Critical Debrief: The Pitt Episode 2

Critical Debrief: Episode 2: The Pitt 

The team explores ACS updates, AI ECG interpretation, antibiotic stewardship, and febrile infant risk stratification. The second half applies these principles through a discussion of The Pitt Episode 2, focusing on ethical decision-making, paediatric toxicology, mandatory reporting, and airway management in trauma.

Hosts: Shreyas Iyer, Pramod Chandru, Caroline Wilson

Topic: Clinical updates in cardiology, antimicrobial stewardship, and febrile infants, followed by a case-based discussion of The Pitt Episode 2.

Episode Timestamps

• 00:00 – Intro
• 02:04 – Cardiology update: ACS, OMI concepts
• 10:28 – AI ECG (Queen of Hearts)
• 18:42 – Antibiotic duration
• 26:10 – Febrile infants (61–90 days)
• 35:23 – The Pitt Episode 2 recap
• 39:50 – End-of-life care
• 46:30 – Paediatric THC ingestion
• 54:40 – Mandatory reporting
• 1:02:10 – Airway management in trauma

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References & Resources (in order of discussion)

1. Heart Foundation & CSANZ (2025) – ACS Guideline

New Australian clinical guideline for diagnosing and managing acute coronary syndromes 2025

• Referenced during ACS discussion; outlines modern troponin and risk pathways.

2. AI ECG (Queen of Hearts)

Shroyer S, Mehta S, Thukral N, Smiley K, Mercaldo N, Meyers HP, Smith SW. Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs. AI (Queen of Hearts by PMcardio). Am J Emerg Med. 2025 Nov;97:193-199.

• Validation study of Queen of Hearts AI detecting occlusion MI.

3. Antibiotic duration

Zahavi I, Kunwar D, Olchowski J, Dallasheh H, Paul M. Short vs. long antibiotic treatment for pyelonephritis and complicated urinary tract infections: a living systematic review and meta-analysis of randomized controlled trials. Clin Microbiol Infect. 2025 Aug;31(8):1263-1271. 

• Short-course antibiotics non-inferior for pyelonephritis.

4. Febrile infants (61–90 days) – Low risk

Aronson PL, Mahajan P, Meeks HD, Nielsen B, Olsen CS, Casper TC, Grundmeier RW, Kuppermann N; PECARN Registry Working Group. Prediction Rule to Identify Febrile Infants 61-90 Days at Low Risk for Invasive Bacterial Infections. Pediatrics. 2025 Sep 1;156(3):e2025071666.

• Low-risk stratification for febrile infants.

5. Febrile infants (61–90 days) – Respiratory viruses

Aronson PL, Mahajan P, Nielsen B, Olsen CS, Meeks HD, Grundmeier RW, Kuppermann N; PECARN Registry Working Group. Risk of Bacterial Infections in Febrile Infants 61 to 90 Days Old With Respiratory Viruses. Pediatrics. 2025 Jul 1;156(1):e2025070617.

• Lower bacterial infection risk in viral-positive infants.

6. Febrile infants (61–90 days) – 2021

Pantell RH, Roberts KB, Adams WG, Dreyer BP, Kuppermann N, O’Leary ST, Okechukwu K, Woods CR Jr; SUBCOMMITTEE ON FEBRILE INFANTS. Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics. 2021 Aug;148(2):e2021052228

• Foundational AAP febrile infant guideline.

7. Paediatric THC ingestion

Wang GS, Le Lait MC, Deakyne SJ, Bronstein AC, Bajaj L, Roosevelt G. Unintentional Pediatric Exposures to Marijuana in Colorado, 2009-2015. JAMA Pediatr. 2016 Sep 6;170(9):e160971

• Paediatric cannabis toxicity data.

8. NSW Mandatory Reporter Guide

• The Mandatory Reporter Guide (MRG)
• Framework for reporting child safety concerns.

9. Difficult Airway Society Guidelines

• DAS guidelines for management of unanticipated difficult intubation in adults
• Principles of difficult airway management.

10. ATLS – American College of Surgeons

• Advanced Trauma Life Support
• Trauma airway management principles.

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