PT Inquest is an online journal club. Hosted by Jason Tuori, Megan Graham, and Chris Juneau, the show looks at an article every week and discusses how it applies to current physical therapy practice.
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İçerik Dr. Pradip Kamat, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Rahul Damania tarafından sağlanmıştır. Bölümler, grafikler ve podcast açıklamaları dahil tüm podcast içeriği doğrudan Dr. Pradip Kamat, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Rahul Damania veya podcast platform ortağı tarafından yüklenir ve sağlanır. Birinin telif hakkıyla korunan çalışmanızı izniniz olmadan kullandığını düşünüyorsanız burada https://tr.player.fm/legal özetlenen süreci takip edebilirsiniz.
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PICU Management of Malignant Hyperthermia
MP3•Bölüm sayfası
Manage episode 412409697 series 2873095
İçerik Dr. Pradip Kamat, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Rahul Damania tarafından sağlanmıştır. Bölümler, grafikler ve podcast açıklamaları dahil tüm podcast içeriği doğrudan Dr. Pradip Kamat, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Rahul Damania veya podcast platform ortağı tarafından yüklenir ve sağlanır. Birinin telif hakkıyla korunan çalışmanızı izniniz olmadan kullandığını düşünüyorsanız burada https://tr.player.fm/legal özetlenen süreci takip edebilirsiniz.
Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists.
- Hosts:
- Dr. Pradip Kamat: Children’s Healthcare of Atlanta/Emory University School of Medicine
- Dr. Rahul Damania: Cleveland Clinic Children’s Hospital
Introduction:
- Pediatric Intensive Care Unit (PICU) physicians passionate about medical education in the acute care pediatric setting
- Episode focus: A case of a 23-month-old ex-28 week premie presenting with sudden high fever and rapidly rising ETCO2 during surgery
Case Presentation:
- Presented by Dr. Rahul Damania
- 23-month-old ex-28 week premie intubated during hernia repair surgery
- Noticed rapidly rising ETCO2, unprovoked tachycardia, and elevated temperature
- Transferred to PICU, exhibiting rigidity, clenched jaw, metabolic acidosis, and elevated lactate.
- Consideration of Malignant Hyperthermia (MH) crisis
Key Points:
- Elevated temperature, hypercapnia, metabolic acidosis, and unprovoked tachycardia raise concern for MH
- Organized discussion on pathophysiology, clinical signs, symptoms, and management
Multiple Choice Question:
- Diagnosis of MH crisis during scoliosis repair
- Correct Answer: D) Sarcoplasmic reticulum
- Dantrolene acts on the sarcoplasmic reticulum to inhibit calcium release, crucial in MH management
Clinical Presentation of MH Crisis:
- Tachycardia, acidosis, muscle stiffness, and hyperthermia are hallmark features
- Potential life-threatening complications underscore the urgency of recognition and treatment
Triggers and Pathophysiology of MH Crisis:
- Triggered by inhalational agents and depolarizing neuromuscular blocking agents
- Pathophysiology involves defective Ryanodine receptor leading to uncontrolled calcium release
Differential Diagnosis:
- Includes sepsis, thyroid storm, pheochromocytoma, and neuroleptic malignant syndrome
- Differentiation from similar conditions crucial for accurate management
Diagnostic Approach:
- High clinical suspicion
- Genetic testing (ryanodine receptor gene sequencing) and Caffeine Halothane Contracture Test (CHCT) for diagnosis
- Immediate workup during crisis includes blood gas, lactate, CPK, CMP, and urine analysis
General Management Framework:
- MH crisis is a medical emergency requiring rapid intervention
- Dantrolene Na administration, supportive measures, and continuous monitoring in PICU
- Utilization of Malignant Hyperthermia carts and involvement of specialized hotlines
Clinical Pearls and Pitfalls:
- Early recognition is crucial.
- Proper administration of Dantrolene Na without delay
- Extended monitoring period in PICU to ensure stability
Conclusion:
- Importance of recognizing and managing MH crisis
- Feedback, subscription, and reviews encouraged
- Website picudoconcall.org for additional resources
References:
- Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter
- Malignant Hyperthermia Association of the United States
- What is MH?
- [Managing a crisis](https://www.mhaus.org/ healthcare-professionals/managing-a-crisis/)
- Rosenbaum HK, Rosenberg H. UpToDate: Malignant hyperthermia: diagnosis and management of acute crisis.
87 bölüm
MP3•Bölüm sayfası
Manage episode 412409697 series 2873095
İçerik Dr. Pradip Kamat, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Rahul Damania tarafından sağlanmıştır. Bölümler, grafikler ve podcast açıklamaları dahil tüm podcast içeriği doğrudan Dr. Pradip Kamat, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Rahul Damania veya podcast platform ortağı tarafından yüklenir ve sağlanır. Birinin telif hakkıyla korunan çalışmanızı izniniz olmadan kullandığını düşünüyorsanız burada https://tr.player.fm/legal özetlenen süreci takip edebilirsiniz.
Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists.
- Hosts:
- Dr. Pradip Kamat: Children’s Healthcare of Atlanta/Emory University School of Medicine
- Dr. Rahul Damania: Cleveland Clinic Children’s Hospital
Introduction:
- Pediatric Intensive Care Unit (PICU) physicians passionate about medical education in the acute care pediatric setting
- Episode focus: A case of a 23-month-old ex-28 week premie presenting with sudden high fever and rapidly rising ETCO2 during surgery
Case Presentation:
- Presented by Dr. Rahul Damania
- 23-month-old ex-28 week premie intubated during hernia repair surgery
- Noticed rapidly rising ETCO2, unprovoked tachycardia, and elevated temperature
- Transferred to PICU, exhibiting rigidity, clenched jaw, metabolic acidosis, and elevated lactate.
- Consideration of Malignant Hyperthermia (MH) crisis
Key Points:
- Elevated temperature, hypercapnia, metabolic acidosis, and unprovoked tachycardia raise concern for MH
- Organized discussion on pathophysiology, clinical signs, symptoms, and management
Multiple Choice Question:
- Diagnosis of MH crisis during scoliosis repair
- Correct Answer: D) Sarcoplasmic reticulum
- Dantrolene acts on the sarcoplasmic reticulum to inhibit calcium release, crucial in MH management
Clinical Presentation of MH Crisis:
- Tachycardia, acidosis, muscle stiffness, and hyperthermia are hallmark features
- Potential life-threatening complications underscore the urgency of recognition and treatment
Triggers and Pathophysiology of MH Crisis:
- Triggered by inhalational agents and depolarizing neuromuscular blocking agents
- Pathophysiology involves defective Ryanodine receptor leading to uncontrolled calcium release
Differential Diagnosis:
- Includes sepsis, thyroid storm, pheochromocytoma, and neuroleptic malignant syndrome
- Differentiation from similar conditions crucial for accurate management
Diagnostic Approach:
- High clinical suspicion
- Genetic testing (ryanodine receptor gene sequencing) and Caffeine Halothane Contracture Test (CHCT) for diagnosis
- Immediate workup during crisis includes blood gas, lactate, CPK, CMP, and urine analysis
General Management Framework:
- MH crisis is a medical emergency requiring rapid intervention
- Dantrolene Na administration, supportive measures, and continuous monitoring in PICU
- Utilization of Malignant Hyperthermia carts and involvement of specialized hotlines
Clinical Pearls and Pitfalls:
- Early recognition is crucial.
- Proper administration of Dantrolene Na without delay
- Extended monitoring period in PICU to ensure stability
Conclusion:
- Importance of recognizing and managing MH crisis
- Feedback, subscription, and reviews encouraged
- Website picudoconcall.org for additional resources
References:
- Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter
- Malignant Hyperthermia Association of the United States
- What is MH?
- [Managing a crisis](https://www.mhaus.org/ healthcare-professionals/managing-a-crisis/)
- Rosenbaum HK, Rosenberg H. UpToDate: Malignant hyperthermia: diagnosis and management of acute crisis.
87 bölüm
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