Common Conditions Requiring Emergency Life Support

Kelsey Fawcett; Nicole Gerber; Shweta Iyer; Guillermo De Angulo; Martin Pusic; Michael Mojica

doi:10.1542/pir.2017-0331

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Kelsey Fawcett, MD*,^†
Nicole Gerber, MD*,^†
Shweta Iyer, MD*,^†
Guillermo De Angulo, MD, MPH*,^†
Martin Pusic, MD, PhD*
Michael Mojica, MD*,^†,^‡

^*Department of Emergency Medicine and
^†Department of Pediatrics, New York University School of Medicine, New York, NY
^‡Department of Emergency Medicine, Bellevue Hospital Center, New York, NY

AUTHOR DISCLOSURE
Drs Fawcett, Gerber, Iyer, De Angulo, and Mojica have disclosed no financial relationships relevant to this article. Dr Pusic has disclosed that he receives research study funding from the Department of Defense and the American Medical Association. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

AHA:: American Heart Association
CPR:: cardiopulmonary resuscitation
CT:: computed tomography
ED:: emergency department
ICP:: intracranial pressure
ROSC:: return of spontaneous circulation

Education Gaps

Providers should be up to date on the evidence-based current guidelines for pediatric resuscitation and be able to identify and manage life-threatening illness and injury.

Objectives

After completing this article, readers should be able to:

Understand the major changes in the 2015 American Heart Association guidelines for pediatric basic life support, advanced life support, and postresuscitation care.
Initiate the management and identify prognostic factors associated with near drowning.
Identify the signs and symptoms of life-threatening thoracic injuries, including pneumothorax, hemothorax, flail chest, and cardiac tamponade.
Identify and manage cerebral edema in the asphyxiated patient.

Overview

There are common emergencies in pediatrics that any pediatrician needs to be equipped to handle. Common office emergencies include respiratory distress, dehydration, seizures, and anaphylaxis. However, pediatricians also need to be prepared for common conditions that require emergency life support. These include, but are not limited to, cardiac arrest, near drowning, thoracic injuries, and cerebral edema. This article focuses on these common conditions that require emergency life support.

Pediatric Resuscitation

Introduction

Cardiac arrest is rare in the pediatric population. In 2015, the American Heart Association (AHA) released updated recommendations for pediatric advanced life support. (1) These updated guidelines, incorporating the available evidence, can guide resuscitation efforts to continue to improve overall survival after pediatric cardiac arrest and, in particular, improve survival with a favorable neurologic outcome.

Basic Life Support

An estimated 6,000 children experience out-of-hospital cardiac arrest per year in the United States. (2) The survival to hospital discharge is 11.3%, and survival with a neurologically favorable outcome is …