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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Tag: child (Page 1 of 3)

The effect of posture modification during continuous one-handed chest compression: A pilot study using in-hospital pediatric cardiac arrest simulation

Abstract

Background. We modified the posture of the one-handed chest compression (MOHCC) as follows: first, the axis of the rescuer’s compression hand was adjusted to the lower half of the patient’s sternum; second, the opposite hand was wrapped around the elbow joint of the rescuer’s compression arm. This study evaluated the effect of the MOHCC on the mean chest compression depth (MCD) over time.

Methods. Thirty medical doctors conducted 2 min of continuous MOHCC without ventilation using the in-hospital pediatric arrest model (70-cm-high bed, 25-cm-high stepstool, a pediatric manikin and a cardiopulmonary resuscitation (CPR) meter). The MCD and mean chest compression rate (MCR) were measured at 30 s intervals using the Q-CPR review software.

Results. The MCD changed significantly over time (0–30 s, 41.9–44.7 mm; 30–60 s, 40.4–43.6 mm; 60–90 s, 39.2–42.8 mm; 90–120 s, 38.6–42.3 mm; [95% CI], P=0.002). However, it did not decrease significantly between 60–90 s and 90–120 s (P=0.173). The total decrease in MCD was 2.9 mm over a 2 min period. The MCR did not change significantly over time (0–30 s, 108.6–118.9 /min; 30–60 s, 107.9–119.1 /min; 60–90 s, 107.7–119.3 /min; 90–120 s, 107.4–119.0 /min; P=0.800).

Conclusions. Although the MCD changed significantly over a 2 min period, it did not decrease significantly after 90 s during performance of MOHCC. The MOHCC might be considered when the one-handed chest compression (OHCC) is selected as a chest compression method for cardiac arrest in small children.

Key words: cardiopulmonary resuscitation, cardiac arrest, child, fatigue

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Biomarkers of sepsis in neonates and children

Abstract

Sepsis, and related complications, is still a common cause of death in hospitalized patients worldwide, especially in critically ill neonates and children. Sepsis is also responsible for significant morbidity, and financial burden. It is very important to recognize sepsis early, since delayed diagnosis is associated with worse outcome. The early detection of sepsis remains a great challenge for clinicians because the use of blood cultures, the gold standard for diagnosis of bacteremia, is fraught with difficulties. The role of different immune and metabolic biomarkers is to improve the diagnosis, treatment and prognosis of sepsis. White blood cell count, C-reactive protein and procalcitonin are currently the most widely used biomarkers, but they have limited abilities to distinguish sepsis from other inflammatory conditions or to predict outcome. In this review, these biomarkers will be discussed along with novel diagnostic, prognostic and treatment response biomarkers, including interleukins -6, -8, -18, tumor necrosis factor – alpha, CD11b, CD64 and CD15s. The future of sepsis biomarkers lies in extensive validation studies of all novel biomarkers and their combinations as early predictors of sepsis. Also, research to identify novel sepsis biomarkers and develop specific therapeutic strategies based on biomarker information has to be continued.

Key words: infant, child, biomarkers, CD15s antigen, C-reactive protein, procalcitonin

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Acute intoxication and poisoning in children: the experience of a tertiary-care hospital from 2001-2012

Abstract

The frequency and distribution of acute intoxications and poisoning from non-pharmacological substances in children was evaluated in this observational-descriptive study. This was done by analyzing all admissions to the Emergency Room of our University in Rome during the period 1st January 2001 to 31st December 2012. We found 249 patients aged 0-14 years: 147 males and 102 females. The highest incidence occurred in the first 4 years of life: 44.2% in the 1-2 year age-group. Cases were mostly related to solvents (44.6%), natural products (17.7%), agricultural products (12.9%), corrosive acids and alkaline caustics (14.8%). Most admissions occurred during the time slot 18:00 to 21:00 (23.7%). No clinical symptoms were observed in 116 children (46.6% of the total), and physical examination was unrevealing. The remaining 133 displayed nausea/vomiting (22%) and pharyngeal hyperemia (18.8%). Laboratory tests and imaging studies were only performed in selected cases. In terms of consulting requests, the Poisons Center was contacted 156 times (62.6% of cases), the Pediatric Intensive Care Unit 38 times (15.2%), and the surgeon-endoscopist 18 times (7.2%). A short period of observation and monitoring in the Emergency Room was warranted in 106 children (42.5%). Gastroprotective drugs were used in 75 cases (30.1%) and activated charcoal in 18 (7.2%). Nintey-five children (38.2%) were admitted to the pediatric department , but no complications occurred. Targeted information programs in schools and during pediatric check-ups should decrease the risk of ingestion of non-pharmacological substances in children, and the costs of its management.

Key words: intoxication, poisoning, child

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Carbamazepine overdose presenting as a diabetes insipidus – like condition in a child

Abstract

Carbamazepine is a commonly used antiepileptic medication. In overdoses it can produce various side effects involving neurological, cardiac, hematological and endocrinal systems. Inappropriate secretion of Anti Diuretic Hormone (ADH) is a well-known complication of carbamazepine toxicity. We are reporting an unusual complication in an adolescent girl with intentional carbamazepine overdose. A sixteen year old female with carbamazepine ingestion presented to our hospital with altered sensorium. On admission she was found to have a very high serum carbamazepine level and metabolic acidosis. In contrast to the possible inappropriate secretion of ADH, as an adverse effect of carbamazepine, her hospital course was complicated with a diabetes insipidus – like condition following treatment with multiple doses of activated charcoal and sodium bicarbonate therapy.

Key words: Carbamazepine, Diabetes Insipidus, activated charcoal, child

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The most common conditions in children that require haemodialysis

Abstract

Haemodialysis is a fast and efficient method for removing toxins from the body in a straightforward manner. This has been a regular practice at the Paediatric Clinic in Sarajevo, Department of Paediatric Intensive Therapy since January 2009. By December 2014 there were 34 patients treated by haemodialysis, who had undergone 253 haemodialyses in total. There were 18 (52.9%) primary nephrologic patients, while 16 (41.05%) were patients whose renal failure was caused by other etiology. The main objective of this paper is to present the most common conditions in childhood that require haemodialysis in its treatment. The Department of Paediatric Intensive Therapy for this period had hospitalized 1,226 patients in total. Out of this number 2.77% of patients required the application of haemodialysis in their treatment.

The results show that the most common renal causes to perform haemodialysis are: haemolytic uremic syndrome (HUS), chronic renal failure, nephrotic syndrome and congenital bilateral nephrolithiasis. For the others, the most common non-renal causes are multiple organ dysfunction syndrome (MODS) that occurs as a result of cardiac insufficiency, hepatic insufficiency or after surgeries, as well as in hemato-oncologic diseases.

Key words: child, haemodialysis

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