PEDIATRICS Vol. 91 No. 4 April 1993, pp. 726-729
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Management of Cardiopulmonary and Trauma Resuscitation in the Pediatric Emergency Department

Philip S. Schoenfeld MD, MS Ed1 and M. Douglas Baker MD2

1 From the Department of Emergency Medicine, The Children's Hospital of Philadelphia
2 From the Department of Emergency Medicine, The Children's Hospital of Philadelphia and the Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia

The etiology and management of critical illness and injury in a pediatric emergency department were reviewed to survey the use of cardiopulmonary and trauma resuscitation and to compare these data with the educational content of Pediatric Advanced Life Support (PALS) courses. The emergency department records of 183 patients treated in the cardiopulmonary/trauma resuscitation room of a pediatric emergency department over a 17-month period were reviewed for data on diagnosis, morbidity, presence of apnea or pulselessness, and utilization of several resuscitation skills: intubation, cardioversion, tibial interosseous line placement, and other resuscitation techniques. Apneic and pulseless pediatric patients had poor survival (10.3%), but apneic patients had excellent survival (96.9%). Endotracheal intubation (57.9%), bag-valve-mask ventilation (63.9%), and medications for rapid-sequence induction of anesthesia prior to endotracheal intubation (25.7%) were used frequently. Inasmuch as asystole was the most common rhythm in pulseless patients, cardioversion and defibrillation were rarely used (2.2%). Specialized vascular access techniques, tibial interosseous lines (24.0%), and femoral intravenous lines (19.7%), were used frequently in pediatric patients. The frequent use of airway management skills and the excellent survival of apneic pediatric patients supports the current emphasis on airway management in PALS courses. Cardioversion/defibrillation should receive less emphasis in PALS courses. The frequent use of rapid-sequence induction of anesthesia prior to endotracheal intubation indicates that these techniques might warrant increased emphasis in the training of pediatric emergency department personnel and in PALS courses.

Key Words: cardiopulmonary resuscitation • trauma resuscitation • emergency department • pediatric advanced life support course

Submitted on June 5, 1992
Accepted on November 6, 1992




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