@eUSMD #EMW2016

You do WHAT?%#!

@eUSMD

The Fast Changing Practice of Pediatric Emergency Medicine

I have no actual or potential conflict of interest in relation to this program.

I also assume responsibility for ensuring the scientific validity, objectivity, and completeness of the content of my presentation.

Declaration of Disclosure

Jason W. Fischer MD MScAssistant ProfessorDepartment of Paediatrics, University of Toronto Interim Division HeadDivision of Emergency MedicineThe Hospital for Sick Children, Toronto 

1 Case 5 Game Changers

Case9 m/o F BIBA from PCP office to your EDc/o vomiting, diarrhea, poor feeding x 5 daysnow lethargic, mottled, delayed cap refill

38.2C 220 50/p 60 97%RA

Case ContinuesUnable to acquire access in 2 attempts.ION placed. IVFs started.More access required. Concern for pain.

38.2C 220 50/p 60 97%RA

0.1 - 0.5 mg/kg IVP

Game Changer #2

Ketamine for pain control.

Case Continues

100mL/kg in 60 minutes. Next steps?

38C 210 54/p 64 98% 2LNC

Game Changer #3

POCUS for fluid management and the identification of fluid threshold.

Case Continues

Continue fluids. Preparing vasopressors.

37.8C 210 54/p 70 88% NRB

Game Changer #4

POCUS for ETT confirmation.

Case Continues

Intubated. Begin vasopressor.

37.6C 220 54/p 60 96%V

Ventura AMC, Shieh HH, Bousso A, et al. Double-Blind Prospective Randomized Controlled Trial of Dopamine Versus Epinephrine as First-Line Vasoactive Drugs in Pediatric Septic Shock. Crit Care Med. 2015;43(11):2292-2302.

0.1–0.3 μg/kg/min

Game Changer #5

Use epinephrine first and peripherally as needed.

Case Concludes

Intubated. Vasopressors. Transfer PICU.

37.6C 180 60/p 50 96%V

1 Case 5 Game Changers

Your Take-home

@eUSMD #EMW2016