Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2
Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2
PartinResuscitation, Stabilization, and Transport of the Critically III or Injured ChildVinay NadkarniPost-resuscitation Care25Monica E. Kleinman and Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2 Meredith G. van der VeldenAbstractPediatric cardiac arrest is an infrequent but potentially devastating event. While return of spontaneous circulation (ROSC) is the immediate objective, the ultimate goal is survival with meaningful neurologic outcome. Once a perfusing rhythm is established, the ped Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2iatric cardiac arrest victim requires expert critical care Io optimize organ function, prevent secondary injury, and maximize the child’s potential foEbook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2
r recovery. Common post-resuscitation conditions include acute lung injury, myocardial dysfunction, hepatic and renal insufficiency. and hypoxic-ischePartinResuscitation, Stabilization, and Transport of the Critically III or Injured ChildVinay NadkarniPost-resuscitation Care25Monica E. Kleinman and Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2n sepsis or major trauma. Children may have single organ failure or multi-organ dysfunction, and the need for critical care therapies may delay accurate evaluation of neurologic status and limit prognostic ability. Pediatric post-resuscitation therapies are not typically evidencebased given the pauc Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2ity of randomized trials and heterogeneous nature of the patient population. Goals of care include normalizing physiologic and metabolic status, preveEbook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2
nting -secondary organ injury, and diagnosing and treating the underlying cause of the arrest. Therapeutic hypothermia has been shown to mitigate the PartinResuscitation, Stabilization, and Transport of the Critically III or Injured ChildVinay NadkarniPost-resuscitation Care25Monica E. Kleinman and Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2phalopathy at birth, but the role of targeted temperature control in pediatric post arrest care is an area of active investigation There is no single diagnostic test or set of criteria to accurately predict neurologic outcome, providing a challenging situation for critical care specialists and famil Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2ies alike.KeywordsResuscitation • Cardiac arrest • Critical care • Organ dysfunction • Post-cardiac arrest syndrome • Reperfusion • Brain injuryIntrodEbook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2
uctionM E. Kleinman. MD(S)Division of Critical Care Medicine.Department of Aneslhesiolrrgy, Children's Hospital Ihtvlnn.300 Longwood Avenue. Bader 631PartinResuscitation, Stabilization, and Transport of the Critically III or Injured ChildVinay NadkarniPost-resuscitation Care25Monica E. Kleinman and Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 20 Longwocd Avenue. Bader 634. Boston. MA 02115. USA e-mail: merodilh.vandervelden^childrenx-harvard.ixliiThe immediate objective of pediatric cardiopulmonary resuscitation is return of spontaneous circulation (ROSC). while the ultimate goal is survival with a favorable neuro logic outcome. Once a pe Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2rfusing rhythm is established, the pediatric cardiac arrest victim requires critical care focused to optimize organ function, prevent secondary injuryEbook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2
, and maximize the child's potential for recovery. Common post resuscitation conditions include acute lung injury, myocardial dysfunction, hepatic andPartinResuscitation, Stabilization, and Transport of the Critically III or Injured ChildVinay NadkarniPost-resuscitation Care25Monica E. Kleinman and Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 214271272M.E. Kleinman and M.G. van der Veldenseizures/cnccphalopathy. The extent of neurologic injury may be initially difficult to assess due to multi-organ system failure following hypoxia-ischemia and reperfusion. In the pediatric intensive care unit (PICU). the most common cause of death followi Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2ng admission after cardiac arrest is hypoxic-ischemic encephalopathy [ 1,2|, which is also responsible for the most significant morbidity in survivorsEbook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2
.Considerations for post-resuscitation care are impacted by whether the resuscitation occurs out-of-hospital or in-hospital. since the epidemiology anPartinResuscitation, Stabilization, and Transport of the Critically III or Injured ChildVinay NadkarniPost-resuscitation Care25Monica E. Kleinman and Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2rest is the end result of progressive hypoxia and ischemia. Multiple cohort studies of out-of-hospital pediatric cardiac arrests have found that most were of respiratory origin 13-12]. A recent report from 11 North American sites participating in the Resuscitation Outcomes Consortium (ROC) found tha Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2t the incidence of non-lraumatic out-of-hospital cardiac arrest in patients <20 years of age was 8.04 per 100.000 person-years, and was significantlyEbook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2
higher among infants than children or adolescents (5]. The initial cardiac rhythm was asystole or pulseless electrical activity (PEA) in 82 % of patiePartinResuscitation, Stabilization, and Transport of the Critically III or Injured ChildVinay NadkarniPost-resuscitation Care25Monica E. Kleinman and Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2drome remain the most common causes of pediatric out-of-hospital cardiac arrest [3. 13]. Survival ranges from 6.4 to 12 %. with rates of neurologically-intacl survival of only 2.7-4 it [3-6. 13|.Pediatric cardiac arrest in the inpatient setting is more likely to he witnessed or to occur in a monitor Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2ed setting, but a high proportion of patients have pre-existing co-morbidilies 114]. Not surprisingly, the highest incidence of in-hospital pediatricEbook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2
cardiac arrest is in the PICU. affecting 1-6 % of patients admitted 115. 16|. Regardless, the outcome from in-hospital arrest is const sternly better PartinResuscitation, Stabilization, and Transport of the Critically III or Injured ChildVinay NadkarniPost-resuscitation Care25Monica E. Kleinman and Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2rge was 27 %. while a 2009 review of 353 in-hospital cardiac arrests reported a survival to discharge rate of 48.7 % 117, I8|. The etiology of pediatric in-hospital arrest differs from out-of-hospital events in that cardiac conditions (including shock) are as likely as respiratory failure to be the Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2immediate cause of the arrest (61-72 %) 112. 17Ị. Asystole and PEA account for 24-64 % of the initial cardiac rhythms. Interestingly, infants and chilEbook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2
dren who are resuscitated from inpatient cardiac arrest have a high likelihood of favorable neurologic outcome, with results ranging from 63 to 76.7 %PartinResuscitation, Stabilization, and Transport of the Critically III or Injured ChildVinay NadkarniPost-resuscitation Care25Monica E. Kleinman and Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2tion have led to the description of the "post-cardiac arrest syndrome" [I9|.This condition is characterized by myocardial dysfunction, neurologic impairment, and endothelial injury that resemble inflammatory conditions such as sepsis (capillary leak, fever, coagulopathy, vasodilation). The series of Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2 events during reperfusion can be divided into four phases: (1) immediate (first 20 min after ROSC); (2) early post-arrest (20 min through 6-12 h afteEbook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2
r resuscitation); (3) intermediate phase (6-12 h through 72 h post-arrest); and (4) recovery phase (beyond 72 hl. Some experts have included a fifth pPartinResuscitation, Stabilization, and Transport of the Critically III or Injured ChildVinay NadkarniPost-resuscitation Care25Monica E. Kleinman and Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2ac arrest syndrome results from two distinct but serial events - a period of ischemia, during which cardiac output and oxygen delivery are profoundly compromised, followed by a period of tissue and organ reperfusion. Al the time of cardiac arrest, oxygen extraction increases in an effort to compensa Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2te for reduced delivery. As demand rapidly exceeds supply, tissue hypoxia triggers anaerobic metabolism and lactate production. At the cellular level,Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2
hypoxia limits oxidative phosphorylation and mitochondrial ATP production. As a result. ATP-dependent membrane functions such as maintenance of ion gPartinResuscitation, Stabilization, and Transport of the Critically III or Injured ChildVinay NadkarniPost-resuscitation Care25Monica E. Kleinman and Ebook Pediatric critical care medicine (Volume 1: Care of the critically ill or injured child - 2nd edition): Part 2alth)25 Post-resuscttatlon Care273PartinResuscitation, Stabilization, and Transport of the Critically III or Injured ChildVinay NadkarniPost-resuscitation Care25Monica E. Kleinman andGọi ngay
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