Articles: critical-care.
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Several factors increase the difficulty and urgency of airway management in children in the emergency setting. Early and appropriate airway management are of prime importance in improving the outcome of such patients. The major decision points of airway management include one's assessment of the airway and ability to perform endotracheal intubation. ⋯ Regardless of the technique chosen, appropriate personnel and preparation are mandatory to ensure the safe and effective management of the airway in the pediatric trauma patient. Due to the various skills and expertise of different subspecialists, a multidisciplinary approach to such patients is recommended. Such an approach may include pediatricians, emergency room physicians, surgical subspecialists, anesthesiologists, and critical care physicians.
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Pediatric cardiac emergencies require very specific treatment in the emergency room setting. Considering the possibility of a cardiac problem as the cause for the presenting symptoms is the initial step in successful management. Many patients present with what is initially considered a primary pulmonary disorder such as pneumonia, asthma, or bronchiolitis. ⋯ Supraventricular tachycardia is a frequent arrhythmia, especially in young children. If the patient is unstable, immediate intravenous administration of adenosine or synchronized cardioversion are the initial interventions. In stable patients, vagal maneuvers may be attempted to abort the arrhythmia.
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Induced hypothermia as adjunctive therapy has been the subject of considerable research interest and debate for over fifty years. Recently the first prospective randomized controlled trials were undertaken in humans with severe traumatic brain injury, with supportive results. Another prospective controlled study of induced hypothermia in severe septic adult respiratory distress syndrome also suggested improved outcome. ⋯ In addition, hypokalaemia, prolonged clotting times and neutropenia may occur. The evidence that induced hypothermia may be hazardous is mostly drawn from the literature on accidental hypothermia occurring in trauma, or patients with sepsis. It is likely that further trials will be conducted and if benefit is confirmed, induced hypothermia may become more widely used in selected patients in the intensive care unit.
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Arch Neurol Chicago · Jun 1996
Detection of nontraumatic comatose patients with no benefit of intensive care treatment by recording of sensory evoked potentials.
To determine the predictive ability of sensory evoked potential recordings in nontraumatic comatose patients. To evaluate the hypothesis that patients with bilateral absent cortical responses ultimately die despite long-term intensive care treatment. ⋯ Recording of sensory evoked potentials identifies a subgroup of adult nontraumatic comatose patients with a mortality rate of 100% in our sample. In these patients, advanced intensive care treatment should be withdrawn to provide limited ICU resources for patients with higher probability of favorable outcome. We emphasize that these results are not applicable to comatose patients following closed head trauma and particularly not to children.