PICU Doc On Call Podcast Por Dr. Pradip Kamat Dr. Rahul Damania Dr. Monica Gray arte de portada

PICU Doc On Call

PICU Doc On Call

De: Dr. Pradip Kamat Dr. Rahul Damania Dr. Monica Gray
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PICU Doc On Call is the podcast for current and aspiring Intensivists. This podcast will provide protocols that any Critical Care Physician would use to treat common emergencies and the sudden onset of acute symptoms. Brought to you by Emory University School of Medicine, in conjunction with Dr. Rahul Damania and under the supervision of Dr. Pradip Kamat.Copyright 2025 Dr. Pradip Kamat, Dr. Rahul Damania, Dr. Monica Gray Ciencia Ciencias Biológicas Enfermedades Físicas Higiene y Vida Saludable
Episodios
  • Approach to Bleach Ingestion in the PICU
    Jul 13 2025

    Have you ever wondered what happens when a toddler gets into something they definitely shouldn’t? Today, Dr. Monica Gray, Dr. Pradip Kamat, and Dr. Rahul Damania discuss the case of an 18-month-old boy who accidentally ingested concentrated bleach, presenting with stridor, drooling, and vomiting. They review the clinical approach to caustic ingestions in children, including airway management, diagnostic workup, and the roles of endoscopy, steroids, and multidisciplinary care. The episode also highlights potential complications such as esophageal strictures and cancer, emphasizes prevention strategies, and provides key takeaways for intensivists managing similar pediatric emergencies. If you’re an intensivist or just want to know what to do in a pediatric emergency, don’t miss these essential takeaways for managing one of the scariest situations in the ER.

    Show Highlights:

    • Case study of an 18-month-old boy who ingested concentrated bleach
    • Clinical presentation including symptoms like stridor, drooling, and vomiting
    • Management strategies for caustic ingestions in children
    • Importance of airway management and monitoring in cases of caustic ingestion
    • Diagnostic workup including imaging and endoscopy
    • Differential diagnosis considerations for similar presentations (e.g., button batteries, laundry detergent pods)
    • Mechanism of injury caused by alkaline substances like bleach
    • Long-term complications associated with caustic ingestions, such as esophageal strictures and cancer
    • Multidisciplinary approach to treatment involving various medical specialties
    • Prevention strategies to reduce the incidence of accidental caustic ingestions in children

    References:

    • American Academy of Pediatrics – Pediatric Care Online: Esophageal Caustic Injury (AAP clinical guidance on caustic ingestions).
    • Fuhrman & Zimmerman’s Pediatric Critical Care textbook – Chapters on toxicology and gastrointestinal emergencies (covering caustic injury management and critical care approach).
    • Hoffman RS, et al. “Ingestion of Caustic Substances.” New England Journal of Medicine. 2020; 382(18):1739-1748. A comprehensive review of caustic ingestion injuries and management.
    • Arnold M, Numanoglu A. “Caustic ingestion in children – a review.” Semin Pediatr Surg. 2017;26(2):95-104. Review of epidemiology, pathophysiology, and treatment of caustic injuries in kids.
    • Johnson CM, Brigger MT. “The public health impact of pediatric caustic ingestion injuries.” Arch Otolaryngol Head Neck Surg. 2012;138(12):1111-1115. (Epidemiology study showing declining incidence).
    • Pediatric Critical Care Medicine (PCCM) Journal – various case reports and series on caustic ingestion (for case-based insights), and annual National Poison Data System reports (for statistics on pediatric poisonings).
    • Tringali A, et al. ESGE/ESPGHAN Pediatric GI Endoscopy Guidelines (Endoscopy, 2017) – Includes recommendations for endoscopy timing and steroid use in caustic ingestions.
    • Usta M, et al. “High doses of methylprednisolone in the management of caustic esophageal burns.” Pediatrics. 2014;133(6):E1518-24. (Key study demonstrating steroids benefit in grade 2b injuries).
    • Royal Children’s Hospital Melbourne – Clinical Practice Guidelines: Caustic Ingestions (2019) – Practical hospital guidelines emphasizing early intubation for airway threat, endoscopy within 24h, IV PPI, and supportive care.


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    31 m
  • Salty Saga of Hyponatremia and Hypotension in the PICU
    Jun 29 2025

    Today, Dr. Monica Gray, Dr. Pradip Kamat, and Dr. Rahul Damania discuss two real-life pediatric cases of hyponatremia in the PICU. They talk through a case of a six-month-old baby with severe sodium depletion and a teenager dealing with cancer-related hyponatremia. The team breaks down the pathophysiology, walks us through the diagnostic workups, and discusses the careful management needed for these cases. They emphasize the importance of correcting sodium levels gradually and addressing the root cause of the problem. They share practical tips for intensivists and highlight why staying vigilant and following evidence-based care is so crucial when managing critically ill kids with electrolyte disturbances. Tune in to hear more!

    Show Highlights:

    • Discussion of hyponatremia in pediatric patients, particularly in the PICU
    • Presentation of two case studies illustrating different presentations of hyponatremia
    • Examination of the pathophysiology of hyponatremia, including its classification into hypovolemic, euvolemic, and hypervolemic types
    • Overview of diagnostic investigations for hyponatremia, including volume status assessment and serum/urine electrolyte measurements
    • Management strategies for hyponatremia, emphasizing the importance of gradual correction of sodium levels
    • Risks associated with rapid correction of hyponatremia
    • Importance of fluid management in different types of hyponatremia
    • Role of pharmacological interventions in specific cases, such as SIADH
    • Clinical presentation and symptoms associated with hyponatremia in pediatric patients
    • Emphasis on continuous monitoring of sodium levels and clinical status during treatment

    References:

    • Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 71. Fluid and electrolyte issues in pediatric critical illness. Evans I, Joyce E. Page 866-872
    • Rogers' textbook of Pediatric Intensive Care Chapter 108: Disorders of Water, Sodium and Potassium homeostasis: Schneider J & Glater-Welt L. Pages 1868-1880
    • Harrison’s Principles of Internal Medicine Volume 1. Chapter 53: Fluid and Electrolyte Disturbances. Mount D. Pages 338-347

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    40 m
  • Cardiopulmonary Interactions (basics) in the PICU
    Jun 15 2025

    Today, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Monica Gray, pediatric intensivists, sit down to chat about the diagnosis and management of acute myocarditis in children. They focus on a real-life case involving a one-month-old infant who presented with poor feeding, respiratory distress, and fever. Together, they break down the possible causes, key clinical signs, diagnostic approaches, and treatment options for pediatric myocarditis. Throughout the discussion, they highlight the importance of early recognition, a multidisciplinary team approach, and supportive care in improving outcomes for these critically ill infants. This episode is packed with practical insights and is designed to help pediatric intensivists tackle this challenging and potentially life-threatening condition. Tune in to hear more!

    Show Highlights:

    • Definition and etiology of acute myocarditis in pediatric patients
    • Clinical case presentation of a one-month-old infant with acute myocarditis
    • Symptoms and clinical manifestations of acute myocarditis in children
    • Diagnostic approaches for identifying acute myocarditis, including echocardiography and laboratory tests
    • Management strategies for acute myocarditis, including intensive care and medication
    • Importance of recognizing atypical presentations in infants
    • Prognosis and risk factors associated with acute myocarditis
    • Role of multidisciplinary collaboration in managing acute myocarditis
    • Impact of viral infections on the development and severity of myocarditis
    • Outcomes and potential complications related to acute myocarditis in pediatric patients

    References:

    • Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 108. Life-threatening viral diseases and their treatment. Vora S et al. Pages 1273-1278
    • Rogers’ textbook of Pediatric Intensive Care. Chapter 74: cardiomyopathy, myocarditis, and mechanical circulatory support. Harmon WG et al. Pages 1247-1255
    • Robinson J, Hartling L, Vandermeer B, Sebastianski M, Klassen TP. Intravenous immunoglobulin for presumed viral myocarditis in children and adults. Cochrane Database Syst Rev. 2020 Aug 19;8(8): CD004370. Doi: 10.1002/14651858.CD004370.pub4. PMID: 32835416

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    29 m
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