Critical Points
@CritPoints
Early-impact critical care CME course for ED providers, adult and pediatric hospitalists, nurses, and prehospital providers. Come join us!
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It’s on, people. We’re in Scottsdale at the Omni resort. So good! Wish you were here.
Critical Points 2018 Day1: Rancho San Bernardo, Ca. Starting the day talking shock
Dr. DeBlieux: When you want MAP >65 in resuscitation: post-ROSC and spinal shock patients. How much MAP? Keep it above 75 mmHg. #CritPoints17SD
It’s about to start! 10 minutes until Critical Points San Diego gets underway. #CritPoints17SD
Treat status like a code!! run on a clock 3-5 minutes and have your next drug ready before the timer is up. #CritPoints17SD
If a kid is seizing for more than 5 minutes… They will continue until you do something to break it. : Lorazepam:0.1mg/kg Diazepam: 0.1mg/kg Diazepam: 0.5mg/kg Midazolam: 0.1mg/kg IV,IN or IM seizures beget seizures #CritPoints17SD
Bronchiolitis: risk for apnea: Full term<1mo of age, born<37 and less than 48 weeks post conception, If the kid has had a single apnea episode. Needs admission: Toxic, persistent hypoxia, apnea, RR>70, Inability to feed or dehydration. #CritPoints17SD
Bronchiolitis: <2 years of age. Big risk in: Premature, younger and medically fragile. NO: dilators(Strong level B, steroids(strong level A). High risk kids… bets are off #CritPoints17SD
Pressing kids: Cold shock(constricted) EPi 0.05-0.3mcg/kg/min Warm shock (dilated) Norepi: 0.05-0.3mcg/mg/min. Dr Nate Mick #CritPoints17SD
Which Fluid for kids? LR or Normosol. Saline is not normal…. Abnormal Saline can cause renal injury and worsening acidosis. Fluid bolus is 60ml/kg/1st hour. #CritPoints17SD
Acyclovir: All really sick kids <4 weeks of age get it!!! Sepsis syndrome with negative culture, skin vessicles, Hepatic failure all get it. . Dr. Nate Mick
Lactate of greater than 4 in a kid is highly suspicious for pending organ failure… Serial lactates in sick kids can give you the warning #CritPoints17SD
You won’t find the patechia if you don’t take off the diaper.
Peds Sepsis: Death increases with every hour of delay in resuscitation.. Each hour of persistent shock doubles your mortality in kids. #CritPoints17SD
Critical Points Peds Sepsis: IV/IO Fluids Antibiotics 20ml/kg. B4 ETT (If you can)
Sepsis in kids: Not easy automatic trigger: Can get sick from bacteria or virus, Most common cause of the “sick kid”. 4 beasts: Newborns, “Syndromes", Cancers & Teens. #CritPoints17SD
When to terminate: 10 minutes without heart rate and asystole. tough calls... #CritPoints17SD
The only kids we cool are hypoxic newborns. It is the only time cooling has been shown to be helpful. It can usually wait for the ICU. #CritPoints17SD
United States Tendencias
- 1. #Daytona500 N/A
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- 8. Austin Dillon N/A
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- 19. Hamlin N/A
- 20. Tom Wilson N/A
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