Annals of emergency medicine
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The concept of the chain of survival for children has been extended to include prevention, bystander CPR, prehospital CPR, and acute care. Two clinical cases are presented as examples. The current status and possible weaknesses in each link of the chain are discussed, and suggestions are made for possible research initiatives.
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Medication usage in neonatal resuscitation has been largely extrapolated from adult resuscitation guidelines. Compared to older children and adults, newborn infants have major anatomical and physiological differences which affect their need for and response to medications during resuscitation. This article discusses some of these differences, highlights the discussion of the Emergency Cardiac Care Panel for Neonatal Pharmacology, lists the recommendations of the panel to the Emergency Cardiac Care Committee, and discusses areas of future research in neonatal resuscitation.
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Submersion injury is so often lethal because it inflicts severe hypoxia. To prevent hypoxic end-organ damage to the heart and brain, the goals of resuscitation are immediate ventilation and oxygenation. Issue 1: Should submersion victims receive the Heimlich maneuver? The pathophysiologic assumptions for this intervention are that water in the airway is obstructive, thus precluding ventilation, and that aspiration of water is the major injury. ⋯ With inadequate data to support benefit from the Heimlich maneuver and concern that the Heimlich maneuver would delay initiation of ventilation, basic life support procedures are recommended in managing the airway of the submersion victim. Issue 2: What is the role of prehospital care? Outcomes of submersion victims treated with rapid, aggressive prehospital care show that the window for medical intervention for the submersion victim is in the prehospital setting, not in the emergency department or intensive care unit. The submersion victim should be provided advanced cardiac life support, including intubation as needed, as soon as possible.
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Significant hypothermia is an increasing clinical problem that requires a rapid response with properly trained personnel and techniques. Although the clinical presentation may be such that the victim appears dead, aggressive management may allow successful resuscitation in many instances. Initial management should include CPR if the victim is not breathing or is pulseless. ⋯ In-hospital management should consist of rapid core rewarming in the severely hypothermic victim with heated humidified oxygen, centrally administered warm IV fluids (43 C), and peritoneal dialysis until extracorporeal rewarming can be accomplished. Postresuscitation complications should be monitored; they include pneumonia, pulmonary edema, cardiac arrhythmias, myoglobinuria, disseminated intravascular thrombosis, and seizures. The decision to terminate resuscitative efforts must be individualized by the physician in charge.
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Comparative Study
An experimental algorithm versus standard advanced cardiac life support in a swine model of out-of-hospital cardiac arrest.
To compare an experimental algorithm with standard advanced cardiac life support in a swine model of out-of-hospital cardiac arrest. ⋯ In this swine model of out-of-hospital cardiac arrest, animals treated with an experimental algorithm had a significant improvement in one-hour survival compared with those treated with advanced cardiac life support.