Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2011
Case ReportsRescue treatment with terlipressin in different scenarios of refractory hypotension in newborns and infants.
Terlipressin has been successfully used as rescue treatment in hypotensive adults and children with septic shock, but only exceptionally in neonates. The aim of this study is to describe original clinical scenarios in which terlipressin, in newborns and infants, resolved the catecholamine-refractory hypotension. ⋯ Although the number of reported infants is little, terlipressin appears to be an effective rescue treatment in different scenarios of refractory neonatal hypotension. Further controlled studies are required to confirm its efficacy and safety.
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Pediatr Crit Care Me · Nov 2011
Pediatric emergency mass critical care: focus on family-centered care.
Pediatric emergency mass critical care during disasters requires modifications to standard healthcare operations. Modification of standards for pediatric emergency mass critical care should include incorporation of family-centered care principles. Family-centered care, which is an integral aspect of current pediatric practice, encourages active participation of the child's family in medical care delivery. While family-centered care should be practical in most disasters, whether we can operationalize it in pediatric emergency mass critical care is unknown. However, every effort to adhere to the principles should be made. This manuscript addresses some of the basic tensions that exist between creating efficient disaster-related standards and offering family-centered care by augmenting the concepts outlined elsewhere in the supplement with practical suggestions on incorporating family-centered care. In addition, this manuscript demonstrates how family-centered care benefits not only children and families, but also the staff providing care to pediatric patients in disasters. ⋯ This paper offers a list of practical suggestions for incorporating family-centered care principles into each of the following healthcare settings during a disaster, including a pediatric emergency mass critical care event: emergency medical services transport, emergency departments, pediatric intensive care units, general pediatric wards, and alternative sites. Disaster and pediatric emergency mass critical care responses must incorporate family-centered care principles to the extent possible in a variety of healthcare settings.
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Pediatr Crit Care Me · Nov 2011
Treatment and triage recommendations for pediatric emergency mass critical care.
This paper will outline the Task Force recommendations regarding treatment during pediatric emergency mass critical care, issues related to the allocation of scarce resources, and current challenges in the development of pediatric triage guidelines. ⋯ Recommendations are divided into three operational sections. The first section provides pediatric emergency mass critical care recommendations for hospitals that normally provide care to pediatric patients. The second section provides recommendations for pediatric emergency mass critical care at hospitals that do not routinely provide care to pediatric patients. The final section provides a discussion of issues related to developing triage algorithms and protocols and the allocation of scarce resources during pediatric emergency mass critical care.
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An emergency mass critical care event puts significant strains on all healthcare resources, including equipment, supplies, and manpower; it leads to extraordinary stresses on healthcare providers, many of whom will be expected to deliver care outside of their usual scope of practice. Education and educational resources will be critically important for training providers and diminishing the stress, anxiety, and chaos of delivering pediatric emergency mass critical care. This article suggests educational tools, as well as potential resources, that need to be developed to cope with a pediatric emergency mass critical care event. ⋯ Identifying educational needs to prepare for a pediatric emergency mass critical care event is essential for all healthcare organizations. Educational strategies and tactics should be developed at multiple levels for a comprehensive approach to preparing for pediatric emergency mass critical care.
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Pediatr Crit Care Me · Nov 2011
Intracranial pressure monitoring in childhood meningitis with coma: a national survey of neurosurgeons in the United States.
To describe the beliefs and attitudes of U.S. neurosurgeons regarding the use of intracranial pressure monitors among comatose children with meningitis. ⋯ Most neurosurgeons are willing to consider monitoring intracranial pressure among comatose children with meningitis in the presence of abnormal findings on computed tomography scan and with older patient age. These findings are instructive in view of the current uncertainty and equipoise in clinical practice regarding intracranial pressure monitoring in these critically ill children.