Annals of emergency medicine
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Comparative Study
Clinical decisionmaking based on venous versus capillary blood gas values in the well-perfused child.
In children aged 1 month to 18 years, we sought to examine the correlation between venous and arterialized capillary blood gas values, and to determine whether the source of blood sample influenced the interpretation of the acid-base status and clinical management. ⋯ In the well-perfused patient, we believe that venous samples are an acceptable alternative to capillary blood samples for determination of blood gas values and for making clinical management decisions.
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No large study has addressed whether parents want to be present when invasive procedures are performed on their children in the emergency department. We conducted a survey to address this question. ⋯ Most parents surveyed would want to be present when invasive procedures are performed on their children. With increasing procedural invasiveness, parental desire to be present decreased. However, most parents would want to be in attendance if their child were likely to die, and nearly all parents want to participate in the decision about their presence.
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[McCollough M: Progress toward eliminating Haemophilus influenzae type b disease among infants and children-United States, 1987-1997 [commentary]. Ann Emerg Med July 1999;34:110-111.]
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Early countershock of ventricular fibrillation (VF) has been shown to improve immediate and long-term outcome of out-of-hospital cardiac arrest. However, studies indicate that countershock of prolonged VF most commonly results in asystole or a nonperfusing bradyarrhythmia (pulseless electrical activity [PEA]), which rarely respond to current therapy. The cause of these postcountershock rhythm disturbances is not well understood but may be related to electrical injury of the globally ischemic myocardium or to local metabolic abnormalities that impair impulse formation and cardiac contraction. The purpose of this study was to evaluate changes in serum potassium and free calcium homeostasis during cardiac arrest and advanced cardiac life support (ACLS) interventions. ⋯ Ionized hypocalcemia and hyperkalemia occur during prolonged resuscitative efforts and may be related to dysfunctional transcellular ionic transport mechanisms. These cations play important roles in cardiac electrical and contractile activity and may play a role in refractory postcountershock rhythm disturbances.