Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-10T13:00:14.624Z Has data issue: false hasContentIssue false
  • English
  • Français

Resuscitation interventions in a tertiary level pediatric emergency department: implications for maintenance of skills

Published online by Cambridge University Press:  11 May 2015

F. Jonathan Guilfoyle ,
Ruth Milner  and
Niranjan Kissoon
F. Jonathan Guilfoyle
Affiliation:
Department of Paediatrics, Division of Emergency Medicine, Alberta Children's Hospital, Calgary, AB
Ruth Milner
Affiliation:
Dept of Paediatrics and Division of Emergency Medicine, University of British Columbia, Vancouver, BC
Niranjan Kissoon*
Affiliation:
Children's Hospital and Child and Family Research Institute, Vancouver, BC
*
BC Children's Hospital, 4480 Oak Street, Room B245, Vancouver, BC V6H 3V4; nkissoon@cw.bc.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

To describe the frequency and proportion of successful resuscitation interventions in a pediatric emergency department (PED).

Methods and Material:

This was a retrospective chart review of children at the BC Children's Hospital (BCCH) PED who were admitted to the BCCH pediatric intensive care unit (PICU) in 2004 and 2005. Demographic data, diagnosis, and resuscitation interventions in the PED and within the first 24 hours of PICU admission were recorded. The training of the operator and the number of attempts needed were also recorded.

Results:

There were 75,133 PED visits; 304 of 329 (92.4%) who met inclusion criteria were reviewed. Diagnoses included respiratory distress (n = 115, 35%), trauma (n = 50, 15%), sepsis (n = 36, 11%), seizures (n = 37, 11%), and cardiac disease (n = 22, 7%). Ninety-nine patients required intubation. Intubations in the PED were performed by residents (20%), pediatric emergency medicine (PEM) fellows (15%), PEM attending staff (29%), and PICU fellows (12%); 81% of these were successful on the first attempt. In the PED, seven central lines were placed, seven intraosseous needles were inserted, 15 patients required inotropes, and 9 patients required chest compressions.

Conclusion:

Critical illness in our emergency department is a rare event; hence, opportunities to resuscitate, secure airways, and place central venous catheters are limited. Additional training, close working relationships between the PED and the PICU teams, and resuscitation protocols for early PICU involvement may be needed.

Keywords

childrencritical illnessemergencyendotracheal intubationintensive careintraosseous cannulationresuscitationsimulationvascular access
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 2 , March 2011 , pp. 90 - 95
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

References

REFERENCES

1.Donoghue, AJ, Nadkarni, VM, Elliott, M, et al. Effect of hospital characteristics on outcomes from pediatric cardiopulmonary resuscitation: a report from the National Registry of Cardiopulmonary Resuscitation. Pediatrics 2006;118:995–1001.Google Scholar
2.Chen, EH, Cho, CS, Shofer, FS, et al. Resident exposure to critical patients in a pediatric emergency department. Pediatr Emerg Care 2007;23:774–8.Google Scholar
3.Gemke, RJ, Weeteling, B, van Elburg, RM. Resuscitation competencies in paediatric specialist registrars. Postgrad Med J 2007;83:265–7.CrossRefGoogle ScholarPubMed
4.Schoenfeld, PS, Baker, MD. Management of cardiopulmonary and trauma resuscitation in the pediatric emergency department. Pediatrics 1993;91:726–9.Google Scholar
5.Chen, EH, Shofer, FS, Baren, JM. Emergency medicine resident rotation in pediatric emergency medicine: what kind of experience are we providing? Acad Emerg Med 2004;11:771–3.Google Scholar
6.Reis, AG, Nadkarni, V, Perondi, MB, et al. A prospective investigation into the epidemiology of in-hospital pediatric cardiopulmonary resuscitation using the international Utstein reporting style. Pediatrics 2002;109:200–9.CrossRefGoogle ScholarPubMed
7.Losek, JD, Olson, LR, Dobson, JV, et al. Tracheal intubation practice and maintaining skill competency: survey of pediatric emergency department medical directors. Pediatr Emerg Care 2008;24:294–9.CrossRefGoogle ScholarPubMed
8.Sakles, JC, Laurin, EG, Rantapaa, AA, et al. Airway management in the emergency department: a one-year study of 610 tracheal intubations. Ann Emerg Med 1998;31:325–32.CrossRefGoogle ScholarPubMed
9.Sagarin, MJ, Barton, ED, Chng, YM, et al. Airway management by US and Canadian emergency medicine residents: a multicenter analysis of more than 6,000 endotracheal intubation attempts. Ann Emerg Med 2005;46:328–36.Google Scholar
10.Tayal, VS, Riggs, RW, Marx, JA, et al. Rapid-sequence intubation at an emergency medicine residency: success rate and adverse events during a two-year period. Acad Emerg Med 1999;6:31–7.Google Scholar
11.Falck, AJ, Escobedo, MB, Baillargeon, JG, et al. Proficiency of pediatric residents in performing neonatal endotracheal intubation. Pediatrics 2003;112(6 Pt 1):1242–7.Google Scholar
12.Sagarin, MJ, Chiang, V, Sakles, JC, et al. Rapid sequence intubation for pediatric emergency airway management. Pediatr Emerg Care 2002;18:417–23.CrossRefGoogle ScholarPubMed
13.White, JR, Shugerman, R, Brownlee, C, et al. Performance of advanced resuscitation skills by pediatric housestaff. Arch Pediatr Adolesc Med 1998;152:1232–5.CrossRefGoogle ScholarPubMed
14.Nadel, FM, Lavelle, JM, Fein, JA, et al. Assessing pediatric senior residents’ training in resuscitation: fund of knowledge, technical skills, and perception of confidence. Pediatr Emerg Care 2000;16:73–6.CrossRefGoogle ScholarPubMed
15.Overly, FL, Sudikoff, SN, Shapiro, MJ. High-fidelity medical simulation as an assessment tool for pediatric residents’ airway management skills. Pediatr Emerg Care 2007;23:11–5.CrossRefGoogle ScholarPubMed
16.Chiang, VW, Baskin, MN. Uses and complications of central venous catheters inserted in a pediatric emergency department. Pediatr Emerg Care 2000;16:230–2.CrossRefGoogle Scholar
17.Horton, MA, Beamer, C. Powered intraosseous insertion provides safe and effective vascular access for pediatric emergency patients. Pediatr Emerg Care 2008;24:347–50.Google Scholar
18.de Oliveira Filho, GR. The construction of learning curves for basic skills in anesthetic procedures: an application for the cumulative sum method. Anesth Analg 2002;95:411–6.Google Scholar
19.Mulcaster, JT, Mills, J, Hung, OR, et al. Laryngoscopic intubation: learning and performance. Anesthesiology 2003;98:23–7.Google Scholar