Articles: patients.
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Outcome of patients receiving cardiopulmonary resuscitation in the ED of an urban academic hospital.
The success of Closed Chest Cardiopulmonary Resuscitation (CC-CPR) degrades with prolonged times. Open Chest CPR (OC-CPR) is an alternative that may lead to superior coronary and cerebral perfusion. It is critical to determine when continued CC-CPR is unlikely to be successful to justify initiating OC-CPR as rescue therapy. The purpose of this study is to review CC-CPR outcomes to define a time threshold for attempting OC-CPR. ⋯ In patients suffering OHCA and requiring CC-CPR in the ED, overall survival rate to good neurologic function is low. OC-CPR could potentially be attempted after 10 minutes of CC-CPR in the ED.
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Pediatr Crit Care Me · Aug 2016
ReviewHeart Transplantation-The Pediatric Cardiac Critical Care Perspective.
Although there have been tremendous advancements in the care of severe pediatric cardiovascular disease, heart transplantation remains the standard therapy for end-stage heart disease in children. As such, these patients comprise an important and often complex subset of patients in the ICU. The purpose of this article is to review the causes and management of allograft dysfunction and the medications used in the transplant population. ⋯ Pediatric heart transplant recipients represent a complex group of patients that frequently require critical care. Their immunosuppressive medications, while being vital to maintenance of allograft function, are associated with significant short- and long-term complications. Graft dysfunction can occur from a variety of etiologies at different times following transplantation and remains a major limitation to long-term posttransplant survival.
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Randomized Controlled Trial Comparative Study
A deliberately restricted laryngeal view with the GlideScope® video laryngoscope is associated with faster and easier tracheal intubation when compared with a full glottic view: a randomized clinical trial.
During video laryngoscopy (VL) with angulated or hyper-curved blades, it is sometimes difficult to complete tracheal intubation despite a full view of the larynx. When using indirect VL, it has been suggested that it may be preferable to obtain a deliberately restricted view of the larynx to facilitate passage of the endotracheal tube. We used the GlideScope® GVL video laryngoscope (GVL) to test whether deliberately obtaining a restricted view would result in faster and easier tracheal intubation than with a full view of the larynx. ⋯ Using the GVL with a deliberately restricted view of the larynx resulted in faster and easier tracheal intubation than with a full view and with no additional complications. Our study suggests that obtaining a full or Cormack-Lehane grade 1 view may not be desirable when using the GVL. This trial was registered at ClinicalTrials.gov: NCT02144207.
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Pediatr Crit Care Me · Aug 2016
ReviewFunction of the Left and Right Ventricles and the Interactions Between Them.
There has been a recent increase in our understanding of mechanisms whereby the two sides of the heart interact and modulate each other that may be particularly relevant to patients in the ICU. For this review, our objectives are to examine the function of the left ventricle, consider some of the ways in which the function of the right ventricle differs from that of the left, and examine the effects of the left ventricle on the function of the right and vice versa. ⋯ There are fundamental differences between the function of the left and right ventricles, which relate to a significant extent to differences in their respective arterial loads. Although traditionally it has been usual to consider the function of the left and right ventricle in isolation, it is now recognized that this approach is flawed and as a result there is an increasing appreciation of the continual cross talk between the two sides of the heart in both the normal and diseased states. A more rational approach to the use of standard therapies frequently used in the cardiac ICU will come from a better understanding of these important fundamental concepts, and novel therapeutic concepts are already emerging from new data regarding biventricular interactions.
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The objective of the study is to examine the effect of the opening of a freestanding emergency department (FED) on the surrounding emergency medical services (EMS) system through an examination of EMS system metrics such as ambulance call volume, ambulance response times, and turnaround times. ⋯ The opening of an FED was associated with a modest improvement in time-specific EMS system metrics: a decrease in ambulance turnaround time and shorter out-of-service intervals.