Continuous venovenous rewarming: results from a juvenile animal model.

OBJECTIVE: To compare a standard and an experimental method of rewarming in 5-wk-old goats with induced moderate hypothermia. DESIGN: Hypothermia was induced in ten juvenile Nubian goats. Five goats were randomly assigned to be rewarmed using standard techniques, and five were assigned to the experimental rewarming technique of a modified continuous venovenous hemofiltration circuit. SETTING: Animal research facility, Greenville Hospital System/Clemson University Biomedical Cooperative, Clemson, S.C. SUBJECTS: Ten 5-wk-old goats. INTERVENTIONS: Hypothermia to a body temperature of 29.4 degrees C was induced in the goats. Each of the control group of five goats was rewarmed using standard methods. Each of the experimental group of five goats was rewarmed using a modified continuous venovenous hemofiltration circuit. MEASUREMENTS AND MAIN RESULTS: At 2 hrs, the median temperature increase in the experimental group was 6.5 degrees C, compared with an increase of only 1.5 degrees C in the control group (p=.02). The mean increase in core body temperature over time (from baseline to 150 mins) was also significantly greater in the experimental group (p=.006). CONCLUSIONS: The use of a modified continuous venovenous hemofiltration circuit for rewarming in a juvenile goat model after induction of moderate hypothermia is more effective than are standard methods.

Intraosseous infusion performed in the prehospital setting: South Carolina's six-year experience.

Our data do not demonstrate that a prehospital intraosseous infusion protocol will improve the outcome of prehospital pediatric patients with cardiac arrest. The number of patients in our study is too small to allow us to draw a conclusion as to the effect of intraosseous infusion on altering survivability of pediatric cardiac arrest in the prehospital setting. More study is necessary to determine whether there might be a group of pediatric patients with cardiac arrest or hypovolemic shock who could potentially benefit in a prehospital setting from this procedure.

Bacterial tracheitis: recognition and treatment.

Bacterial tracheitis is a rare, life-threatening form of upper airway obstruction usually seen in children. It is often confused with other forms of upper airway obstruction and must be distinguished from viral croup and epiglottitis. The mainstay of treatment is establishing and maintaining an artificial airway, thus clearing the trachea of the mucopurulent exudate which has accumulated. It is wise for the physician to maintain a high index of suspicion for bacterial tracheitis especially in those children with fever and an upper airway obstruction who fail to exhibit the typical clinical features of croup or epiglottits.

The effect of diazepam enema on the rectal mucosa of rats.

The use of undiluted intravenous diazepam solution administered as an enema has been recommended for the acute management of seizures when intravenous access cannot be obtained. It is well absorbed, rapidly effective, and generally accepted as being safe when used in this manner. The effect of intravenous diazepam solution on the rectal mucosa has not been studied. This study demonstrates that there are no acute changes in the rectal mucosa of adult rats after administration of 10 to 20 times the recommended human dose.

The administration of rectal diazepam for acute management of seizures.

The emergency management of seizures often involves the use of diazepam as a first-line medication. Intravenous access is difficult in pediatric patients who are having seizures, and for this reason alternate routes of administration have been sought. This paper reviews the recent literature concerning the efficacy of rectal administration of intravenous diazepam solution for the purpose of emergency management of seizures in children. Although intravenous diazepam is the preferred route for the child with active seizure activity, undiluted diazepam intravenous solution administered per rectum is an excellent alternative. The technique of administration is reviewed.

Prehospital intraosseous infusion by emergency medical services personnel: a prospective study.

Intraosseous infusion technique by paramedics in the prehospital setting was prospectively evaluated. Intraosseous access was successfully established in 16 of 17 pediatric patients with cardiopulmonary arrest. There were 13 successful first attempts with intraosseous access established within 1 minute. No significant complications occurred. In this study, the ease of establishing intraosseous access by paramedics in the field is documented.