Critical Points

Early-impact critical care CME course for ED providers, adult and pediatric hospitalists, nurses, and prehospital providers. Come join us!

[Critical Points @CritPoints]

@ER_Dr_ummer: Do not let US worsen your resus!
To scan within CPR pauses of <10sec is exceedingly challenging!

Prepare your machine, team, environment, yourself

[Critical Points @CritPoints]

It’s on, people. We’re in Scottsdale at the Omni resort. So good! Wish you were here.

[Critical Points @CritPoints]

Critical Points 2018 Day1: Rancho San Bernardo, Ca.

Starting the day talking shock

[Critical Points @CritPoints]

Dr. DeBlieux: Why do we intubate? The three biggies. #CritPoints17SD

[Critical Points @CritPoints]

Dr. DeBlieux: When you want MAP >65 in resuscitation: post-ROSC and spinal shock patients. How much MAP? Keep it above 75 mmHg. #CritPoints17SD

[Critical Points @CritPoints]

It’s about to start! 10 minutes until Critical Points San Diego gets underway. #CritPoints17SD

[Critical Points @CritPoints]

Treat status like a code!!
run on a clock 3-5 minutes and have your next drug ready before the timer is up.

#CritPoints17SD

[Critical Points @CritPoints]

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

[Critical Points @CritPoints]

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

[Critical Points @CritPoints]

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

[Critical Points @CritPoints]

Pessor-resistant shock=steroids

[Critical Points @CritPoints]

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

[Critical Points @CritPoints]

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

[Critical Points @CritPoints]

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

[Critical Points @CritPoints]

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

[Critical Points @CritPoints]

You won’t find the patechia if you don’t take off the diaper.

[Critical Points @CritPoints]

Peds Sepsis:
Death increases with every hour of delay in resuscitation.. Each hour of persistent shock doubles your mortality in kids. #CritPoints17SD

[Critical Points @CritPoints]

Critical Points Peds Sepsis:
IV/IO
Fluids
Antibiotics
20ml/kg. B4 ETT (If you can)

[Critical Points @CritPoints]

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

[Critical Points @CritPoints]

When to terminate: 10 minutes without heart rate and asystole. tough calls... #CritPoints17SD