Biomedical subjects

M F Hazinski

Publications and source records attributed to M F Hazinski.

At least 55 records · Page 3Linked to original sources

PubMed1995

Recommended guidelines for uniform reporting of pediatric advanced life support: the pediatric Utstein style. A statement for healthcare professionals from a task force of the American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council.

This consensus document is an attempt to provide an organized method of reporting pediatric ALS data in out-of-hospital, emergency department, and in-hospital settings. For this methodology to gain wide acceptance, the task force encourages development of a common data set for both adult and pediatric ALS interventions. In addition, every effort should be made to ensure that consistent definitions are used in all age groups. As health care changes, we will all be challenged to document the effectiveness of what we currently do and show how new interventions or methods of treatment improve outcome and/or reduce cost. Only through collaborative research will we obtain the necessary data. For these reasons, and to improve the quality of care and patient outcomes, it is the hope of the task force that clinical researchers will follow the recommendations in this document. It is recognized that further refinements of this statement will be needed; these recommendations will improve only when researchers, clinicians, and EMS personnel use them, work with them, and modify them. Suggestions, emendations, and other comments aimed at improving the reporting of pediatric resuscitation should be sent to Arno Zaritsky, MD, Eastern Virginia Medical School, Children's Hospital of The King's Daughter, Division of Critical Care Medicine, 601 Children's Lane, Norfolk, VA 23507.

Child↗

PubMed1994

Outcome of cardiovascular collapse in pediatric blunt trauma.

STUDY OBJECTIVES: To determine the survival and functional outcome of pediatric blunt trauma victims demonstrating cardiovascular collapse, including pulseless cardiopulmonary arrest or severe hypotension, on initial presentation in an emergency department. DESIGN: Seven-year consecutive case-control series. SETTING: Level I trauma center and university teaching hospital. PARTICIPANTS: Two thousand one hundred twenty consecutive pediatric victims of blunt trauma less than 16 years old admitted to a Level I trauma center from August 1984 through December 1991 had a mortality of 5.2%. Thirty-eight patients (1.8%) demonstrated pulseless cardiac arrest or severe hypotension (systolic blood pressure of 50 mm Hg or less) on initial presentation in the ED. INTERVENTIONS: All patients received basic and advanced life support consistent with guidelines published by the American Heart Association, American Academy of Pediatrics, and American College of Surgeons. MEASUREMENTS AND MAIN RESULTS: Survival, functional outcome, and donor status were reviewed. Outcome of ED resuscitation (death or reanimation), post-ED destination (morgue, operating room, or pediatric ICU) length of hospitalization, functional outcome after hospital discharge, time to death (time from admission to ED to declaration of death), cause of death, total hospital costs, total hospital charges, and organ donation were reviewed. There were no functional survivors among 38 pediatric victims of blunt trauma who presented to the ED in pulseless cardiac arrest or with severe hypotension. Eleven of the 12 patients who were transferred to the pediatric ICU died; the single survivor demonstrated profound neurologic impairment six years after hospitalization. Six of these 12 patients were eligible potential donors and resulted in four multiorgan donors during the seven-year study. The mean hospital unreimbursed care for the 38 study patients was $3,514 per patient. CONCLUSION: No child who presented with pulseless cardiac arrest or severe hypotension following blunt trauma achieved functional survival. Reimbursed care for pediatric victims of blunt trauma demonstrating cardiovascular collapse is disproportionately poor compared with that for pediatric patients who maintain hemodynamic integrity in the ED. Half of all patients who were stabilized sufficiently for transfer to the pediatric ICU were eligible potential organ donors. Therefore aggressive resuscitation of these patients may be justified if organ donation is seriously contemplated and aggressively pursued.

Adolescent↗

PubMed1994

Mediator-specific therapies for the systemic inflammatory response syndrome, sepsis, severe sepsis, and septic shock: present and future approaches.

Despite recent advances in critical care and cardiopulmonary support, mortality from septic shock and its complications remains high. Effective therapies are needed to halt the progression of SIRS and the septic cascade prior to development of shock and organ ischemia/dysfunction. Such therapies are directed at prevention of infection/endotoxemia and modulation of mediators. These therapies are the focus of this article.

Anti-Bacterial Agents↗

PubMed1993

Citizen response to cardiopulmonary emergencies.

Since 1985, it has become apparent that the key to survival from adult sudden cardiac death is prompt defibrillation. Any delay from the time of collapse to the initial countershock will decrease the likelihood of survival. It also has been determined that CPR performed by lay rescuers is not begun promptly and, once started, often is performed for more than one minute before the emergency medical services (EMS) system is accessed, which significantly delays the time to defibrillation. In adults, therefore, the rescuer should phone first to activate the EMS system before performing CPR. In the pediatric population, respiratory arrests are far more common than cardiac arrests. Therefore, a rescuer should perform one minute of rescue support before activating the EMS system (a concept termed phone fast). It is recognized that this change is dependent upon a national EMS system that is still evolving. It is hoped that this change to phone first and phone fast will provide an impetus for rapid development of the EMS infrastructure.

Cardiopulmonary Resuscitation↗

PubMed1993

Pediatric injury prevention.

Pediatric injuries are the leading cause of childhood death and disability and are responsible for more childhood deaths than all other diseases combined. The panel summarized the principles of pediatric injury prevention and reviewed the incidence, epidemiology, and prevention of six common pediatric injuries.

Accidents, Traffic↗

PubMed1993

Epidemiology, pathophysiology and clinical presentation of gram-negative sepsis.

OBJECTIVE: To review the epidemiology and pathophysiology of gram-negative sepsis and the new consensus terminology describing the clinical signs of sepsis. DATA SOURCES: Review of the medical literature and compiled data from animal and clinical trials. PARTICIPANTS: Members of the Society of Critical Care Medicine, American College of Chest Physicians and American Association of Critical-Care Nurses with expertise on the subject of sepsis and its complications. RESULTS: Preconference and general sessions were offered at the National Teaching Institutes of the American Association of Critical-Care Nurses, with the goal of clarifying the epidemiology, risk factors and pathophysiology of gram-negative sepsis. In addition, current terminology and new (1992) consensus terminology describing the clinical signs of sepsis were presented. Special emphasis was placed on the role of the healthcare provider in the prevention and recognition of sepsis and the role of the septic mediators in the septic cascade. CONCLUSIONS: If the incidence of sepsis is to be reduced, the healthcare provider must be aware of the risk factors for sepsis and methods of reducing nosocomial infections. A thorough understanding of the role of mediators and consensus terminology used to describe sepsis, severe sepsis, septic shock and multiple organ dysfunction syndrome is necessary to recognize early or progressive signs of sepsis and to initiate state-of-the-art therapy.

Adult↗

PubMed1992

Advances and controversies in cardiopulmonary resuscitation in the young.

Pediatric resuscitation is most frequently required for respiratory arrest. Cardiac arrest is a rare and ominous event and usually develops as a complication of shock or respiratory failure. Once asystolic cardiac arrest occurs, the outcome of any resuscitation is dismal; if cardiopulmonary arrest persists longer than 15 minutes in the normothermic child, further efforts are unlikely to result in patient recovery. For this reason, attention must focus on prevention of arrest and prompt restoration of oxygenation and ventilation, heart rate, and systemic perfusion.

Airway Obstruction↗

PubMed1990

Postoperative care of the critically ill child.

Postoperative care of the pediatric surgical patient requires knowledge of the signs of cardiorespiratory and neurologic deterioration in the child as well as familiarity with particular postoperative complications associated with various types of surgery. This article briefly reviewed the principles of postoperative care of the critically ill child, and included references for more comprehensive sources of information.

Adolescent↗

PubMed1990

Shock in the pediatric patient.

Care of the child in shock requires careful and constant assessment of the child's systemic perfusion. In addition, oxygenation and ventilation must be supported. The child's heart rate must be maintained, since pediatric cardiac output often is directly related to heart rate. The goal of treatment of shock of any origin is to ensure that cardiac output is adequate to provide tissue oxygenation and substrate delivery. This goal is accomplished through careful titration of intravenous fluids to optimize ventricular preload and maximization of ventricular function (often with inotropic or vasodilator support). The child should be kept warm, and careful regulation and evaluation of total fluid intake and output is necessary. Parents should be allowed to remain with the child as much as possible, since this will comfort both the child and the parents. The child should be prepared gently for any painful procedures, and realistic but compassionate communication with the entire family is essential. Through constant assessment and evaluation of patient response to therapy, the nurse is in the best position to detect early signs of compromise and to determine effectiveness of therapy. Therefore, it is imperative that the nurse possess a thorough understanding of the pathophysiology and clinical progression of shock in the child, as well as the rationale and potential complications of management.

Adolescent↗

PubMed1981