Journal of pediatric surgery
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Cardiopulmonary resuscitation (CPR) occasionally is necessary in the operating-room setting. In such instances, it may be difficult to perform CPR if the patient is in the prone position. ⋯ Successful CPR was performed with the patient in the prone position, with the use of "reversed precordial compressions," and the patient was resuscitated despite 7 minutes of asystole. Effective cardiac output was maintained and was confirmed by systolic blood pressure readings of 80 to 90 mm Hg on both the arterial catheter waveform and the noninvasive blood pressure cuff, by a waveform and the reading on the pulse oximeter, and by the presence of end-tidal carbon dioxide.
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Tracheobronchial tree injuries occur in a small number of patients after blunt chest trauma, and their occurrence is even more uncommon in the pediatric trauma population. The authors present the case of a 2-year-old boy who presented with rupture of the trachea and disruption of the right upper lobe bronchus and bronchus intermedius.
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A 10-year-old girl had hemobilia and a biliocutaneous fistula after blunt abdominal trauma. Embolization of the right hepatic artery occluded the hepatic artery aneurysm, but the cutaneous biliary fistula persisted despite prolonged (8 months) conservative management including sphincter decompression with an endoscopically placed biliary stent. Roux-en-Y fistuloenterostomy eventually cured the bile leak.
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Case Reports
Intrapleural instillation of urokinase in the treatment of loculated pleural effusions in children.
The authors report on the use of intrapleural instillation of urokinase in the treatment of loculated pleural effusions in two pediatric patients. Urokinase helps to lyse fibrin by converting plasminogen to plasmin. The intrapleural instillation of urokinase is safe and effective for promoting drainage of loculated intrapleural effusions, and it proved a useful option in the treatment of persistent loculations.