Annals of emergency medicine
-
Medication usage in neonatal resuscitation has been largely extrapolated from adult resuscitation guidelines. Compared to older children and adults, newborn infants have major anatomical and physiological differences which affect their need for and response to medications during resuscitation. This article discusses some of these differences, highlights the discussion of the Emergency Cardiac Care Panel for Neonatal Pharmacology, lists the recommendations of the panel to the Emergency Cardiac Care Committee, and discusses areas of future research in neonatal resuscitation.
-
Randomized Controlled Trial Clinical Trial
Dexamethasone as adjuvant therapy for severe acute pharyngitis.
To determine the efficacy of dexamethasone as adjuvant therapy to improve pain relief in patients with severe, acute exudative pharyngitis. ⋯ In patients with severe, acute exudative pharyngitis, single-injection dexamethasone adjuvant compared with placebo resulted in statistically and clinically significant improvement, as evidenced by more rapid onset and greater degree of pain relief.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of intramuscular meperidine and promethazine with and without chlorpromazine: a randomized, prospective, double-blind trial.
To compare the effectiveness of intramuscular meperidine (2 mg/kg) and promethazine (1 mg/kg) with chlorpromazine (MPC) or without chlorpromazine (MP) (1 mg/kg) for sedation of children undergoing emergency department procedures. ⋯ Elimination of chlorpromazine from the IM combination of meperidine and promethazine for pediatric sedation during ED procedures results in a significant reduction in efficacy.
-
Significant hypothermia is an increasing clinical problem that requires a rapid response with properly trained personnel and techniques. Although the clinical presentation may be such that the victim appears dead, aggressive management may allow successful resuscitation in many instances. Initial management should include CPR if the victim is not breathing or is pulseless. ⋯ In-hospital management should consist of rapid core rewarming in the severely hypothermic victim with heated humidified oxygen, centrally administered warm IV fluids (43 C), and peritoneal dialysis until extracorporeal rewarming can be accomplished. Postresuscitation complications should be monitored; they include pneumonia, pulmonary edema, cardiac arrhythmias, myoglobinuria, disseminated intravascular thrombosis, and seizures. The decision to terminate resuscitative efforts must be individualized by the physician in charge.
-
Real-time hemodynamic monitoring provides useful information that can be used to assess and optimize mechanical and pharmacological interventions during CPR. The standard algorithms should always be the initial approach to resuscitation, because they offer a rapid, logical, coordinated series of treatments with proven success. Pressure and flow measurements during conventional, closed-chest CPR in humans indicate that the technique typically produces a hemodynamic state resembling profound cardiogenic shock, with a low systemic arterial pressure, markedly reduced cardiac output, and high intravascular filling pressures. ⋯ If one or more hemodynamic parameters are being monitored at the time the patient develops cardiac arrest (eg, an intensive care unit patient who has an arterial line and a pulmonary artery catheter in place), it is appropriate for the resuscitation team to pay attention to the data that are generated during the resuscitation, particularly if the initial algorithm approach is not successful. For patients who are not being monitored at the time of their arrest, end-tidal carbon dioxide measurements provide noninvasive, semiquantitative information that can help the team detect and troubleshoot problems during resuscitation. Further research and better, more affordable technologies are needed to provide in- and out-of-hospital resuscitation teams feedback on the hemodynamic effectiveness of their resuscitative efforts.