Indian Journal of Trauma and Emergency Pediatrics

Epinephrine is the recommended agent for the medical treatment of all forms of cardiac arrest according to the European Resuscitation Council and American Heart Association guidelines. The same guidelines also permit the use of vasopressin as an alternate to epinephrine in cardiac arrest. In this issue we have tried to focus on the literature available on the use of vasopressin in cardiac arrest, and its advantages, if any, when used in lieu of or simultaneously with epinephrine.

Keywords: Cardiac arrest, epinephrine, vasopressin, return of spontaneous circulation.

In this era of evidence based practice, there are therapies which still continue to be used despite lack of evidence supporting their use. One of them is the use of bicarbonate therapy in newborn resuscitation and cardiac arrest. Sodium bicarbonate has been used for many years to treat neonatal cardiac arrest and metabolic acidosis. Both animal studies and human studies have however failed to provide any benefit associated with bicarbonate administration. In this article we have briefly reviewed the evidence pertaining to the use of this drug in newborn resuscitation which may be serve as a useful tool to the newborn community to decide for or against using this drug in their day-to-day practice.

Key words: Sodium bicarbonate; Newborn; Metabolic acidosis; Cardiac arrest; Resuscitation. 

Epinephrine is the recommended agent for the medical treatment of all forms of cardiac arrest according to the European Resuscitation Council and American Heart Association guidelines. The same guidelines also permit the use of vasopressin as an alternate to epinephrine in cardiac arrest. In this issue we have tried to focus on the literature available on the use of vasopressin in cardiac arrest, and its advantages, if any, when used in lieu of or simultaneously with epinephrine.

Keywords: Cardiac arrest, epinephrine, vasopressin, return of spontaneous circulation. 

There have been major changes in the way that newborn infants are managed in the delivery room. The International Liaison Committee on Resuscitation guidelines incorporated much of the newly available evidence on the management of newborn infants and was last updated in 2010. The most important updates being; resuscitating term newborns with room air, use of blended oxygen for preterm infants, use of pulse-oximeter in the delivery room, to provide positive pressure ventilation with one of the three devices (self-inflating bag, flow inflating bag or T piece) when necessary. The updated guidelines also provide indications for use of intravenous epinephrine, which is the preferred route of administration, and recommend not to use sodium bicarbonate or naloxone during resuscitation. Other recommendations includethermal support to resuscitate preterm infants and use of therapeutic hypothermia for infants born at or more than 36 weeks’ gestation with moderate to severe hypoxic-ischemic encephalopathy.

Keywords: Neonatal advanced life support; NALS 2010; Newborn resuscitation guidelines.

Management of cardiopulmonary arrest in children is one of the most important aspects of post graduate training in Pediatrics that needs understanding of current guidelines and expertise on skills of performing CPR. Team leader and every team member should know his/her role and limitations. New guidelines of performing CPR advocate compression-airway-breathing (C-A-B) rather than airway-breathing-compression (A-B-C) sequence practiced before. Here we discuss current CPR guidelines and use of common drugs during or immediately after performing CPR.

Keywords: Pediatric advanced life support; PALS; Cardiac arrest; Cardiopulmonary resuscitation; CPR. 

Objective: To evaluate the impact of an informal training program on the knowledge and skills of nursing personnel posted in pediatric acute care areas at pre-specified time points.Methods: This repeated measures quasi-experimental study design was conducted in a tertiary care teaching hospital between March and April 2011. In the first phase, the knowledge and skills of the participants were assessed using a validated questionnaire and a skill checklist. This was followed by an informal training program on pediatric cardio pulmonary resuscitation (CPR) and retest immediately following the training and again at 6 weeks. Results: A total of 65 nursing personnel were enrolled in the study. Of these 22 (34%) were staff nurses and 43 (66%) were final year nursing students. All of them had been trained 6 weeks earlier in an informal training and evaluation program carried out in the department. The mean knowledge score of the participating nurses increased from 9.7 before training to 13 while the mean skill score increased from 8.9 before training to 10.7 immediately following the training. At 6 weeks, the participants seemed to retain the knowledge acquired but not the skills with the mean knowledge score remaining at 13 while the mean skill score dropped to 9.8, the difference between the immediate post-test and 6 weeks skill re-test being statistically significant. Also greater proportion of participants passed the 6 weeks knowledge test (62%) in comparison to skills (26%), the difference in scores between immediate and 6 weeks re-test being statistically significant (p< 0.03) only in skills. Conclusion: Knowledge and skills of pediatric nursing personnel posted in acute care areas improved with the new teaching program. However, knowledge seemed to be retained with time in comparison to skills.

Keywords: CPR; Cardiopulmonary resuscitation; Nursing personnel; Nursing staff; Nursing students; Knowledge; Skills. 

 Not Provided.