A hemoglobin increase from 8 to 12 can boost oxygen delivery far more than raising oxygen saturation from 88% to 98%—but that doesn’t mean transfusing every child to 12 is the right call. In part one of this pediatric Critical Care Board Review, Dr. Pradip Kamat, Dr. Rahul Damania, and Dr.Monica Gray connect high-yield equations to urgent bedside decisions: when intubation may improve a failing heart, why a normal blood gas can hide impending respiratory failure, and how hyperventilation can lower intracranial pressure while dangerously reducing cerebral blood flow. They also tackle ventilator waveforms, ECMO anticoagulation, transfusion complications, and the test-taking strategies that make physiology easier to apply under pressure.

Show Highlights:

• Board-preparation strategies and physiology-based clinical reasoning
• Oxygen delivery, oxygen content, and hemoglobin’s role
• Cardiac shunts, Qp:Qs, and duct-dependent congenital heart disease
• Cardiopulmonary interactions, ventilation, and hemodynamics
• Rhythm disturbances, CPR, and ECMO perfusion concepts
• Gas exchange, alveolar gas equation, and oxygenation indices
• Ventilator pressures, waveforms, time constants, and dead space
• Cerebral perfusion, traumatic brain injury, and neurologic emergencies
• Neuromuscular respiratory failure, seizures, and brain death assessment
• Anticoagulation, transfusion complications, sickle cell disease, and other hematologic emergencies

Resources:

• American Board of Pediatrics. Pediatric Critical Care Medicine Content Outline. https://www.abp.org/sites/abp/files/outline-critical-care-updated.pdf
• Fuhrman & Zimmerman’s Pediatric Critical Care, 6th ed. (Elsevier) — chapters on cardiopulmonary interactions, respiratory physiology and mechanical ventilation, neurocritical care, and hematologic emergencies. (add chapter numbers)
• Emeriaud G, et al. Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2). Pediatr Crit Care Med. 2023;24(2):143–168.
• Greer DM, et al. Pediatric and Adult Brain Death/Death by Neurologic Criteria Determination: Consensus Guideline. Neurology. 2023.
• Kochanek PM, et al. Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition. Pediatr Crit Care Med. 2019;20(3S Suppl 1):S1–S82.
• American Heart Association & American Academy of Pediatrics. 2025 Pediatric Advanced Life Support Guidelines. https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/pediatric-advanced-life-support
• Kapur J, et al. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus (ESETT). N Engl J Med. 2019;381:2103–2113.
• Lacroix J, et al. Transfusion Strategies for Patients in Pediatric Intensive Care Units (TRIPICU). N Engl J Med. 2007;356:1609–1619.
• Valentine SL, et al. Consensus Recommendations for RBC Transfusion Practice in Critically Ill Children (TAXI). Pediatr Crit Care Med. 2018;19(9):884–898.

In this episode of *PICU Doc on Call*, Drs. Pradip Kamat and Rahul Damania dive into the topic of beta-blocker toxicity. They walk through a case of a 15-year-old who comes in with bradycardia, hypotension, hypoglycemia, and altered mental status after an intentional ingestion. Using a board-style question, they break down how to tell the difference between beta-blocker and calcium channel blocker poisoning and review key points about cardiac physiology and receptor signaling.

Drs. Kamat and Damania discuss management strategies, including glucagon, high-dose insulin therapy, vasopressors, calcium, and ECMO as a last resort. They also spend some time focusing on specific agents like propranolol and sotalol, highlighting what makes their toxicologic profiles unique. This is a high-yield episode packed with pearls for pediatric intensivists!

Show Highlights:

• Clinical case of a 15-year-old patient with bradycardia and hypotension due to intentional drug ingestion
• Beta-blocker toxicity and its clinical features
• Differentiation between beta-blocker and calcium channel blocker toxicity
• Key physiological concepts related to cardiac action potentials and beta receptor function
• Clinical presentation and diagnostic workup for beta-blocker toxicity
• Management strategies for beta blocker overdose, including airway control and fluid resuscitation
• Specific toxicologic profiles of common beta-blockers (e.g., propranolol, sotalol, metoprolol)
• Importance of recognizing hypoglycemia and CNS effects in beta-blocker toxicity
• Summary of critical management steps and take-home points for pediatric intensivists
• Encouragement for further learning and engagement on related topics

References:

• Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 126. Toxidromes and their treatment. Joshi P. Pages 1504-1505
• Reference 1: Rogers textbook of Pediatric Intensive Care: Chapter 36: Poisoning. Nares M, Jeyapalan A, Weisman R: pages 525-543
• Reference 2: Lavonas EJ, Akpunonu PD, Arens AM, Babu KM, Cao D, Hoffman RS, Hoyte CO, Mazer-Amirshahi ME, Stolbach A, St-Onge M, Thompson TM, Wang GS, Hoover AV, Drennan IR; American Heart Association. 2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2023 Oct 17;148(16):e149-e184. doi: 10.1161/CIR.0000000000001161. Epub 2023 Sep 18. PMID: 37721023.
• Suarez F, Koyfman A, Long B. Pearls and Pitfalls for the Emergency Clinician: Beta Blocker and Calcium Channel Blocker Toxicity. J Emerg Med. 2026 May;84:1-11. doi: 10.1016/j.jemermed.2026.01.021. Epub 2026 Jan 27. PMID: 41833262.

In this episode of PICU Doc on Call, third-year PICU fellow Dr. Alexandria Edwards joins Drs. Pradip Kamat, Monica Gray, and Rahul Damania for a quick and practical dive into pediatric transport medicine. Dr. Edwards walks us through her go-to framework for handling transport calls, highlighting the importance of systematically checking vitals, respiratory support, the physical exam, labs, and any interventions. The team uses a real-life case of a 12-year-old with severe status asthmaticus to talk through how to pick the right transport mode, why it’s best to avoid intubation if you can, and how to make sure you’re on the same page with the ICU team before the patient arrives. The main message? Build a solid, structured approach to transport calls and practice it every time.

Show Highlights:

• Overview of pediatric intensive care unit (PICU) fellowship and training
• Importance of transport medicine in the PICU setting
• Framework for handling transport calls effectively
• Key considerations for assessing patient stability during transport
• Importance of vital signs and current patient status in decision-making
• Strategies for communicating with referring providers
• Discussion of a specific case involving a pediatric patient with asthma exacerbation
• Decision-making process for mode of transport (ground vs. air)
• Role of critical care transport teams in patient transfer
• Tips for preparing the receiving ICU team for incoming patients

We welcome your feedback and reviews. Please visit our website at https://picudoconcall.org/, where you can find our episodes.