Recent discussions
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Виктория Антонова
I would welcome a change in recommendation. My experience from many simulation-based trainings and emergency care of pediatric patients shows that the chest compressions are carried out much later when using ABC compared to CAB, since a ready-to-use bag for bag-mask ventilation is rarely directly available. In my opinion, changing the recommendations would not delay bag ventilation, but decrease the time to initiation of chest compressions. -
Виктория Антонова
Thank you for your comments. These are adult guidelines, but could probably have been marked more clearly. The BLS ILCOR treatment recommendation in 2015 was: "We suggest commencing CPR with compressions rather than ventilations (weak recommendation, very-low-quality evidence)." -
Виктория Антонова
My comments would be that (whilst I have not done a literature search or research on this) that I was always told historically that the neonatal bone is not calcified well and this increase risk of going straight through the bone, current IO needles are developed for paediatrics/adults only and drills create increased risk as you are unable to feel the pop (which is minimal on premature infant) Umbilical vein is usually very accessible and neonatal staff are usually skilled to perform the task. There are risks involved with emergency UVC also of course. My personal opinion is to continue UVC in emergency but research and equipment manufacturing could be evolved. -
Виктория Антонова
I agree. Many paediatric trainees nowadays have never been involved with UVC insertion and many complete their training with little confidence in UVC insertion and may be called upon to attend a newborn requiring immediate access. They may though have skills of IO insertion as may their adult colleagues who may be called upon to help in such a situation. -
Виктория Антонова
Many NICU transport teams are not permitted to perform UVCs. IO is now their go to device for resuscitation use. IO placement is easily completed rapidly compared to attempting UVC access. -
Виктория Антонова
When comparing humeral IO to IV placement I have found that medication is just as fast by humeral IO. -
Виктория Антонова
In our state, Ceará, we practice umbilical catheterization instead of the intraosseous pathway. -
Виктория Антонова
Why is there a change in recommendations in the absence of any new evidence?? There is a substantial difference in adult and paediatric resuscitation but this was not reflected in the justification and treatment recommendations at all. The clinical evidence in not new norr sufficient for the change of recommendation in my opinion. The value of chest compressions in CA secondary to asphyxia where blood is already almost completely deprived of oxygen is debatable at the best (most cases of paediatric CAs). Also, for the same pathophysiological reason, the ERC started to recommend in 2015 the initial 5 rescue breaths not only for paediatric resuscitation but also for drowning (in the special circumstances section). -
Виктория Антонова
We train the rescue service, anaesthesiologists and obstetricians in the use of an umbilical vein access with a blunt hollow cannula. Although this is not a central venous access, but you get an easy and fast venous access. -
Виктория Антонова
The Royal Dutch Dental Association (Koninklijke Maatschappij voor Tandheelkunde) launched in 2019 a public campaign on what to do with avulsed permanent tooth. The striking message is: "is rinse the tooth, place it back and instead of going to the emergency or go directly to the dentist." Striking because the ILCOR 'Treatment Recommendations' in the systematic review assumes storing a tooth in Hank's Balanced Salt solution (HBSS), propolis, ORS or milk and no evidence-remarks about the possibility of temporarily replacing after cleaning (with water). What seems to be an effective and fast way to offer a tooth some survival rate. Although the review stated that “making these recommendations, we recognize that survival of an avulsed tooth requires that it must be replanted as soon as possible, but this procedure may not be possible in the first aid setting.” A large contrast to the mentioned public campaign!