Annals of emergency medicine
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CPR in infants and children has a number of unique clinical, legal, and ethical aspects. The distinguishing clinical aspects relate to the circumstances of pediatric cardiopulmonary arrest and their prognostic implications. The relevant legal and ethical considerations derive from the special triadic physician-child-parent relationship, the standing of parents as surrogate decision makers, and the progressive development of decisional capacity in maturing children. This paper discusses the implications of guidelines and policies concerning decisions to provide, withhold, or withdraw CPR and life support systems.
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CPR has been incorporated into emergency cardiac care with the evolution of both basic and advanced life support components. To date, however, the psychological issues associated with these skills have not been addressed. ⋯ This paper describes ongoing research on the impact of CPR on the rescuer, discusses a method of talking to families after a loved one has suddenly died, and provides insights into the psychological dysfunctions that emergency personnel may be exposed to. The technique and importance of critical incident debriefing following an unsuccessful CPR attempt is discussed.
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At present, fewer than 10% of cardiopulmonary resuscitation (CPR) attempts prehospital or in hospitals outside special care units result in survival without brain damage. Minimizing response times and optimizing CPR performance would improve results. A breakthrough, however, can be expected to occur only when cerebral resuscitation research has achieved consistent conscious survival after normothermic cardiac arrest (no flow) times of not only five minutes but up to ten minutes. ⋯ More than ten drug treatments evaluated have not reproducibly mitigated brain damage in such animal models. Controlled clinical trials of novel CPCR treatments reveal feasibility and side effects but, in the absence of a breakthrough effect, may not discriminate between a treatment's ability to mitigate brain damage in selected cases and the absence of any treatment effect. More intensified, coordinated, multicenter cerebral resuscitation research is justified.
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Review
Pediatric resuscitation pharmacology. Members of the Medications in Pediatric Resuscitation Panel.
The goal of resuscitation pharmacology is to restart the heart as quickly as possible while preserving vital organ function during chest compression. Unfortunately, the application of advanced life support to pediatric cardiac arrest patients is often unsuccessful. The goal of this paper is to review the scientific rationale and educational considerations used to derive the guidelines for medication use in the pediatric patient during CPR. ⋯ This includes the use of high-dose epinephrine, calcium, bicarbonate, and other buffer agents such as Carbicarb and THAM. Animal models simulating the etiology and pathophysiology of pediatric arrest also are needed. In both clinical and animal studies, neurologic outcome and long-term survival should be assessed rather than simply the rate of restoration of spontaneous circulation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of intramuscular meperidine and promethazine with and without chlorpromazine: a randomized, prospective, double-blind trial.
To compare the effectiveness of intramuscular meperidine (2 mg/kg) and promethazine (1 mg/kg) with chlorpromazine (MPC) or without chlorpromazine (MP) (1 mg/kg) for sedation of children undergoing emergency department procedures. ⋯ Elimination of chlorpromazine from the IM combination of meperidine and promethazine for pediatric sedation during ED procedures results in a significant reduction in efficacy.