Fifteen-minute consultation: Intubation of the critically ill child presenting to the emergency department

2021 ◽  
pp. edpract-2021-322520
Author(s):  
Constantinos Kanaris ◽  
Peter Croston Murphy
Keyword(s):  
Emergency Department ◽  
Critically Ill ◽  
Critically Ill Children ◽  
Successful Intubation ◽  
Patient Harm ◽  
Failed Intubation ◽  
Drug Choice ◽  
Critically Ill Child ◽  
Adequate Oxygenation ◽  
Selection Of

Intubation of critically ill children presenting to the emergency department is a high-risk procedure. Our article aims to offer a step-by-step guide as to how to plan and execute a rapid, successful intubation in a way that minimises risk of adverse events and patient harm. We address considerations such as the need for adequate resuscitation before intubation and selection of equipment and personnel. We also discuss drug choice for induction and peri-intubation instability, difficult airway considerations as well as postintubation care. Focus is also given on the value of preintubation checklists, both in terms of equipment selection and in the context of staff role designation and intubation plan clarity. Finally, in cases of failed intubation, we recommend the application of the Vortex approach, highlighting, thus, the importance of avoiding task fixation and maintaining our focus on what matters most: adequate oxygenation.

Pediatric Obesity in Acute and Critical Care

2008 ◽  
Vol 19 (1) ◽  
pp. 38-46
Author(s):  
Andrea M. Kline
Keyword(s):  
United States ◽  
Critical Care ◽  
Critically Ill ◽  
Pediatric Obesity ◽  
The United States ◽  
Critically Ill Children ◽  
Surgical Strategies ◽  
Specific Effects ◽  
Critically Ill Child

Pediatric obesity has reached epidemic proportions in the United States. Significant obesity-related comorbidities are being noted at earlier ages and often have implications for the acute and critically ill child. This article will review the latest in epidemiologic trends of pediatric obesity and examine how it affects multisystem body organs. The latest data evaluating the specific effects of obesity on acute and critically ill children will be reviewed. Available nonpharmacologic, pharmacologic, and surgical strategies to combat pediatric obesity will be discussed.

Safety of the Manchester Triage System to Detect Critically Ill Children at the Emergency Department

2016 ◽  
Vol 177 ◽  
pp. 232-237.e1 ◽  
Author(s):  
Joany M. Zachariasse ◽  
Jan Willem Kuiper ◽  
Matthijs de Hoog ◽  
Henriëtte A. Moll ◽  
Mirjam van Veen
Keyword(s):  
Emergency Department ◽  
Critically Ill ◽  
Critically Ill Children ◽  
Triage System ◽  
Manchester Triage System

scholarly journals Feeding the critically ill child in intensive care units: a descriptive qualitative study in two tertiary hospitals in Ghana

2021 ◽  
Author(s):  
Alhassan Sibdow Abukari ◽  
Angela Kwartemaa Acheampong
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Medical Condition ◽  
Teaching Hospitals ◽  
Critically Ill Children ◽  
Feeding Method ◽  
Tertiary Teaching ◽  
Critically Ill Child ◽  
Descriptive Qualitative

Abstract Background: Critically ill children require optimum feeding in the intensive care for speedy recovery. Several factors determine their feeding and the feeding method to adopt to address this phenomenon. The aim of this study was to explore and describe the feeding criteria of critically ill children at the neonatal and paediatric intensive care units.Methods: A descriptive qualitative design was used to conduct the study. Six focus group discussions were conducted, and each group had five members. In addition, twelve one-on-one interviews were conducted in two public tertiary teaching hospitals in Ghana and analyzed by content analysis using MAXQDA Plus version 2020 qualitative software. Participants were selected purposively (N=42).Results: The decision to feed a critically ill child in the ICU was largely determined by the child’s medical condition as well as the experts’ knowledge and skills to feed. It emerged from the data that cup feeding, enteral, parenteral and breastfeeding were the feeding processes employed by the clinicians to feed the critically ill children.Conclusions: Regular in-service training of clinicians on feeding critically ill children, provision of logistics and specialized personnel in the ICU is recommended to reduce possible infant and child mortality resulting from feeding.

scholarly journals Recommendations for Analgesia and Sedation in Critically ill Children Admitted to Intensive Care Unit

2021 ◽  
Author(s):  
Angela Amigoni ◽  
Giorgio Conti ◽  
Alessandra Conio ◽  
Manuela Corno ◽  
Paola Claudia Fazio ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Children ◽  
Level Of Evidence ◽  
Assessment Development ◽  
Research Questions ◽  
The Difference ◽  
Final Agreement ◽  
Grade Approach ◽  
Selection Of

Abstract We aim to develop evidence-based recommendations for intensivists caring for children admitted to intensive care units and requiring analgesia and sedation. A panel of national pediatric intensivists expert in the field of analgesia and sedation and other specialists (a pediatrician, a neuropsychiatrist, a psychologist, a neurologist, a pharmacologist, an anesthesiologist, two critical care nurses, a methodologist) started in 2018 a 2- years process. Three meetings and one electronic-based discussion were dedicated to the development of the recommendations (presentation of the project, selection of research questions, overview of text related to the research questions, discussion of recommendations). A telematic anonymous consultation was adopted to reach the final agreement on recommendations. A formal conflict-of-interest declaration was obtained from all the authors. Eight areas of direct interest and one additional topic were considered to identify the best available evidence and to develop the recommendations using the Evidence-to-Decision framework according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. For each recommendation, the level of evidence, the strength of the recommendation, the benefits, the harms and the risks, the benefit/harm balance, the intentional vagueness, the values judgment, the exclusions, the difference of the opinions, the knowledge gaps and the research opportunities were reported. The panel produced 17 recommendations. Nine were evaluated as strong, 3 as moderate, 5 as weak. Conclusion: a panel of national experts achieved consensus regarding recommendations for the best care in terms of analgesia and sedation in critically ill children.

scholarly journals Medical Tourism and the Best Interests of the Critically ill Child in the Era of Healthcare Globalisation

2020 ◽  
Vol 28 (4) ◽  
pp. 696-730
Author(s):  
Neera Bhatia ◽  
Giles Birchley
Keyword(s):  
Critically Ill ◽  
Healthcare Professionals ◽  
Medical Tourism ◽  
Case Law ◽  
Best Interests ◽  
Critically Ill Children ◽  
Medical Law ◽  
Novel Treatments ◽  
Critically Ill Child ◽  
The Law

Abstract In this article, we examine emerging challenges to medical law arising from healthcare globalisation concerning disputes between parents and healthcare professionals in the care and treatment of critically ill children. We explore a series of issues emerging in English case law concerning children’s medical treatment that are signs of increasing globalisation. We argue that these interrelated issues present distinct challenges to healthcare economics, clinical practice, and the operation of the law. First, social media leverages the emotive aspects of cases; secondly, the Internet provides unfiltered information about novel treatments and access to crowdfunding to pay for them. Finally, the removal of barriers to global trade and travel allows child medical tourism to emerge as the nexus of these issues. These aspects of globalisation have implications for medicine and the law, yet child medical tourism has been little examined. We argue that it affects a range of interests, including children’s rights, parents’ rights as consumers, and the interests of society in communalised healthcare. Identifying putative solutions and a research agenda around these issues is important. While cases involving critically ill children are complex and emotionally fraught, the interconnectedness of these issues requires the law to engage and respond coherently to the impacts of healthcare globalisation.

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