James S. Seidel’s research while affiliated with Harbor-UCLA Medical Center and other places

A 10 month-old infant was given a Lychee Mini Fruity Gel (AP Frozen Foods Ltd, Thailand) by his mother while shopping in a supermarket. The child was sucking on the gel when he began to choke and have difficulty breathing. Emergency medical services were called, and paramedics found the child to be in respiratory arrest with a palpable pulse of 40 beats/min. They transported him to the pediatric emergency department, performing bag-valve-mask ventilation with a manual resuscitator. The child was intubated and taken to the operating room for bronchoscopy and then the pediatric intensive care unit for critical care. The initial report was that he choked on gelatin. However, he was found to have aspirated a large hard gel found in the lychee-flavored candy that totally obstructed his airway. This is the third case of aspiration of a gel candy we have seen in 5 years. Parents should be warned not to give these candies to children younger than 5 years.

Context Endotracheal intubation (ETI) is widely used for airway management of children in the out-of-hospital setting, despite a lack of controlled trials demonstrating a positive effect on survival or neurological outcome.Objective To compare the survival and neurological outcomes of pediatric patients treated with bag-valve-mask ventilation (BVM) with those of patients treated with BVM followed by ETI.Design Controlled clinical trial, in which patients were assigned to interventions by calendar day from March 15, 1994, through January 1, 1997.Setting Two large, urban, rapid-transport emergency medical services (EMS) systems.Participants A total of 830 consecutive patients aged 12 years or younger or estimated to weigh less than 40 kg who required airway management; 820 were available for follow-up.Interventions Patients were assigned to receive either BVM (odd days; n = 410) or BVM followed by ETI (even days; n = 420).Main Outcome Measures Survival to hospital discharge and neurological status at discharge from an acute care hospital compared by treatment group.Results There was no significant difference in survival between the BVM group (123/404 [30%]) and the ETI group (110/416 [26%]) (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.61-1.11) or in the rate of achieving a good neurological outcome (BVM, 92/404 [23%] vs ETI, 85/416 [20%]) (OR, 0.87; 95% CI, 0.62-1.22).Conclusion These results indicate that the addition of out-of-hospital ETI to a paramedic scope of practice that already includes BVM did not improve survival or neurological outcome of pediatric patients treated in an urban EMS system. Figures in this Article Although bag-valve-mask ventilation (BVM) and endotracheal intubation (ETI) are both widely used in the out-of-hospital setting in caring for critically ill or injured children, there has been no controlled study comparing the outcomes of pediatric or adult patients treated with these 2 procedures. In 1 out-of-hospital study, BVM did compare favorably to non-ETI advanced airway management techniques (pharyngeal tracheal lumen, laryngeal mask, and esophageal tracheal combination esophageal-tracheal tube) among adults and children, as measured by PO2 and PCO2 values on arrival in the emergency department (ED), frequency of vomiting, and patient outcome.1 There have been a number of descriptive studies of ETI in the out-of-hospital setting. Reported success rates of pediatric ETI vary from 50% to 100%, depending on the patient's presenting illness or injury, the age of the patient, education level of the health care provider, and use of neuromuscular blocking agents to facilitate intubation.2- 10 Major complications of ETI, such as esophageal intubation, have been reported in as little as 1.8% and as many as 17% of pediatric patients in the out-of-hospital setting.7,10 One study reported an overall complication rate of 22.6%, using succinylcholine to facilitate intubation.10 Despite the fact that retrospective studies comparing the survival of patients treated with BVM and ETI have generally found no difference, some investigators have suggested that ETI may be beneficial in certain patient subgroups, such as those with submersion injury and cardiopulmonary arrest.4,6,11- 13 Moreover, despite limited comparative data for BVM and ETI, and the high complication rates reported for pediatric ETI in the out-of-hospital setting, pediatric ETI is taught in 97% of paramedic training schools and widely used by out-of-hospital providers.14 This study compared the survival and neurological outcomes of pediatric patients assigned to receive BVM with those of patients assigned to receive ETI in the out-of-hospital setting.

The new guidelines for pediatric cardiopulmonary resuscitation are based on the best present in the literature. Although there are few studies in the pediatric population, recommendations have been made for lay-person basic life support (BLS), airway m MM gement, drugs, treatment of rhythm disturbances, mid newborn resuscitation.

[Seidel JS, Gausche-Hill M. Pediatric equipment availability and emergency preparedness. Ann Emerg Med. April 2001;37:388-389.]

We designed this study to determine the experiences, attitudes, and beliefs of teenagers regarding violence in their lives and to gain an understanding of the perceived role of the emergency health care professional. A qualitative study involving 10-person focus groups was conducted in 4 cities representing urban/low socioeconomic and suburban/high socioeconomic areas. Participants were 14 or 15 years of age and were recruited from local community centers. Moderators were matched by sex to the teenagers, and groups were segmented by race and sex. A semistructured guide was developed to help facilitate the discussion. All groups were audiotaped and videotaped, and the tapes were reviewed by the investigators for reoccurring themes. A total of 140 adolescents (14 groups of 10) participated; one half were male. Urban teenagers expressed concerns about gangs, rape, and homicide; suburban teenagers were concerned about parental pressure and suicide. The teenagers expressed distrust of teachers, police officers, and doctors and felt safest with their parents. The emergency department was viewed as a confusing and frightening place, and participants believed that the role of the ED staff was to treat the patient's medical problem and not inquire or counsel about violence. All of the teenagers, regardless of socioeconomic status, were concerned about violence in their lives. All of the teenagers believed that the emergency department is not the place for patients to be counseled about safety and violence prevention. A better understanding of the problem of violence from the point of view of the teenager is important in refining an effective role for the emergency health care provider in adolescent violent injury prevention.