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Purpose The purpose of this review is to describe the epidemiology of out-of-hospital cardiac arrest (OHCA), disparities in organisation and outcome, recent advances in treatment and ongoing controversies. We also outline the standard of care that should be provided by the critical care specialist and propose future directions for cardiac arrest research. Methods Narrative review with contributions from international resuscitation experts. Results Although it is recognised that survival rates from OHCA are increasing there is considerable scope for improvement and many countries have implemented national strategies in an attempt to achieve this goal. More resources are required to enable high-quality randomised trials in resuscitation. Conclusions Increasing international collaboration should facilitate resuscitation research and knowledge translation. The International Liaison Committee on Resuscitation (ILCOR) has adopted a continuous evidence review process, which facilitate the implementation of resuscitation interventions proven to improve patient outcomes., Author(s): Jerry P. Nolan [sup.1] [sup.2], Robert A. Berg [sup.3] [sup.4], Clifton W. Callaway [sup.5], Laurie J. Morrison [sup.6], Vinay Nadkarni [sup.7], Gavin D. Perkins [sup.8], Claudio Sandroni [sup.9], Markus [...]

Over the last 15 years, treatment of comatose post-cardiac arrest patients has evolved to include therapeutic strategies such as urgent coronary angiography with percutaneous coronary intervention (PCI), targeted temperature management (TTM)-requiring mechanical ventilation and sedation-and more sophisticated and cautious prognostication. In 2015, collaboration between the European Resuscitation Council (ERC) and the European Society for Intensive Care Medicine (ESICM) resulted in the first European guidelines on post-resuscitation care. This review addresses the major recent advances in the treatment of cardiac arrest, recent trials that have challenged current practice and the remaining areas of uncertainty., Author(s): Jerry P. Nolan [sup.1] [sup.2], Robert A. Berg [sup.3] [sup.4], Stephen Bernard [sup.5], Bentley J. Bobrow [sup.6], Clifton W. Callaway [sup.7], Tobias Cronberg [sup.8], Rudolph W. Koster [sup.9], Peter [...]

Purpose Angiopoietin 2 (Ang2) and soluble receptor for advanced glycation end products (sRAGE) are markers of endothelial and pulmonary epithelial damage with prognostic implications in adult acute respiratory distress syndrome (ARDS), but unclear significance in pediatric ARDS (PARDS). Methods This was a prospective, observational study in children with PARDS (2012 Berlin and 2015 PALICC definitions) at the Children's Hospital of Philadelphia. Plasma was collected within 48 h of PARDS onset and biomarkers quantified by enzyme-linked immunosorbent assay. Results In 82 children with PARDS (12 deaths, 15 %), Ang2 and sRAGE were higher in non-survivors than survivors (p < 0.01 for both). Mortality was highest in patients with Ang2 and sRAGE levels both above median values. Ang2 and sRAGE correlated with the number of non-pulmonary organ failures (both p < 0.001). Ang2 was higher in indirect lung injury and in immunocompromised children. In stratified analysis, both Ang2 and sRAGE were associated with mortality only in direct lung injury and in immunocompetent children, with no association evident in indirect lung injury or in immunocompromised children. Conclusions Ang2 and sRAGE in early PARDS were higher in non-survivors than survivors and strongly correlated with number of non-pulmonary organ failures. When stratified by type of lung injury, Ang2 and sRAGE were associated with mortality only in direct lung injury. Similarly, when stratified by immunocompromised status, Ang2 and sRAGE were associated with mortality only in immunocompetent children. The utility of these biomarkers for prognostication and risk stratification requires investigation., Author(s): Nadir Yehya [sup.1] [sup.3], Neal J. Thomas [sup.2], Nuala J. Meyer [sup.3], Jason D. Christie [sup.3] [sup.4], Robert A. Berg [sup.1], Susan S. Margulies [sup.5] Author Affiliations: (1) grid.239552.a, [...]

The correlation existing between the automated external defibrillators (AEDs) and survival after in-hospital cardiac arrest is analyzed. The application of AEDs is not shown to enhance the survival of such patients.

A study was conducted to evaluate and compare the survival rate in out-of-hospital cardiac arrest using compression-only (COCPR) by lay rescuers against conventional CPR. Results indicated that lay person COCPR resulted in higher survival rates in the case of such patients.

Author(s): Sophie Skellett [sup.1], Masahiko Nitta [sup.2], Robert A. Berg [sup.3] [sup.4] Author Affiliations: (1) grid.424537.3, 0000000404267394, Great Ormond Street Hospital for Children NHS Trust, , London, UK (2) grid.444883.7, [...]

The study attempts to investigate the efficacy of the use of a scorpion-specific [F(ab').sub.2] antivenom as a form of treatment for critically ill children with neurotoxicity from scorpion stings. The results indicate that the use of antivenom was very effective as a mode of treatment and started showing positive results within four hours itself.

A study was conducted to evaluate the rates of hospital-wide codes and mortality before implementation by a rapid response team intervention and after. Results indicated that rapid response team intervention did not impact hospital-wide code rates or mortality.

A study was conducted to determine whether minimally interrupted cardiac resuscitation (MICR) which is considered an alternate emergency medical procedure could improve the survival rate. MICR was found to improve the survival rate of cardiac patients.

A study to record if the outcomes after a cardiac arrest in hospital differed during nights and weekends as against days or evening and weekdays is conducted. Results show lower survival rates from cardiac arrests during nights and weekends.

BACKGROUND. Age is an important determinant of outcome from adult cardiac arrests but has not been identified previously as an important factor in pediatric cardiac arrests except among premature infants. Chest compressions can result in more effective blood flow during cardiac arrest in an infant than an older child or adult because of increased chest wall compliance. We, therefore, hypothesized that survival from cardiac arrest would be better among infants than older children. METHODS. We evaluated 464 pediatric ICU arrests from the National Registry of Cardiopuimonary Resuscitation from 2000 to 2002. NICU cardiac arrests were excluded. Data from each arrest include >200 variables describing facility, patient, prearrest, arrest intervention, outcome, and quality improvement data. Age was categorized as newborn ( RESULTS. Overall survival was 22%, with 27% of newborns, 36% of infants, 19% of younger children and 16% of older children surviving to hospital discharge. Newborns and infants demonstrated double and triple the odds of surviving to hospital discharge from a cardiac arrest in an intensive care setting when compared with older children. When potential confounders were controlled, newborns increased their advantage to almost fivefold, while infants maintained their survival advantage to older children. CONCLUSIONS. Survival from pediatric ICU cardiac arrest is age dependent. Newborns and infants have better survival rates even after adjusting for potential confounding variables. Key Words cardiac arrest, resuscitation, CPR, cardiopulmonary resuscitation, heart arrest, age, intensive care, pediatric, survival, AGE IS AN important determinant of outcome from adult cardiac arrests. Moreover, survival from cardiac arrests seems to be especially poor among extremely premature infants. (1-4) Yet, there are no [...]

In this article, I review the first seven volumes of an unprecedented history of ideas and the UN. This fascinating history covers oral interviews with key personalities as well as [...]

The incidence of ventricular fibrillation or tachycardia among children is determined, while also examining whether the outcome is better for initial than for subsequent ventricular fibrillation or tachycardia. Results demonstrate that in pediatric patients with in-hospital cardiac arrests, survival outcomes were highest among patients in whom ventricular fibrillation or tachycardia was present initially than among those in whom it developed subsequently.

Theft and vandalism on construction sites in the commercial construction industry is a problem that can affect productivity and drain profits. To explore the impact of theft and vandalism in the commercial construction industry, a survey was sent to commercial construction firms to gather information by which the magnitude of the problem of theft and vandalism could be estimated; and to determine what techniques have been successfully used to deter thieves and vandals. The responses were analyzed and several conclusions were developed. Firms engaging in all types of projects are susceptible to theft and vandalism. Theft is more costly to large sized firms ($100 million and over in annual volume of construction work) than smaller firms, but vandalism is more costly for smaller firms. This occurs despite the tact that larger firms use a greater number of measures to combat theft and vandalism on their construction sites. The results should be of particular interest to construction firms that want to reduce the number of theft and vandalism incidents. CE Database subject headings: Construction costs; Construction equipment; Construction sites; Losses; Security; Site preparation, construction; Productivity.

We describe two primary standards for gas flow in the range from 0.1 to 1000 µmol/s. (1 µmol/s ≡ 1.3 c[m.sup.3]/min at 0°C and 1 atmosphere.) The first standard is […]

A study is conducted to find any benefits of high-dose epinephirine rescue therapy for in-hospital cardiac arrest in children. High dose therapy may be worse than standard dose therapy.

ABBREVIATIONS. PALS, Pediatric Advanced Life Support; ILCOR, International Liaison Committee on Resuscitation; AED, automated external defibrillator; VF, ventricular fibrillation; CPR, cardiopulmonary resuscitation; FDA, Food and Drug Administration; J, Joule; SIDS, [...]

Objective. Data regarding pediatric in-hospital cardiopulmonary resuscitation (CPR) have been limited because of retrospective study designs, small sample sizes, and inconsistent definitions of cardiac arrest and CPR. The purpose of this study was to prospectively describe and evaluate pediatric in-hospital CPR with the international consensus-derived epidemiologic definitions from the Utstein guidelines. Methods. All 129 in-hospital CPRs during 12 months at a 122-bed university children&apos;s hospital in Sao Paulo, Brazil, were described and evaluated using Utstein reporting guidelines. These guidelines include standardized descriptions of hospital variables, patient variables, arrest/event variables, and outcome variables. CPR was defined as chest compressions and assisted ventilation provided because of cardiac arrest or because of severe bradycardia with poor perfusion. Outcome variables included sustained return of spontaneous circulation, 24-hour survival, 30-day survival, 1-year survival, and neurologic status of survivors by the Pediatric Cerebral Performance Category Scale. Results. Of the 6024 children admitted to the hospital, 176 (3%) had an episode that met the criteria for provision of CPR and 129 (2%) received CPR, 86 for clinical cardiac arrest and 43 for bradycardia with poor perfusion. Most of the children (71%) had preexisting chronic diseases. The most common precipitating causes were respiratory failure (61%) and shock (29%). The initial cardiac rhythm was asystole in 71 children (55%), pulseless electrical activity in 12 (9%), ventricular fibrillation in 1, and bradycardia with pulses and poor perfusion in 43 (33%). Eighty-three children (64%) attained sustained return of spontaneous circulation (>20 minutes), 43 (33%) were alive at 24 hours, 24 (19%) were alive at 30 days, and 19 (15%) were alive at 1 year. Although many factors correlated with 24-hour survival, multivariate logistic regression analysis revealed independent association of 24-hour survival with respiratory failure as the precipitating cause (odds ratio [OR]: 4.92; 95% confidence interval [CI]: 1.73-14.0), bradycardia with pulses as the initial event (OR: 2.68; 95% CI: 1.01-7.1), and shorter duration of CPR (OR: 0.92; 95% CI: 0.89-0.96 for each elapsed minute). Similarly, 30-day survival was independently associated with respiratory failure as the precipitating cause and shorter duration of CPR. Thirty-day survival decreased by 5% with each elapsed minute of CPR. Nineteen (91%) of the 21 survivors to hospital discharge and 16 (83%) of the 19 1-year survivors had no demonstrable long-term change in neurologic function from their pre-CPR status. Conclusions. During this study, CPR was uncommon but not rare. Respiratory failure was the most common precipitating cause, followed by shock. Preexisting chronic diseases were prevalent among these children. Asystole was the most common initial cardiac rhythm, and bradycardia with pulses and poor perfusion was the second most common. Ventricular fibrillation was rare, but children with acute cardiac diseases, such as cardiac surgery and acute cardiomyopathies, were not admitted to this children&apos;s hospital. CPR was effective: nearly two thirds of these children were initially successfully resuscitated, and one third were alive at 24 hours compared with imminent death without CPR and advanced life support. Nevertheless, survival progressively decreased over time, generally as a result of the underlying disease process. One-year survival was 15%. Importantly, most of these survivors had no demonstrable change in gross neurologic function from their pre-CPR status. Pediatrics 2002;109:200-209; cardiopulmonary resuscitation, cardiac arrest, respiratory failure, in-hospital, children, Utstein style., ABBREVIATIONS. CPR, cardiopulmonary resuscitation; VF, ventricular fibrillation; VT, ventricular tachycardia; ICU, intensive care unit; ROSC, return to spontaneous circulation; PCPC, pediatric cerebral performance category; PICU, pediatric intensive care unit; OR, [...]

Dental care for patients age 75 or more presents special concerns. The dentist should evaluate the elderly patient's financial and social resources. The patient's medical condition must be considered, including whether the patient has hypertension, heart disease, diabetes, or has had a stroke. Other considerations include whether the patient is depressed or has dementia, has multiple chronic conditions, or takes other medications. Care should be coordinated with the patient's other health care providers. The goals of care vary according to the patient's needs and priorities. In general, the patient needs to be able to chew, should be free from oral pain, have adequate saliva, and an intact sense of taste. Cosmetic needs may also be important to the patient. Clinical assessment should consider cavities, gum disease, oral cancer, bone resorption, sores or inflammations, and saliva production. The treatment plan should take into account the individual patient's dental needs, physical and mental health, resources, priorities and concerns, and the dentist's capabilities.

The scorpion Centruroides exilicauda, also known as C. sculpturatus, lives in the southwestern United States, mainly in Arizona, but also in parts of Texas, New Mexico, and California. When this scorpion stings, a potent venom, which affects the nervous system, is emitted from its tail. The clinical effects of the toxin are increased contractions of the heart, increased rate of breathing, high blood pressure, local pain, flailing of arms and legs, increased salivation, roving eye movements, slurred speech, and stridor (a high-pitched sound when breathing). These symptoms are more severe in children under five years. The clinical symptoms of four children, aged 3 months to 3.5 years, who were stung by C. exilicauda and had severe or unusual reactions are described. Two of the children had respiratory failure and required the insertion of a tube into the trachea to create an artificial airway because their airways were blocked. In one child, many of the organs of the body were affected, including the heart, lungs, kidneys and nervous system. Two children had greater than normal numbers of cells in the spinal fluid. These cases show that being stung by the scorpion C. exilicauda may lead to severe and life-threatening conditions in young children. (Consumer Summary produced by Reliance Medical Information, Inc.)

An analysis of a fictitious engineer's financial analysis and management of his startup consultancy called Simple Services Inc will show that it was destined to fail from inception because of poor financial planning. A careful cash flow analysis at the beginning of the business startup and its update when the firm obtained its first contract would have uncovered likely problems it would encounter such as adverse audit findings.

High-pressure sterilization is discussed relative to maximizing the benefits of adiabatic heating. According to scientists in process engineering, microbiology, and food technology, allowing for the importance of temperature and temperature control may help to make high-pressure sterilization more economically feasible. Topics includeadiabatic temperature increase, tecnical solutions, testing of a lab-scale system, and development of a prediction model.

Sir,--The frontispiece of E. M. Butler's biography Rainer Maria Rilke (Cambridge, At the University Press, 1941) is an image listed as 'Rilke at the age of twenty', with 'Drawing by [...]