J Emerg Med
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Application of the sepsis resuscitation bundle is limited by clinician knowledge, skills, and experience. We used the adjusted first-hour basic care tasks in pediatric patients in three tertiary hospitals in Shanghai, China. ⋯ In situ simulation team training is an effective method of teaching the tasks of septic shock care to clinicians and nurses on the front line and of improving the compliance of the tasks.
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With increased concussion awareness and significantly increased numbers of emergency department (ED) visits for pediatric concussion, a seamless process of managing a patient with a concussion can begin in the ED. ⋯ This article demonstrates the effectiveness of the Remove-Reduce/Educate/Adjust-Accommodate/Pace (REAP) concussion management program in the evaluation, management, and return to play of an acutely concussed pediatric patient. The REAP program was developed in Colorado and promotes a multidisciplinary team approach to concussion management. The team consists of parents, teachers, athletic personnel, and clinicians. The patient described in this case report had concussion management initiated in the ED. He was able to successfully return to sports, having recovered from his concussion with the guidance of the Center for Concussion (Centennial, Colorado) staff utilizing the REAP model of care and the currently recommended graduated return-to-play process. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Busy EDs are often the initial point of contact for school-aged patients with concussion. We present a program that we believe represents a good model of patient care with concussion management implemented in the ED and carried through to clearance of the patient.
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The loss of pulses after successful return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) is known as rearrest (RA). The causes of RA are not well understood. ⋯ Shock pause length was inversely associated with RA when shock pause intervals were limited to 30 s or less. Shock pauses and RA were not associated when all durations of shock pauses were considered.