Indian Journal of Trauma and Emergency Pediatrics

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Septic shock is a common cause of admission to the pediatric emergency and Pediatric Intensive Care Units requiring prompt recognition and management. The dynamic nature of the illness and the high mortality and morbidity rates associated with it make septic shock the most challenging disease to treat. Early recognition and aggressive time bound resuscitation is the key to successful outcome in children with septic shock. Therefore, guidelines for the management of septic shock laid down by the Surviving sepsis Campaign Committee are base on these principles. In this article, the physiologic principles behind shock states, the types of septic shock and the management of septic shock are discussed in detail with a special reference to resource restricted settings.

Key Words: sepsis, septic shock, physiologic principles, surviving sepsis campaign guidelines, Early goal directed Therapy, mixed venous oxygen saturation

Tuberculous CNS infections and especially tuberculous meningitis [TBM], still account for major morbidity and mortality in developing countries. While effective treatment is available now, the need for rapid and accurate diagnosis, along with the tendency toward non-invasiveness in this age has turned the attention to the radiologist, who must equip himself with the latest that the field has to offer. Indeed, the role of radiology, especially CT and MR imaging, is rapidly evolving, and includes not just diagnosis but also extent and complication assessment, outcome measures and even treatment. This article reviews the role of imaging in the diagnosis of TBM, along with a discussion of other manifestations of CNS tuberculosis, and the imaging differential that must be kept in mind.

Key words: Tuberculosis; tuberculous meningitis; tuberculoma; meningeal enhancement; magnetic resonance imaging, vasculitis; hydrocephalus; ring enhancing lesion.

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Baro- and volutrauma, surfactant deficiency, oxygen toxicity, and the development of atelectasis have been investigated in depth in recent years in order to protect the lung during ventilation and reduce the risk of ventilation induced lung injury (vili). Protective lung strategies have been implemented in a variety of clinical contexts that require transferring to emergency room., Pressure ventilation can control the risk of elevated airway pressure (pip) but does not assure less damage to the lung. Tidal volumeappears to be more damaging for the lung as it can favour lung over-distension or create hypoventilation, both harmful clinical conditions for the lung. Peep plays an important role in avoiding the closure and re-opening of the terminal bronchioles implicated in lung damage, and in maintaining the alveolus continuously open. Peep improves oxygenation (increase of functional residual capacity – frc) and can reduce the need for high fio2 (less oxygen toxicity). Maintaining the lung distended for 8-15 seconds at the end of inspiration appears to be helpful in lung recruitment strategy and in the resolution of atelectasis., Ventilation of a child in emergency needs skill and competence that must be acquired in ordinary routine and not in critical care

Key words: emergency, emergency room, lung protective strategy, ventilation, baro-volutrauma, oxygen toxicity, atelectasis, infant, children.

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