Cardiology clinics
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Advances in cancer therapies have significantly improved patient outcomes. However, with improvements in survival, the toxicities associated with cancer therapy have become of paramount importance and oncologists are faced with the challenge of establishing therapeutic efficacy while minimizing toxicity. Cardiovascular disease represents a significant risk to survivors of childhood cancer and is a major cause of morbidity and mortality. This article outlines the current state of knowledge regarding cardiotoxicity in children undergoing cancer therapies, including the impact of specific oncologic therapies, recommendations for cardiovascular screening, the management of established cardiac disease, and the evolving field of pediatric cardio-oncology.
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The post-cardiac arrest syndrome is a highly inflammatory state characterized by organ dysfunction, systemic ischemia and reperfusion injury, and persistent precipitating pathology. Early critical care should focus on identifying and treating arrest etiology and minimizing further injury to the brain and other organs by optimizing perfusion, oxygenation, ventilation, and temperature. Patients should be treated with targeted temperature management, although the exact temperature goal is not clear. No earlier than 72 hours after rewarming, prognostication using a multimodal approach should inform discussions with families regarding likely neurologic outcome.
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Much of the current evidence and many of the recent treatment recommendations for increasing survival from cardiac arrest revolve around improving the quality of cardiopulmonary resuscitation during resuscitation. A focus on providing treatments proved beneficial and providing these treatments reliably, using measurement, monitoring, and implementation of quality-improvement strategies, will help eliminate variation in outcomes and provide a foundation from which future improvements in resuscitation care can be developed. Using the knowledge and tools available today will help reduce the ambiguity and variability that exists in resuscitation today and provide the ability to save more lives in communities.
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High-quality cardiopulmonary resuscitation, in particular chest compressions, is a key aspect of out-of-hospital cardiac arrest (OHCA) resuscitation. Manual chest compressions remain the standard of care; however, the extrication and transport of patients with OHCA undermine the quality of manual chest compressions and risk the safety of paramedics. Therefore, in circumstances whereby high-quality manual chest compressions are difficult or unsafe, paramedics should consider using a mechanical device. By combining high-quality manual chest compressions and judicious application of mechanical chest compressions, emergency medical service agencies can optimize paramedic safety and patient outcomes.
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Ventricular fibrillation (VF) is the most commonly encountered arrhythmia following out-of-hospital cardiac arrest. Previous studies have demonstrated early defibrillation and bystander cardiopulmonary resuscitation as essential in reducing patient mortality. ⋯ This article provides a discourse regarding refractory VF, and a review of double sequential defibrillation literature. Further study is required before the recommendation for widespread implementation of this defibrillation technique.