IAP Specialty Series on Pediatric Intensive Care Nitin K Shah, Soonu Udani, Jayashree Muralidharan
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flow chart, and t refer to table.
A
ABC See Airway breathing circulation
ABCD See Airway, breathing, circulation, disability
Abdomen 222
Abdominal compartment syndrome 377
treatment of 377
Abdominal distension 312, 387
Abdominal ultrasound in trauma, focused 388
Abdominal wall 265
ABO
and Rh compatibility 481
incompatible transplant 354
ABP See Arterial blood pressure
Abrasions 387
Absorbed toxin, elimination of 401
Absorption atelectasis 59
Abundant secretions 92
Acalculous cholecystitis 366
Accelerated protocol 272
Accidents 392
ACE See Angiotensin converting enzyme
Acetaminophen poisoning 336
Acetyl salicylic acid toxicity, severity of 406b
Acid peptic disease 314
Acid-base
analysis, steps in 132
disorders 132
Acidemia 129
Acidosis 9, 132, 235, 244, 274, 363
persistent 295
severe 192, 293
Acinetobacter
baumannii 528
calcoaceticus 494
species 498
ACLS See Advanced cardiac life support
Acorus calamus 397
Acquired immunodeficiency syndrome 40
ACTH See Adrenocorticotropic hormone
Activated charcoal 397, 403, 410
administration 412
Activated partial thromboplastin time 330
Acute respiratory distress syndrome 59, 91, 92, 136, 137, 137b, 138b, 230, 296, 332, 430f, 487, 543, 556
clinical features 143
epidemiology 139
history of 143
incidence 139
investigations 143
management of 143
pathophysiology 140
pediatric 149
phases of disease 141
risk factors for 138b
Adenosine 199
triphosphate consumption 275
Adjunctive drugs 274
Adrenal hyperplasia, congenital 235
Adrenal insufficiency, risk of absolute 235
Adrenal pituitary axis failure 235
Adrenergic agent 180
Adrenergic alpha-2-agonists 539
Adrenergic receptors 206
Adrenocorticotropic hormone 278
Adsorption 300
Advanced airway 28
considerations 28
in place 26t
Advanced cardiac life support 404
Advanced life support 4
pediatric 1, 19
AED See Automated external defibrillator
Aedes aegypti 363
Aedes albopictus 363
Aerodigestive colonization 500
Agents causing seizure 400
Agitation 413
AIDS See Acquired immunodeficiency syndrome
Air-entrainment in venturi mask 55f
Airway 6, 9, 10, 21, 27, 243, 383, 470
and breathing 12, 230
and respiratory issues 437
breathing circulation 200
disability 314
disability assessment 314
cartilage formation 137
disease 77, 82
driving pressure 70
inability to protect 92
injury 434
management 435
obstruction 91, 434
opening 22
parts of 83f
pressure 90f
release ventilation 81
resistance 137
trauma 89
Alagille syndrome 343, 344, 350
Alanine
aminotransferase 366
transaminase 166
Albumin 347, 481
infusion 349
Alcohol 409, 568
Alcohol poisoning 427
clinical features 427
differential diagnosis 428
laboratory investigations 428
management 428
source 427
toxic levels 428
Aldicarb (temik) 427
Aldosterone antagonist 175
ALF See Acute liver failure
ALI See Acute lung injury
Alimemazine 534
Alkalemia 129
Alkali denaturation test 312
Alkalosis 45
Alloimmune hepatitis, congenital 330
Allopurinol inhibits 466
ALT See Alanine aminotransferase
Alveolar capillary
barrier dysfunction 141
membrane 59
Alveolar disease, diffuse 145
Alveolar fluid clearance, impaired 142
Alveolar gas equation 130
Alveolar maturation 137
Amanita phalloides 327
Amenable lesions, surgically 255
American College of Cardiology 202
American College of Critical Care Medicine 159, 227
American Epilepsy Society 269, 278
American European Consensus Conference 136
American Heart Association 20, 122, 164, 202
Aminoglycosides 45, 335
Amiodarone 200
Amlodipine 224
Ammonia serum levels 328
Amrinone 180
ANA See Antinuclear antibody
Analgesia 536
Analgesic
agents 537t
drugs 539
Ancillary studies 8, 568
Andom blood sugar 39
Anemia 166, 171, 187
severe 174
Angiotensin 208, 224, 227
Angiotensin converting enzyme 181, 224
inhibitors 176, 181
Anion gap
acidosis
high 295
normal 295
estimation 294
Anomalous left coronary artery 166
Anterograde amnesia 534
Anti liver, kidney microsome 330
Antiarrhythmic drugs 193
Antiasphyxia valve 100, 100f
Antibiotic 230, 234, 314, 517, 523
class of 524
cycling 524
inhaled 504
selection of 522
stewardship 530
Stewardship Program 522, 530
use, transparent monitoring of 523
Antibiotic therapy
administration of 523
de-escalation of 523
management 522
prolonged 510
Antibody and complement 493
Anticholinergic effects 412
Anticoagulant 314
balance disturbance 227
Anticonvulsant overdose, clinical manifestation of 446t
Anti-D globulins 481
Antidiuretic hormone 33
in critical illness, causes of increased 39t
Antidotes 248, 402
Antiepileptic agents 568
Antihistamines 412
management 412
source 412
Antihypertensive drugs 224t
Anti-inflammatory response syndrome, compensatory 327
Anti-LKM See Anti liver, kidney microsome
Antimicrobial resistance 521
Antimicrobial therapy initiation 523
Antinuclear antibody 330, 247
Antipsychotic drugs 422
clinical manifestations 422
management 422
Antipsychotics, spectrum of 422
Antipyretics 411
Antiseizure medication 225
Antiseptic cleaning of meatus 518
Antismooth muscle antibody 330
Antisnake venom 248, 453, 454t
doses of 455
Antitrypsin deficiency, alpha-1 350
Antitubercular drugs isoniazid 327
Antivenom 453
Anti-voltage gated potassium channel 275
Anxiety 34
Aortic arch, interrupted 166
Aortic blood flow 158
Aortic dissection 225
Aortic regurgitation 169, 171
Aortic valve, bicuspid 171
Aplastic anemia 483
Apnea 392
testing 567
APTT See Activated partial thromboplastin time
AR See Aortic regurgitation
Arachidonic acid 538
ARDS See Acute respiratory distress syndrome
ARF See Acute renal failure
Arrhythmia 44, 183, 184, 190, 375, 572
cause of 198
diagnosis of 197
management of 197
reentrant 185
Arterial blood 128
Arterial blood gas 8, 117, 129, 172
analysis 128
basic concepts 129
systematic analysis of 129, 130
Arterial blood pressure 157f, 278
Arterial hypoxemia 50
Arterial ischemic stroke 242
Arterial lactate 8
Arterial oxygen gradient 130
Arterial pressure monitoring, systolic pressure for 155
Arterial pulse
contour methods 161
pressure variation 158
Arterial saturation 122
Arteriovenous
fistula 303
graft 303
Artesunate 247
Ascites 349
Aseptic technique 518
ASMA See Antismooth muscle antibody
Aspartate aminotransferase 366
Aspartate transaminase 166
Aspergillus 494
Asphyxia 19
Aspirin 134
AST See Aspartate aminotransferase
Asthma 12, 91
Asymptomatic bacteriuria 515
Asynchrony 79
termination 79
Ataxia 413
Atelectasis 58, 91
Atelectrauma 144
Atenolol 181
Atracurium 542
Atrial fibrillation 183, 187, 187f
Atrial flutter 187, 187f, 190
Atrial tachycardia 184
ectopic 184, 188, 188f, 190
multifocal 184, 188
Atrioventricular block
first degree 195, 195f
third degree 196f
Atrioventricular canal, common 166
Atrioventricular nodal reentry tachycardia 189, 186
Atrioventricular reciprocating tachycardia 185, 186, 189
Atrioventricular tachycardias 184
reentrant 184
Atrium, right 157
Atropine 426
test 426
Auditory canal, external 439
Autoimmune 327
hemolytic anemia 327
hepatitis 327, 330, 349
Automated external defibrillator 201
Auto-trigger 109
AVNRT See Atrioventricular nodal reentry tachycardia
AVRT See Atrioventricular reciprocating tachycardia
Axonal injury, diffuse 242, 249
B
Bacillus Calmette-Guérin 352
Bacillus species 513
Bacteremia 509
Bacterial meningitis 242
Bacterial pneumonias, severe 556
Bag-mask
one rescuer using 23
rescuers using 24
technique 23
ventilation 243, 253
Balloon atrial septostomy 177
Barbiturates 263, 409, 536, 568
Barium swallows 318
Barotrauma 68
Basic life support 19, 201
Basilar skull fractures 266
Battery support 101
BCG See Bacillus Calmette–Guérin
Bendiocarb (Ficam) 427
Benzodiazepine 230, 413, 534, 535
Beriberi 166
Beta adrenergic 206
Beta-agonist therapy 44
Beta-blocker 178, 181, 224, 225, 416
management 416
nonselective 316, 320
source 416
Bicarbonate 294
loss of 294
Bicycle injury 381
Bile duct
excretory pump defects 349
paucity syndrome 344
Biliary atresia 342, 350
Bilirubin 347
Biological pacemakers 179
Bispectral index 541
Bladder, full 265
Bleeding 308, 466
active 314
control of 387
diathesis 313
management of 374
severe 369, 374
tendency 431
ulcers 322
Blood
ammonia levels 247
beta-hydroxybutyrate 294
components, availability of 480
gas and electrolytes 172
group compatibility 353t
ketones 294
mimicking substance 311
products 476
substance 311
sugar 8, 573
transfusion 45, 149, 177, 440
Blood flow 215f
increase in 258
manipulation of 319
rate 304
Blood glucose 290, 294
by glucometer 398
levels 289
Blood pressure 9, 154, 173, 205, 215f, 216, 220, 385, 386, 458, 460
diastolic 153
elevated 220
four-limb 223
in head injury 253
increases 260
measurement of 223
monitoring, noninvasive 154
normal 220, 232
systolic 229
Blood urea nitrogen 432
high 316
levels 303
Blood vessels 260
change in resistances of 260f
Blood volume loss 385
estimation of 314
Blood-brain barrier 249, 303
Blood-gas analyzer 494
Blood-stained vomiting 387
Blow-by oxygen 52
BLS See Basic life support
Body
antioxidant defense mechanisms 59
compartments in children, water content of 33t
homeostatic mechanisms 464
surface area 159
water distribution in children 32
Bowel infarction 318
Bowel irrigation, whole 403, 446
BP See Blood pressure
Bradyarrhythmias 194
treatable causes for 197t
treatment of 197
Bradycardia 183, 197, 392, 399, 411, 424
cause of 9, 202
child with 9
mechanisms of 194
Bradypnea 400
Brain
abscess 242
compliant 258
malformation, congenital 270
parenchyma 258
tissue 262
tumors 270
Brain death 572t
current consensus 564
diagnosis of 568, 569, 571
examination 568
in term newborns 569
apnea testing 570
clinical examination 570
mimic 568
Brain injury
prevent secondary 248
primary 249
secondary 249
Brain-dead
donor 573
organ donor 573
patient, management of 571
Brainstem
death 567, 571
testing for 565
dysfunction 248
function 242
examination of 244
severe 254
testing 566
Breath
exhaled 505
types of 79, 80f, 80t
Breathing 6, 9, 10, 21, 22, 27, 243
decreasing patient's work of 87
pattern 88
rescue 22, 27
work of 5
Bronchial asthma 58, 132
Bronchiolitis 91
acute 57
Bronchodilator medications 413
Bronchopneumonia 430f
Bronchoscopes 494
Bronchospasm 424
Budd-Chiari syndrome 327, 344
Bufencarb 427
BUN See Blood urea nitrogen
Burkholderia
cepacia 494
cereus 494
Burkitt's lymphoma 465
Burns, severe 138
Button battery ingestion 436
clinical manifestation 437
complications 439
differential diagnosis 437
investigations 437
management 437
prevention 439
source 436
Butyrophenones 534
Byler disease 344
C
Calcium 45, 235
and phosphorus in blood, normal ranges for 46t
concentration 235
sensitizers 208
Calcium channel blocker 223, 224
poisoning 417
Calcium level 216
routine 235
Candida 498, 512, 513
species 511, 512
Candiduria 517
persistent 517
Cannula 53f
Capillary blanch test 385
Capillary filling time 173, 229, 386
Capnogram
differential diagnosis of abnormal 124, 125t
normal 123f
Capnography 122
indications for 126
Captopril 181
Carbamazepine 403, 409, 446
Carbaryl (Sevin) 427
Carbofuran (Furadan) 427
Carbon dioxide
displaces 130
end-tidal 8, 123, 125, 384
monitors
clinical applications of 124
mainstream 123
side stream 124
types of 123
Carbon monoxide poisoning 440
clinical features 441
differential diagnosis 442
laboratory tests 442
management 442
prevention 443
sources 440
Cardiac arrest, primary nature of 19
Cardiac arrhythmias 183, 444
Cardiac catheterization 174
Cardiac complications 429
Cardiac dysfunction 244
Cardiac evaluation 573
Cardiac failure 36, 305, 361
Cardiac injury 191
Cardiac lesion 172
Cardiac manifestations 366
Cardiac output 161
assessment of 159
effect on 88
factors affecting 165
terms of 205
Cardiac resynchronization therapy 205
Cardiac rhythm disorders 392
Cardiac sodium, blocks 202
Cardiac tamponade 386
Cardiac tumors 191, 192, 196
Cardiogenic pulmonary edema 96
Cardiogenic shock 38, 191, 374, 445
Cardiomyopathy 191
Cardiopulmonary
arrest 4
bypass, prolonged 556
resuscitation 9, 19, 21, 28, 122, 200, 201, 269
two-rescuer 24t
status, assessment of 350
Cardiorespiratory
arrests, pediatric 197
problems 117
status 282
Cardiotoxicity 444
Cardiotoxins 450
Cardiovascular
effects 412
function, effects on 142
illness 217
issues 572
side effects 422
system 345, 397
Carnitine 181
Caroli's disease 344
Carvedilol 181, 320
Catalase 59
Catastrophic illness, cases of 324
Catecholamine 191, 207f, 227
resistant shock 232
Catheter
management 517
material 510
Catheter-associated urinary tract infection 515
clinical presentation 516
laboratory findings 516
Catheter-related bloodstream infection 509-511
diagnostic criteria 511
etiological agents 511
management 512
prevent 513b
risk factors for 510, 510b
Cationic detergents 434
Causing injury, highest risk of 533
CBC See Complete blood count
CCF See Congestive cardiac failure
Cefepime 502
Ceftazidime 502
Cellular dysfunction 361
Central diabetes insipidus 42
Central nervous system 40, 213, 242, 330, 345, 366, 381, 397, 400, 446, 485
depression 400
disorders 132
effects 412
severe 568
symptoms 406, 476
Central sleep apnea 111
Central venous
line, long-term 513
oxygen saturation 161, 162
interpreting 162
pressure 165, 278, 573
monitoring 156
saturation 161
Centres for Disease Control 524
Cephalhematoma 266
Cerebral blood 260
flow 249
autoregulation of 221f
Cerebral cortex, intact 241
Cerebral cortical function, loss of 242
Cerebral disease 41
Cerebral edema 290, 296, 324, 328, 333, 337
Cerebral herniation syndrome, evolving 265
Cerebral hypoperfusion 296
Cerebral malaria 242
Cerebral metabolic rate 275
Cerebral monitoring 266b
Cerebral perfusion pressure 259
Cerebral salt wasting 41, 41t
Cerebral vessels, severe constriction of 262
Cerebrospinal fluid 246
Cerebrovascular accidents 398
Cerebrovascular event 270
Cervical spine
immobilization 254
injury 254
protection 384f
CFT See Capillary filling time
Channelopathy 193
Chelation in iron poisoning, indications for 415b
Chelation therapy 415
Chennai declaration, goals of 529b
Chest
compression 21, 24, 27, 197
and ventilation ratio 25t
pain 312
radiograph 469
Chest wall
compliance 137
reduced 144
elastance 144
CHF See Congestive heart failure
Child
abuse 392
chest rise 22
receiving desferrioxamine 414f
with encephalopathy, transport of 331
with polytrauma, management of 380, 382
with toxin ingestion, management 398b
Children and infants, relief of choking in 29
Children, reference charts for 238
Chin-lift maneuvers 253
Chloral hydrate 536
triclofos 534
Chloride 294
containing fluids 294
Chlorpromazine 534
Chlorpropamide 418
Chlorthiazide 180
Cholestasis 358
Cholestatic diseases 344
Cholinergic (nicotinic) 401
Cholinergic symptoms 444
Chronic dialysis 303
Ciprofloxacin 502
Cisatracurium 542
Citrate intoxication 308
Citrobacter 498
Clonidine 224, 225, 534, 539, 544
side effects 544
Clostridioides difficile
colitis 313
infection 236, 524
CMPA See Cow's milk protein allergy
CMV See Cytomegalovirus
CNS See Central nervous system
Coagulation disturbances 324
Coarctation of aorta 225
Cobra toxin 450
Cobratoxin 450
Codextrin 301
Coexistent pneumonia 172
Cold caloric test 566
Cold shock 227
Cold water causes, immersion in 391
Colloid 38
Colonic polyps 313
Colonoscopy 322
Coma 241, 400
etiology of 242t, 248
inducing agents 272t
level of 251
phase 278
repeat 278
Comatose child 241
evaluation of 243
management of 247
Comorbid conditions 314
Compassionate family support 284
Complete blood count 278, 315, 367
Compression 9
ventilation ratio 24
Computerized tomography scans 388t
Condom catheters 515
Conduction abnormalities 195
Confusion 413
Confusional migraine, acute 242
Congenital heart disease, postoperative 168
Congestive cardiac failure 57, 458, 459
Congestive heart failure 40, 219
signs of 196
Conjugated pneumococcal 352
Consciousness 241
level of 244, 398, 426
loss of 250, 381
Continuous positive airway pressure 58, 86, 93f, 96, 138
circuit 58f
mode 93
Convection 300
Conventional medical therapy 555
Conventional pulse oximetry 122
Conventional ventilators 98f
Convulsive status epilepticus 535
Corticosteroids 148
Counterregulatory hormones 288
Cow's milk protein allergy 313
CPAP See Continuous positive airway pressure
CPK See Creatine phosphokinase
CPR See Cardiopulmonary resuscitation
Cranial nerves, examination of 244
Craniofacial trauma 92
C-reactive protein 359
Creatine phosphokinase 272
Crepitations 171
Crigler-Najjar syndrome 344
Critical aortic stenosis 177
Critical care, association of 546
Critical illness neuromyopathy 236
Critically ill children 4, 358, 510
colloids in 38
crystalloid in 38
energy expenditure in 357
Critically ill state 4
Crohn's disease 314
Croup 12
CRT See Cardiac resynchronization therapy
Cryoprecipitate 481
Crystalloid 11
fluid normal saline 228
Cushing's triad 243, 254, 262
CVP See Central venous pressure
CVS See Cardiovascular system
CVVHDF See Continuous venovenous hemodiafiltration
Cyanide poisoning 50
Cyanosis 244, 400
Cyanotic heart disease 140
Cyclic adenosine monophosphate 540
Cyclooxygenase, inhibition of 538
Cyclosporin 342
Cytomegalovirus 330
Cytopenia, effect of 480
Cytosolic calcium 208
D
Death, predictors of 394
Decerebrate posturing 262
Decompensation, signs of 349
Decompressive craniectomy 265
Decontamination procedures 415, 432
De-escalation phase 235
Dehydration 296, 335
assessment of 291
treat 43
Dengue 244, 246, 363
case classification 366t
diagnosis 368
hemorrhagic shock 38
illness, course of 364f
in pediatric intensive care unit 362
infection 363
management of 370fc, 371fc
severe 363, 369
shock 36
syndrome 38
syndrome, expanded 366
treatment of 378
vasculitis 375
virus 375
with hypotensive shock 372fc
Dental hygiene, assessment of 351
Deoxyribonucleic acid 275
Dexmedetomidine 539, 540, 544
Diabetes 359
insipidus 42, 572
treatment of 43
mellitus 132
type 1 290, 297
Diabetic ketoacidosis 42, 43, 246, 288, 290, 297, 406, 459
diagnostic criteria for 288b
in children 288
severity of 289t
Dialysate flow rate 304
Dialysis disequilibrium syndrome 303
Diamond-Blackfan syndrome 483
Diaphoresis 400, 444
Diarrhea 132, 424, 444, 466
Diastolic dysfunction 166, 374
accounts 166
Diastolic function 205
Diastolic relaxation 211
Diazoxide 224
DIC See Disseminated intravascular coagulation
Dichlorvos 424
Diffusion 300
defects 51
Digeorge syndrome 45
Digoxin 175, 180, 191, 202, 403
Dimethoate 424
Diphtheria 196, 352
Diphtheria/pertussis/tetanus 242
Disability 6, 12, 243, 385
Discharge planning 111
Disclosure to family 282
Disease, unilateral 139
Disseminated encephalomyelitis, acute 242, 247, 366
Disseminated intravascular coagulation 244, 459, 485
Diuretics 180, 466
Dizziness 466
DKA See Diabetic ketoacidosis
DNA See Deoxyribonucleic acid
Dobutamine 175, 180, 208, 214
Domestic accidents, result of 249
Donor evaluation 353
Donor selection 353
Donor's organ system 571
Dopamine 175, 180, 207, 208, 214
Downey test 312
Doxorubicin 166
Doxycycline 247
DPT See Diphtheria/pertussis/tetanus
Driving pressure 144
Drowning 138, 269, 391
hospital management 393
management 392
prehospital care 392
Drowsiness 413
Drug
blocking renin 224
cycling 536
intoxications 568
overdose 138
removal, altered 308
toxicities 191, 192
Dual-lobe transplant 354
Dudenal ulcer 314
Dynamic respiratory mechanics, measurement of 66
Dysconjugate gaze 245
Dyserythropoietic anemia, congenital 483
Dysfunction, surfactant 142
Dysphagia 321
Dyspnea 171
Dysrhythmias 183
E
Early goal directed therapy 233, 234b
Ebstein's anomaly 172, 188, 195, 198
EBV See Epstein-Barr virus
ECG See Electrocardiography
Echocardiogram 198
Echocardiography 2
ECMO See Extracorporeal membrane oxygenation
Ecstasy 327
ECT See Extracorporeal treatment
Edema
formation 141
forming states 40
EEG See Electroencephalogram
Ejection fraction 165
Elapids 449, 451
Electrocardiography 278
Electrocerebral silence 568
Electroconvulsive therapy 276
Electroencephalogram 246, 278
burst suppression on 273f
Electroencephalography 330
Electrolyte 360
abnormality 192
and sugar 331
disorders 38
imbalance 191, 284, 293
in critically ill child 32
Electrophysiological
monitoring 266
testing 197
Emergency care, pediatric 395
Emergency management 12
Emergency response system 27
Emergency room
pediatric 13
steps of stabilization in 291
Emesis 424
Enalapril 181
Enalaprilat 224
Encephalitis 269, 366
Encephalopathy 41, 327, 469
End-expiratory
occlusion maneuver 65
positive pressure 89
volume 88
End-inspiratory occlusion maneuver 65
Endocrine changes 572
End-of-life care 280, 281, 286
guidelines for providing 281
Endogenous colonization 492f
End-organ
damage 223
perfusion 154
Endoscopic sclerotherapy 321
Endoscopic therapy techniques 320t
Endoscopic variceal band ligation 321
Endoscopy 320
upper 321
Endothelial cells, non-fenestrated 301
Endothelial dysfunction 363
Endothelin 227
Endotoxin production 227
Endotracheal intubation 147
Endotracheal tube 58, 75, 87, 122, 493
Enteral nutrition, hurdles in establishing 359
Enteric fever 242, 244
Enterobacter 498
Enterococcus species 516
Envenomation 397, 398, 449
stage of 461
treatment of 248
Environmental stimulation 265
Eosinophilia 360
Eosinophilic gastroenteritis 314
EPAP See Expiratory positive airway pressure
Epidural empyema 242
Epidural hematoma 255, 266
Epigastric pain, history of 312
Epilepsy 392
surgery 276
Epinephrine 175, 180, 197, 209, 214, 231
injection, diluted 320
Epithelium and mucous, ciliated 493
Epstein-Barr virus 330, 344
Equation of motion, elements of 64f
Erabutoxins 450
Erythrocyte sedimentation rate 247
Escherichia coli 498, 511, 516
Esmolol 181, 224, 225
Esomeprazole 319
Esophageal Doppler 160
Esophageal perforation 321, 439
Esophageal stricture 321
Esophagitis 314
Estimated creatinine clearance 237
Estimation of weight 7
Ethylene glycol 429
Etiology-specific treatment 336
Etomidate 536
Eucalyptus oil 397
Euphoria 427
Exhaled tidal volume 68
Expiratory asynchrony 79, 109
Expiratory port 100, 100f
Expiratory positive airway pressure 90, 94-96, 139
Extracellular fluid 42
volume 41
Extracorporeal life support organization 149
Extracorporeal membrane oxygenation 2, 149, 179, 209, 216, 482, 555, 560
arterio-venous 559
care, post 561
circuit 558f
contraindications to 557
eligibility criteria 556
evidence base for 555
history 555
indications for 556
journey of 555
machinery and tubing 557
management 560
neonatal respiratory 561
role of 149
veno-arterial 559
veno-venous 559
Extracorporeal treatment 403, 404, 404b
algorithm for 404fc
Extrahepatic biliary atresia 342, 344
Extrahepatic manifestations 343
Exudates 219
Eye 222, 434
conjugate lateral deviation of 245
examination 244
F
Fab fragment antivenom 453
Facemask
full 104f
simple 53, 53f
total 104f
Facial nerve paralysis 439
Familial adenomatous polyposis 322
Familial hemophagocytic lymphohistiocytosis 477
Fanconi's anemia 483
Fatal arrhythmias 203
Fatty acid
long-chain 360
oxidation defect 330
Febrile neutropenia 468
clinical evaluation 469
core concepts 468
laboratory evaluation 469
management of 470, 471fc
patients
high-risk 469
low-risk 469
risk stratification 469
Febrile nonhemolytic transfusion reaction 482
Fecal occult blood test 317
Feeding
difficulty 171
in special situations 358
poor 516
Fenitrothion 424
Fenoldopam 225
Fentanyl 181, 537, 538
bolus 544
Fenthion 424
Fever 187, 244, 265, 468, 516
FFP See Fresh frozen plasma
Fiber optic cable 261
Filtered red cells 481
FIO2 See Fraction of inspired oxygen
Firstline initial therapy phase 271
Fixed-concentration devices 52, 54
Flail chest 387
Flaviviridae 363
Flecainide 202
Fluconazole 512
Fluid 229, 332
administration, principles of 230b
balance 234
calculation 291
correction, rate of 292
in critically ill child 32
management 147, 573
overload 299, 376, 377
treatment of 377
refractory shock 231
replacement 37
resuscitation, guidelines basic tenets of 229b
type of 292
Fluid therapy 291
in hemorrhagic shock 386
in intensive care unit 36
rationale 291
Fluoroquinolones 512
FOBT See Fecal occult blood test
Focal alveolar consolidation 145
Forced expiratory volume 127
Forced vital capacity 127
Formetanate (carzol) 427
Fosphenytoin 264
Frank-Starling
curve 156, 157f, 206f
principle 165
Free fatty acid 459
Fresh frozen plasma 234, 386, 433, 480, 481, 489
Frozen cells 488
Fulminant colitis 322
Fungal infection 478
risk of 470
Fungemia 509
Furosemide 174, 180, 224, 225, 466
Futility, recognition of 282
FVC See Forced vital capacity
G
G6PD See Glucose 6-phosphate dehydrogenase
GABA See Gamma aminobutyric acid
Galactosemia 326, 330
Gallop sounds 171
Gamma aminobutyric acid 446
Gamma globulins 481
Gamma irradiation 488
Gamma-aminobutyric acid 269, 273, 275
Gas
chromatography mass spectroscopy 247
exchange, alterations in 142
generators, types of 113
source 74
Gastric contents, aspiration of 138
Gastric lavage 401, 410, 423
Gastritis 314
Gastroenteritis 43
with systemic toxicity 444
Gastroesophageal reflux 312
Gastrointestinal bleeding 335
Gastrointestinal hemorrhage 335
Gastrointestinal irritation 406
Gastrointestinal symptoms, nonspecific 516
Gastrointestinal tract 34, 40, 312-314, 436t
Gastrointestinal tract bleed 310, 314b
acute 311
overt 317fc
causes
of lower 312
of occult 314b
child with 315t
chronic 311
occult 317fc
epidemiology 310
etiology of 311
in children 313
initial evaluation 314
management 315
obscure 311, 318fc
Gaze palsy, lateral 245
Genitourinary trauma 389
GER See Gastroesophageal reflux
Germ cell tumor 466, 471
GIT See Gastrointestinal tract
Glasgow coma scale 40, 243, 251, 384
Glimepiride 418
Glipizide 418
Globular cardiomegaly 172
Glomerular filtration rate 33
Glucose 235
6-phosphate dehydrogenase 397, 440
delivery rates 235
homeostasis 327
Glutamate 269
Glutaminergic drive 275
Glutathione 59
Glyburide 418
Glycopyrrolate 426
Graft availability, innovations to increase 354
Graft versus host disease 482, 487
Gram's stain 497
Gram-negative bacilli 511
Granulocytes 487
Great arteries 172, 196
Great vessels 470
H
Haemoglobin, deoxygenated 119
Haemophilus influenzae 352
Hallucinations 413
Haloperidol 534
Hand hygiene 518
Handling extubation failure 91
HAP See Hospital-acquired pneumonia
Harris benedict formula 358
Hashimoto's encephalopathy 247
HAV See Hepatitis A virus
Hb See Hemoglobin
HBSAG See Hepatitis B surface antigen
HBV See Hepatitis B virus
Head injured patients, triage of 253fc
Head injury 9
in children 249
minor 252
moderate 251
radiological criteria for minor 252
severe 251
Heart 219
burn 312
disorders, congenital 192
transplant study, pediatric 180
transplantation 180
Heart block 202, 366
complete 196, 197
third-degree 195
Heart disease
acquired 192
congenital 188, 191, 195
structural 178
Heart failure
acute 164, 167t, 168, 181
based on pathophysiology, etiology of acute 166
classification of acute 170
etiology of acute 166
management in acute 173t
mild 190
pathophysiology of acute 171t
pediatric 179
severity of acute 170t
symptoms in acute 165
Heart rate 8, 165, 200, 205, 386, 460
abnormal 244
normal range of 184t
particularly 5
Heat moisture exchanger 74
Heimlich maneuver, role of 392
Heimlich's maneuver 29
Helmet mask 105f
Hemangioendothelioma 344
Hematemesis, cause of 312
Hematocrit 367
Hematoma 249
Hemodialysis 404
indication of 408
intermittent 299, 302
Hemodynamic considerations 332
Hemodynamic monitoring 153
clinical examination 153
preload assessment 156
Hemodynamic variables, common 160
Hemodynamics instability 92
Hemoglobin 120
concentration 8
Hemolysis 308, 360
Hemolytic uremic syndrome 485, 489
Hemophagocytic lymphohistiocytosis 377, 476, 477, 478fc
acquired 478
classification of 477
clinical features 476
laboratory abnormalities 477
management 478
pathophysiology 476
Hemorrhage 219, 434
control of 385
stigmata of recent 322
with exudates, flame-shaped 244
Hemorrhagic enteritis 414
Hemorrhagic shock, classification of 385t
Hemorrhagins 450
Hemothorax 387
Henoch-Schönlein purpura 312, 313
Heparin 45
Hepatic artery 331
Hepatic decompensation
assessment of 349
management of 349
Hepatic dysfunction 238, 411
severe 568
Hepatic encephalopathy 324
advancing 334
stages of 329t
Hepatic enzymes 166
Hepatic failure 132, 342
Hepatic fibrosis, congenital 350
Hepatic malignancy, primary 343
Hepatic vein occlusion 327
Hepatitis 244, 336, 366
A 325, 326, 352
infection 330
virus 330, 344
B 352
acute 336
infection 330
surface antigen 330
virus 344
C infection 330
D infection 330
Hepatoblastoma 343, 344, 466
Hepatocellular carcinoma 342, 344
Hepatocellular injury 327
Hepatotoxic drug, dose-related 327
Herniation syndromes 245, 245t
Herpes simplex encephalitis 246
HHV-6 See Human herpes virus 6
High frequency
oscillator ventilation 82, 83t, 84, 145
ventilation 145
Histotoxic hypoxia 50
Hodgkin lymphoma 471
Home mechanical ventilation 109
Home noninvasive ventilation
machine 97f
ventilator 96
Home ventilation
long-term 112
via tracheostomy 110
Hospital antibiotic stewardship programs 524, 525t, 526t
Hospital treatment, out of 270
Hospital-acquired
infection 509
pneumonia 491, 492, 499b, 503
Host genetic factors 140
Host's deleterious 227
HR See Heart rate
HSP See Henoch-Schönlein purpura
Human coronavirus 494
Human herpes virus 6 326
Human immunodeficiency virus 353
Human Organ Act, transplantation of 566
Human Organ Transplantation Act 342
Human Organs and Tissues Act, transplantation of 571
Human papillomavirus 352
Human T-cell lymphotropic virus 487
Humidification 99
devices 99f
system 74
HUS See Hemolytic uremic syndrome
Hybrid therapy 304
Hydralazine 224, 225
Hydration, aggressive 475
Hydrocarbon ingestion 429
Hydrocephalus 242, 243
Hydrocortisone 235
Hydrophidae 449
Hyperaldosteronism 349
Hyperammonemia 336, 358
Hyperbaric oxygen 442
Hypercalcemia 46, 235
causes 46
clinical features 46
treatment 47
Hypercapnic respiratory failure 91
Hypercarbia 249, 253, 270, 392, 570
Hyperemia 258
Hyperglycemia 235, 288, 358, 400
Hyperglycemic hyperosmolar state 290
diagnostic criteria for 290b
Hyperkalemia 9, 44, 45f, 174, 192, 197, 299, 464, 467
Hyperleukocytosis 474
clinical features 474
differential diagnosis 474
etiology 474
management of 475, 475fc
pathophysiology 474
Hypermagnesemia 48
causes 48
clinical features 48
management 48
Hypernatremia 41
approach to 42fc
Hypernatremic dehydration 43
Hyperoxaluria, primary 344, 350
Hyperphosphatemia 47, 432, 467
causes 47
clinical features 47
treatment 47
Hypersplenism 486
Hypertension 219, 220, 254, 303, 349, 399
acute severe 219
alpha-mediated 224
applied physiology 220
bradycardia 254
clinical features 222t
etiology of 221, 221t
initial stabilization 223
malignant 220
management 223
noncirrhotic portal 344
portal 349
severe 225
stage I 220
stage II 219
Hypertensive crises 219
Hypertensive emergency 219
and urgency 219
Hypertensive encephalopathy 219
Hypertensive urgency 219
Hyperthermia 399, 400
Hypertonic saline 263, 333
Hypertriglyceridemia 477, 535
Hyperuricemia 174, 464
management of 466
Hyperventilation 262
Hypoalbuminemia 349
Hypocalcemia 45, 192, 196, 243, 308, 432, 464, 467
Hypocapnia 262
Hypofibrinogenemia 477
Hypoglycemia 174, 243, 246, 248, 269, 274, 296, 331, 400
Hypokalemia 9, 43, 45f, 174, 192, 193, 197, 293, 308, 432
severe 293
Hypomagnesemia 48, 308
causes 48
clinical features 48
treatment 48
Hyponatremia 38, 39, 174, 263, 270
causes of 40t
degrees of 34
dilutional 41
Hyponatremic dehydration 41
Hyponatremic encephalopathy 40
Hyponatremic seizure 41
Hypoperfusion 249
Hypophosphatemia 47, 294, 308
clinical features 47
treatment 47
Hypoplastic left heart syndrome 177
Hypotension 132, 227, 269, 270, 399, 422, 469, 572
persistent 334, 566
Hypotensive shock 243, 371
Hypothermia 197, 243, 264, 275, 308, 393, 399, 566, 572
prolonged 264
Hypotonic intravenous solutions 34
Hypotonic solutions as maintenance fluids 37
Hypoventilation 254
reflection of 130
Hypovolemia 9, 187, 197
Hypovolemic shock 37
Hypoxemia 50, 129, 132, 197
mechanisms of 50
Hypoxemic respiratory failure 91
Hypoxia 12, 50, 187, 191, 192, 249, 363, 392, 429
Hypoxic ischemic
encephalopathy 244
insult, acute 269
I
IBD See Inflammatory bowel disease
Ibuprofen 537
ICP See Intracranial pressure
Icterus 327
IDA See Iron deficiency anemia
Idiogenic osmoles 296
Idiopathic neonatal hepatitis 344
Idiopathic thrombocytopenic purpura 486
IEM See Inborn errors of metabolism
Illness, severe 512
Imipenem 502
Immune
deficiencies 324
function 148
Immunization status, assessment of 351
Immunocompromised children 91
Immunodeficiency 140
Immunonutrition 360
Immunosuppressants 327
Immunosuppression 342, 510
In situ urinary catheter 516
Inborn errors of metabolism 242, 269
Indian Academy of Paediatrics 4, 529
Indolent infection 243
Indomethacin 43
Infant's airway 29
Infection 290, 326, 478
bacteria 478
control, effective 494
parasites 478
prevention of 517
severity of underlying 510
treatment of 247
virus 478
Infectious disease consideration 334
Infectious Disease Society of America 521
Infective endocarditis 171
Inflammatory bowel disease 313, 314
Inflammatory cytokine mediated multiorgan 464
Inflammatory disorders 196
Influenza 352
A 494
vaccine 528
INH See Isonicotinic acid hydrazide
Inhalation anesthetics 568
Inhalational injury 138
Inherited disorders 270
Injury leads to secondary injury, primary 250fc
Injury, unidentified 398
Inotropes 180
Inspiratory
asynchrony 108
cycling 109
hold maneuver 65f
positive airway pressure 88, 90, 94, 95
pressures 68
trigger, ineffective 108
Inspired oxygen, fraction of 56, 137, 138
Insulin 288
administration of 293
requirements 235
therapy 293
rationale 293
type and route of 293
Intensive care
issues, other 376
practice, blood components in 480
unit 1, 20, 87
Intensive chemotherapy, after 463
Interfaces 101
components of 102f
full facemask 103
helmet 105
nasal 101
masks 103
pillows 102
prongs 102
total facemask 104
types of 101f
Intermediate syndrome 425
International league against epilepsy 268
Interstitium 301
Intestinal duplication 313
Intoxication, stages of 414t
Intra-aortic balloon pump 179
Intracellular fluid 32
Intracerebral hemorrhage 555
Intracranial bleed 396
Intracranial hypertension 333
Intracranial injury, severity of 252t
Intracranial malformation 244
Intracranial pressure 223, 257, 257f, 330
patients with raised 36
raised 12, 74, 243
wave forms 258f
Intrahepatic cholestasis 342
progressive familial 344
Intranasal catheter 52, 53, 53f
Intraparenchymal injury 266
Intraparenchymal pressure transducers 261
Intrathecal perfusion, analgesic in 540
Intravascular hemolysis 440
Intravenous anesthesia-inducing agents 536
Intravenous calcium chloride 44
Intravenous hydration, aggressive 466
Intravenous immunoglobulin 354
Intubation and ventilation 333
Invasive blood pressure 573
Invasive hemodynamic monitoring 154
Invasive monitoring 128
indications for 261
IPAP See Inspiratory positive airway pressure
Iron
deficiency anemia 317
preparations 413
Irritability 171, 516
Ischemia 249, 262
Ischemia-related cerebral injury 296
Ischemic heart disease 19
Ischemic stroke 375
Isoniazid 419
clinical manifestations 420
management 420
source 419
Isonicotinic acid hydrazide 409, 420
Isoprenaline 211
Isoproterenol 175, 180
Isotonic saline 292
J
Jaundice 244
absence of 327
worsens 328
Jugular vein, internal 303
Jugular venous oxygen saturation 262
Jumpstart pediatric multiple casualty incidents triage 17fc
Junctional ectopic tachycardia 188
K
Kaliuretic action 175
Kawasaki disease 196
Kayser-Fleischer rings 329
Kerosene 429, 430f
clinical features 430
management 430
source 429
Ketamine 230, 539
Ketoacidosis 294
Ketonemia 288
Ketones 134
Ketonuria, mild 290
Ketosis 400
Ketotic hypoglycemia 327
Kidney 219
disease, chronic 223
functions 360
injury 238, 464
acute 219, 292, 296, 299, 335
Klebsiella 511
pneumonia 494, 528
species 498
L
Labetalol 224, 225
Lacosamide 275
Lacrimation, excess 424
Lactic acidosis 327, 432, 535
Lansoprazole 319
Laryngeal edema 434
Laryngeal mask airway 28
Laundry detergent packets 434
Left ventricle failure 165
Left ventricular dysfunction 140
Leg raising, passive 158, 158f
Legionella pneumophila 494
Leptospira serology 246
Leptospirosis 244, 326
Leucodepleted blood components 487
Leucodepletion 487
methods of 487
Leukemia 465, 473
Leukemoid reaction 474
Leukopheresis 475
Levetiracetam 264
Levofloxacin 502
Levosimendan 178, 208, 210
Lidocaine 202
Life support
discontinuation of 30
withdrawal of 283
Life-threatening
organ ischemia 220
problems, immediate 434
symptoms, case of 223
Light-emitting diodes 119
Linezolid 512
Lithium dilution 161
Live donor liver transplant 342, 352
Liver
functions 315, 360
support systems 337
tests 331
Liver disease
end-stage 346, 349, 351
pediatric end-stage 347
primary 343
Liver enzymes 328
elevated 432
Liver failure
acute 324, 328, 336, 336t, 344-345, 400, 414
causes of acute 326, 327
chronic 328
etiology of acute 330t
management of acute 331
pathogenesis of acute 327
pediatric acute 324
subacute 328
subdivisions of acute 325t
Liver transplant
evolution of 341
indication of 411
pediatric 342, 344b
patients listed for 334
Loop diuretics 45
Lorazepam 535
Low blood pressure 233
Low efficiency dialysis, sustained 299, 304, 404
Lower gastrointestinal tract bleed 311, 316fc
causes of 313t
endoscopy 322
in children 312
Lower respiratory tract 497
infection 117, 483
Low-middle income countries 297
Low-platelet count 363
LRT See Lower respiratory tract
LSD See Lysergic acid diethylamide
Lumbar puncture 246
Lung
collapsed 90
normal 82
recruitment of 560
rest, initial period of 560
restrictive 96
tissue 498
ultrasound 505
virtues of monitoring 62
Lung disease
chronic 91, 140
restrictive 110
type of 145
Lung injury
acute 136, 137, 144
causes of direct 141
direct 59
transfusion-related acute 138
Lung mechanics
from chest wall, dissociation of 66
mathematics of 68t
monitoring of 67
with ventilation 62
Lychee fruit consumption 444
Lyme disease 195, 196
Lymphocyte 480, 488, 493
Lymphohistiocytosis 330
Lymphoma 473
Lysergic acid diethylamide 400
M
Machine with nasal cannula 113f
Magnesium 47, 278
depletion 45
Magnetic resonance imaging 278
Magnetoencephalography 278
Maintenance fluid 36, 573
calculation 292
Malaria 244, 246, 359
Malathion 424
Male sex 392
Malnutrition, severe 345
Management skills 171
Mandatory ventilation, intermittent 80
Mannitol 263
MAO See Monoamine oxidase
Masimo pulse oximetry 122
Mask hypovolemia 254
Maternal blood ingestion 314
Maternal lupus 196
Mature cells 474
Mean arterial pressure 9, 153, 155, 259
Measles 352
Mechanical ventilation 74, 86, 122, 157f, 332
basics of 73
control variables in 77
controlled 83
indications 73
physiology 74
Mechanical ventilatory cycle 79f
Meckel's diverticulum 312, 313, 314, 322
Meckel's scan 318, 319f
Meconium aspiration syndrome, severe 556
Mediastinal mass 472f
anterior 471
posterior 471
Mediastinal syndrome
management of superior 473fc
superior 470
etiology 471
laboratory evaluation 472
management 473
pathophysiology 470
Mediastinitis 321
Medical management, supportive 324
Mefenamic acid 411
MEG See Magnetoencephalography
Membrane's effectiveness 300
Meningitis 269
Mental status 385
altered 444
Meperidine 537
Meropenem 502
Mesothelium 301
Metabolic abnormalities 192
management of individual 467
Metabolic acidosis 288, 289, 406, 407
cause of 419
Metabolic activity of brain 263
Metabolic alkalosis 132, 174, 308
Metabolic cause 246
Metabolic derangements 457, 459fc
Metabolic disease 269, 326, 344
Metabolic disorder 343
Metabolic liver disease 330
Metabolic requirements 137
Metamizole 538
Methemoglobinemia 445
causes 447
clinical features 447
investigations 447
management 448
Methiocarb (mesurol) 427
Methomyl (lannate) 427
Methylene blue 448
Methylprednisolone 572
Metolazone 180
Metoprolol 181
Microcentrifuge 367f
Micrococcus 513
Micronutrients 360
Microstream technology 126
advantages 127
Midazolam 272, 534, 541
infusion syndrome 535
Midbrain 244
Milk bank pasteurizer 494
Milk protein allergy 312
Milrinone 180, 214
Mimic common diseases 400t
Mineral 360
deficiency 359
Minoxidil 224
Miosis 424
Mitochondrial
cardiomyopathies 174
dysfunction 275
hepatopathies 330
Mitral regurgitation 169
Mitral stenosis 166
Mivacurium 542
Mixed venous
blood 161
oxygen saturation 162, 215, 231
Molecular adsorbent recirculating system 404
Monitoring devices 261
Monoamine oxidase 326
Monro-Kellie doctrine 257f
Morphine 181, 537, 543
side effects 543
Mortality and morbidity, cause of 249
Mortality in trauma 380
Mosquito repellent poisoning 439
clinical manifestations 439
management 440
source 439
Motion, equation of 63
Motor system examination 245
Motor vehicle occupant injury 381
Mouthwash 494
MR See Mitral regurgitation
MRI See Magnetic resonance imaging
MRSA See Methicillin-resistant Staphylococcus aureus
Mucosal edema 434
Mucosal irritation and swelling 444
Multidrug-resistant 506
pathogens, risk factors for 499b
Multiorgan dysfunction 337
syndrome 326
Multiple-dose activated charcoal 403
Mumps 352
Muscarinic antagonist 426
Muscarinic effects 424
Muscle
relaxants 253, 392, 543
twitching 303
Muscular dystrophies 196
Mushroom poisoning 327, 336
Mycobacterial infection 478, 513
Mycobacterium tuberculosis 494
Myeloid leukemia, acute 471
Myocardial contractility 165
Myocardial contraction 165
Myocardial contusion 386
Myocardial dysfunction 46, 73
Myocardial ischemia 187, 196
Myocardial necrosis, less 203
Myocardial oxygen 175
Myocardial performance, increase 175
Myocardial relaxation 178
Myocarditis 191, 192, 366, 375, 556
Myocardium 165
Myoclonic epilepsy, progressive 270
N
N-acetyl cysteine, role of 337
N-acetylcysteine infusion 410
oral route 411
side effects 411
Naloxone 248
Narcotics 34
Nasal cannula 53, 56
heated-humidified high-flow 57
high-flow 113f, 147
oxygen
delivery 57f
therapy, high-flow 112
Nasal masks 103f
Nasal pillows 102, 102f
Nasal prongs 52, 53, 53f, 102, 102f
Nasal septum perforation 439
National Antimicrobial Resistance Surveillance System 529
National Policy for Containment of Antimicrobial Resistance 529
Natriuretic peptide 178
Natural killer 330
NAVA See Neurally adjusted ventilatory assist
NCS See Nonconvulsive status
Near-infrared spectroscopy 162, 262
Nebulized medication 494
NEC See Necrotizing enterocolitis
Necrotizing enterocolitis 313, 318
Neem oil 397
Neisseria meningitides 352
Neonatal and childhood illness, management of 528
Neonatal hemochromatosis 330, 336
Neoplasm 242
Nephroblastoma 466
Nephrotoxic drugs 335
Nerium oleander 443
Nesiritide 178
Neural mechanism 110f
Neuroblastoma 466, 471
Neuroimaging 276
Neuroleptic malignant syndrome 422
Neurological complications 375
Neurological deficit 250
Neurological disorder 251
Neurological examination 244, 252
Neurological function 398
Neurological status, assessment of 350
Neurological survey, quick 385
Neurology 222
Neuromuscular blockade 149
context of 541
Neuromuscular blocking agents 542, 542t
Neuromuscular disease 110
severe 110
Neuromuscular disorders 74
Neuromuscular excitability 46
Neuromuscular weakness 58
Neuronal death, severe global 260
Neuronal injury, reducing 263
Neuroparalytic snakebite 248
Neurophysiological methods 541
Neurosurgeon 265
Neurotoxins 450
Neutropenia 468, 512
profound 468
prolonged 468
Neutrophil count, absolute 471
New York Heart Association 170
Newer agents 213
angiotensin II 213
istaroxime 213
methylene blue 213
omecamtiv mecarbi 213
Nicardipine 224
Nifedipine 223, 224, 225
Nitric oxide 148, 332
inhaled 148
Nitroglycerine 176, 181, 212, 214, 460
Nitroprusside 212
NIV See Noninvasive ventilation
NK See Natural killer
NMDA See N-methy-d-asparate
N-methyl-d-aspartate 269, 275
Nodalol 320
Nonbleeding visible vessels 322
Noncardiogenic pulmonary edema 296
Nonconvulsive status 272
epilepticus 398
Nonhemolytic febrile transfusion reactions 487
Non-Hodgkin lymphoma 471
Noninvasive measures 262
Noninvasive respiratory monitoring 118
Noninvasive respiratory support 147
Noninvasive ventilation 86, 87, 98, 373
acute 106
advantages of 89
contraindications for 91, 92f
data monitoring 106
disadvantages of 89
goals of 89
indications for 90
machines
components of 98
of action of 88
mode of 92, 93f
monitoring 106
physiology of 87
specific hospital-based ventilator 97f
steps of initiating 105
terminologies in 90
troubleshooting 107
Nonionic detergents 434
Nonketotic hypoglycaemia 400
Nonmalignant causes 471
Non-neurological injuries, management of 388
Non-pharmacological treatment 533
Nonpulmonary sepsis 138
Nonrebreathing mask 52, 55, 56, 56f
Nonresolving inflammatory 227
Nonsteroidal anti-inflammatory drugs 312, 365, 537, 538
Nontraumatic cardiac arrests 19
Nontraumatic coma 251
Nontuberculous mycobacteria 494
Nonvariceal bleed 321
Noradrenergic neurons, hyperpolarization of 540
Norepinephrine 180, 209, 214, 232
Normocarbia, maintain 332
Nosocomial
infection 491
pneumonia 491
Novel therapies 275
NSAIDs See Nonsteroidal anti-inflammatory drugs
NSBB See Nonselective beta blocker
Nucleic acid metabolism, product of 464
Numbness 444
Nurse competencies 548
advocacy/moral agency 548
caring practices 548
clinical judgment 548
collaboration 549
facilitator of learning 549
systems thinking 549
Nursing care 213
general 573
Nutrition 336
assessment of 359
enteral 359
goals of 357
in critically ill children 357
parenteral 359
Nutritional assessment 359
clinical examination 359
laboratory examination 359
Nutritional status, assessment of 350
Nutritional support 149
O
Obesity hypoventilation 110
Obstructive lung disease 111
Obstructive sleep apnea 86, 96, 111
Occasionally colloid 11
Odor 400
Oleander poisoning 443
clinical features 443
differential diagnosis 444
laboratory investigations 445
management 445
source 443
Oliguria, child with 238
Ominous sign 289
Oncologic emergencies, common pediatric 463t
Oncological emergencies 463
ONSD See Optic nerve sheath diameter
OPC See Organophosphate
Ophitoxemia 451
Opioid 535, 538, 568
derivatives 537
Optic nerve sheath diameter 330
Optiflow system 113
Oral fluids, intravenous to 373
Oral hypoglycemic agents 418
clinical features 418
management 419
source 418
sulfonylurea compounds 418
Oral intubation 332
Oral mucosa 118
Oral rehydration solution 42
Organ allocation and prioritization 347
Organ donation statistic 564f
Organ dysfunction 369, 568
Organ function assessment, tests for 368
Organ hypoperfusion, denoting 228
Organic acidemia 344, 358
Organocarbamate poisoning 426
Organophosphate 420
compounds 424
induced delayed polyneuropathy 425
Organs donated 564f
Ornithine aspartate 333
Ornithine transcarbamy 330
ORS See Oral rehydration solution
Orthogonal polarization spectral 161
OSA See Obstructive sleep apnea
Osmotherapy 243
Osmotic agent 301
Osmotic compensatory mechanisms 328
Osmotic diuretics 263
Osmotic therapy 333
Osteomyelitis 513
Ototoxicity 174
Overfeeding 358
Oxamyl (vydate) 427
Oxidative stress 59
Oxygen 50, 101, 120, 177, 442
and face tents 52
consumption 162, 263
content 120
facemask 56
hazards of 59
hood (oxyhood) 52, 55, 56f
humidification of 51
masks, simple 52
utilization 275
Oxygen delivery 120, 162
and consumption 51
Oxygen delivery devices 11, 56t
low-flow 53f
and high-flow 52t
Oxygen dissociation curve 120f
with left shift 120f
Oxygen extraction
indicator of 262
ratio 162
Oxygen saturation 571
index 139, 140
of arterial blood 120
Oxygen therapy 50
administration of 52
monitoring of 58
weaning from 59
Oxygenation 130, 197
determining 130
index 140
common 162
P
Packed red blood cells 303, 482, 483b
indications 483
Paget's disease, advanced 166
Pain 34, 532
abdominal 516
assessment of 540
Painless rectal bleeding, causes of 313b
Pancreatitis 138, 366
Pancuronium 542
Pantoprazole 319
PAO2 See Partial pressure of arterial oxygen
Papilledema 219, 244
Paracetamol poisoning 408
management of 409
Paracetamol toxicity, stages of 409b
Paracetamol-induced hepatotoxicity, mechanism of 408
Paraoxysmal neurological disorder 242
Parasympathetic stimulation 457
Parenchymal disease 76
Parenchymal lung disease 82
Parenteral fluids 34
maintenance 35t
Parenteral nutrition 510
induced liver injury 344
total 360
Paresthesias 444
Partial pressure
of arterial oxygen 131, 137, 138, 172
of carbon dioxide 126, 131
of oxygen 50
in alveolus 131
Patent ductus arteriosus 166, 169
Pathology, type of 96t
Patient level outcomes 552
Patient population 546
Patient's brain death 573
Patient-nurse level outcomes 552
PAWP See Pulmonary arterial wedge pressure
PCV See Pressure control ventilation
PDA See Patent ductus arteriosus
PDE See Phosphodiesterase
Peak end expiratory pressure 76
Peak inspiratory pressure 68, 144
Pedestrian injury 381
Pediatric arrhythmias, treatment of 198
Pediatric assessment triangle 5
Pediatric bradycardia algorithm 200fc
Pediatric cardiac arrest 26fc
algorithm 20fc
Pediatric injury severity, measurement of 381
Pediatric intensive care 1
unit 117, 211, 254, 280, 423, 480, 491, 532
Pediatric liver transplant, contraindications to 345, 345b
Pediatric oncology 483
Pediatric organ donation and donor maintenance 563
Pediatric population 184
Pediatric rifle criteria, modified 237t
Pediatric trauma 382
score 381t
unique aspects of 382
PEEP See Positive end-expiratory pressure
Peptic ulcer 314, 365
Perforation 434
Pericardial effusion 375
Pericarditis 321, 366
Peripheral capillary oxygen saturation 573
Peripheral vein 511
Peritoneal dialysis 299, 301
advantages of 301b
mechanisms 301
prescription 302
Peritonitis 321
Pertussis 352
Petechiae 244
Phenobarbitone 446
Phenomena, transient 253
Phenoxybenzamine 224
Phenylephrine 212, 214
Phenytoin 446
Phosphate 294, 464
enema 294
Phosphodiesterase 181
III inhibitors 211
Phosphorus 47, 278
Physical examination 314
Physiology, pediatric and adult 137t
PICU See Pediatric intensive care unit
Piggy backing 232
Pimobendan 208
Piperacillin-tazobactam 502
Pirimicarb (pirimor) 427
Plant toxidrome 444t
Plasma 480
exchange and oxygen 440
leakage, severe 369, 373
proteins 481
Plateau pressure 66, 68, 144
Plateau waves 259f
Platelet 480, 481
aggregation 148
destruction, increased 486
dysfunction 363, 486
increased consumption of 485
production, decreased 485
random donor 484
single donor 484
types of 484
Platelet transfusion 374, 484
criteria to transfuse 484
efficacy 486
indications 485
Platinum half hour or golden hour 382
PMN See Polymorphonuclear neutrophils
Pneumonia 57, 58, 91, 132, 138, 228, 263, 332, 429
characterization of 496
development of 491
healthcare-associated 491, 499b
Pneumothorax 387, 439
Point-of-care ultrasound 2
Poison
categorization of 396
classification of 396
indicated 402
individual 405
Poisoning 395
acute single dose 408
anticholinergic 244
antidepressant 244
childhood 395
epidemiology of 395
general management 396
in children 395
and adults 396t
management of 405
treatment of 248
unrecognized 397, 398
Poisonous and nonpoisonous sting, phases of 459fc
Poisonous snakes, common 453
Poisonous sting 458
Polio virus, inactivated 352
Polymorphic ventricular tachycardia 202
Polymorphonuclear
leukocytes 493
neutrophils 497
Polyp 314
Polysaccharide pneumococcal 352
Polytrauma, child with 383f
Pontine lesions 244
Porphobilinogen 247
Porphyria 247
Positive end-expiratory pressure 65, 71, 87, 138, 145, 177, 230, 332, 460
Positive pressure ventilation 34, 87f, 143, 177
Postcardiac arrest care 30
Post-concussion syndromes 252
Postprandial hyperglycemia 289
Post-pyloric feeding 359
Post-traumatic seizures, immediate 265
Potassium 43, 464
correction 293
Potential organ donors, management of 571t
PPI See Proton pump inhibitor
Pralidoxime 402, 426
Prazosin 181
Precordial activity, increased 171
Predigested formulae 360
Pressure control ventilation 96
mode 94
Pressure support 90
ventilation 81
Pressure ventilation, negative 74, 86, 87f
Pressure versus flow 155
Pressure-regulated volume control ventilation 81
Pressure-volume
curve relationship 128
loop 69
PRIS See Propofol infusion syndrome
Probable tests 246
Promethazine 534
Prophylactic medication 264
Prophylactic platelet 485
transfusion 484
Propionibacterium 513
Propofol 272, 535, 541
infusion syndrome 272, 535
Propoxur (baygon) 427
Propranolol 320
Propylene glycol 535
Prostaglandin 181
Protein 360
C deficiency 344
energy malnutrition 359
metabolism 358
Prothrombin time 278
altered 315
Proton pump inhibitor 316
Pseudohyponatremia 40
Pseudomonas 511, 524
aeruginosa 494, 498, 500, 512, 513, 528
species 516
Psychosocial assessment 352
PTT See Partial thromboplastin time
Pulmonary arterial wedge pressure 137
Pulmonary artery 166
catheters 138
Pulmonary contusion 138
Pulmonary edema 58, 91, 299, 572
Pulmonary function tests 127
clinically relevant 127
research 127
Pulmonary hypertension 166, 168
acute 168
persistent 556
Pulmonary mechanics, alteration of 142
Pulmonary metastasis 343
Pulmonary pressures, reduces 211
Pulmonary vascular
remodelling, risk of 137
resistance 142
tone, systemic and 205
Pulmonary vasculitis 138
Pulse
amplification, distal 155
check 24, 27
oximeter work 119
poor 173
rate 8, 385
Pulse oximetry 118, 172
critical discussion on 119
limitations of 119
Pulse pressure 229
maximal 157
minimal 157
narrow 229
variation 157
wide 229
Pulseless
arrest algorithm 201fc
electrical activity 197
ventricular tachycardia 28, 193
Pulsus paradoxus 171
Pupil
constricted 399
dilated 399
unequal 243
Pupillary size and reaction 398
Purious hyperkalemia 44
Pyrazinamide 327
Pyrexia 400
Q
QRS complexes 187
QT syndrome, long 191, 193
QTC prolongation 422, 432
Quinine 247
R
RAAS See Renin-angiotensin-aldosterone system
Rabies 242, 352
Rabiprazole 319
Ramsay sedation scale 541b
Rat killer poisoning 431
clinical manifestations 431
laboratory investigations 432
prevention 433
prognosis 433
source 431
Rebreathing mask, partial 52, 54, 56
Rectal diazepam 270
Red blood cells 361, 480
Refeeding syndrome 361
Refractory metabolic acidosis 299
Refractory seizures 536
Refractory status epilepticus 243, 278
Remifentanil 537, 538
Remote symptomatic epilepsy 270
Renal disease 43
Renal disorders 132
Renal dysfunction 568
Renal failure 36, 46, 376
acute 40
chronic 483
indices, classification using 237t
transient 263
Renal function 33
assessment of 350
Renal insufficiency, physiological 33
Renal replacement therapy 299, 468
basics of 299
continuous 299, 305, 336
modes of 301
Renal stones 274
Renal support 237, 561
Renal tubular acidosis 44
Renal tubules 464
Renin-angiotensin-aldosterone system 178, 220, 224
blockade 225
stimulation of 167
Residual capacity, functional 88, 137
Residual pyloric stenosis 414
Respiration 426
accessory muscles of 118
Respiratory
alkalosis 406
depression 413
distress and shock 377
distress/failure 373
endoscopy 535
mechanics, physiology of 63
monitoring 117
muscle reserve 137
syncytial virus 494
therapy equipment, contaminated 500
Respiratory failure 10, 73, 555
acute 91, 96
anticipate 10
pathology causing 96
severe 92
Respiratory rate 9, 244, 385
by age, normal 239
normal 118t
Respiratory syndrome
pediatric acute 140t
severe acute 494, 501
Respiratory system 66
and ventilation 332
compliance 144
mechanical properties of 63
Resuscitation 19, 407
fluid 37
monitoring of 386
Retinal hemorrhage 244
Reye's syndrome 327, 333
Rh negative 482
Rh positive 482
Rhabdomyosarcoma 471
Rheumatic fever 195, 196
Rib injuries 387
Ribonucleic acid 275, 363
Rickettsial infections 247
Rickettsial meningoencephalitis 242
Rifampicin 327, 409
Ringer's lactate 362
RNA See Ribonucleic acid
Rocuronium 542
Ross classification 170, 170t
Rotavirus 352
RSE See Refractory status epilepticus
Rubella 352
Rumack-Matthew nomogram 410, 410f
S
Safety devices and monitors 557
Salicylate 403
poisoning 405
Saline, volumes of normal 292
Sarcoma 471
Sarin 424
SARS See Severe acute respiratory syndrome
Schizophrenia, drugs in 534
Schofield's equations 358
Schwartz formula 237
Sclerosant injection 320, 321
Sclerosing cholangitis 344
primary 342, 349
Scorpion 457
venom, pathogenesis of 458fc
Scorpion envenomation 457
clinical features 458
diagnosis 460
incidence 457
pathogenesis 458
prognosis 461
treatment 460
Scorpion sting 449
envenomation 459fc
Sea snakes 452
Second therapy phase 271
Sedation 532, 533
and analgesia 264
protocol for 540fc
assessment of 540
goals of 533
holidays 536
sedative drugs 534
Sedative agents 534t
Sedative drugs 539
Seizures 242, 250, 264, 270, 400
aggressive treatment of 264
unrecognized 265
Senning operation 168
Sensorium 292
altered 303
Sepsis 226, 227, 263
syndrome 228
with organ dysfunction 228
Septic shock 38, 74, 226, 235, 556
compensatory mechanisms 227
management of 229t
microcirculatory changes 226
pathophysiology 226
pediatric and neonatal 233fc
symptoms for 231
therapy of 226, 235
Septicemia 132, 335
Sequential organ failure assessment 228t
Serotonin and noradrenaline reuptake inhibitors 423
Serotonin reuptake inhibitors, selective 423
Serotonin syndrome, risk of 423
Serratia 511
Serum
ache 426
alpha fetoprotein 346
bicarbonate 290
electrolytes 466, 573
glutamic pyruvic transaminase 314
glutamic-oxaloacetic transaminase 314
osmolality 292
effective 295
salicylate level 406
Severity assessment, quick 426t
Shigella encephalopathy 242
Shock 132, 187, 244, 363, 369, 377, 566
anaphylactic 38
clinical parameters for 227b
cold hypotensive 362
compensated 369, 371fc
delayed 414
management 205
of snake bite 455
neurogenic 386
non-cardiogenic 138
recognition of 227
resolution, signs of 369
severe 215
steps in management of 205b
types of 216fc
Shunt 51
Sick-day rules 297
Sickle cell disease 483
Sideroblastic anemia 483
Sieving coefficient 300
Silverman-Anderson index 118t
Sinus
bradycardia 195
treatment of 195
nodal dysfunction 197
tachycardia 8, 183, 184, 187, 422
treatment of 188
venous thrombosis 242
SIRS See Systemic inflammatory response syndrome
Skin 222
burns 203
dry 400
integrity, loss of 510
necrosis 439
Skull fractures 266
SLED See Sustained low-efficiency dialysis
Snake
poisonous 453
cobra 453
krait 453
russell's viper 453
saw-scaled viper 453
Snake bite 455
renal failure 456
Snake envenomation 449
clinical features 451
epidemiology 449
first aid 452
local signs of envenomation 451
severity of 454t
treatment 452
inside hospital 453
Snake venom 450
enzymes 450
nonenzyme
polypeptides 450
proteins 450
SNP See Sodium nitroprusside
Sodium 38
benzoate 333
corrected 292
loss of 39, 40
nitroprusside 176, 181, 214, 216, 224, 225, 460
overload 42
valproate 446
Solute and fluid removal, mechanisms of 300
Solvent-induced encephalopathy, chronic 276
Spironolactone 175, 180, 224
Spontaneous eye opening 241
Staphylococcus 510
coagulase negative 498
Staphylococcus aureus 510, 512, 516, 524
methicillin-resistant 494, 498, 503
methicillin-sensitive 503
Static preload measurements 156
Static respiratory mechanics 64
Status asthmaticus 539
Status epilepticus 242, 268, 444
etiology 269
pathophysiology 269
protocol 277t
systemic effects during 270
Stem-cell therapy 179
Stenotrophomonas maltophilia 494
Sterile equipment 518
Steroid 262, 327
administration 235
and immunotherapy 275
therapy 235
Stomach contents, aspiration of 321
Storage and shelf life 481
Stroke volume 165
variation 157
Subarachnoid hemorrhage, particularly 41
Subcutaneous catheter 513
Subcutaneous emphysema 438f
Subcutaneous insulin, transition to 295
Subdural
empyema 242
hematoma 255, 266
Subfalcine herniation 245
Subgaleal hematomas 266
Subglottic secretion drainage 505f
Submersion 391
Succinylcholine 542
Sulpha 409
Superoxide dismutase 59
Supratherapeutic ingestion, repeated 408
Supraventricular tachyarrhythmia 184, 188
Supraventricular tachycardia 8, 183, 189fc
management of 189
Surfactant therapy 147
SVR See Systemic vascular resistance
Swap transplant 354
Sweating 171
Swimming skills, inadequate 392
Sympathetic storm 457
Sympathetic tone, increase in 167
Sympatholytic agents 224
Sympathomimetic poisoning 244
Symptomatic hyponatremia 39
Synchronization 79
Synchronized intermittent mandatory ventilation 80
Syndrome of inappropriate antidiuretic hormone secretion 34, 40, 41t
treatment 41
Syndromic epilepsies 270
Systemic endogenous vasodilators, levels of 332
Systemic inflammatory response syndrome 216, 227, 327, 334
Systemic toxicity 451
Systemic vascular resistance 153, 224, 229
Systemic ventricular failure 168
Systolic dysfunction 166, 374
Systolic pressure variation 157
T
Tabun 424
Tachyarrhythmias 184, 199fc
management of 198t
Tachycardia 171, 173, 184, 186, 375, 399, 422, 444
child with 8
narrow complex 185f
reentrant 186f
type of 188
Tachypnea 171, 399, 400
Talbot formula 358
Tamponade (cardiac) 9
Tandem mass spectrometry 247
TAPVC See Total anomalous pulmonary venous connection
TCA See Tricyclic antidepressant
Tension pneumothorax 9
Teratoma 471
Terlipressin 319, 320
Tetanus 352
Tetralogy of Fallot 211
Thalassemia 483
Theophylline 45, 403, 413
Thermodilution 159
Thiazides 174
Thioridazine 422
Third therapy phase 272
Thoracic disorders, restrictive 110
Thoracic electrical bioimpedance 159
Thoracic fluid index 160
Thoracic trauma 388
Thrombocytopenia 315, 360
dilutional 486
with absent radius syndrome 485
Thromboplastin time, partial 278
Thrombosis 308, 327
Thrombotic thrombocytopenic purpura 485, 489
Thymic tumor 471
Thyrotoxicosis 166
Tidal volume 143
TIPSS See Transjugular intrahepatic portosystemic shunt
Tissue
capnometry 161
engineered vessels 179
oxygenation 161
assessment of 161
monitoring 161
Tolerance development, causes for 275b
Tongue, cyanosis of 118
Tonic downgaze 245
Tonic upwardgaze 245
Tonic-clonic seizures 419
Tonsillar herniation 245
Topiramate 275
Torsemide 224
Total anomalous pulmonary venous connection 169
Total blood volume 303
Tourniquet test 364
Toxic
dose 405
encephalopathy 242
ingestion 244
level 441
symptoms 420
Toxicity
acute 424
mechanism of 405, 416, 418, 419, 421-424, 427, 429, 436, 439, 443
of chemicals, mechanism of 431t
Toxidromes 395, 400, 401t
Toxins 9
and specific antidote 402t
cause of 444
TR See Tricuspid regurgitation
Tracheal intubation 253
Tracheobronchial obstruction 472
Tracheostomy 561
Tramadol 537, 539
Transcatheter interventions 178
Transitory state, type of 241
Transjugular intrahepatic portosystemic shunt 316, 321
Transplant recipients, vaccination in 352t
Transpulmonary pressure 66, 70, 88
Transpulmonary thermodilution 161
Transverse myelitis 375
Trauma 9, 138
abdominal 388
score, revised 381t
Traumatic brain injury 270, 535
severe 249
Tricuspid regurgitation 169
Tricyclic antidepressant 402, 420, 421
clinical manifestations 421
management 421
source 421
Trigger asynchrony 79
Triglycerides 272, 360
Trimethoprim-sulfamethoxazole 326
TTP See Thrombotic thrombocytopenic purpura
Tubercular meningitis 242
Tubular necrosis, acute 43
Tumor burden, large 465
Tumor lysis syndrome 46, 464
clinical evaluation 466
laboratory evaluation 466
management 466
pathophysiology 464
risk factors 465
risk stratification 465
Tympanic membrane, perforation of 439
Tyrosinemia 326, 330
U
Ultrafiltration 300
Ultrasonography abdomen 388
Uncal herniation 245
Uncertain compensation 134
Underfeeding 358
Upper gastrointestinal
endoscopy 437
role of 435
series 318
Urea cycle defect 330, 344
Uremia 299
Urethral catheter, indwelling 515
Uric acid 464
Urinalysis 466
Urinary alkalinisation 467
Urinary catheter 518
in-dwelling 543
Urinary retention 422
Urinary tract infection 515
Urination 424
Urine
analysis 573
osmolality 237
output 229, 385
reduced 171
sediment 237
sodium 237
V
Vagal maneuvers 190
Valproate 264
Valve stenosis 166
Vancomycin intermediate staphylococci 528
VAP See Ventilator-associated pneumonia
Variable-concentration devices 52
Variceal bleed 321
Varicella 352
Varicella-zoster virus 326
Vascular malformation 313, 314
Vasculotoxins 450
Vasoactive agents 205, 207t
classification of 206
effects of 215f
individual 208
Vasoactive drugs 232
titration of 232
Vasoactive therapy, goals of 215
Vasodilators, direct 224
Vasopressin 210, 214, 227, 232
receptors 208
Vecuronium 181, 542, 543
Venom 457
Venomous snakes, species of 449b
Veno-occlusive disease 327, 330
Venous blood gas 8
Venous oxygen saturation 161
Venous reservoir 557
Venous system, intracranial to extracranial 258
Venovenous hemodiafiltration, continuous 306, 307f, 404
Venovenous hemodialysis, continuous 306, 307f
Venovenous hemofiltration, continuous 306, 306f, 560
Ventilation 21, 197
adaptive support 81
assist-control mode 81
assisted modes 81
control mode of 78f, 80
dual mode 81
duration of 84
hybrid modes 81
machines, types of noninvasive 95
modes of 80
newer mode 81
noninvasive 86
contraindications 90
indications 90
phases of 77
proportional assist 81
Ventilator
hardware 74
settings 560
settings, initial 82
Ventilator-associated pneumonia 491, 492, 494t, 496-498, 499b, 501t, 506, 561
diagnosis 495
management of 504
pathogenesis 492
prevention 499
probable 496
risk factors 493
treatment 501
Ventilator-induced lung injury 62
Ventricle failure, right 166
Ventricular arrhythmias 48, 202, 375
Ventricular assist device 179
Ventricular contractions, premature 191, 191f
Ventricular fibrillation 19, 193, 193f, 200, 201
Ventricular septal defect 166, 169
Ventricular tachyarrhythmias 191
Ventricular tachycardia 19, 185, 192, 200, 201
wide complex 192f
Venturi mask 52, 54, 55f, 56
VF See Ventricular fibrillation
Viperidae 449
Vipers 451
Viral
infections, transmission of 487
meningoencephalitis 242
pneumonias 556
Virtual anesthesia 533
Vital signs, interpreting abnormal 8
Vitamin
deficiencies 349, 359
essential 360
K 343, 433
administration 238
Volatile agents 541
Volatile organic compounds, analysis of 505
Vomiting 132, 444, 466
and gastric bleeding 92
VSD See Ventricular septal defect
VT See Ventricular tachycardia
W
Warfarin compounds 431
Warm shock 205
Warning signs 369
Washed cells 488
Water
gain 39
homeostasis 33
intake, excessive 40
loss into cells 42
losses, unreplaced 42
Weakness 444
Weaning from invasive ventilation 91
Weaning phase 278
Wenckebach phenomena 195
Wheezing 171
White blood cell 480
filter 488
Whole blood 482
indications 482
unit of 480
Wilson's disease 327, 328, 330, 344
Withdrawal syndrome 543
Wolff-Parkinson-White syndrome 186, 188, 198
Worsening hypoxemia 59
Y
Yellow phosphorus 432
Z
Zidovudine 409
Ziprasidone 422
Zygomycetes 494
×
Chapter Notes

Save Clear


Critical Care Scenario in India1

Santosh T Soans,
P Sahana
 
 
Every year about 5 million patients are admitted to the intensive care units (ICUs) in India. Pediatric intensive care in India started in the early 1990s. It simultaneously initiated at four centers in the north, south, and west by individual efforts. The pioneering institutions were the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh; Sir Ganga Ram Hospital, Delhi; Hinduja Hospital, Mumbai; and Child Trust Hospital, Chennai. Pioneers who were trained abroad returned to India to set up pediatric ICUs (PICUs). Soon the specialty became popular with pediatricians; and in 1996, there were already 21 centers offering pediatric intensive care and the number grew steadily. In 2004, the number of ICUs in the country had surpassed 100. During the early period, intensivists worked with limited gadgets and encouraged indigenous manufactured equipment.
The tremendous growth in pediatric intensive care (PIC) was due to the continuous emphasis on training programs. The Indian Academy of Pediatrics (IAP) was quick in realizing the importance of critical care training. IAP introduced Pediatric Advanced Life Support (PALS) courses in the early 1990s with the help of Dr N Janaki Raman. In 1995, a formal IAP-PALS course was launched. By the year 2000, almost 200 courses were conducted and more than 7,000 pediatricians had been trained. The IAP—Intensive Care Chapter was established in 1998 to provide satisfactory critical care to the needy children across the country. And in the year 2000, the Indian Society of Critical Care Medicine—Pediatric Section was founded. The first National Conference of PIC was held at Nagpur in the year 1999. It was followed next year at Chandigarh. Since then the conference is conducted every year with faculties from India and abroad. From national to international conference was not a long journey. In 2007, the International Advanced Course in PIC was organized, and in 2009, the First Asian Congress of PIC was conducted at Chandigarh. The later was attended by delegates from 21 countries and regional leaders from Asia, and the faculty included giants of PIC.
In the past decade, pediatric critical care has rapidly grown, but still remains a developing branch as far as our country is concerned. Throughout modern science, and increasingly within the fields of medicine, new hybrid disciplines have emerged from division and recombination of mature specialties. Pediatric critical care is one such permutation and combination in evolving medicine. Subspecialty chapters were identified to promote research, 2to impart specialized training in pediatric subspecialties, and to organize scientific meetings on pediatric subspecialties. Pediatric critical care medicine is a relatively new but a rapidly growing pediatric specialty in resource-limited countries.
Since then we have come a long way with more than 1,500 members, 17 state branches, 3 city branches, around 300 fellows, and an index journal. The intensive care chapter of the IAP started a formal fellowship program in 2002, and it is now being run through 22 accredited centers in India. A well-organized, multi-layered, training program has evolved—we are one of the few countries with a well-organized training program in pediatric critical care.
Because of its lack of ionizing radiation, as well as its availability and its ability to be performed without sedation, ultrasound is an ideal imaging modality for children, and numerous pediatric-specific point-of-care ultrasound (POCUS), echocardiography (ECHO) applications are clinically relevant and is being introduced in the fellowship training curriculum. An adequate dose of subspecializing training cannot be defined as it is not known whether “bolus” doses of focused subspecialty care of 3–6 months or steady infusion of caring for similar patients over 1–2 years results in a better retention of knowledge and skills.
The role of pediatric critical care nursing is complex. First, the nurse has to continually examine physiologic monitors and treatment devices, along with the child's body. Second, in the event of any irregularity, the nurse has to instantly judge the significance of the event and initiate an appropriate response. Third, the nurse has a primary responsibility for ensuring patient safety. Fourth, the nurse is also responsible for maintaining a bedside environment that fosters the psychosocial adaptation of the child and family. Fifth, the nurse also functions as an “integrator” of patient information. The strength of a PICU's service is directly tied to the quality and rigor of care that the nursing team can provide, in collaboration with the entire pediatric critical care team.
Many of the PICUs in metropolitan cities have state-of-the-art facilities, including extracorporeal membrane oxygenation (ECMO). In large cities, the transportation of a critically ill child has moved on from a hand–ventilated child in a basic ambulance to the state-of-the-art transport which includes a trained team, transport ventilators, oximetry, and end-tidal CO2 (ETCO2). Children previously thought to be too unstable for transport can now be safely transported from one center to a higher one. Needless to say, large proportions of children in rural and remote parts of India are still deprived of timely critical care services and succumb to the illness. Simulation is now a well-accepted and practiced method of training.
India is a fast-growing emerging market, with a great potential for research, especially in pediatrics given the young population and disease burden. As the Pediatric Critical Care Medicine specialty continues to grow, more research is likely to occur at both government-run teaching institutions and corporate hospitals. Multidisciplinary, interdisciplinary, and transdisciplinary are the ways forward in pediatric critical care. Sharing knowledge and research bring multiple perspectives and help avoid some of the blind spots of a single discipline. Patient care shared by a local regular pediatrician and the superspecialist known as “shared care” is an appropriate model for our country.
The biggest question is whether specialization is a boon or a bane? Do we need people who know more and more about less and less until they know everything about nothing? Subsub-specialists should develop new knowledge in their areas of critical care, identify best practices and at the same time—keep in touch with basics and other systems. The contributions of 3national societies and quality of standards of Pediatric Critical Care Medicine Fellowship programs will define the future of pediatric critical care training in India.
In short, since the beginning of the new century, the Pediatric Critical Care Medicine training in India has grown by leaps and bounds and is still growing. About 30–40 years from now, will there still be an ICU? There will be a department of intensive care for sure, but a dedicated unit for that maybe obsolete. Experts suggest that rather than having a separate ICU, if a patient needs intensive care, the regular hospital bed itself can be transformed into a critical care bed by bringing in equipment like the respirators and other sophisticated monitors.
SUGGESTED READING
  1. Bhalala US, Sadawarte J, Sadawarte S, et al. Development and Implementation of Pediatric Critical Care Focused Simulation Workshop and Program in India. J Paediatr Critical Care. 2014;1(4):240–4.
  1. Bhalal U, Khilnani P. Pediatric Critical Care Medicine Training in India: Past, present and future. Front Pediatr. 2018;6:34.
  1. Carnevale FA, Dagenais M. Nursing care in the paediatric intensive care unit. In: Wheeler D, Wong H, Shanley T (Eds). Paediatric Critical Care Medicine. London: Springer;  2014.
  1. Good R, Orsborn J, Stidham T. Point-of-care ultrasound education for pediatric residents in the pediatric intensive care unit. MedEdPORTAL. 2018;14:10683.
  1. IAP-Intensive Care Chapter. Available from: http://www.piccindia.com.
  1. World Federation of Pediatric Intensive and Critical Care Societies. Available from: http://www.wfpiccs.org/history-of-picu-in-india.
  1. Yeolekar ME, Mehta S. ICU Care in India - status and challenges. April 2008;56:221–2.