The American journal of emergency medicine
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Vascular access during advanced life support is essential. Vascular access in the critically ill child can be particularly difficult and often causes unacceptable delay. ⋯ A case is presented illustrating the value of familiarity with this procedure. Use of the bone marrow for emergency administration of fluids and medications should be considered early in resuscitation until vascular access is obtained.
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Transcutaneous cardiac pacing has recently been rediscovered as a rapid means of initiating emergency cardiac pacing. Potential myocardial injury from extended transcutaneous pacing could adversely affect cardiac hemodynamics during pacing. This canine study compares the hemodynamics of transcutaneous and transvenous cardiac pacing in animals with induced chronic heart block. ⋯ A hemodynamic difference between pacing techniques was evident only for mean arterial blood pressure; pressure measurements during transvenous pacing were slightly greater than those during transcutaneous cardiac pacing. The hemodynamic measurements were found to be stable during a 60-minute period of transcutaneous cardiac pacing. This study demonstrates that transcutaneous cardiac pacing is as effective hemodynamically as conventional transvenous pacing in animals with induced chronic heart block.