PedsCrit

Dr. Pradip Kamat is an Associate Professor of Pediatrics at Emory School of Medicine and practicing pediatric intensivist at Children's Healthcare of Atlanta. His clinical and research interests are in procedural sedation and education. We are very excited to have him on our podcast.

Dr. Kamat is also active in PICU open access education. Please check out the PICU Doc On Call podcast co-hosted by Rahul Damania and him at https://picudoconcall.org 

During our conversation we discuss:
1.  Why this topic is so important for PICU physicians
2.  Procedural sedation vs. general anesthesia
3.  Conscious sedation???
4.  Safety considerations, risk factors and adverse events
5.  Patient selection
6.  Drug selection
7.  Appropriate monitoring
8.  Rescue medications.

 References and further reading:

Coté CJ, Wilson S; AMERICAN ACADEMY OF PEDIATRICS; AMERICAN ACADEMY OF PEDIATRIC DENTISTRY. Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016. Pediatrics. 2016 Jul;138(1):e20161212. doi: 10.1542/peds.2016-1212. PMID: 27354454.

Emrath ET, Stockwell JA, McCracken CE, Simon HK, Kamat PP. Provision of deep procedural sedation by a pediatric sedation team at a freestanding imaging center. Pediatr Radiol. 2014 Aug;44(8):1020-5. doi: 10.1007/s00247-014-2942-z. Epub 2014 May 24. PMID: 24859263.

Grunwell JR, McCracken C, Fortenberry J, Stockwell J, Kamat P. Risk factors leading to failed procedural sedation in children outside the operating room. Pediatr Emerg Care. 2014 Jun;30(6):381-7. doi: 10.1097/PEC.0000000000000143. PMID: 24849275.

Hooper MC, Kamat PP, Couloures KG. Evaluating the Need for Pediatric Procedural Sedation Training in Pediatric Critical Care Medicine Fellowship. Pediatr Crit Care Med. 2019 Mar;20(3):259-261. doi: 10.1097/PCC.0000000000001809. PMID: 30431555.

Kamat PP, McCracken CE, Simon HK, Stormorken A, Mallory M, Chumpitazi CE, Cravero JP. Trends in Outpatient Procedural Sedation: 2007-2018. Pediatrics. 2020 May;145(5):e20193559. doi: 10.1542/peds.2019-3559. PMID: 32332053.

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Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected].  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Dr. Alyssa Stoner is an Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine and practicing pediatric intensivist at Children's Mercy Kansas City.
Dr. Gina Patel is a fellow in pediatric critical care at Children's Mercy Kansas City.

How to support PedsCrit?
Please share, like, rate and review on Apple Podcasts or Spotify!
Donations appreciated @PedsCrit on Venmo --100% of all funds will go to supporting the show to keep this project going.

Objectives

• The participant will compare and contrast various medications for an induction plan for intubation, highlighting the pros and cons for each medication.
• The participant will appropriate describe a medication plan for induction based upon the clinical scenario provided
• The participant will accurately describe the procedure for rapid sequence intubation including the administration of the medication. 

Send us Fan Mail

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected].  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Dr. Alyssa Stoner is an Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine and practicing pediatric intensivist at Children's Mercy Kansas City.
Dr. Gina Patel is a fellow in pediatric critical care at Children's Mercy Kansas City.


Objectives

• The participant will compare and contrast various medications for an induction plan for intubation, highlighting the pros and cons for each medication.
• The participant will appropriate describe a medication plan for induction based upon the clinical scenario provided
• The participant will accurately describe the procedure for rapid sequence intubation including the administration of the medication. 

Send us Fan Mail

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected].  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Dr. Alyssa Stoner is an Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine and practicing pediatric intensivist at Children's Mercy Kansas City.
Dr. Gina Patel is a fellow in pediatric critical care at Children's Mercy Kansas City.

How to support PedsCrit?
Please share, like, rate and review on Apple Podcasts or Spotify!
Donations appreciated @PedsCrit on Venmo --100% of all funds will go to supporting the show to keep this project going.

Objectives

• The participant will compare and contrast various medications for an induction plan for intubation, highlighting the pros and cons for each medication.
• The participant will appropriate describe a medication plan for induction based upon the clinical scenario provided
• The participant will accurately describe the procedure for rapid sequence intubation including the administration of the medication. 

Send us Fan Mail

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected].  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Dr. Alyssa Stoner is an Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine and practicing pediatric intensivist at Children's Mercy Kansas City.
Dr. Gina Patel is a fellow in pediatric critical care at Children's Mercy Kansas City.


Objective

• The participant will be able to compare and contrast a standard intubation and a COVID intubation, highlighting the key differences. 

Send us Fan Mail

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected].  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Dr. Alyssa Stoner is an Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine and practicing pediatric intensivist at Children's Mercy Kansas City.
Dr. Gina Patel is a fellow in pediatric critical care at Children's Mercy Kansas City.


Objectives

• The participant will be able to determine the appropriate size and depth of insertion of endotracheal tube based on patient’s age utilizing a common estimation formulas.
• The participant will be able to describe the appropriate patient set up; including positioning for a successful intubation. 

Send us Fan Mail

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected].  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Dr. Alyssa Stoner is an Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine and practicing pediatric intensivist at Children's Mercy Kansas City.
Dr. Gina Patel is a fellow in pediatric critical care at Children's Mercy Kansas City.

Objectives

• The participant will be able to compile a complete list of equipment necessary to perform a pediatric intubation, with acknowledgment of mnemonic.
• The participant will be able to determine the appropriate size and depth of insertion of endotracheal tube based on patient’s age utilizing a common estimation formulas.
• The participant will be able to describe the appropriate patient set up; including positioning for a successful intubation. 

When a checklist is elusive a simple mnemonic can be helpful to recall the necessary equipment:

Mnemonic: SOAP ME

Suction Device: Ensure suction is turned on and at appropriate level

• Yaunker or large bore suction tube 14 French
• Consider second suction set up especially if concerned about pulmonary hemorrhage or pulmonary edema

Oxygen Delivery system: ensure oxygen sources is connected and functioning appropriately

• Nasal Cannula vs. High Flow/ Non-Rebreather
• Consider non-Invasive if poor oxygenation
• Consider need for apneic oxygenation depending on clinical situation 
• Self-inflating anesthesia bag with appropriately sized mask 

Airway Equipment:

• Direct Laryngoscope: Blade type and size considerations 
• Video Laryngoscope: CMAC or Glidescope dependent upon access and comfort 
• Endotracheal tube: Correct size + size down
• Back up airway IE: Laryngeal Mask Airway (LMA)

Patient Position: Most of procedural success is based upon the appropriate patient positioning

Medication plan: specific to patient and clinical scenario, there are many combinations that can be utilized and some for specific scenarios. 

Equipment: ensure all monitors placed appropriately (BP cuff and pulse ox on separate extremities)

Send us Fan Mail

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected].  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Listener Feedback Survey
Welcome to PedsCrit! We are a collaborative educational PICU podcast working with pediatric critical care educators around the world to create high-yield podcast episodes on core PICU topics. Find us at PedsCrit.com, or reach us via email at [email protected]. We hope you enjoy!

How to support PedsCrit?
Please share, like, rate and review on Apple Podcasts or Spotify!
Donations appreciated @PedsCrit on Venmo --100% of all funds will go to supporting the show to keep this project going.

Send us Fan Mail

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected].  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!