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Grand Rounds January 18, 2024

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GRAND ROUNDS January 18, 2024

8) Pediatric Cardiology.  Dr. Amir Toib 

Acute Heart failure in Pediatrics

  • Tachypnea, tachycardia, hepatomegaly = think heart failure
  • Buzz words for boards to think cardiac.
    • Feeding difficulty, prolonged feeding time
    • Sweating with feeds
    • Exercise intolerance
    • Failure to thrive.
    • Dependent edema

Sick Baby: Day 0-4 Life

  • Ductal dependent lesions
    • HLHS
    • Coarctation
    • Critical Aortic stenosis
  • Pulmonary Vein obstruction
  • Arrhythmia
  • Neonatal Cardiomyopathy, Myocarditis

How do you treat this?

  • PALS
  • Respiratory support
  • Inotropes- epi, dopa
  • RESTRICT Fluids
  • Sedation & paralysis
  • Glucose and calcium
  • Prostaglandin- PGE1

Sick Baby: Weeks 2-8 of life

  • Shunts lesions
    • Vsd, pda, AV canal
    • ALCAPA: Anomalous origin of the left coronary artery from pulmonary artery: ischemic cardiomyopathy
  • Arrythmia
  • Neonatal cardiomyopathy, myocarditis

Sick Baby: Toddlers

  • Kawasaki disease
  • Rheumatic valvar disease
  • Arrythmia
  • Cardiomyopathy, myocarditis
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Sick Kid: Teens and early adults

  • Failed single ventricles (Fontan procedure in the past)
  • Arrhythmia
  • Cardiomyopathy, myocarditis (HOCM)
    • TX HOCM
      • BB, CCB, disopyramide, surgical myectomy, transplant, mavacamten, valsartan

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9) Cardiology Jeopardy. Patrick Cheatle, MD 

10) Pelvis and Femur Fractures Philip Salen, MD 

http://www.emdocs.net/pelvic-fractures-ed-presentations-management/

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11) Morbidity & Mortality Conference. David Pronchik, MD 

12) EM Case Presentation. 

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12:30) HYPOTHERMIA

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Pediatric review stuff (:

LETS REVIEW THE Sick neonate: THE MISFITS

  • Trauma
  • Heart
    • Congential heart
    • Hypovolemia
  • Endocrine
    • Hypoglycemia
    • Hypothyroidism
    • Congential adrenal hyperplasia
  • Metabolic
    • Sodium
    • Calcium
    • Glucose
  • Inborn errors of metabolism
  • Seizure
  • Formula/ feeding issues
    • Hyponatremia
    • Hypocalcemia
  • Intestinal Disasters
    • Duodenal atresia
    • Midgut volvulus
    • Nec enterocolitis
    • Intussusception
  • Toxin
  • Sepsis

Cyanotic heart – 5 Ts

  • 1: truncus arteriousus
  • 2: Transposition of great vessels
  • 3= TRIcuspid: tricuspid atreasea
  • 4 defitis: tetralogy fallot
  • 5 letters: Total anomalous pulmonary vascular return
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