Resuscitation
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Applying adult learning principles in healthcare education is increasingly recognised as useful and effective. We designed and evaluated an educational package for medical student basic life support (BLS) skills that placed the responsibility of skill acquisition with the learner. The package provided hardcopy and web based information, an in-house produced audio-video tape demonstrating BLS, and open access to manikins in a Skills Centre where the students learnt in pairs. ⋯ Where failure occurred, it was due to inadequate student learning in the Skills Centre. The importance of practice needs emphasis in future use of the programme, as does the virtual guarantee of success, if all steps are followed. A similar programme could be devised for other technical skills.
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Because children have less subcutaneous fat, and a higher surface area to body weight ratio than adults, it has been suggested that children cool more rapidly during submersion, and therefore have a better outcome following near-drowning incidents. ⋯ Although submersion time is usually an estimate, it is the best prognostic factor after a near drowning incident. Children did not have a better outcome than adults.
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Case Reports
Cold water submersion and cardiac arrest in treatment of severe hypothermia with cardiopulmonary bypass.
In the paediatric population, submersion injury with drowning or near-drowning represents a significant cause of morbidity and mortality. This study reviews retrospectively our own experiences and the literature on the use of cardiopulmonary bypass (CPB) to rewarm paediatric victims of cold water submersion who suffer severe hypothermia (<28 degrees C) and cardiac arrest (asystole or ventricular fibrillation). In addition to three children treated at our institution, nine other victims were found in the literature. ⋯ Compared with adults, children, especially smaller ones, require special consideration with regard to intravenous cannulation as drainage can be inadequate using femoral-femoral cannulation. In hypothermic children we advocate, therefore, emergency median sternotomy. Until more information regarding prognostic factors are available, children who are severely hypothermic and clinically dead after submersion in cold water--even if for an unknown length of time--should receive cardiopulmonary resuscitation (CPR) and be transported without delay to a facility with capabilities for CPB instituted via a median sternotomy.
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Biography Historical Article
James Blundell: the first transfusion of human blood.