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Introduction: High-quality chest compressions (CCs) are the main component of cardiopulmonary resuscitation (CPR). Objectives. T o assess the depth of CCs during CPR using a pediatric patient manikin. A secondary objective was to explore the association between CC depth and sex, level of training, body mass index, and periodic physical training., Material and Methods: Prospective study with experimental observation. Pediatric residents, pediatricians, nurses, and other health care providers trained in CPR and who attended children were included. A software program was used to record the depth of CCs while performing CPR during 2 minutes. Tiredness was defined as a deterioration in the number of adequately deep CCs (> 50 mm) by more than 3 CCs between the first and the last cycles., Results: A total of 137 subjects participated (85.4 % were women). Only 48 participants (35.8 %) showed an adequate performance in terms of depth. Significant differences were observed for men (p < 0.0001) and trained pediatricians compared to the rest (p = 0.038). A worsening was observed in performance in terms of depth after 2 minutes in 36.5 % of participants. No significant differences were observed in relation to body mass index and physical activity., Conclusions: Depth rate reduced after 2 minutes. No association was observed with the body mass index or regular physical activity of resuscitators but with their sex and level of training., (Sociedad Argentina de Pediatría.)

Objetive: To evaluate the performance of resident physicians in diagnosing and treating a case of anaphylaxis, six months after participating in simulation training exercises., Methods: Initially, a group of pediatric residents were trained using simulation techniques in the management of critical pediatric cases. Based on their performance in this exercise, participants were assigned to one of 3 groups. At six months post-training, 4 residents were randomly chosen from each group to be re-tested, using the same performance measure as previously used., Results: During the initial training session, 56 of 72 participants (78%) correctly identified and treated the case. Six months after the initial training, all 12 (100%) resident physicians who were re-tested successfully diagnosed and treated the simulated anaphylaxis case., Conclusions: The training through simulation techniques allowed correction or optimization of the treatment of simulated anaphylaxis cases in resident physicians evaluated after 6 months of the initial training.

Introduction: The probability of making mistakes in the prescription of medicines is high in pediatrics, and substantially increases in emergency situations., Material and Methods: This prospective observational study analyzed the prescriptions issued by physicians during 23 cardiopulmonary resuscitation pediatric emergency training sessions., Results: During 94 simulated cases, 96 physicians participated. Forty-four prescriptions on paper were analyzed (48%) including 120 doses. Twelve medication errors were found (10%, CI 95%: 5.517.2). Stress was identified as the primary cause of prescription mistakes., Conclusions: Drug prescription mistakes frequently occurred during pediatric emergency simulations.

Introduction: Physicians are frequently victims of both physical and verbal violence. Specific training is required for staff so that they are able to deal with these situations., Objetive: To assess the clinical management and behavior of pediatric medical residents towards a violent mother during a pediatric emergency simulation., Materials and Methods: To assess the clinical management and behavior of pediatric medical residents towards a violent mother during a pediatric emergency simulation., Results: Sixty-eight pediatric medical residents divided into 15 groups were observed. Twelve handled the episode appropriately; only two groups asked the security staff to remove the mother from the scene (recommended behavior). Other two groups managed to remove the mother from the clinical scenario but in the midst of struggles. Out of all physicians, 54.4% (n = 37) came into physical contact with the mother, and 95.6% had not previously received guidelines on how to manage violent situations., Conclusions: Only a few groups managed to remove the violent mother from the scene. Unconsented physical contact with the mother was one of the most commonly observed behaviors. A lack of institutional guidelines on how to handle violent situations was detected., Key Words: patient simulation, violence, workplace violence., (Sociedad Argentina de Pediatría.)

Cardiopulmonary resuscitation (CPR) courses meet all the definitions of an educational activity for prevention of cardiac arrest death by risk patients' parents and/or the general population. The aim is to improve patients' home care and turn parents confident before their children are discharged from hospital, mainly from intensive care units. Currently these courses are part of discharge protocols in many neonatologist services although there are offers that exceed this target, and extend to other areas such as education and caregivers. Locally the experience of neonatal CPR at the Sociedad Argentina de Pediatría stands out in connection with delivering courses to high risk patients' parents as well as designing and spreading learning material.

Introduction: Although the provision of effective assisted ventilation is the most effective intervention in delivery room resuscitation of depressed newborn infants, there is still limited evidence about which is the optimal device to deliver positive pressure ventilation (PPV)., Objective: To compare the accuracy of pressures and ventilation rate (VR) delivered to a neonatal simulator with three devices: 240 ml and 450 ml self-infating bags (SIB) and a T-piece resuscitator, and to evaluate the variability in terms of providers' experience., Material and Methods: 76 health care providers divided in two groups according to experience were asked to provide positive pressure ventilation to a neonatal simulator through a facial mask or an endotracheal tube with three ventilating devices: a T-piece resuscitator, a 240 ml and a 450 ml self-infating bags. Participants used each combination of device and interface randomly on 2 consecutive occasions. Mean and maximum PIP and respiratory rate were recorded. Statistical analyses were performed using two-factor analysis of variance for repeated measures., Result: SIB 240 and 450 were similar in the mean target peak inspiratory pressure (PIP) but both were significantly different (p < 0.001) from T-piece, although all values were close to the target. Mean VR was over the target for all the devices (p < 0.001). The highest difference found was 7 ± 1.7 breaths/minute with the 240 ml bag when compared with the T-piece using a mask. Experienced operators were closer than novice operators to target VR, regardless of the device or interface., Conclusion: The accuracy for the devices was comparable in the variables measured regardless operator´s experience. Overall, the T-piece provided lower PIP while both SIB, higher than the target. The VR was over the target for all the devices. Both SIB and novice participants were associated with higher VR. The intraoperator consistency was comparable in the variables measured with all devices.

Unlabelled: Based on the results of two large RCTs, guidelines from NRP/AAP, ILCOR, ACOG, and from Argentinean scientific societies for intrapartum and postpartum management of pregnancies with Meconium Stained Amniotic Fluid (MSAF) have radically changed. However, there are no data as to current delivery room management of infants born through MSAF., Objectives: 1) To assess current delivery room approaches in infants born through MSAF in Argentina; 2) To evaluate the adherence to NRP/AAP recommendations among different centers., Design/methods: A 20-question anonymous web-mail based survey was sent to 121 institutions with > or = 500 births a year., Results: The response rate was 63% representing 182,540 deliveries/year (26% of the total number of births in the country). Among the surveyed institutions, 24% were located in the city of Buenos Aires and 72% were public hospitals. Although no longer recommended, the following procedures are frequently performed: 1) Oro-nasopharingeal suctioning of meconiumstained infants before the delivery of the shoulders: sometimes, 50% of centers; always, 7 %. 2) Routine tracheal suctioning in vigorous infants, 30%. 3) Glottis exposure under laryngoscopy, 13 % for thin-consistency MSAF and 43% for thick-consistency MSAF. On the contrary, and although strongly recommended, only 69% of depressed infants have tracheal suctioning before ventilation. Up to 7% of centers perform other non recommended procedures such as chest compression and pressure over the larynx, to avoid breathing, and gastric lavage., Conclusions: In spite of not being currently recommended, intrapartum suction and postnatal intubation and suction of vigorous infants with MSAF are commonly performed in Argentina while in depressed newborns the latter procedure is not always carried out. Our study confirms the frequent gaps observed between scientific evidence, guidelines and clinical practice.