f
Cricothyrotomy 35
Criminal liability 656
Critical illness-related corticosteroid insufficiency 282
Critical tropical infections, diagnosis and management of 200
Critically ill children 322t, 633, 634, 639
Crush injury 378
Cryoprecipitate 381, 385
Cryoprecipitate antihemophilic factor 384
Cryoprecipitate transfusion 388
Crystalloid
prime 165
set for rapid infusion
solution 165
CSF waveform 688f
Cuff pressure 148
Cuffed tube 29
Cushing's syndrome 336, 507, 737
Cyanosis variable temperature 14
Cyanotic heart defects, approach to 520
Cyclic guanosine monophosphate 157
Cyclosporine 347
Cystic fibrosis 99, 550, 713
Cytokines 281
Cytomegalovirus 370, 378
D
Dalfopristin 714
Damage control resuscitation 602
Daptomycin 235
Dead space ventilation 102, 103
Defective substrate delivery 611
Defibrillation 6667
Defibrillator, use of 57
Degenerative brain diseases 336
Dehydration 358, 424
correction of 282
Delivered tidal volumes 566
Dengue 195199, 203
chikungunya 195
fever 76, 206, 2015 203
hemorrhagic fever 76, 203, 206
infection 203
mild 203
moderate 203
severe 204, 208
shock syndrome 162, 199, 206
Device accuracy and stability 681
Dexamethasone 547
suppression test, lose dose 344
Dexmedetomidine 628, 630, 631, 632
infusion 531
Dextrose in water 426
Diabetes
insipidus 76, 738, 333, 336
ketoacidosis 322
mellitus 269
Diabetic ketoacidosis 81, 269, 329, 343
Dialysate sodium 490
Dialysis 296, 484
quotient index, acute 477
Diaphoresis 413, 501
with feeding 501
Diaphragmatic hernia, congenital 154, 162
Diarrhea 76, 404, 447
Diazepam 631, 632
Diet dietary salt substitutes 346
DiGeorge syndrome 354
Digoxin 502, 503, 535, 718
Dilated cardiomyopathy 504
Dilated pupils 328
Dilution 517
Dimercaprol 732
Dimethyl chlortetracycline therapy 287
Diminished pulses 83
Dinoprostone 517
Diphenhydramine 89
Diphtheria 144
Direct vasodilator 512
Discharge planning and care at home 149
Disconnect gas 174
Disease-specific
mechanical ventilation 108
ventilation 111
Disordered control of breathing 15
Disseminated encephalomyelitis, acute 179
Disseminated intravascular coagulation 281, 369370, 372, 377386, 398, 448
uncontrolled 162
Distal pulse 679f
Distilled water 104
Distributive 77
Diuretic administration 76
Diuretic exposure 480
Dizziness 509
Dobutamine 434, 499, 516517, 643, 739
Double-balloon enteroscopy 454
Doxycycline 236
Drainage system 697f, 698f, 699f
Dressing tray 676
Drugs
associated with acute tubular necrosis 480
in pediatric intensive care unit 709, 711
nonshockable rhythm 57
shockable rhythm 57
Dual lumen cannula 165
Dural sinus thrombosis 336
Dyselectrolytemia 425, 637
Dysgenesis 354
Dysnatremias 483
Dyspnea 87, 88, 99, 393395, 501
E
Ebola virus disease 199
Ebstein anomaly, single ventricle, cardiac surgeries 43
Ebstein's anomaly 521
Ectopic pregnancy 470
Ectopic tachycardia 540
Effective team dynamics 61
Ejection fraction 503
Electric
injuries, classification of 590
shock 63
Electrical injuries in children 590
Electrocardiographic signs of hyperkalemia 348f
Electroclinical syndrome 189
Emergency department management 609
Emergency department resuscitation 85
Emesis 327
with ipecac 426
Empiric therapy 213, 222, 224, 252f
Empyema 228, 551, 560, 690
Enalapril 502, 535, 508, 718
Encephalitis 179, 288
Encephalopathy 293, 404
End stage renal disease 477
Endocarditis, acute 232
Endoscopic
retrograde cholangiopancreatography 462
sclerotherapy 452
variceal ligation 452
Endotracheal 114, 153, 421, 607
intubation 18, 23, 2829, 31
indications for 599t
suctioning 567
tube 20, 24, 28, 39, 125, 254, 567, 600
End-points of mechanical ventilation 115
End-tidal carbon dioxide 186
Energy expenditure formulas 633
Envenomation 108
severity, classification of 436
Environmental injuries 575
Enzyme-linked immunosorbent assay (ELISA) 204
Eosinopenia 212
Epidermis 582
Epiglottis 143, 558, 712
Epiglottitis, acute 144
Epilepsy 197
Epilepticus, etiology of status 190b
Epinephrine 87, 89, 455, 499, 516
Epistaxis 106
Epithelial hyper-permeability, altered microbiome 612
Epstein-barr virus 370
Equipment
failure 99
malfunction 117
Esmolol 512
Esophageal candidiasis 716
Ethanol gel assay 379
Etomidate 36, 631, 632
Euglobulin test 379
European Society of Paediatric Endocrinology 270
Euvolemic hypernatremia 339, 284
causes for 285b
Exhaled CO2
Expiratory phase 117
Expiratory valve 26
Extended spectrum beta-lactamases 236
Extracorporeal
blood volume 489
devices 222
life support therapies 615
membrane oxygenation 161, 163f, 169, 384, 537, 538, 539, 615
indications for 161
management of patient on 168
procedures to remove toxins 295
technique 579
volume 490
Extrapulmonary ARDS 139
Extremity fractures, upper 596, 597
F
Face mask 95
Facial
injuries 100
trauma 135
Familial hypocalciuric hypercalcemia 357
Fatigue 358
Fatty acid oxidation defects 296
Faucial diphtheria 229
Feasible noninvasive airway maintenance 32
Febrile 190
encephalopathy 197
neutropenia 231, 398, 403
neutropenia 405
nonhemolytic 390
non-hemolytic transfusion reactions 391
seizures 216
Feed and nutrition management 460
Felodipine 509
Femoral vein 665, 666f
cannulation 668
Fenoldopam 513
Fentanyl 631, 739
infusion 531
Fever with
ARDS 196
encephalopathy 202
hepatic syndrome 197
hypotensive shock 199
jaundice 202
multiorgan dysfunction 197
renal failure 202
respiratory distress 202
thrombocytopenia 202
thrombocytopenia coagulopathy 196
Fibrin
clot in pump inlet line 172
degradation products 379
monomer 379
Fibrinogen level 379
Fibrinolytic defect 372
Fibrinopeptide A 379
Fixation of chest tube 696f
Flail chest with pulmonary contusion 601
Flash capillary refill 83
Fluconazole 535, 716
Flucose 342
Fluid
allowance 529
and electrolyte 282, 483
deficit in dehydration 324
balance 529
deficits, correction of 426
loss 490
management 270, 322, 459, 568
overload 168
requirement based on body surface area 321
requirement in neonates 321t
requirement neonates 321
restriction 84, 285
retention 722
therapy in pediatric intensive care unit 319
Flumazenil 732
Fluoroquinolone 214
Flutter valve 689
Focal neurologic signs 36
Foley manometer 705, 706
Folic acid 295
Folinic acid responsive seizures 293
Foreign body
around larynx 31
aspiration 13, 144, 446, 558
faucial diphtheria 15
in larynx 144
ingestion 570
Fosfomycin 236
Fraction of inspired oxygen 103, 105, 111
Fresh frozen plasma 384385, 387, 466
transfusion 387
Fructose-1,6 diphosphatase deficiency 293
Fungal cultures 403
Fungal infection 406, 716
Furosemide 351, 502, 721
G
Gabapentin 628
Galactomannan 403
Gas flow 167
Gas source 117
Gastric lavage 426
Gastritis 446
Gastroesophageal reflux 550
Gastrointestinal
bleed and trauma 480
bleeding
approach to 445
lower 446, 455
upper 445, 446
decontamination 414
diseases 230, 378
disorders 550
endoscopy, upper 451
hemorrhage 346
loss 329, 479, 480
tract surgeries, upper 100
Gentamicin 236, 289, 535, 713
Germ cell tumor 399, 406
Giant hemangioma 378
Gitelman's syndrome 289, 344
Glasgow coma scale 5, 108, 185, 198, 272, 273, 472, 583, 598, 599, 613
Glucocorticoid 359
deficiency 330
treatment 281
Glucometer random blood sugar level 190
Gluconate 350
Glucose
homeostasis, severe dysregulation of 278
ionized calcium. 85
transporter-1 deficiency syndrome 293
Glucose-6-phosphate dehydrogenase 400
Glutaric aciduria type i and ii, complex i deficiency 295
Glutathione synthetase deficiency 295
Glycemic control 615
Glyceryl trinitrate 739
Glycogen storage disorders 293
Goodpasture syndrome 480
Gram-negative bacilli 551252
Gram-negative bacteria 252
Gram-positive aerobic 712
Granulocyte colony stimulating factor 342
Granuloma formation 146
Great arteries, transposition of 520, 522
Gresh frozen plasma 168
Guidewire tube thoracostomy 694, 694f
Guillain-Barré syndrome 112, 144, 197, 578
H
Haemolytic, acute 390
Haemothorax 689
Hallucination 327, 358, 631, 619
Hantavirus 196, 198
infection 199
Head and neck injury 603
Head
bobbing 105
injury
mild 186
moderate 186
severe 186
severity of 186
of bed 253
trauma 185, 252, 336
ultrasonography 168
Headache 187, 277, 327
Head-down tilt 38
Healthcare-associated infection 247, 250, 551
Healthcare workers 619
Healthy children 369
Heart
block, complete 53
disease
congenital 52, 81, 550, 555
underlying 551
failure 331
acute, management of 497
chronic, management of 501
management of 503
severity, classification of 501t
treatment of 499t
rate 5, 76, 105, 517
Heat
cramps 577
exchanger 163, 170
exhaustion 577
moisture exchanger (HME) 147
related illness 577
stroke 76, 378, 577
syncope 577
Heavy metals 480
Heimlich's maneuver 11f, 15
Hematochezia 445
Hematocrit 78, 206, 207, 208, 209
Hematoma 680, 700
Hematopoietic stem cell 242
Hemmorhage 683
Hemobilia 446
Hemodialysis 300, 351, 427, 489, 492
Hemodynamic
instability 36, 139, 154
monitoring 568
Hemofiltration, indications for 168
Hemoglobin 383
Hemoglobinuria 173
Hemogram, complete 78
Hemolysis, elevated liver enzymes 376
Hemolytic
fatal reaction 391
reaction, acute 391
transfusion reaction, acute 378
uremic syndrome 369, 370, 372, 480, 482, 387, 482, 515
uremic syndrome, TTP 346, 198
Hemophagocytosis 247
Hemoptysis, breathlessness 219
Hemorrhage 219220
Hemorrhagic
disease of newborn 446
fever with renal failure 198
hypovolemic shock 76
Hemothorax 690
from intercostals vessel injury 700
Henderson-Hasselbalch equation 305
Henoch-Schonlein purpura 195
Henoch-Schönlein syndrome 480
Heparin 347, 382, 490
Heparin-induced thrombocytopenia 171
Heparinization, protocol for 165
Hepatic
coma 180
encephalopathy 180, 322, 466
failure 331
resection 374
Hepatitis A and E 199
Hepatoblastoma 399
Hepatomegaly 204
Hepatorenal fossa 603
Hepatosplenomegaly 212
Hereditary fructose intolerance 293
Herpes simplex virus 370, 715
High frequency oscillatory ventilation 138, 153, 155, 156
Histoplasmosis 357
Hoarseness of voice 406
Hodgkin lymphoma 406
Holliday-Segar method 319, 321t
Homicide 657
Homocystinuria 295
Hospital acquired infection 245, 552
prevention of 619
Hospital acquired pneumonia 552
Hospital waste
disposal 624
management 650
Hospitalization, indications for 551
Human chorionic gonadotropin 470
Human metapneumovirus 551
Humidification 147, 567
Humidified inspired air 320
Humidifier 96, 104
Humidity, high 320
Hyaline membrane disease 154
Hybrid procedures 524
Hydralazine 512, 513
Hydration, assess state of 270
Hydrocarbon ingestion 428
Hydrocephalus 182, 288
Hydrochloride 719
Hydrochlorothiazide 509
Hydrocortisone 547
Hydrogen ion 46
Hydrophilic catheters 261
Hydroxyzine 531
Hyperammonemia 299
acute 300
Hyperbilirubinemia 198
Hypercalcemia 289, 336, 357, 398
approach to 360
causes of 357b
patients 359
Hypercarbia 99
Hyperglycemia 329, 637, 717
and hypocalcaemia 336
Hyperkalemia 345347, 349, 399, 483, 487, 731, 738
anaphylaxis 350t
causes of 345
correction 282
Hyperleukocytosis 398, 399, 401
clinical features of 401t
management of 402
symptomatic 402
Hyperlipasemia 329, 457
Hypermetabolism 611
Hypernatremia 168, 335
causes of 336t
consequences of 336
management of 336
Hyperosmolar hyperglycaemic state 343
Hyperoxaluria type I 295
Hyperparasitemia 211
Hyperparathyroidism 354, 358
Hyperphosphatemia 354, 399, 483
Hyperproteinemia 329
Hyperpyrexia 211
Hypersensitivity reaction 722
Hypertension 328, 358, 363, 395, 506, 719
approach to 506
arrhythmia, headache 720
chronic, drugs for 508t
crisis algorithm 515
Hypertensive
crisis 506, 511
emergency 506
encephalopathy
urgency 507
Hyperthermia 46
Hypertonic saline 556
Hypertriglyceridemia 637
Hypertrophic aortic stenosis 518
Hypertrophic cardiomyopathy 504
Hyperuricemia 399
Hyperventilation 320
Hypervolemic hypernatremia 331, 339
Hypoalbuminemia, severe 76
Hypoaldosteronism 289
Hypocalcemia 353, 363, 399, 483, 578
causes of 354b
Hypoglycemia 211, 276, 293, 531
in infants and children, symptomatic 277t
Hypoglycemic, episodes of 276
Hypokalaemic periodic paralysis 343
Hypokalemia 341, 342, 363, 509
approach to 344
related symptoms and signs 341
Hypomagnesemia 342, 354355, 361365, 717
clinical manifestations of 363t
Hypomagnesemic hypokalemic ventricular arrythmia 365
Hyponatremia 286, 289, 327, 333
diagnosis of 329t
treatment of 329t
Hyponatremic neurological, approach to 289
Hypophosphatemia 271, 578
severe 271
Hypotension 51, 54, 328, 355, 404, 478, 531, 552
and shock 578
in children 77t
thrombocytopenia 720
Hypotensive 390
acute 674
shock 5, 209
Hypothalamus-pituitary-adrenal 280
Hypothermia 320, 378
Hypothyroidism 330, 354
congenital 738
Hypotonia 88
Hypovolemic 77
hypernatremia 329, 337
shock 5, 76
Hypoxemia 88
oxygen saturation 551
Hypoxia 531
quick assessment 40
Hypoxic-ischemic encephalopathy 292
I
Ibuprofen ketorolac 535
Ice packs 579
Idiopathic thrombocytopenic purpura 369, 370, 372, 376
Ileal perforation 214
Imipenem 713
Immune
cells 281
phase 220
Immunocompromised 252, 551
Immunodeficiency 555
Impaired gas exchange 14
Implantable cardioverter defibrillator 504
Inability to concentrate 277
Inborn error of metabolism 292, 487
Indian Academy of Pediatrics 60
Indian National Guidelines for clinical managemen
Indirect calorimetry 633
Infants to diagnose pneumothorax 571
Infectious
agents 554
diseases 224
enterocolitis
mononucleosis 195
Inflammatory bowel disease
Influenza A and B viruses 550, 551
Inhalational injury 144
Inhaled
nitric oxide 157, 567
short acting beta agonist 15
Injury 657
management 188
morbidity and mortality 185
Inotropes 498, 518
and vasopressors 516
Insulin 271, 294, 738
with dextrose 350
Intact
cough reflex 124
gag reflex 124
neurological survival 60, 69
Intensive care unit, pediatric 90, 111, 122, 182, 222, 248, 383, 457, 479, 497, 511, 515
Intermediate syndrome 422
International League Against Epilepsy 189
International Liaison Committee on Resuscitation 60
International Normalized Ratio 416, 464
International Society on Thrombosis and Haemostasis 379t
Interstitial fluid 320
Interstitial lung disease 570
Interstitial nephritis, acute 281
Intestinal
bleeding 212
candidiasis prophylaxis 716
Intoxication 657
Intra-abdominal
hypertension 472, 701, 702t
infection, severe 702
pressure monitoring 701
Intra-aortic balloon pump 537
Intracellular 320
concentration 157
fluid 346
Intracranial
hemorrhage 158, 162, 681
pressure 134, 108, 182, 608, 680, 688
Intractable arrhythmias 161
Intrahospital transfer 639
Intrapulmonary shunt 157
Intraventricular conduction defects 578
Intraventricular ICP monitoring system 685f
Intrinsic
acute kidney injury 479
conduction system abnormalities
Invasive aspergillosis 241, 242
Ionized calcium 78
Ionotropes 720
Iron overload 390
Iron poisoning 419
Ischemia complications, treat 680
Ischemic brain injury 182
Ischuria renalis 477
Isoprenaline 517, 739
Isoprinosine 517
Isoproterenol 516
Isotonic crystalloid fluids 81
Isovaleric academia 293
Itch-flush 88
Itching 88
J
Japanese encephalitis 216
Jaundice 219220
Jaundice, ascites: liver disease 447
Jaw thrust 19, 20f
Jugular
double lumen, internal 165
femoral, internal 165
vein cannulation, internal 667, 668t
vein, internal 164, 665
venous pressure 538
Junctional escape rhythm 51
K
Kasabach-Merritt syndrome 378
Kassirer-Bleich equation 305
Kearns-Sayre syndrome 295
Ketamine 643, 36, 531, 628, 631, 632
Ketonemia, monitor 271
Kidney failure, acute 281
Kidney function tests 465
Kidney injury, acute 211, 399, 466, 477, 487, 533, 591
biomarkers of 481
causes of 480t
Kink resistant tube 22
Klebsiella 551
Klebsiella pneumoniae 228
Krebs cycle 424
L
Labetalol 512
Lactic acidosis 297
Laryngeal fracture with cricoid damage 32
Laryngeal mask airway 23, 23f, 31
Laryngeal web 144
Laryngoscope 29, 36
Laryngospasm 355
Late septic shock 517
Later wound closure 696f
Lateral decubitus 693f
Latex agglutination test 219
Left atrial pressure 536, 537
Left ventricle 522
Left ventricular
afterload 100
assist devices 537
dysfunction 537
hypertrophy 519, 520
Legionellae 252
Leptospirosis 195199, 219
Lethargy, lassitude 277
Leukemia, acute 196
Leukocytosis 212
Leukopenia 212, 586
Leukopheresis 402
Levetiracetam 535
Levosalbutamol 731
Levosemendan 517, 499
Levosimendan 718
Lidocaine 37
Life support
advanced 56, 60, 269
basic and advanced 1
Life-threatening
emergencies 61
hypertension 511
symptoms 43
Linezolid 235, 713
Lipase 457
Lipid administration 354
Lisinopril 508
Liver
and renal function tests 292
disease, infection 369
disorders 374
dysfunction 278
enlargement
enzymes 416
failure, acute 464, 578
function tests 168, 470
injury: acute, biochemical evidence of 464
toxicity 717
transplantation 374, 466, 702
role of 466
Loin pain 394
Losartan 502, 508
Low molecular weight heparin 490
Ludwig's angina 144
Lung injury: acute, transfusion-related 396
Lung parenchymal disease 15
Lymph nodes 6
Lymphoblastic leukemia, acute 399, 401, 406
M
Macroselective action 157
Mafenide acetate 586
Magnesium
chloride 365
formulations of 365t
gluconate 365
hydroxide 365
oxide 365
sulfate 298
Malaria 196199, 210
severe complicated, management of 210
Malignancy 378
Malignant hyperthermia 38, 398, 487
Malnutrition, severe acute 81
Mammalian bites 440
Mannitol 490
Maternal systemic lupus erythematosus 52
Maxillofacial injury 144
Maxillofacial trauma, severe 31
Maximal expiratory pressure 129
Mean airway pressure 154, 472, 701
Mechanical circulatory support 497, 504
Mechanical ventilation, indications for 108
Meckel's diverticulum
Meconium aspiration syndrome 378
Mediastinal
cysts 406
masses, posterior 406
syndrome, superior 398, 405
Melioidosis 196
Meningitis 197, 711, 712, 713, 714, 736
Meningococcemia 195
Mental status 77
Meropenem 213, 535, 713
Mesobuthus tamulus 432
Metabolic
abnormality, correct acidosis 211
severe 487
derangements 69, 401
disorder 296
effects 347
encephalopathies 292
encephalopathy 182
Methemoglobin reductase deficiency 158
Methhemoglobin levels 160
Methicillin-resistant Staphylococcus aureus 235, 252
Methylmalonic acidemia 293
Meticulous technique 524
Metoprolol 502
Metronidazole 460, 713
Mexiletine 434
Microcirculatory dysfunction 611
Microcytic anemia 371
Microscopic agglutination test 219, 220
Microselective action 157
Midazolam 631, 632, 739
Migraine prophylaxis 719
Mild allergic reactions 391
Milrinone 434, 498, 499, 517, 739
Mineralocorticoid
deficiency 329, 346
excess 336
Minimum inhibitory concentration 263
Minor edema of lips, tongue and uvula 394
Minoxidil 513
Minute ventilation 129
Misplaced tube 700
Mitochondrial and endothelial dysfunction 612
Mitochondriopathies 297
Mitral
stenosis 521
valve repair 521
venous oxygen 80
Molecular
diffusion 154
genetic studies 507
Moraxella catarrhalis 251
Morphine 739
Mouse brain-derived inactivated vaccines 218
Mucociliary clearance 102
Mucormycosis 241, 242
Mucus plugging 99
Multidrug-resistant bacterial pathogens 235
Multidrug-resistant organisms 237
Multiorgan failure, severe 162
Multiple carboxylase defects 293
Multiple myeloma 289
Multiple organ dysfunction syndrome 611
treatment of 615
Multiple trauma, pediatric 606
Mupirocin 586
Muscarinic effects 420
Muscle
contraction 590
fatigue 577
tremor 363
weakness 363
Musculoskeletal system 593
Musculoskeletal trauma 604
Mycobacterium tuberculosis 622
Mycoplasma pneumoniae 551
Myeloid leukemia, acute 378, 399, 401, 406
Myocardial
depression 727
dysfunction, arrhythmias 199
hypokinesia 69
infarction 52
Myocarditis 15, 44
autoimmune disorders 199
septic shock 199
N
Nakayama strain 218
Nasal
flaring 105
mask 95, 98
pillows 98
prongs 95
saline drops 557
suction 557
Nasogastric aspiration 447
Nasogastric tube and drainage system 643
Nasopharyngeal airway 22, 22f
National Vector Borne Disease Control Program 204
Nebulized epinephrine 90
Necrotizing
enterocolitis 173, 472
pneumonia 552, 570
Needle
cricothyroidotomy 31
cricothyrotomy, contraindications of 32t
thoracentesis 690
thoracostomy 30
Neisseria meningitidis 622
Neomycin 586
Neonates, indications for 162
Nephroblastoma 399
Nephrogenic SIADH 330
Nephronophthisis ineffective breast feeding 336
Nephrotic syndrome 76, 331
Nerve damage 680
Nesiritide 498
Neuroblastoma 399, 406
Neurocognitive disorder 551
Neuroleptic malignant syndrome 727
Neurologic status 167
Neurological
deterioration 292
indications 108
involvement 198
Neuromuscular
blockade 567
disorders 99, 100, 550
effects 347
junctions 420
weakness 34, 108
severe 13
Neuronal
apoptosis 281
death 189
injury 189
networks, alteration of 189
Neuroprotective measures 273
Neuropsychological 126
Neurosurgical patient, approach to 289
Neutrophil gelatinase-associated lipocalin 481
New York Heart Association 501
Newborn infant 299
Nicotinamide 295
Nicotinic effect 420
Nifedipine 434, 509
Nitric oxide 157, 159
Nitrofurantoin 236
Nitroglycerin 499, 433434, 498
Nitroprusside 739
Noninvasive positive pressure ventilation 548
Noninvasive ventilation 95, 130
benefits and risks of 100t
contraindications of 99
indications of 99t
support 642
types of 95
use in children 101
Nonketotic hyperosmolality 272
Nonsteroidal anti-inflammatory drug 347, 370, 460, 473
Nontraumatic
illnesses, causes of 13
intracranial bleeding 374
Noradrenaline 499, 516, 518, 739
Normothermia 124
Norwood surgery 522
Nucleic acid detection 199, 216
Nutrition in critically ill children 633
Nutritional
deficiencies 252
support 615
Nystagmus 724
Nystatin 586
O
Obese children 19
Obscure gastrointestinal bleeding 454
Obstructive
lung disease 112
shock 5
sleep apnea 99
Obtundation 327
Ofloxacin 213, 713
Oligoanuria 400
Olmesartan 508
Oncologic emergencies 398, 398t
Oozing bleeding 451
Operative tube thoracostomy 695f
Opioid 37, 54, 628
doses of 630t
Oral
candidiasis treatment 716
lorazepam 531
trauma 447
Organ dysfunction criteria, pediatric 614
Organ system dysfunction 213
Organ systems 459
Organic acidemias 297
Organophosphate-induced delayed polyneuropathy 422
Organophosphate poisoning, treatment of 717
Organophosphorus poisoning 420
Orogastric 530
Oronasal 98
Oropharyngeal
airway 21, 22f, 27
candidiasis 716
posterior wall 22
Oseltamivir 535, 715
Osmolal gap 310
Osmolality measurement 285
Osmotic
agents 289
demyelination syndrome 332
diuresis 329
Ovarian torsion 470
Overdamped waveforms, characteristic of 678t
Oxic hydrocarbons 429
Oxygen
blender 95
delivery, increased 43
desaturation 395
inhalation 434
requirement 555
saturations 699
saturation, monitor 155, 273
supplementation 461
supply 29
Oxygenation 154
and ventilation 153
decrease postoxygenator pressure 167
index 608
response 136
Oxygenator
failure 171, 173
rupture 170
P
Pacemaker therapy 504
Pain 587
and anxiety 500
assessment scales 627
management 459, 531
Painful stimuli 327
Palamneus gravimanus 432
Palatal injury 445
Pancreatic
injuries 603
pseudoaneurysm sepsis 460
trauma 462
Pancreatitis 76, 354, 358, 509, 702
acute 457
severe acute 459
severity score, acute 458
Pancuronium 38
Pantothenic acid 295
Paracetamol 531
ingestion, dose and pattern of 412
poisoning 412
toxicity, pathophysiology of 412
Parainfluenza virus 551, 622
Paralysis 36
Paralytic agents 36, 38, 38t
Parameter settings 104
Parapneumonic effusion 560
Parathormone 361
Parathyroid
adenoma 357, 359
gland formation 354
hormone related 354
Parenchymal lung disease 111
Parenteral nutrition 530, 663, 672
Partial
pressure of oxygen 304
thromboplastin time 165, 388
Passive external rewarming 609
Passive pulmonary blood flow dependency 154
Patient-ventilator asynchrony 100
Peak inspiratory pressure 140
Pediatric
acute liver failure 464
Acute Lung Injury Consensus Conference Group 564
acute respiratory distress syndrome 566
airway, anatomy of 598
and adult airway 143t
assessment triangle, components of 4t
cardiac patients 519
endotracheal intubation 600t
fresh frozen plasma transfusions, guidelines for 371
hypertension 510
injury, mechanisms and patterns of 596
intensive care unit 245, 457
infection control protocol 619
infections and antimicrobials 193
management in 607
platelet transfusions, guidelines for 386
postoperative order 528f
trauma 599t
Pelvic X-ray 603
Penetrating trauma 702
Peptic ulcer disease 447
Percussion wave 688
Percutaneous
thoracostomy 690
tracheostomy 148
Pericardial sac 603
Peri-extubation monitoring sheet 131f
Perinatal lung disease 564
Periodic liver function tests 465
Periorbital itch 393
Periosteal burns 591
Peripheral
and central pulses 85
blood smear 371
cannulation 164
edema 509
pulses 5
Peritoneal dialysis 487, 492
protocol for 488
Periventricular closure 524
Persistent
hypotension 466
pneumothorax, management of 572
pulmonary hypertension 162
tachycardia 552
vomiting 187
Petechiae 370
Petechial spots 4
pH 304
change in acidosis and alkalosis 307t
Phenobarbital 643
Phenylketonuria 295
Phenytoin 445, 643
Pheochromocytoma 507
Phlebotomy 388
Phosphoenolpyruvate carboxykinase 277
Phosphorylated cholinesterase 421
PICU admission, indications for 551
Piperacillin 713, 714
Piperacillin-tazobactam 252
Pip-tazobactam 535
Plague 196
Plasma
ammonia 300
catecholamines 507
cholesterol 507
cortisol 507
creatinine 507, 535
deoxycorticosterone 508
paracetamol concentration 415
Plasminogen activator inhibitor-1 372
Plateau pressure limitations 566
Platelet
concentrate 384385
consumption 379t
disorders in PICU 370t
function disorder 372
Pleural
cavity, sterilization of 560
effusion 204, 689
effusions 398
Pneumocystis carnii 252
Pneumomediastinum 146
Pneumonia 112, 161, 404
approach to management 563
severe
Pneumonitis 197
Pneumothorax 117, 173
and pulmonary interstitial emphysema 161
Poisoning, approach to a child with 411
Polyarteritis nodosa 515
Polystyrene sulfonate 351
Polyuria 289, 358
Poor access to medical care 187
Positive end-expiratory pressure 102, 103, 110, 117, 133, 138, 140, 157, 162, 429, 431, 565566
Positive inotropic therapy 503
Positive pressure ventilation 500
Postcardiopulmonary resuscitation
Postextubation
stridor 115
support 103
Postintubation management 40
Postnatal exposure to cigarette smoke 554
Potassium
containing fluid 345, 483
levels 342t
loss 342
Pouch of Douglas 603
Prazosin 434
Prednisolone 547
Pregnancy 702
Pre-hospital care 607
Preoxygenation 36
Preoxygenator pressure 166167
Prepump pressure 166
Pressure
areas 99
controlled 109
controlled ventilation 166
lines 163
monitoring 166
sores 136
support 124, 127, 129
waves 687
Pressurized oxygen source 104
Procainamide 719
Prominent motor seizures 189
Promyelocytic leukemia, acute 378
Prophylactic role of antifungal agents 242
Propionic academia 293
Propofol 36, 628, 631632
infusion syndrome 631
Prostaglandin E1 719
Protamine paracoagulation 379
Prothrombin fragment 379
Proton pump inhibitors 198, 448
Pseudoaneurysm 680
Pseudohyperkalemia 285, 345
Pseudohyponatremia 329
Pseudomonas 551
Pseudomonas aeruginosa 228, 252, 263, 712, 712, 713
Psychogenic polydipsia 330
Psychological support 588
Pulmonary
arterial hypertension 172
arterial pressure 160
artery 520
band 522
pressure 536
atresia, severe 522
blood flow 519, 520
circulation 157
disease 252
acute 564
dysfunction 168
edema 108, 395, 433434, 487
acute 108, 211
hypertension 158, 536
primary 158
stenosis 520, 521
valve replacement 521
vascular
disease 158
reactivity 158
resistance 158
vasodilation 157, 730
vessels, smooth muscle of 157
Pulse oximeter 5, 85, 642
fluoroscopy, low dose 524
for measuring oxygen saturation 600
paradoxus 406, 545
ventricular tachycardia 57, 67
Pump inlet pressure 172
Pyridoxal phosphate deficiency 293
Pyridoxal PO4 295
Pyridoxine dependency 293, 295
Q
QRS tachycardia 4344
Quantitative fibrinogen assay 379
Quinapril 508
Quinine dihydrochloride 715
Quinupristin 714
R
Rabies
human diploid cell vaccine 441
immunoglobulin 441
prophylaxis 441
Raised intracranial pressure 182, 139, 184, 406
management of 183
Ramipril 508
Random blood sugar 292
Random donor platelet 381
Ranitidine 89, 535
Rape 657
Rapid
adaptation 335
assessment 75
blood glucose 78
diagnostic test 205
inactivation limits 157
lysis 399
sequence intubation 34, 465
sequence intubation algorithm 41
shallow breathing index 129
Rasburicase 402
Rastelli 522
Ratio of respiratory rate 129
Recruitment maneuvers 138, 142
contraindications of 139
indications for 139
Red blood cells 207, 208, 209, 383
Refeeding syndrome 637
Refractory septic shock 738
Refractory status epilepticus 190
Regurgitation
and aspiration 34t
increase risk of 36
Renal
and liver function tests 396
angina
concept 482
index, injury 482
index, risk 482
angle tenderness 231
calculi, neurogenic bladder 480
dysfunction 38, 173
failure 81, 108, 220, 320, 331, 354, 358
acute 322, 346, 477
severe 346
function tests 168, 534
impairment 728
losses 76, 342, 479, 480
protection strategies 533
replacement therapy 400, 484, 487
indications for 487
stones 358
system 475
tubular acidosis 330, 342, 347
ultrasound 173
Rescue steroid 15
Reservoir 26
Respiratory
alkalosis 354
arrest 87, 273, 328
complications 590
depression 631
depression 727
disorders, acute 307
distress 13, 14t, 15t, 16, 51, 105, 392, 395, 404
moderate to severe 551
syndrome 378
acute 99, 103, 108, 133, 138, 144, 157, 161, 252, 487, 564, 564t, 565, 566
emergencies 13
failure 1315, 56, 106
acute 100
postoperative 103
infection upper 13
insufficiency 13, 327
approach to a child with 13
load 123f, 126
muscles, unload 100
rate 5, 105, 555, 699
assessment of 600
syncytial virus 550, 551, 554
system 543, 591
tract infection, lower 570
Resuscitation cart 691
Retroperitoneal bleeding 374
Revised trauma score 597, 598t
Reye's syndrome 378, 681
Rhabdomyolysis 346, 578, 590
Rhabdomyosarcoma 406
Rhythm
identification 57t
on cardiac monitor 42
Riboflavin 295
Richmond Agitation Sedation Scale 626
Rickettsial
infections 199
spotted fever 195
Rifampicin 445
Ringer's lactate 437
Rituximab 399
Rocuronium 643
Ross kono 521
Rotational thromboelastometry 168
Rumack-Matthew nomogram 417f
Ruptured abdominal aortic aneurysm 702
S
Salbutamol 90
Salicylate
dosages 424
intoxication 424
poisoning 424
Salmonella 214
Sarcoidosis 199, 357
Sarcoma 406
Scorpion sting envenomation 432
Scrub typhus 195199
Sedation
assessment scales 627
plan 648
vacations 253
Sedatives in children 630t
Sedillot's triangle 665
Seizure 363, 355, 399, 643
activity 327, 328
disorder 180
Selective
arterial embolization 452
vasodilation 157
Self-inflating bag 25, 25f
Semiconscious patients 24
Sepsis 15, 76, 174, 199, 278, 378, 702
antibiotic therapy for 234
severe 196
ulcer 446
Septic arthritis 232
Septic shock 75, 108, 162, 199
diagnosis 83
management algorithm 86
Septicemic phase, acute 220
Sequential organ failure assessment 612
Serum
creatinine 190
electrolytes 78, 167, 273
lactates 175
magnesium concentration 342
osmolarity 284
Severe bleeding refractory 374
Sheehan's syndrome 336
Shock 394
advised 65
and cardiac arrest 42
assessment algorithm 79
correction 282
delivery 67
distributive 5, 76
energy for defibrillation 57
in children 80
assessment of 75
causes of 76
types of 77t
Sickle cell anemia 158
Sickle cell disease 336, 550
Signs of
bleeding, monitor for 160
internal bleeding 603
symptomatic bradycardia 51
Sildenafil 720
Silver sulfadiazine 586
Single acute acetaminophen poisoning 417f
Sinus
bradycardia 51
treatment of 717
node dysfunction 51
tachycardia 42, 43, 43f, 44t, 578
Skin
irritation 106
lesions 100
rash 219
Sleep apnea 103
Snake bite 162, 378
management 436
Snake envenomation 198
Society of Critical Care Medicine 633
Sodium
benzoate 296
channel blockers 54
nitroprusside 433, 434, 499, 512, 515
phenylbutyrate 296
reabsorption 289
tetradecyl sulphate 452
thyroxine 738
wasting from CSF drainage 289
Solid tumors 378
Specific disorders, treatment of 374
Specimen collection 261
Spectrum of
electrical injuries 590
heat-related illness 577
Speech and tracheostomies 148
Spiegelberg 682
Spinal
cord compression 398
injuries 584
Spine fractures, lower 596
Spironolactone 502
Splenorenal fossa 603
Spontaneous
bleeding and coagulopathy 211
breathing trial 124, 127, 129
breathing trial, failure of 125
circulation, return of 57, 69
pneumothorax 570
primary 570
secondary 570
Stable hemodynamics
Staphylococcal pneumonia 227
Staphylococcus aureus 226, 228, 235, 622
Staphylococcus pneumoniae bacterial sepsis 608
State behavioral scale 531
Status asthmaticus 161
Status epilepticus 36, 189, 189t
classification of 189
malaria 191
Sterile
dressing 691
gauze sponges 691
gloves 691
Strenuous physical activity 51
Streptomycin 236
Stress
gastritis 446
ulcer prophylaxis 460
Stridor 88, 394
Stroke volume 517
Subarachnoid hemorrhage 286288
Subclavian artery 164
Subclavian vein 666f
cannulation 667, 667t
Succinylcholine 38
Sucralfate 535
Sudden cardiac arrhythmias 56
Sudden cardiac death 504
Superficial burn 594
Superior mediastinal syndrome 406t
management of 407
Supraglottic advanced airway 57
Supraventricular tachycardia 42, 43, 43f, 44t, 66, 578
Surgery, mode of 145
Surgical
closure 521
repair, urgent 521
Symptomatic hyperammonemia 299
Symptomatic hypocalcemia
acute 355
severe, treatment of 334
Synchronize, failure to 99
Synchronized intermittent mandatory ventilation 109
Syncopal attacks 51
Syndrome of inappropriate antidiuretic hormone 284, 331, 285t, 286t, 288t, 398
differential diagnosis for 285b
Syndrome-based treatment guidelines 202
Systemic bleeding diathesis 446
Systemic corticosteroids in acute severe asthma 547
Systemic inflammatory response syndrome 459, 466
Systemic lupus erythematosus 199, 370, 480, 515
Systemic vascular resistance 166, 461, 516517
Systemic vasodilators 157
T
Tachyarrhythmias 42
Tachycardia 42, 277, 393395
algorithm 49
hypertension 716
Tachypnea 87, 395, 501
mild 501
Teicoplanin 535, 714
Tension pneumothorax 18, 30, 76, 600, 689
Teratoma 406
Tetanus 232
immunoglobulin 441
prophylaxis 441
status 584
Tetrahydrobiopterin 295
Tetralogy of Fallot 521
Thiamine 295
Thiazide diuretics 509
Thiopentone 36, 38
Thoracocentesis 570
Thoracoscopy 570
Thrive, failure to 554
Thrombin time 379
Thrombin-antithrombin complex 379
Thrombocytopenia 196, 198, 212, 374, 615
mild 196
Thrombocytosis 345
Thrombophlebitis 247
Thrombosis
coronary arteries
pulmonary arteries
Thrombotic
complications 336
features of dic 377
thrombocytopenic purpura 370, 376, 387
Thrombus formation 247
Thymic tumor 406
Thyroid
and cricoid cartilage 39
function tests 508
hormone replacement 500
Thyrotoxicosis 357, 508, 720
Tigecycline 236
Tissue necrosis 346
Tissue plasminogen activator 372
Tobramycin 714
Tonic-Clonic SE 189
Torsades de pointes 44, 45f
Total leukocyte count 401
Total parenteral nutrition 672
Toxic reactions to paracetamol 412
Toxicity 53t, 159
Toxicology analysis 190
Toxin exposure 57
Tracheal
stenosis 144, 146
suction equipment 29
Tracheoesophageal fistula 100, 144, 146, 550
Tracheomalacia 146
Tracheostomy 18, 15, 531
advantages of 144
complications of 146, 146t
cuff pressure 148
in children 143
indications of 144t
pediatric 143
procedure 146
tube
care 146
change 147
sterilization of 147
types of 145
Tramadol 535
Trandem mass spectrometry 190
Tranexamic acid 451, 535
Transcellular fluid 320
Transcutaneous
pacemaker 642
pacing 53
Transducer
selection 669
side identification 669f
Transfusion reactions 390, 390t
Transfusion transmitted bacterial infection 391
Transfusion-associated
circulatory overload 391, 395
dyspnea 390
graft versus host disease 391
Transfusion-related
acute lung injury 391
adverse reactions. 391t
immune modulation 391
sepsis 390
Transmission based 622t
Transport algorithm 646
Trauma score, pediatric 597, 598t
Traumatic brain injury 182, 287
severe 681
Trendelenburg position 38
Triage of patients 429t
Triclofos sodium 531
Tricuspid
atresia 522
valve, reconstruction of 521
Triiodothyronine 499, 738
Trocar tube thoracostomy 694, 695
Trousseau's sign 363
Truncus arteriosus 521
Tube thoracostomy 689
Tuberculosis 406
Tubular necrosis, acute 289, 479
Tubulointerstitial disease 347
Tumor lysis syndrome 396, 398, 399t, 401
management of 401
Tumors of tongue 144
Typhoid fever, treatment of 213t
Tyrosine kinase inhibitors 281
U
Uncal herniation 180
Unconscious
patient 34, 336
victim termed basic life support 60
Uncuffed tube 29, 143
Unfractionated heparin 381, 490
Unusual death 657
Upgrade ventilator setting 175
Upper airway
obstruction 13
structure swelling 31
Upper gastrointestinal bleeding in
children, therapeutic strategy 451
pediatrics, age-wise etiology of 446t
Upper respiratory tract infections 229
Urea
creatinine 337
cycle defects 293, 295
Urethral catheter use 257
Uric acid 507
metabolism 399
Urinalysis 507
Urinary
alkalinization 426
catheter insertion 258
catheter use 257
retention, postoperative 262
steroid profiles 507
tract infection 198, 231, 482
tract infection, constipation 470
Urine
analysis 78, 425
anion gap 310
chloride concentration 344
drainage 706
for hemoglobin, assessment of 396
ketones 180
microscopy 273
osmolarity 284
output 77, 80, 85
criteria 534
potassium concentration 342
sodium 284
high 289
Urosepsis 460
Urticaria 8788, 393
V
Vaccination 218
Vacuum bottle 691
Vagal maneuver 46f, 47
Vancomycin 535, 714
Vancomycin-resistant Enterococcus 235
Vanillylmandelic acid 515
Variceal bleed, management pathway 453
Variceal bleeding 452
Varicella
zoster 378
access 489, 492
ultrasound use for 669
Vascular muscle tone 157
Vasculitic disorders 195
Vasculitis 378
Vasculopathy 203
Vasoactive drugs 450, 483, 643
use of 674
Vasodilation 516, 498, 721
Vasopressin 499, 517, 738
derivatives 450
Vasopressor agents, treatment with 281
Vasopressor support 278
Vecuronium 38, 531, 739
Vena cava, superior 405
Vena caval syndrome, superior 398, 405
Venoarterial ECMO 164, 174
Venous
blood gas 166, 664
cannula 164t, 169
thrombosis 406
vascular pressures, measurement of 664
Ventilation
advanced 151
continues for long duration 27
in ARDS 134
in respiratory failure 28
malfunction
mode of 138, 566
strategies 465
Ventilator associated pneumonia 115, 228, 247, 251, 252
Ventilator
associated pneumonia 253f
prevention 252
etiology of 251
CPAP 96
induced lung injury 115, 161
monitoring alarms 116
tubing 117
Ventilator parameters 396
Ventricular
assist device 504
dysrhythmias 358
ectopics 342
fibrillation 44, 57, 67, 342, 590
obstructive lesions 76
premature contractions 434
septal defect 520
tachycardia 42, 44, 45f, 342
Verapamil 720
Video-assisted thoracoscopic surgery 563
Video laryngoscope 35, 37
Viral
bronchiolitis 554
encephalitis 197
exanthemata 195
hemorrhagic fevers 195, 196
hepatitis 196, 197
illness 195
Virological testing 556
Visual disturbances 277, 401
Vital
parameters 167
signs 186, 555
Vitamin
A intoxication 357
D deficiency 354
D resistance 354
E 295
K 450
K absorption 369
K deficiency 369, 450
Vocal cords 144
Volume
loops 120f
support 109
Vomiting 76, 715, 718, 732
von Willebrand disease 369, 372, 388
W
Warm and dry 497
Warm and wet 497498
Warm extremities 85
Water
clogging 105
intoxication 331
loss replacement in neonates 321t
vapors in tube on expiration 29, 40
Waveform capnography 57
Weakness 106, 277
Weaning
and coming off ECOM 174
and extubation readiness 569
classification of 124t
from ventilation 122
modality 124
mode of 124
process 124
therapy 103
Wegener's granulomatosis 357
Weight of child 23t
Westley's croup score 130
Wheeze 394
Widal test 212
Williams syndrome 357
Withdrawal syndrome 632
World Health Organization 436, 441, 607, 628f
World Society of the Abdominal Compartment Syndrome 701t
X
Xanthurenic aciduria 295
Xenograft 587
X-rays and results of other investigations 643
Y
Yellow fever 198
×
Chapter Notes

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IAP Textbook of PEDIATRIC ICU PROTOCOLS
IAP Textbook of PEDIATRIC ICU PROTOCOLS
THIRD EDITION
Founder Editor Praveen Khilnani MD FAAP MCCM (USA) Senior Consultant Pediatric Pulmonology and Critical Care Clinical Director Madhukar Rainbow Children's Hospital New Delhi, India Chief Academic Editor Vinayak Patki MB DNB FCCP FIAP FCCM (USA) FICCM Chief Consultant Advanced Pediatric Critical Care Unit Head, Department of Pediatrics Wanless Hospital Miraj, Maharashtra, India Editor-in-Chief Santosh T Soans MD FIAP President, IAP 2018 Professor and Head Pediatric Intensive Care Services Department of Pediatrics AJ Medical College and Hospital Mangaluru, Karnataka, India Executive Editor Bakul Parekh MD Chairperson IAP-Intensive Care Chapter 2019 Consultant Pediatric Intensivist Mumbai, Maharashtra, India Associate Editors Kundan Mittal MD PGDMLS MBA FISCD FIAP FICCM FCCM (SCCM, USA) FNNF MAMS FIAMS Senior Professor (Pediatrics) Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Haryana, India Arun Bansal MD FCCM FRCPCH FICCM Professor Division of Pediatric Critical Care Department of Pediatrics Advanced Pediatrics Center Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh, India Mahesh Mohite MD Medical Director Sai Children's Hospital Navi Mumbai Honorary Pediatric Intensivist Bai Jerbai Wadia Hospital for Children Mumbai, Maharashtra, India Rakshay Shetty MD FCCM (Toranto) Head Pediatric Intensive Care Services Rainbow Children's Hospital Bengaluru, Karnataka, India Foreword Digant D Shastri, Remesh Kumar R, Bakul Parekh
Jaypee Brothers Medical Publishers (P) Ltd
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© 2019, Indian Academy of Pediatrics
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
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Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
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IAP Textbook of Pediatric ICU Protocols
First Edition: 2006
Second Edition: 2013
Third Edition: 2019
9789352709694
Printed at
Contributors Foreword
Dear Readers,
We are very happy to launch the third edition of IAP Textbook of Pediatric ICU Protocol. First edition of this book was released in 2006 and later second edition in 2013. It was strong need and request from fellow Pediatricians and Postgraduates to have updated version of this protocol book as many changes in the management guidelines have occurred in last five to six years.
Pediatric critical care is the most dynamic subspecialty of Pediatrics, not only in terms of disease process and management but also in terms of updating of knowledge. We feel that so many new things are happening in the arena of Pediatric Critical Care that sometimes it is difficult to keep pace with updating those. Better understanding of disease process, newer drugs, novel biomedical engineering and multicentric research, have translated the treatment of critically ill children into systematically approached, evidenced based management. So, we have decided to bring this 3rd edition of Pediatric ICU (PICU) Protocol book with updated knowledge, under the auspices of Indian Academy of Pediatrics (IAP).
The IAP specialty series books serve the purpose of providing evidence based, authentic and updated information to IAP members, other pediatricians, and both under and postgraduate students of Pediatrics in this country. Guidelines and protocols on disease management will not only be helpful for their everyday practice but will also bring uniformity in their management.
Renowned pediatric intensivist across the country, mixture of young and enthusiastic consultants and experienced and senior national faculties has written this book. Almost 30 new chapters have added in this edition. Recently published international and national guidelines pertaining to that disease entity has been adopted in brief and summarized manner. Protocols are grouped under small sub-sections in a systematic manner to find out the topics easily and to read associated topic to that system. Evidence based and practice-oriented protocols have been used in an easy to read format with flow diagram after every chapter as much as feasible.
Creating a book is not an easy task. Right from conception to delivery, there is long and complex process. It is very labor intensive and time-consuming work that involves considerable precious time of authors and editors. We congratulate Dr Santosh T Soans, Editor in Chief and Dr Vinayak Patki, Chief Academic Editor for their untiring hard work of conceptualizing, conveying and coordinating chapters with authors, editors and publishers.
We also appreciate the contribution by associate editors and section editors, towards this book. Despite their busy schedule, they have completed their editorial work in timely manner. It goes without saying that efforts put by all authors’ needs special mention, as they created the foundation of each chapter. We thank whole team of authors and all editors for their valuation contribution towards this book. We thank M/s Jaypee Brothers Medical Publishers for publishing this book.
It is our sincere hope that this “IAP Textbook of Pediatric ICU protocol” would be available in all emergency room and Pediatric Intensive Care Units as well as medical colleges, and would be used to improve the outcome of critically ill children
Digant D Shastri
President, IAP 2019
Remesh Kumar R
Hon. Secretary General, IAP 2018–19
Bakul Parekh
President Elect 2019
Preface to the Third Edition
It gives us immense pleasure to present this new edition of IAP Textbook of Pediatric ICU Protocols to you. The book will be officially released during PEDICON 2019 at Mumbai. It was almost six years ago that the 2nd edition of this book was published. From A-B-C to C-A-B in advanced life support and resuscitation, from dopamine to adrenalin as first choice of inotropes in septic shock management, from aminophylline to magnesium sulfate as second line drug in status asthmaticus and from 60 mL rapid bolus to repeated 20 mL slow boluses in graded manner for fluid resuscitation of shock, pediatric critical care has seen substantial changes in the management protocols in recent years. So, we have decided to bring out this 3rd edition with updated knowledge, under the auspices of Indian Academy of Pediatrics (IAP).
This protocol book will update your knowledge with respect to published national and international guidelines published for different category of diseases in the pediatric intensive care unit (PICU). Most of the protocols are based upon recent published data or best practice strategies of reputed institutes. The aim of the book is to make the management of the sick child with uniformity, across the hospitals in India. This uniformity will not only improve the standard of quality practice in various hospitals but also will give an edge in facing medicolegal issues when conflict develops, as these protocols will set a standard of care for Indian context.
In this edition you will find system-based protocols divided in almost 20 sub-sections. Each section has been written by esteemed faculty with substantial authority on that subject, many are either fellows of pediatric subspecialty or having vast experience in that field and edited by renowned Pediatric Intensivists. All the aspects of basic and advanced life support as per recent Pediatric Advanced Life Support (PALS) guidelines are incorporated. In basic mechanical ventilation, protocols on trouble shooting, ventilation, weaning, extubation, prone positioning, recruitment maneuvers and tracheotomy are added. Shock has been revised and new American College of Critical Care Medicine (ACCM) guidelines for septic shock are included. Many centers in India are now using inhaled nitric oxide and extracorporeal membrane oxygenation (ECMO); hence protocols on these advanced therapies are added. Tropical infections are still a major contributor for admissions in our ICUs and healthcare-associated infections are increasing in India too, hence protocols on these infections are added with chapters on antibiotics and antifungals in PICU.
Special chapter on fluids in different situations in PICU has been added. Chapters on DIC, transfusion of blood and blood products, transfusion reactions and oncological emergencies are added in hematology section. Gastroenterology section is added with protocols on acute pancreatitis and surgical abdomen. Protocols on renal replacement therapy are also newly added. There is a new addition on common respiratory problems like severe pneumonia, bronchiolitis, acute croup, empyema, acute respiratory distress syndrome (ARDS) and air leak syndrome. In environmental injuries section we have included management issues about heat stroke, burns, electrical injury, poly trauma and drowning. New sections on quality care in PICU and medicolegal issues in PICU are specially incorporated to address the special needs of the present era.
We sincerely thank our associate editors Dr Kundan Mittal, Dr Mahesh Mohite, Dr Arun Bansal and Dr Rakshay Shetty for critically evaluating all the protocols and editing those to best possible way. We are also thankful to all section editors and authors for completing the work in stipulated time, despite their busy schedule.
We hope this book will help the postgraduates, fellows, consultants and pediatric intensivists for better management of critically ill children and improving their outcome and should be a standard book available always in any PICU.
Santosh T Soans
Vinayak Patki
Preface to the Second Edition
This book entitled IAP Textbook of Pediatric ICU Protocols is intended to be a practical current state of the art resource for pediatric residents, pediatricians and physicians involved in care of neonatal and pediatric emergency, and intensive care patients commonly seen in the Indian scenario.
A practice-oriented protocol-based approach to common conditions such as acute pneumonia, severe asthma, acute respiratory distress syndrome (ARDS), cardiorespiratory failure, shock, sepsis, coma, raised intracranial pressure, status epilepticus protocol, cardiac failure, rhythm abnormalities, including postoperative cardiac surgery in critically ill children has been discussed. It has been the effort to include as much evidence-based protocols as feasible.
Basic mechanical ventilation details have been emphasized including airway management, rapid sequence intubation, initial ventilator settings, maintenance, monitoring and ongoing adjustment of mechanical ventilation, arterial blood gas analysis and weaning from the ventilator.
Besides a discussion of basic conventional ventilation, advanced ventilation modes, high frequency oscillatory ventilation (HFOV) and noninvasive ventilation protocols have also been included. Wherever feasible, practical case scenarios of commonly seen neonatal and pediatric conditions involving acute renal failure, fulminant hepatic failure, inborn errors of metabolism, acid-base, and fluid and electrolyte disturbances have also been included.
Finally, a brief description of commonly seen poisonings, multiple trauma, standard basic life support (BLS), pediatric advanced life support (PALS) protocols, sedation protocols, pediatric intensive care unit (PICU) drug dosages as well as PICU procedures have been covered with a view of having that information readily available to the reader.
Hope this protocol book finds important place in emergency rooms and PICUs at various institutions facilitating delivery of appropriate and timely emergency and intensive care at right time by all residents, fellows and consultant pediatricians.
Praveen Khilnani