Annals of emergency medicine
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CPR in infants and children has a number of unique clinical, legal, and ethical aspects. The distinguishing clinical aspects relate to the circumstances of pediatric cardiopulmonary arrest and their prognostic implications. The relevant legal and ethical considerations derive from the special triadic physician-child-parent relationship, the standing of parents as surrogate decision makers, and the progressive development of decisional capacity in maturing children. This paper discusses the implications of guidelines and policies concerning decisions to provide, withhold, or withdraw CPR and life support systems.
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Comparative Study
An experimental algorithm versus standard advanced cardiac life support in a swine model of out-of-hospital cardiac arrest.
To compare an experimental algorithm with standard advanced cardiac life support in a swine model of out-of-hospital cardiac arrest. ⋯ In this swine model of out-of-hospital cardiac arrest, animals treated with an experimental algorithm had a significant improvement in one-hour survival compared with those treated with advanced cardiac life support.
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To compare infusion rates from various intraosseous sites (tibial, medial malleolar, distal femoral, and humeral) and at a peripheral IV site under gravity and pressure flow in normovolemic and hypovolemic states. ⋯ Intravenous access is the most efficacious method of acute volume replacement. Intraosseous sites differ in the infusion rates obtained--descending order is humerus, femur, malleolus, and tibia, but each is a reasonable alternative for short-term vascular access.
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To test the hypothesis that two-thumb chest compression generates higher arterial and coronary perfusion pressures than the current American Heart Association-approved two-finger method. ⋯ The two-thumb method of chest compression generates significantly higher arterial and coronary perfusion pressures than the two-finger method in this infant model of cardiac arrest.
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To examine the cardiovascular toxicity of calcium channel blockers and the efficacy of various treatments. ⋯ Atrioventricular nodal depression is more common with verapamil overdoses. Calcium and dopamine are useful in treating toxicity from calcium channel blocker overdose, whereas atropine is sometimes useful.