Near drowning: is emergency department cardiopulmonary resuscitation or intensive care unit cerebral resuscitation indicated?
ABSTRACT a) To report the neurologic outcome of a series of near-drowning victims treated with supportive management without aggressive cerebral resuscitation; and b) to identify patient characteristics that indicate prognosis and guide therapy at the scene, the Emergency Department, and in the intensive care unit (ICU).
Retrospective review of all near-drowning patients requiring admission to the ICU over a 6-yr period (1/1/82 to 12/31/88). Hospital records were examined for the circumstances of submersion and rescue, patient condition on arrival in the Emergency Department and ICU, treatments, hospital course, and ultimate outcome.
Emergency departments of the referring hospital and ICU of Children's Hospital.
Forty-four pediatric submersion victims were treated with therapy limited to the support of vital functions. Three patients who met cold-water drowning criteria were excluded from the analysis for predictors of neurologic outcome.
In our warm-water near-drowning patients, 56% survived neurologically intact, 32% survived in a persistent vegetative state, and the remaining 32% died. Unreactive pupils in the Emergency Department and a Glasgow Coma Score of < or = 5 on arrival to the ICU were the best independent predictors of poor neurologic outcome (odds ratio and 95% confidence intervals 374 [17 to 16,000] and 51 [5 to 2,200], respectively). However, no predictor was absolute and two nonhypothermic patients who arrived to the Emergency Department without vital signs, requiring cardiopulmonary resuscitation and cardiotonic medications, had full neurologic recovery.
Our results cast further doubt on the utility of aggressive forms of cerebral monitoring and resuscitation and emphasize the need for initial full resuscitation in the Emergency Department.
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Chapter: Drowning[Show abstract] [Hide abstract]
ABSTRACT: submersion and immersion. This chapter focuses on submersion and reviews the epidemiol-ogy, pathophysiology, and treatment of this mainly respira-tory problem. Hypothermia-related immersion issues are described in Chapter 49. 1 Epidemiology Circumstances of drowning vary around the world; from healthy toddlers to desperate boat refugees, and from beach to bathtub. According to the WHO report, each year between 350 000 and 450 000 persons die from drowning. In addition, in some years, over 500 000 persons have drowned in floods and tsunamis. Most drowned victims are children, and the potential years of life lost are immense. Within this global perspective, 97% of all drowning occurs in South East Asia, the Pacific, and Africa. In some areas, the drowning rate is as high as 400 persons per 100 000 inhabitants. The leading cause of drowning in these areas is multifactorial. Leisure, work, transport, and collecting water for household purposes occur in the surroundings of water. Swimming skills are lacking, as is the knowledge on how to perform rescue, first aid, or basic life support (BLS). Also, prevention efforts, rescue resources, or communication equipment are poor. 2–4 In the Western world, a combination of socioeconomic factors, legislation, multifaceted prevention programs, improved rescue techniques, and up-to-date medical systems have resulted in a 10-to 20-fold decrease in drowning rates during the last 50 years. The death rate is between 0.1 and 2.5 per 100 000 inhabitants. High risk groups are children (because of their exploratory behav-ior), ethnic minorities (because they have poorer swim-ming skills and are unfamiliar with water hazards), car occupants (because of blocked escape routes from cars with maximum active safety protection), and water recre-ationers (because of inadequate preparation and alcohol use). Certain countries or areas have specific, and some-times unique, riskgroups: Alaska and Iceland (commercial fisherman). 5,6 Japan (hot tub drowning), 7 and Australia and the southern areas of the USA (private swimming pool drowning). 8,9 Recent data from the Netherlands suggest another new trend: scoot-mobiles and walker-related drowning in the elder generation. 10 An important cause of drowning in the Western world is suicide, and in some countries the incidence of suicidal drowning is three times larger than that of accidental drowning. 11 Homicide has been suggested to be underreported in paediatric bathtub drowning. 12 For most types of drowning, males have an approximately 4-fold greater incidence of drowning than do females, except for suicide. 12,13Cardiac Arrest: The Science and Practice of Resuscitation Medicine, 2nd edited by ed. Norman Paradis, Henry Halperin, Karl Kern, Volker Wenzel, Douglas Chamberlain, 01/2007: chapter 61: pages 1086-100; Cambridge University Press.
Article: 5. Acute brain injury in children[Show abstract] [Hide abstract]
ABSTRACT: This self-directed learning module highlights new advances in this topic area. It is part of the chapter on brain injury rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article contains an overview of epidemiology and prevention of pediatric traumatic brain injury (TBI) and highlights issues of assessment and management that differ in the child as compared with the adult with TBI. Prediction and description of outcome after pediatric TBI across the spectrum of injury severity are discussed. Special categories of common pediatric brain injury, including shaking-impact syndrome and near drowning, are also briefly reviewed. New advances covered in this article include new information on pediatric TBI outcomes and recent availability of functional neuroimaging as a tool to explore developmental differences in brain function and plasticity and mechanisms of neurologic and functional recovery after pediatric TBI. More research is needed to evaluate the effectiveness of rehabilitation interventions in improving outcomes after TBI in children.Archives of Physical Medicine and Rehabilitation - ARCH PHYS MED REHABIL. 01/1998; 79(3).
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ABSTRACT: The primary goal of this study is to research the relationship between the reward management system applications and employee performance of bank employees on global banks in Istanbul. It also focuses on the role of motivation as an intervening factor. According to the literature review on the previous studies it is proven that organizations use reward systems and strategies to motivate their employees and to increase their performance. This study will have lots of contributions to the business world. Organizations may improve or change their reward systems to survive in today's environment with the help of this study. They may renew their reward systems and put more efficient and effective ones. In this study, employee performance effectiveness is determined on reward systems. At the beginning of the study, there is a literature review and there are hypotheses concerning the effects of reward management system and motivation on employee performance. Secondly, theoretical framework is discussed through the effects of reward management system applications and motivation on employee performance. Finally hypotheses are tested using data from 116 bank employees in 12 global banks and research results or findings are analyzed.Procedia - Social and Behavioral Sciences 01/2011; 24:1510-1520.