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:

PICU Management of Malignant Hyperthermia

PICU Doc On Call