Clinical Methods II: Acute and critical conditions

accidents and trauma

poisoning

• CNS injuries

• encephalitis

• meningitis

• neonatal abstinence syndrome

• reyes syndrome

neurologic disorders

diffuse brain injury

focal brain injury

CNS injuries

refers to widespread damage to the white matter of the brain resulting from a traumatic acceleration/deceleration type of injury.

diffuse brain injury

occurs in a specific, circumscribed location in the brain and may result from a physical cut or wound to the head, blow to the head, blood clot, or hemorrhage such as an arteriovenous malformation (abnormal connections between arteries and veins).

focal brain injury

Inflammation of brain tissue that may be due to viral infection is common in children, and may also occur in adults and in immunocompromised patients.

ecephalitis

a bacterial infection of the meninges that surround the brain and spinal cord.

Meningitis

results from a sudden discontinuation of fetal exposure to substances (such as narcotics) in utero; multiple systems may be affected, including the central and autonomic nervous systems, and gastrointestinal tract.

Neonatal Abstinence Syndrome (NAS)

a condition that causes swelling in the brain and liver. Signs and symptoms include confusion, seizures, and loss of consciousness, and emergency treatment is required. It affects children and teenagers recovering from a viral infection, such as influenza or chicken pox.

Reye's syndrome

pediatric respiratory disorders

PD

PARDS

a type of lung disease where scarring (fibrosis) develops rapidly, leading to significant declines in lung function and oxygen levels within a short period, typically less than three months

rapidly progressing pulmonary disease

differs in children as compared to adults. ______ in pediatric patients refers to acute, diffuse, inflammatory lung injury caused by both pulmonary and non-pulmonary etiologies. Hypoxia, bilateral opacities on a chest X-ray, decreased lung compliance, and increased physiological respiratory dead space are diagnostic clinical signs.

Acute respiratory distress syndrome (ARDS)

• foreign body obstruction

• smoke or chemical fume inhalation

• allergic reactions

• croup

• bacterial tracheitis

• epiglottits

• peritonsillar abcess

• retropharyngeal abcess

Airway Obstruction and Disorders

what in children (particularly between 6 months and 5 years) is considered a significant health problem. Coins are the most commonly swallowed. Most objects pass harmlessly through the gastrointestinal tract; however, in some cases, they may become lodged in the airway or in the esophagus and require immediate medical attention and intervention. _

Foreign Body Obstruction

from heat, smoke, or chemical irritants may cause damage to the respiratory tract or lung tissue. Edema may be severe and impair the upper airway diameter; damage to the lower respiratory tract also occurs. Depending on the extent of injury, endotracheal intubation or tracheotomy may be required.

Smoke or Chemical Fume Inhalation

may range from skin rashes or hives, sneezing, coughing, nasal congestion, itchy eyes, and upset stomach

such as anaphylaxis (hives, itching, flushing, lip swelling, and narrowing/constriction of the airway, and a dramatic drop in blood pressure).

allergic reaction

a common childhood illness characterized by swelling in the voice box (larynx) and windpipe (trachea), often caused by a viral infection. This swelling makes breathing difficult, leading to a distinctive "barking" cough and a high-pitched, noisy sound when inhaling called stridor. 

viral croup

A bacterial infection of the trachea may cause upper airway obstruction that may result in life-threatening, acute respiratory decompensation

Bacterial tracheitis

refers to inflammation of the epiglottis and may involve the adjacent supraglottic structures (supraglottitis).

epiglottitis

is a collection of infected material in the tonsillar area as a complication of tonsillitis

Peritonsillar Abscess

This collection of pus in the tissues in the back of the throat that may occur during or soon after a throat infection. This disorder occurs most often in children under 5 years of age and can be life-threatening.

Retropharyngeal Abscess

a broad range of conditions affecting the heart and blood vessels. These conditions can include problems with the heart's structure, like congenital heart defects, or issues with blood flow, such as atherosclerosis and coronary artery disease

Cardiovascular System Disorders

refers to blood poisoning by bacteria, viruses, fungi, or parasites; this life-threatening condition results from infection at any location in the body.

Septicemia (Sepsis)

• exchange transfusions

• plasmapheresis (extracorporcal separation of blood components)

• leukopheresis (white blood cells are separated from the blood to decrease white blood cell count)

• severe coagulophathy (bleeding disorder)

• severe anemia that results in hemodynamic or respiratory compromise

• sickle cell crisis

Hematology-Oncology Disorders

• severe diabetic ketoacidosis

• diabetes mellitus

• diabetic ketoacidosis (DKA)

• hypo-or hypernatremia (disorders of salt-water balance)

• hypo- or hyperglycemia (low or high blood glucose levels)

• hypo- or hypercalcemia (abnormal blood calcium levels)

• metabolic acidosis (overproduction of acid in the blood)

• Inborn errors of metabolism

• inotropic support (medicines that alter the strength of contractions of the heart muscle)

Endocrine and Metabolic Disorders

acute hepatic failure with secondary coma

hemodynamic or respiratory instability

severe acute gastrointestinal bleeding leading to hemodynamic or respiratory instability

Gastrointestinal Disorders

Renal replacement therapy (RRT)

acute rhabdomyolysis

peritoneal dialysis

Pediatric Renal Disorders

Post-surgical pediatric patients in the PICU require continuous monitoring and intensive intervention, particularly when patients are status post cardiovascular surgery, thoracic surgery, neurosurgical procedures, otolaryngologic surgeries, craniofacial surgery, orthopedic and spine surgery, organ transplantation, and post-operative care for multiple traumas.

Post-Surgical Monitoring in the PICU

disorders that affect multiple organ systems in the body, rather than being limited to a single organ or tissue. These diseases can arise from various causes, including autoimmune processes, infections, genetic mutations, or environmental exposures. 

Multi-System Diseases

• AMI

• acute pericarditis

• ARDS

• aortic dissection

• arrhythmias

• aspiration

• asthma, reactive airway disease

• bronchopleural fistula (BPF)

• cardiac contusion

• COPD

• CHF

• endocarditis and pericarditis

• hemoptsyis

• hypertensive crisis

cardiac and pulmonary conditions

a condition in which there has been death of heart tissue, usually caused by an interruption in blood flow to the heart muscle due to atherosclerotic coronary artery disease (CAD).

Acute Myocardial Infarction (MI)

a sudden inflammation of the lubricated sac encasing the heart.

Acute Pericarditis

a clinical condition, not a specific disease, in which there is acute dyspnea, severe hypoxemia, decreased lung compliance, and diffuse infiltrates on chest X-rays. Conditions associated with this include aspiration, sepsis, trauma, multiple blood transfusions, drug overdoses, near-drowning, head trauma, and lung contusions.

Adult Respiratory Distress Syndrome (ARDS)

a condition caused by an intimal (within layers) tear from a weakened wall of the aorta, allowing a channel of blood (hematoma) to accumulate within the linings of the vessel.

aortic dissection

heart rhythm disorders, are irregularities in the heartbeat, causing it to beat too fast, too slow, or irregularly.

Arrhythmias

When a foreign body or substance enters the airway, respiratory status is disrupted to varying degrees

Aspiration

A sudden onset of coughing and wheezing can occur in response to a variety of conditions and cause bronchial resistance. It is sometimes referred to as "reversible obstructive pulmonary disease."

Asthma, Reactive Airway Disease

a condition usually associated with mechanical ventilation coupled with chest tube suction. These conditions contribute to a risk of air leaking into the pleural space.

Bronchopleural Fistula (BPF)

Nonpenetrating trauma to the heart can result in petechiae and ecchy moses of the myocardium (small hemorrhages in the heart muscle). More extensive bleeding would be called a "localized cardiac hematoma."

Cardiac Contusion

a condition associated with a chronic dyspnea (shortness of breath) and productive cough.

Chronic Obstructive Pulmonary Disease (COPD)

refers to a condition in which the heart is unable to pump blood sufficiently for the body's needs.

Congestive Heart Failure (CHF)

refers to an inflammation due to infection of the linings in the chambers of the heart.

Endocarditis

refers to inflammation of the fibrous sac surrounding the heart muscle

Pericarditis

coughing up blood or bloody mucus from the lungs or airways

Hemoptysis

a condition in which blood pressure reaches a level high enough to cause damage to vital organs, most notably, intracranial hemorrhages, MI, pulmonary edema, aortic dissection, and renal failure.

Hypertensive Crisis

• pericardial effusion

• pneumothorax

• pulmonary embolism

• unstable angina

• upper airway obstruction

orthopedic and vascular injuries

nonpenetrating trauma, which can result in ecchymosis (bruising of the skin), contusion (bruising within the body), abrasion (scraping tissue), laceration (tear in the tissue), and fracture (broken bone)

blunt-force trauma

such as stab wounds, which can cause a pneumothorax leading to tension pneumothorax, causing respiratory distress, including trachycardia (rapid heart rate) or tachypnea (rapid breathing);

penetrating trauma

such as gunshot wounds that cause hypovolemic shock when there is profuse bleeding and vital organs do not receive blood and oxygen and exsanguination (or bleeding out) leading to death if a knife or bullet injures the heart or major arteries. Penetrating wounds may also cause a serious condition known as flail, which is the result of broken ribs detachment from the chest wall and move in the opposite direction from the chest wall when breathing.

ballistic trauma

Fluid accumulating in the pericardial space is referred to as

Pericardial Effusion

refers to air leaking into the pleural space. The cause can be spontaneous or the result of iatrogenic errors (e.g., an accidental lung puncture during a medical procedure).

Pneumothorax

are most often found in patients who have a history of deep vein thromboses (DVTs). When clots originating from the peripheral venous circulation become dislodged, they may be passed into the right side of the heart and then potentially occluding the pulmonary artery

Pulmonary Embolism (PE)

a condition where the heart doesn't get enough blood and oxygen, potentially leading to a heart attack

Unstable Angina

a life-threatening condition where the upper airway is partially or completely blocked, hindering airflow into the lungs

Upper Airway Obstruction (UAO)

• anticoagulation disorders

• antiplatelet therapy

• disseminated intravascular coagulation (DIC)

• hemostatic failure

• tumor lysis syndrome

hematologic conditions

blood clotting disorders, involve a problem with the blood's ability to clot properly, potentially leading to either excessive bleeding or the formation of blood clots

Anticoagulation Disorders

using medications to prevent blood clots by reducing the stickiness of platelets, which are blood cells that play a role in clot formation. This therapy is crucial for treating and preventing cardiovascular diseases, particularly those related to thrombosis (blood clot formation

Antiplatelet Therapy

a hemorrhagic condition in which there is gross intravascular clotting in association with profuse bleeding

Disseminated Intravascular Coagulation (DIC)

refers to a disruption in the normal processes for blood clotting. It occurs in association with drugs used for or known to affect bleeding, including coagulation therapies and drugs that cause platelet dysfunction (such as aspirin) and with hematologic diseases associated with blood clotting.

Hemostatic Failure

occurs in response to large masses of tumor cells in association with conditions such as small cell lung cancer, widespread metastases, lymphocytic cancer, and myeloma. Widespread cell destruction causes the release of metabolites and intracellular ions, which overwhelms the kidneys, requiring hemodialysis. It can occur following induction of chemotherapy.

Tumor Lysis Syndrome

• acute hepatic failure

• acute intestinal ischemia

• lower GI hemorrhaging

• peritonitis

• upper GI hemorrhaging

GI disorders

a serious condition characterized by the rapid and severe deterioration of liver function in individuals without a history of pre-existing liver disease

Acute Hepatic Failure

Infarction of the bowel can result from occlusive vascular disease or hypoperfusion of the intestinal tissues.

Acute Intestinal Ischemia

bleeding originating in the small intestine, large intestine, rectum, or anus

Lower Gastrointestinal (LGI) Hemorrhaging

a condition in which bacteria have entered the peritoneal cavity (the tissue lining the inner wall of the abdomen).

Peritonitis

bleeding originating from the esophagus, stomach, or duodenum, the upper part of the small intestine. also known as hematemesis

Upper Gastrointestinal (UGI) Hemorrhaging

• acute acid-base disturbances

• acute renal failure

• CKD

fluid, electrolyte and renal disorders

refer to imbalances in the intracellular or extracellular fluids that are either excessively alkaline or excessively acidic.

Acute Acid-Base Disturbances

It refers to a syndrome associated with a dramatic decrease in renal function, causing a reduction in the clearance of solutes (wastes) from the blood, which leads to an increase in the concentration of creatinine and BUN levels.

Acute renal failure (ARF)

medical treatments that process blood or body fluids outside the body to remove toxins, excess water, or disease-causing substances including, dialysis, plasmapheresis, ECMO, and cardiopulmonary bypass during open heart surgery

Extracorporeal Therapies

a type of treatment that helps your body remove extra fluid and waste products from your blood when the kidneys are not able to aka renal replacement therapy (RRT).

dialysis

a progressive condition where the kidneys are damaged and can't filter waste and fluid from the blood effectively. This leads to a buildup of waste products and fluid in the body, potentially causing various health problems.  require some form of dialysis, either hemodialysis (delivered three times a week in a dialysis unit), or peritoneal dialysis (PD).

chronic kidney disease (CKD)

Conditions associated with fluid expansion (hypervolemia) include renal disorders, endocrine abnormalities, and conditions causing edema (such as congestive heart disease).

Patients who are hypervolemic are described as "wet,"

patients who are hypovolemic are described as "dry."

Conditions associated with fluid depletion (hypovolemia) include vomiting; diarrhea: burns; sweating; bemorrhage; diabetes insipidus; chronic renal failure and other renal diseases; and, commonly, the excessive use of diuretics.

Acute Fluid, Electrolyte, or Metabolite Disturbances

• adrenal insufficiency

• diabetic coma and ketocidosis

• thyroid dysfunction

acute metabolic and endocrine disorders

______________ or Addisonian crisis, usually occurs in patients who have some preexisting partial insufficiency. Total failure of the adrenal glands is usually fatal.

Acute adrenal insufficiency,

occurs when the body, lacking sufficient insulin, breaks down fat for energy, producing ketones that accumulate in the blood and blood sugar levels rise excessively.

Diabetic Coma and Ketoacidosis

Acute hyperthyroidism

thyrotoxic crisis

myxedema crisis or myxedema coma

Thyroid Dysfunction

Burns are classified as _______ or _____ according to the amount of the body affected, or the total body surface area (TBSA), and the depth of the burns. The TBSA is measured by an approximation based on the "rule of nines," in which the entire head makes up 9%, each arm makes up 9%, each leg makes up 18%, and the front and back of the body each make up 18%.

moderate or major

associated with sunburn and is superficial, characterized by erythema and dry or blistered skin that is painful

first-degree burn

partial-thickness burn, is associated with severe sunburn, scalding, or flash burn (quick duration exposure to extreme heat), and involves the epidermis, extending into the dermis.

second-degree burn

full-thickness burns, result from prolonged contact with extreme heat and involve the epidermis and dermis. The skin is white, translucent, or charred, and touch sensation is lacking.

Third-degree burns

Gastrointestinal (GI) dysfunctions and hemolytic anemia are often associated with

severe burns

refers to an extremely reduced state of consciousness associated with damage to or disruption of the cerebral hemispheres or the reticular activating system.

Rapid onset coma

a reversible, deep state of unconsciousness intentionally created by doctors using anesthetics or other drugs to protect the brain. It's used to reduce brain activity and protect it from further damage, often after a serious injury or medical emergency

Sedation and Medically-Induced Coma.

has been associated with small cell carcinoma of the lung. This disorder causes thigh, shoulder, and pelvic weakness, sparing bulbar, and ocular muscles.

Acute Eaton-Lambert Syndrome

Clinical features include progressive weakness of the extremities with more proximal than distal involvement, paresthesias, areflexia, cranial nerve involvement, cramping limb pain, and autonomic disturbances.

Guillain-Barré Syndrome

• primary effects or concussive effects

• secondary effects

• Increased intracranial pressure (ICP)

• epidural hematomas

• subdural hematomas

• barachnoid hematomas (bleeding between the layers covering the brain)

• intracerebral hematomas

Severe Head Injury

can involve one or more vital organs, causing lifethreatening acute and critical illnesses. Examples include infections of the heart valves (endocarditis), lining of the heart (pericarditis), the lungs (pneumonia), peritoneal sac (peritonitis), and the brain (encephalitis or meningitis).

Infectious Diseases Involving the Vital Organs and Nervous System

____ is an autoimmune, neuromuscular junction disease in which antibodies to the receptor neurotransmitter acetylcholine are formed. Patients with ____ have increased muscle weakness, potentially requiring intensive care.

Late-Stage Myasthenia Gravis

a state in which there is an acute circulatory failure leading to hypoperfusion of body tissues and damage to organs.

shock

This condition usually is defined as a seizure lasting approximately 20 to 30 minutes, or a series of seizures lasting a total of at least 30 minutes without a return to consciousness. Prolonged seizure activity can cause damage to neurologic substrate due to cerebral hypermetabolism.

Status Epilepticus

edema, inflammation, hyaline membrane formation, or pulmonary hemorrhage are defined as

diffuse alveolar damage

what may result from may result from conditions such as laryngomalacia, glossoptosis, subglottic hemangioma, vocal fold paralysis, and subglottic stenosis

chronic upper airway obstruction

requires an injection of epinephrine (via an EpiPen®), and immediate medical treatment.

Anaphylaxis

(white blood cells are separated from the blood to decrease white blood cell count

leukopheresis

bleeding disorder

severe coagulophathy

results in hemodynamic or respiratory compromise

severe anemia

disorders of salt-water balance

hypo-or hypernatremia

low or high blood glucose levels

hypo- or hyperglycemia

abnormal blood calcium levels

hypo- or hypercalcemia