Resuscitation
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Rapidly determining whether an unresponsive child is in cardiac arrest or in shock, and requiring cardiopulmonary resuscitation can be problematic. The pulse check in children has been shown to be unreliable, not only for laypersons, but also for healthcare providers. The recommendation for checking the pulse in unresponsive children has been eliminated for laypersons in the latest edition of the Emergency Cardiovascular Care guidelines. ⋯ The decision to end resuscitation in children, often an emotionally charged situation, can also be particularly difficult for physicians. Information from focused point-of-care echocardiography that allows for correlation with the presence or absence of a pulse and real time assessment of resuscitation may help direct and optimize the delivery of resuscitative interventions. We report our preliminary clinical observations of using focused point-of-care echocardiography to correlate with the pulse check during resuscitation in a series of pediatric cardiac arrests.
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There is no up-to-date literature review of physiologically based, aggregate weighted 'track and trigger' systems (AWTTS) and few data on their predictive ability for serious adverse outcomes. The aim of this study was to describe the AWTTS in clinical use and assess their ability to discriminate between survivors and non-survivors of hospital admission, based on an initial set of vital signs. ⋯ There is a wide range of unique, but very similar, AWTTS in clinical use. There is no consistency regarding their physiological components, but the majority differ only in minor variations in the weightings for physiological derangement and/or the cut-off points between physiological weighting bands. The performance of most systems tested was poor when used to discriminate between survivors and non-survivors, although 36% discriminated reasonably well. Our results suggest that physiology can be used to predict outcome, but that further work is required to improve the AWTTS models.