A Novel Approach for More Effective Emergency Equipment Storage: The Task-Based Package-Organized Neonatal Emergency Backpack

Objectives: To evaluate a new task-based package-organized (TPO) neonatal emergency backpack and to compare it to the classical (ABC- and material-based) backpack.Methods: Simulation-based assessment of time to retrieve equipment for three different tasks [intraosseous access (IO), intubation and adrenaline administration] using the TPO and the classical emergency backpack was compared.Results: Equipment retrieval times for the three tasks were assessed for 24 nurses (12 intermediate care, 12 intensive care) and were significantly faster in the TPO than in the classical backpack (IO 33 vs. 75 s, p < 0.001; intubation 53 vs. 70 s, p = 0,001; adrenaline 22 vs. 45 s, p < 0.001). The number of missing items was significantly lower using the TPO backpack for IO and adrenaline retrieval (IO 0,9 vs. 2,3 items, p < 00001, adrenaline 0.04 vs. 1, p < 0.001) but not for intubation equipment (0.9 vs. 1, not significant). The subjective rating of overall clearness was significantly higher for the TPO compared with the classical backpack (5,9 vs. 3,5, p < 0.001).Conclusion: Task-based package organization of neonatal emergency backpacks is feasible and might be superior to ABC-/material-oriented storage.

Advanced Vascular Access in Small Animal Emergency and Critical Care

In canine and feline patients presenting in a state of hemodynamic collapse, obtaining vascular access can be challenging. Delays in achieving vascular access interfere with delivery of patient care. In human medicine, definitions of difficult vascular access are variable and include the need for multiple placement attempts or involvement of specialized teams and equipment. Incidence and risk factors for difficult vascular access have not been well studied in veterinary patients, which limits understanding of how best to address this issue. Alternatives to percutaneous peripheral or central intravenous catheterization in dogs and cats include venous cutdowns, umbilical access in newborns, corpus cavernosum access in males, ultrasound-guided catheterization, and intraosseous catheterization. In recent years, advances in ultrasonography and intraosseous access techniques have made these more accessible to veterinary practitioners. These vascular access techniques are reviewed here, along with advantages, limitations, and areas for future study of each technique.

Management of Shock in the Pediatric Emergency Unit of the National Teaching Hospital HKM (CNHU-HKM) in Cotonou

Introduction: The mortality of severely ill children presenting with life-threatening emergencies remains high in emerging countries. The objective of this study was to evaluate the management of shock in the pediatric emergency department of the CNHU in accordance with WHO guidelines. Methods: The cross-sectional study covered the period from 1 November 2019 to 31 October 2020. All records of children aged 1 month to 18 years, who presented with shock, were analysed after implementation of life-saving measures. Results: The hospital incidence of shock was 2.6%, and its diagnosis was made on admission in 81.2% of cases. The median age of the children was 29.50 months. Septic shock occurred in 50% of cases. Mortality was 50%, related to the presence of fever on admission. The triage and sequence of management was correct. However, the median time to care was 30 minutes, the use of the intraosseous access was non-existent, and traceability should be improved. Conclusion: The introduction of an intraosseous kit is essential in order to reduce management delays. The priority remains the fight against infectious pathologies.

Comparison of intraosseous and intravenous epinephrine administration during resuscitation of asphyxiated newborn lambs

ObjectiveIntraosseous access is recommended as a reasonable alternative for vascular access during newborn resuscitation if umbilical access is unavailable, but there are minimal reported data in newborns. We compared intraosseous with intravenous epinephrine administration during resuscitation of severely asphyxiated lambs at birth.MethodsNear-term lambs (139 days’ gestation) were instrumented antenatally for measurement of carotid and pulmonary blood flow and systemic blood pressure. Intrapartum asphyxia was induced by umbilical cord clamping until asystole. Resuscitation commenced with positive pressure ventilation followed by chest compressions and the lambs received either intraosseous or central intravenous epinephrine (10 μg/kg); epinephrine administration was repeated every 3 min until return of spontaneous circulation (ROSC). The lambs were maintained for 30 min after ROSC. Plasma epinephrine levels were measured before cord clamping, at end asphyxia, and at 3 and 15 min post-ROSC.ResultsROSC was successful in 7 of 9 intraosseous epinephrine lambs and in 10 of 12 intravenous epinephrine lambs. The time and number of epinephrine doses required to achieve ROSC were similar between the groups, as were the achieved plasma epinephrine levels. Lambs in both groups displayed a similar marked overshoot in systemic blood pressure and carotid blood flow after ROSC. Blood gas parameters improved more quickly in the intraosseous lambs in the first 3 min, but were otherwise similar over the 30 min after ROSC.ConclusionsIntraosseous epinephrine administration results in similar outcomes to intravenous epinephrine during resuscitation of asphyxiated newborn lambs. These findings support the inclusion of intraosseous access as a route for epinephrine administration in current guidelines.

Comparison of three intraosseous access devices for resuscitation of term neonates: a randomised simulation study

ObjectivesTo compare the success rates and ease of use of three intraosseous (IO) access devices used in term neonates.DesignA three-arm randomised controlled simulation study was conducted.SettingA simulation laboratory.ParticipantsSeventy-two paediatric residents completing their emergency department rotation as part of their residency training, and 20 paediatric specialists.InterventionUsing an animal bone model, the one-attempt success rate of the EZ-IO drill, the NIO-I needle and the Jamshidi needle was compared. Uncooked Cornish Hen bones were used because of their similarity in length and diameter to the bones of neonates. Participants were asked to record the perceived ease of use of their assigned device using a 5-point Likert Scale.Main outcome measureThe main outcome was the visualisation of flow emerging from the distal end of the bone, and perceived ease of use of the three IO devices.ResultsThe EZ-IO, NIO-I and Jamshidi groups included 30, 31 and 31 participants, respectively, with median (IQR) years of experience of 3 (2–5), 3 (2–6) and 4 (3–5) years. Participants had significantly lower one-attempt success rates with the EZ-IO drill than with the NIO-I and the Jamshidi needles (14 of 30 (46.7%) vs 24 of 31 (77.4%); p=0.016, and 14 of 30 (46.7%) vs 25 of 31 (80.7%); p=0.007, respectively). The median (IQR) ease-of-use score of the EZ-IO drill was higher than that of the NIO-I and Jamshidi needles (5 (4–5) vs 4 (4–5); p=0.008, and 5 (4–5) vs 4 (3–4); p=0.0004, respectively).ConclusionsAlthough easier to use, the EZ-IO drill demonstrated lower success rates than the IO needles in establishing IO access on a neonatal bone model.

Paediatric Life Support by Advanced Paediatric Life Support, Australia: course review

The Advanced Paediatric Life Support, Australia Paediatric Life Support course is designed to improve outcomes for critically ill and injured paediatrics treated by healthcare professionals. It is comprised of pre-reading, online learning and a one-day face-to-face session that covers basic life support, airway management, cardiac rhythm recognition and defibrillation, intraosseous access and recognition of the seriously injured and ill child. This paper reviews the course and concludes that it should be considered as part of the continuing professional development requirements for paramedics.

Epilepsy: recognition and management of seizures in children and young people

A seizure describes the signs and symptoms associated with a sudden surge in brain activity. It is a symptom of either acute brain disturbance, or may indicate a diagnosis of epilepsy, which describes an underlying tendency to have seizures. There are many different seizure types, which account for the wide variation in seizure symptoms. The principles of management remain constant for all seizure types: maintain child safety, ABC support, and arrange emergency assistance and hospital transfer for prolonged episodes. In addition to this, tonic-clonic seizures lasting for more than 5 minutes require treatment with benzodiazepines. Buccal midazolam or rectal diazepam are first-line options when intravenous or intraosseous access is not available. Children and young people with epilepsy should have individualised treatment plans which, if available, further simplify emergency treatment decisions.