Childhood submersion injuries.

The overall prognosis for children who sustain a submersion incident is directly related to several variables including length of submersion, initial neurologic evaluation, time to first breath, initial pH, and others. Resuscitation after near-drowning is unsuccessful in terms of death and neurologic deficit in 30% of those children who are treated at our institution. Despite the fact that we have been able to present variables that are somewhat predictive of outcome, it is almost impossible to identify 100% of the time which particular comatose child will survive neurologically intact. Therefore skilled attempts at resuscitation and management are mandatory. The understanding of the sequence of events that occur during the drowning process and the pathophysiologic consequence make it possible for health care personnel to provide aggressive therapeutic interventions that will enhance the likelihood of a normal recovery.

Controlled external lumbar drain as treatment for therapy resistant intracranial hypertension--case report.

We report the case of an eleven year old male with a history of severe head injury who had manifested high intracranial pressure refractory to aggressive medical therapy, including ventriculostomy, controlled hyperventilation, mannitol and barbiturate application. The insertion of an external lumbar drain in this patient resulted in rapid permanent control of the intracranial hypertension. No transtentorial or tonsillar herniation occurred.

Efficacy of audio-prompted rate guidance in improving resuscitator performance of cardiopulmonary resuscitation on children.

OBJECTIVE: To evaluate the effect of audio-prompted rate guidance during chest compressions on the performance of cardiopulmonary resuscitation (CPR) on children. METHODS: This 24-month prospective study occurred in the pediatric intensive care units of a university hospital and a children's hospital. Intubated children with nontraumatic cardiac arrest were eligible. After placement of an infrared capnometer between the endotracheal tube and resuscitation bag, an audiotape instructed the resuscitator to perform chest compressions at 100 per minute or 140 per minute for one minute, followed by another minute at the other rate. End-tidal carbon dioxide partial pressure (PETCO2) was recorded prior to audiotape instruction and after one minute of CPR at each rate. RESULTS: Six patients, two boys and four girls, with a mean age of 15 +/- 13 months (range 2-36 months) were studied. All had asystole or pulseless electrical activity. CPR was provided for 14 +/- 9 minutes prior to institution of the study protocol. PETCO2 at 140/min was higher than at baseline (12 +/- 7 torr verus 4 +/- 3 torr, p < 0.05). There was a trend towards higher PETCO2s at 100/min compared with baseline (11 +/- 12 torr versus 4 +/- 3 torr, p = 0.08). PETCO2s did not differ at 100/min compared with 140/min. CONCLUSIONS: In support of prior adult and animal investigations suggesting that basic CPRR is often performed poorly and at inappropriately slow rates, audio- prompted rate guidance during CPR in children resulted in higher PETCO2, suggesting improved CPR performance.

Pathophysiology of near-drowning and treatment of the child with a submersion incident.

The overall prognosis for children who have had a submersion incident is directly related to several variables including length of submersion, initial neurologic evaluation, time to first breath, initial pH, and others. Resuscitation after near drowning is unsuccessful in terms of death and neurologic deficit in 30% of those children who present to our institution. Despite the fact that we have been able to present variables that are somewhat predictive of outcome, it is almost impossible to identify 100% of the time which particular comatose child will be part of the group that will survive neurologically intact. Therefore, skilled attempts at resuscitation and management are mandatory. The understanding of the sequence of events that occur during the drowning process and the pathophysiologic consequence make it possible for health care personnel to provide aggressive therapeutic interventions that will enhance the likelihood of a normal recovery.

Prehospital care of the child with a submersion incident.

The outcome is excellent for children having had a submersion incident who are quickly rescued and resuscitated. Delay in starting cardiopulmonary resuscitation adds further insult to the neuronal cells by allowing the progress of anoxia and ischemia. The institution of early resuscitation and transport to a pediatric facility will at least serve to maximize the best chance possible for normal survival. Although the ABCs are the hallmark of resuscitation, resuscitative efforts are most effective if one keeps in mind that ABC can also stand for "anticipate before complication."

Heart-rate change as a measure of verbal storage and retrieval.

Heart rate and respiration were monitored while the subject listened for the appearance of a target sentence in a subsequent block of text. In two-thirds of the trails, the target sentence was altered by major or minor changes in wording, and the subject was asked to indicate whether or not a change had occurred. Heart rate preceding the first appearance of correctly recognized target sentences showed a steeper acceleration than heart rate preceding incorrectly recognized sentences. Mean heart rate during the correctly recognized embedded sentences showed a steeper deceleration than was present when the wording change was not recognized. Respiration amplitude decreased signifidantly discriminate between hits and misses, and did not correlate with change of heart rate. It was concluded that falling heart rate may be triggered by a shift in style of listening set in motion when the subject attends more closely to the specific words in the sentence as opposed to its underlying meaning.