CJEM Articles: resuscitation
Displaying 1-8 of 8 results
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March
2011
13
2
F. Jonathan Guilfoyle, Niranjan Kissoon, Ruth Milner
Objective:To describe the frequency and proportion of successful resuscitation interventions in a pediatric emergency department (PED).
Methods and Material:This was a retrospective chart review of children at the BC Children's Hospital (BCCH) PED who were admitted to the BCCH pediatric intensive care unit (PICU) in 2004 and 2005. Demographic data, diagnosis, and resuscitation interventions in the PED and within the first 24 hours of PICU admission were recorded. The training of the operator and the number of attempts needed were also recorded.
Results:There were 75,133 PED visits; 304 of 329 (92.4%) who met inclusion criteria were reviewed. Diagnoses included respiratory distress (n = 115, 35%), trauma (n = 50, 15%), sepsis (n = 36, 11%), seizures (n = 37, 11%), and cardiac disease (n = 22, 7%). Ninety-nine patients required intubation. Intubations in the PED were performed by residents (20%), pediatric emergency medicine (PEM) fellows (15%), PEM attending staff (29%), and PICU fellows (12%); 81% of these were successful on the first attempt. In the PED, seven central lines were placed, seven intraosseous needles were inserted, 15 patients required inotropes, and 9 patients required chest compressions.
Conclusion:Critical illness in our emergency department is a rare event; hence, opportunities to resuscitate, secure airways, and place central venous catheters are limited. Additional training, close working relationships between the PED and the PICU teams, and resuscitation protocols for early PICU involvement may be needed. -
January
2010
12
1
L. McIntyre, P.J. Zed, Reviewed by: R.S. Green
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September
2008
10
5
Daniel Howes, David Easton, Dennis Djogovic, Edward Patterson, Jonathan S. Davidow, Peter G. Brindley, Robert S. Green, Robert Stenstrom, Sara Gray
Introduction: Optimal management of severe sepsis in the ED has evolved rapidly. The purpose of these guidelines is to review key management principles for Canadian emergency physicians, utilizing an evidence-based grading system.
Methods: Key areas in the management of septic patents were determined by members of the CAEP Critical Care Interest Group (C4). Members of C4 were assigned a question to be answered after literature review, based on the Oxford grading system. After completion, each section underwent a secondary review by another member of C4. A tertiary review was conducted by additional external experts, and modifications were determined by consensus. Grading was based on peer-reviewed publications only, and where evidence was insufficient to address an important topic, a "practice point" was provided based on group opinion.
Results: The project was initiated in 2005 and completed in December 2007. Key areas which were reviewed include the definition of sepsis, the use of invasive procedures, fluid resuscitation, vasopressor/inotrope use, the importance of culture acquisitionin the ED, antimicrobial therapy and source control. Other areas reviewed included the use of corticosteroids, activated protein C, transfusions and mechanical ventilation.
Conclusion: Early sepsis management in the ED is paramount for optimal patient outcomes. The CAEP Critical Care Interest Group Sepsis Position Statement provides a framework to improve the ED care of this patient population. -
January
2006
8
1
Michael Shuster
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January
2005
7
1
Andrew Worster, Christopher M.B. Fernandes, Suneel Upadhye
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November
2004
6
6
Angelo Mikrogianakis, Rahim Valani, Ran D. Goldman
Blunt chest trauma in pediatric patients can result in various injuries to the myocardium. Cardiac concussion (commotio cordis) is seen in patients in whom the precordium has been struck with relatively little force at a vulnerable period of the cardiac cycle. These patients have no predisposing cardiac problems, and autopsy reveals no evidence of heart damage. The usual clinical presentation is that of immediate collapse secondary to a lethal arrhythmia. Prevention is the cornerstone of potentially decreasing the incidence with the aid of safety equipment and, possibly, immediate defibrillation.
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November
2004
6
6
Lance Brown
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January
2000
2
1
Cheri Nijssen-Jordan
Objective: To determine the frequency of use and the success rates of intraosseous (IO) vascular access in the emergency department.
Design: A retrospective chart review.
Setting: A tertiary pediatric emergency department (ED) in a large urban centre.
Methods: ED resuscitations (ICD-9 code 996) occurring between Oct. 1, 1989, and Sept. 30, 1995, were identified by searching the ED database, inpatient database, ICU admission log and provincial medical examiner's database. From these, all cases involving IO access were selected and comprised the study sample. Demographics, diagnosis, number of IO attempts, success or failure of IO placement, relevant times and patient outcomes were recorded on standard data forms. Frequency of use, success rates and performance times were reported.
Results: IO access was successful in 36 of 42 (86%) patients. In total, there were 68 attempts, or 1.6 attempts per child. All but one child were less than 3 years of age. The median time to successful IO placement was 8 minutes. Two complications, both fractures, occurred in one patient, a 10-day-old neonate.
Conclusions: IO success rates were high despite infrequent use.
