The advanced pedi-bag program: a hospital-EMS partnership to implement prehospital training, equipment, and protocols.

OBJECTIVE: The Advanced Pedi-Bag Program is a partnership between a trauma center and a county-wide EMS agency (LCEMS) with three major goals: 1) train all LCEMS paramedics in the American Heart Association's Pediatric Advanced Life Support (PALS), 2) stock each Life Squad with a specific bag containing the equipment necessary to treat both basic and advanced pediatric emergencies, and 3) develop treatment protocols for pediatric patients. DESIGN: Descriptive study. SETTING: LCEMS serves a population of 450,000. Pediatric runs account for 800 to 1,200 LCEMS runs per year. RESULTS: The LCEMS Medical Director established and facilitated mandatory PALS training of 180 paramedics. A committee of emergency/pediatric/trauma professionals developed and distributed 40 bags with a comprehensive inventory of basic and advanced pediatric supplies and equipment to all LCEMS Life Squads upon completion of PALS training. Protocols were developed that integrate the use of the bag's contents. CONCLUSION: This partnership between a trauma center and an EMS agency resulted in improved training of county paramedics, Life Squads that have an Advanced Pedi-Bag with specific equipment and supplies to manage pediatric emergencies, and pediatric protocols that support the use of this equipment. Paramedics benefit from advanced training opportunities and patients benefit from improved prehospital care.

[The sodium excretion behavior of anesthetized and conscious spontaneously-hypertensive (SHR) and normotensive (WKY) rats]. / Zum Natriumausscheidungsverhalten von narkotisierten und wachen spontan-hypertensiven (SHR) und normotensiven (WKY) Ratten.

Urethane-anesthetized and conscious, immobilized SHR subjected to osmotic diuresis, responded to intravenous saline loading with a larger natriuresis than WKY-rats due to an increased urine sodium concentration without differences in urine flow. Blood pressure and heart rate reactions after saline loading were qualitatively different in anesthetized and conscious rats. The magnitude of these changes was larger in WKY than in SHR in both experimental groups.

Blood pressure response to intravenous noradrenaline is influenced by substance P in normotensive and hypertensive rabbits.

Substance P (SP) applied to the cerebral ventricles elevates arterial blood pressure (BP). This elevation is mediated by an increased sympathetic tone and, moreover, could be attenuated by intravenous (i.v.) SP. To check the assumption that a change of adrenoceptor efficiency might contribute to the attenuation, SP (5 ng/kg per min) was continuously given i.v. and 20 micrograms SP injected intracerebroventricularly (i.c.v.) in anaesthetized normotensive as well as hypertensive rabbits. The BP response to 5 micrograms noradrenaline (NA) was checked within a control period before SP was given and rechecked 30 min after i.c.v. SP with continued i.v. infusion. Under these circumstances SP altered the BP response to NA qualitatively and quantitatively. An initial BP drop was followed by a rise which was remarkably smaller in magnitude than that obtained within the control period. The BP response to phenylephrine (PHE), however, was not altered by the identical SP protocol. Substance P application only i.v. or only i.c.v. was ineffective. Moreover, no differences could be revealed between normotensive and hypertensive animals in the BP response to NA. It is concluded that the beta-adrenoceptor efficiency changed similarly in the normotensive and hypertensive rabbits with i.v. SP, provided sympathetic tone had previously increased. In this manner i.v. SP might modify an exaggerated sympathetic tone which might be implicated in the pathogenesis of arterial hypertension.

[The antihypertensive effect of saralasin in rabbits with neurogenic interoreceptive hypertension]. / Der antihypertensive Saralasin-Effekt bei Kaninchen mit neurogen-interorezeptiver Hypertonie.

The renal nerve activity plays an essential role in the stimulation of plasma renin activity (PRA), which may be involved in the pathomechanism of neurogenic hypertension after sino-aortic denervation (SAD). Therefore, studies were conducted on unanesthetized rabbits (10 animals; 3-4 kg) after bilateral carotid sinus denervation plus section of cervical aortic nerves and the patterns of blood pressure (BP), heart rate (HR), and PRA were measured after a single injection-dosis of Saralasin (i.v., 10 micrograms/kg). After SAD the BP increased rapidly to 190 mm Hg within one week and remained at this high level (190-220 mm Hg) throughout the whole experiment (120 weeks). No change in BP of control rabbits (100-110 mm Hg) could be observed. Two weeks after SAD, the PRA showed a short elevation (approx. 25 ng) which subsequently returned to the levels of control rabbits (approx. 19 ng). Only in hypertensive rabbits Saralasin produced a short decrease of BP during both the initial and the whole chronic phases of hypertension, which was associated with a larger decrease of HR (1st to 5th min). Surprisingly, Saralasin induced a drop of HR also in the control rabbits. Our results suggest that also the normalized renin-angiotensin system is involved in the pathomechanism of sympathetic induced SAD-hypertension and probable permanently support the chronic state of hypertension by a relative "reninism".