ABSTRACT
Early treatment is a major factor to improve the outcome of children at risk of cardiopulmonary arrest. That's why it is essential to recognize as soon as possible clinical signs that indicate a respiratory and/or circulatory dysfunction. Immediate systematic assessment and re-assessment of oxygenation, ventilation and organ perfusion status is one of the keys in the prevention of cardiorespiratory arrest in children. Health care staff must assure that a child with signs of acute respiratory and/or circulatory dysfunction is under constant surveillance by a person with ability to interpret signs, identify problems and to initiate emergency treatment, if needed. Respiratory assessment must include respiratory rate, signs of mechanical respiratory failure (nasal flaring, respiratory noises, paradoxical breathing, prolonged expiration) as well as skin-mucous colour. Cardiocirculatory failure assessment includes heart rate, blood pressure, peripheral perfusion (capillary refill time and temperature gradient), level of consciousness and urinary output. In a child with impending signs of cardio-respiratory failure, the priority is to warrant adequate ventilation and oxygenation. If, despite this treatment, there is no improvement in perfusion, treatment of circulatory failure with fluids and vasoactive drugs is necessary.
Subject(s)
Heart Arrest/diagnosis , Blood Circulation , Child , Heart Arrest/physiopathology , Humans , Respiration , Risk FactorsABSTRACT
El pronóstico de los niños con riesgo de sufrir una parada cardiorrespiratoria es mejor cuanto antes se inicie el tratamiento. Por eso, es muy importante reconocer cuanto antes los signos clínicos que ponen de manifiesto el compromiso respiratorio y/o circulatorio. Una de las claves de la prevención de la parada cardiorrespiratoria en los niños críticamente enfermos radica en la evaluación rápida, sistemática y constante del estado de oxigenación, ventilación y perfusión. El personal sanitario debe asegurarse de que el niño con insuficiencia respiratoria y/o circulatoria permanezca en todo momento bajo la vigilancia de una persona capaz de identificarlos, interpretarlos, y actuar con rapidez. En la evaluación respiratoria hay que analizar la frecuencia respiratoria, los signos de insuficiencia mecánica respiratoria (aleteo nasal, tiraje, ruidos respiratorios, respiración paradójica, espiración alargada) y la coloración cutáneo mucosa. Los signos más importantes a analizar en la evaluación cardiocirculatoria son la frecuencia cardíaca, presión arterial, perfusión periférica (relleno capilar y gradiente térmico) estado de conciencia y diuresis. Ante un niño con signos de insuficiencia cardiorrespiratoria lo primero es garantizar que la ventilación y oxigenación sean adecuadas y si, a pesar de ello, la perfusión no mejora se realizará tratamiento de la insuficiencia circulatoria con líquidos y fármacos vasoactivos
Early treatment is a major factor to improve the outcome of children at risk of cardiopulmonary arrest. That's why it is essential to recognize as soon as possible clinical signs that indicate a respiratory and/or circulatory dysfunction. Immediate systematic assessment and re-assessment of oxygenation, ventilation and organ perfusion status is one of the keys in the prevention of cardiorespiratory arrest in children. Health care staff must assure that a child with signs of acute respiratory and/or circulatory dysfunction is under constant surveillance by a person with ability to interpret signs, identify problems and to initiate emergency treatment, if needed. Respiratory assessment must include respiratory rate, signs of mechanical respiratory failure (nasal flaring, respiratory noises, paradoxical breathing, prolonged expiration) as well as skin-mucous colour. Cardiocirculatory failure assessment includes heart rate, blood pressure, peripheral perfusion (capillary refill time and temperature gradient), level of consciousness and urinary output. In a child with impending signs of cardio-respiratory failure, the priority is to warrant adequate ventilation and oxygenation. If, despite this treatment, there is no improvement in perfusion, treatment of circulatory failure with fluids and vasoactive drugs is necessary
Subject(s)
Infant, Newborn , Infant , Child , Humans , Respiratory Insufficiency , Heart FailureABSTRACT
La parada cardiorrespiratoria (PCR) de los niños que padecen una enfermedad grave no suele presentarse de una forma brusca o inesperada sino que, con frecuencia, es el resultado de un deterioro progresivo de la función respiratoria y/o circulatoria. Antes de que se produzca el fracaso de estas funciones aparecen una serie de signos clínicos que las ponen de manifiesto. Los sanitarios no sólo deben saber valorar los signos clínicos de alarma de insuficiencia respiratoria, circulatoria o de ambas, sino que han de ser capaces de hacerlo cuanto antes, preferiblemente en la fase de compensación, puesto que las posibilidades de que las medidas terapéuticas puedan revertir el proceso disminuyen con la progresión de éste (AU)
Subject(s)
Infant , Child, Preschool , Child , Adolescent , Humans , Gallstones , Gallstones , Heart Arrest , Risk Assessment , Resuscitation , Heart Function Tests , Respiratory Function TestsABSTRACT
Cardiorespiratory arrest in children with severe disease does not usually present suddenly or unexpectedly but is often the result of a progressive deterioration of respiratory and/or circulatory function. Before failure of these functions occurs, there is a series of clinical signs that serve as a warning. Health professionals should not only evaluate clinical signs of respiratory and/or circulatory insufficiency but should also be able to identify these warning signs as early as possible, preferably in the compensation phase, given that the possibility that this process can be reversed by therapeutic measures decreases as the process progresses.
Subject(s)
Heart Arrest/prevention & control , Resuscitation/standards , Adolescent , Child , Child, Preschool , Heart Function Tests , Humans , Infant , Respiratory Function Tests , Risk AssessmentSubject(s)
Chromosomes, Human, Pair 7 , Trisomy , Abnormalities, Multiple/genetics , Female , Humans , Male , Translocation, GeneticABSTRACT
We present three cases of patients with Wilms' tumour. The first case showed a bilateral tumour with hemihypertrophy and Beckwith-Wiedemann syndrome. The second one had hemihypertrophy and double left pyelocalyceal system with double renal tumour. The last case had a horse-shoe kidney with a tumour on the right and a left hydronephrosis. The second and third cases had a good evolution.
