No. 61

[PubMed]

Kaplan JA, Fossum RM

Office of the Chief Medical Examiner, Concord, NH 03301.

Cardiopulmonary resuscitation (CPR)-related artifacts in pediatric rescue that have the potential for serious complications in surviving patients have been well described in the medical literature. Medically trivial soft-tissue injuries, especially of the face and neck, carry predominantly forensic significance and have received less attention. We describe such injuries in nine of 25 consecutive cases of infants who received CPR, and correlate those injuries with specific rescue maneuvers. Techniques for effective investigation and interpretation of such injuries are suggested.

PMID: 7825546, UI: 95126080

No. 62

[PubMed]

Feldman KW, Brewer DK

Rib fractures have occasionally been described in children receiving cardiopulmonary resuscitation (CPR). Because child abuse is sometimes suspected in these cases, it is both medically and legally important to establish whether the rib fractures are secondary to abuse or CPR. One hundred thirteen children, including 41 victims of child abuse, 50 patients who had CPR, and 22 patients who had rib fractures, were studied. Twenty-nine patients had rib fractures; 14/29 (48%) were abusive. Other causes of fracture were: motor vehicle accidents (four), rickets/osteoporosis (five), surgery (five), and osteogenesis imperfecta (one). In spite of prolonged resuscitation performed with variable degrees of skill, no fractures could be attributed to CPR. On the other hand, rib fractures occurred frequently in abused children (6/41 or 15%). Abusive fractures were often multiple, of different ages, and affected multiple adjacent ribs. Patients with abusive rib fracture also had other physical and radiologic signs of abuse or neglect.

PMID: 6701057, UI: 84143903

No. 63

[PubMed]

Nagel EL, Fine EG, Krischer JP, Davis JH

PMID: 7214982, UI: 81163650

No. 64

[PubMed]

Powner DJ, Holcombe PA, Mello LA

PMID: 6690207, UI: 84083368

No. 65

[PubMed]

Parke TR

Glasgow Royal Infirmary, UK.

During the mouth to mouth ventilation of basic life support, the high inflation pressures generated may result in later complications. Pulmonary barotrauma may result in pneumothorax or pneumomediastinum, and high pressures applied to the gastrointestinal tract may lead to gastric rupture and pneumoperitoneum. A case is reported of pneumoperitoneum in the absence of pneumothorax, pneumomediastinum or gastrointestinal perforation and the literature relating to this unusual condition is reviewed.

PMID: 8290812, UI: 94120199

No. 66

[PubMed]

Kramer K, Goldstein B

Department of Pediatrics, University of Rochester Medical Center, NY 14642.

PMID: 8393755, UI: 93345187

No. 67

[PubMed]

Perlman JM, Risser R

Department of Pediatrics, University of Texas Southerwestern Medical Center, Dallas.

OBJECTIVES: To determine (1) what percentage of infants require chest compressions and medications as part of resuscitation in the delivery room, (2) the associated clinical events contributing to neonatal depression, and (3) the neonatal outcome of such children.

DESIGN: Observational study.

SETTING: Urban county hospital. RESULTS: For 2 years, 39 (0.12%) of 30,839 infants were administered chest compressions and/or epinephrine as part of cardiopulmonary resuscitation in the delivery room. Fifteen were term infants and 24 were premature. Five term infants had evidence of severe fetal acidemia (FA) (umbilical cord arterial pH < 7.00 and/or base deficit > or = -14 mEq/L); two died secondary to severe brain injury, and the neurologic examinations showed abnormalities in the three survivors. The 10 infants without severe FA exhibited an uncomplicated neonatal course. Five infants had evidence of severe FA; the neurologic examination showed abnormalities in four. Of the remaining 19 infants without severe FA, four died and five additional infants have moderate to severe brain injury. Abnormal outcome was more likely to occur with severe FA (P < .002). The presumed clinical events contributing to the neonatal depression were severe FA (n = 10), malpositioning of the endotracheal tube (n = 5), and ineffective or improper initial ventilatory support (n = 24). CONCLUSIONS: Cardiopulmonary resuscitation in the delivery room, resulting in administration of chest compressions and medications, is a rare event. Approximately one third of the infants had evidence of severe FA; in the remaining two thirds, ineffective or improper initial ventilatory support was the presumed mechanism for the continued neonatal depression. The appropriate therapeutic response to continuing neonatal depression should be to optimize ventilatory support before administering chest compressions or medications.

PMID: 7827654, UI: 95128387

No. 68

[PubMed]

Dean JM, Koehler RC, Schleien CL, Michael JR, Chantarojanasiri T, Rogers MC, Traystman RJ

We studied alterations of chest geometry during conventional cardiopulmonary resuscitation in anesthetized immature swine. Pulsatile force was applied to the sternum in increments to determine the effects of increasing compression on chest geometry and intrathoracic vascular pressures. In 2-wk- and 1-mo-old piglets, permanent changes in chest shape developed due to incomplete recoil of the chest along the anteroposterior axis, and large intrathoracic vascular pressures were generated. In 3-mo-old animals, permanent chest deformity did not develop, and large intrathoracic vascular pressures were not produced. We propose a theoretical model of the chest as an elliptic cylinder. Pulsatile displacement along the minor axis of an ellipse produces a greater decrease in cross-sectional area than displacement of a circular cross section. As thoracic cross section became less circular due to deformity, greater changes in thoracic volume, and hence pressure, were produced. With extreme deformity at high force, pulsatile displacement became limited, diminishing pressure generation. We conclude that changes in chest geometry are important in producing intrathoracic intravascular pressure during conventional cardiopulmonary resuscitation in piglets.

PMID: 3610916, UI: 87279663

No. 69

[PubMed]

Becker BL, Idris AH

Section of Emergency Medicine, University of Chicago Hospital, Illinois, USA. Publication Types: Congresses

PMID: 8629773, UI: 96211824