Pediatric emergency medicine trisk 0250 0250

There are many ethical issues surrounding pediatric resuscitation: When are
resuscitation attempts futile? Is the ED physician obligated to provide care at the
families’ insistence? How do family religious beliefs play a role in decision
making? What is the role of parental presence? Should procedures be performed
on the recently dead? Can resuscitation research be performed without informed
consent? Some of these issues have been addressed in policy statements made by
professional organizations, but each question needs to be considered in
discussions that occur at the local ED level.
In response to these varied, complex, and often highly charged issues,
postresuscitation debriefing has become a vital component of the pediatric
resuscitation. Consider taking a few minutes for critical reflection following the
completion of the resuscitation event; this has the potential to enhance teamwork
and communication, and provides an opportunity to improve future performance
through group reflection on the shared experience.
KEY POINTS
The vast majority of out of hospital pediatric cardiac arrests (OHCAs)
are asphyxial and both survival and neurologic outcomes are poor.
Recognition of impending respiratory and circulatory failure and
immediate intervention can be truly lifesaving.
VT/VF is estimated to occur in less than 10% of pediatric OHCA.
IO is the preferred access for arrested patients, as well as for patients
with severe hypotension or other severely ill patients where attempt at
IV access is prolonged.
Resuscitation of newly born infants follows an algorithm with notable
differences from that of older infants and children.
Airway management and high-quality chest compressions are the key
resuscitation interventions.
All EDs should have program for continuous quality improvements
around the care of critically ill children.
Strong leadership and teamwork with closed-loop communication are
essential.

EDs should have practice simulations and skills sessions to assure
competency in knowledge and critical resuscitation skills.