Prehospital Clinical Decision-Making for Medication Administration for Behavioral Emergencies.

Introduction. Prehospital behavioral emergency protocols provide guidance on when a medication may be necessary; however, the final decision of which medication to administer to a patient is made independently by paramedics. This study sought to describe the clinical decision-making process of prehospital behavioral emergencies when paramedics consider chemical restraints, and determine the factors associated with choosing specific medications to administer.

Establishing a Quality Improvement Program for Pediatric In-hospital Cardiac Arrest.

Background: Pediatric In-hospital Cardiac Arrest (IHCA) is a rare event with a 50-55% mortality rate. Techniques of Cardiopulmonary Resuscitation (CPR), medication and electrical therapy timing, team dynamics, simulation and debriefing programs are associated with improved outcomes. This study aimed to improve outcomes after IHCA by describing and implementing quality improvement processes that cross and coordinate among traditional siloed pediatric resuscitation team structures.

Prehospital Clinical Decision-Making for Medication Administration for Behavioral Emergencies.

Introduction: Prehospital behavioral emergency protocols provide guidance on when a medication may be necessary for prehospital behavioral emergency. However, the final decision of which medication to administer to a patient is made independently by paramedics. The authors evaluated circumstances in a prehospital behavioral emergency when paramedics considered chemical restraints, and factors that go into choosing which medications to administer.

Guidance for Structuring a Pediatric Intermediate Care Unit.

The purpose of this policy statement is to update the 2004 American Academy of Pediatrics clinical report and provide enhanced guidance for institutions, administrators, and providers in the development and operation of a pediatric intermediate care unit (IMCU). Since 2004, there have been significant advances in pediatric medical, surgical, and critical care that have resulted in an evolution in the acuity and complexity of children potentially requiring IMCU admission. A group of 9 clinical experts in pediatric critical care, hospital medicine, intermediate care, and surgery developed a consensus on priority topics requiring updates, reviewed the relevant evidence, and, through a series of virtual meetings, developed the document.

Improving the Safety of an Emergency Department-Based Direct Admission Process at a Children's Hospital.

Objectives: Direct admission refers to admitting a patient to a unit avoiding usual entry points such as the emergency department. Inappropriate placement of direct admissions can result in rapid response activations, codes and unanticipated pediatric intensive care unit (PICU) transfers, which correlate with higher mortality and longer lengths of stay. The objective of the project was to improve the safety of the direct admission process as evidenced by decreasing the transfer of direct admission patients to the PICU within 6 hours.

Comparison of Selected Outcomes Associated with Two Postoperative Analgesic Approaches in Patients Undergoing Total Knee Arthroplasty.

Femoral nerve blocks (FNBs) and periarticular injections (PAIs) are often used for analgesia following bone and joint surgery. The purpose of this retrospective analysis was to investigate the association of analgesic technique with outcomes. All patients receiving total knee arthroplasty (TKA) at a regional medical center in 2014 were analyzed.

Effects of a PICU Status Asthmaticus De-Escalation Pathway on Length of Stay and Albuterol Use.

Objectives: Evaluate the effects of an asthma de-escalation clinical pathway on selected outcomes for patients admitted to a PICU with status asthmaticus.

Design: Time series quality improvement trial.

Setting: PICU in a tertiary care children's hospital.

Novel Series of Dihydropyridinone P2X7 Receptor Antagonists.

Identification of singleton P2X7 inhibitor 1 from HTS gave a pharmacophore that eventually turned into potential clinical candidates 17 and 19. During development, a number of issues were successfully addressed, such as metabolic stability, plasma stability, GSH adduct formation, and aniline mutagenicity. Thus, careful modification of the molecule, such as conversion of the 1,4-dihydropyridinone to the 1,2-dihydropyridinone system, proper substitution at C-5″, and in some cases addition of fluorine atoms to the aniline ring allowed for the identification of a novel class of potent P2X7 inhibitors suitable for evaluating the role of P2X7 in inflammatory, immune, neurologic, or musculoskeletal disorders.

The impact of obesity on pediatric procedural sedation-related outcomes: results from the Pediatric Sedation Research Consortium.

Objectives: To evaluate the impact of obesity on adverse events and required interventions during pediatric procedural sedation.

Methods: The Pediatric Sedation Research Consortium database of prospectively collected procedural sedation encounters was queried to identify patients for whom body mass index (BMI) could be calculated. Obesity was defined as BMI ≥95th percentile for age and gender.

Great expectations-defining quality in pediatric sedation: outcomes of a multidisciplinary consensus conference.

Purpose: Recognizing the inconsistencies in sedation practices, the Society for Pediatric Sedation convened this meeting to begin the process of defining quality as it relates to the field of pediatric sedation.

Scope: Millions of procedures are performed each year on children. Caring for children, even for routine procedures, can be challenging.

Development, implementation, and initial participant feedback of a pediatric sedation provider course.

Background: No standardized educational curriculum exists for pediatric sedation practitioners. We sought to describe the curriculum and implementation of a pediatric sedation provider course and assess learner satisfaction with the course curriculum.

Description: The course content was determined by formulating a needs assessment using published sedation guidelines, reports of sedation related adverse events, and a survey of sedation practitioners.

Pyrrolopyrazines as selective spleen tyrosine kinase inhibitors.

We describe the discovery of several pyrrolopyrazines as potent and selective Syk inhibitors and the efforts that eventually led to the desired improvements in physicochemical properties and human whole blood potencies. Ultimately, our mouse model revealed unexpected toxicity that precluded us from further advancing this series.

Physiologic monitoring practices during pediatric procedural sedation: a report from the Pediatric Sedation Research Consortium.

Objectives: To describe the frequency of different physiologic monitoring modalities and combinations of modalities used during pediatric procedural sedation; to describe how physiologic monitoring varies among different classes of patients, health care providers (ie, ranging from anesthesiologists to emergency medicine physicians to nurse practitioners), procedures, and sedative medications employed; and to determine the proportion of sedations meeting published guidelines for physiologic monitoring. DESIGN This was a prospective, observational study from September 1, 2007, through March 31, 2011.

Setting: Data were collected in areas outside of the operating room, such as intensive care units, radiology, emergency departments, and clinics.

Identification of glutathione-derived metabolites from an IP receptor antagonist.

The metabolic fate of three aromatic carboxylic acid analogs under evaluation as prostaglandin I2-preferring receptor antagonists was studied. The initial analog with unsubstituted phenyl groups was subject to a complex set of aromatic oxidative biotransformations. By introduction of one or two fluorines, these pathways were inhibited.

Extubation failure in pediatric intensive care: a multiple-center study of risk factors and outcomes.

Objective: To determine a contemporary failed extubation rate, risk factors, and consequences of extubation failure in pediatric intensive care units (PICUs). Three hypotheses were investigated: a) Extubation failure is in part disease specific; b) preexisting respiratory conditions predispose to extubation failure; and c) admission acuity scoring does not affect extubation failure.

Design: Twelve-month prospective, observational, clinical study.

Paralyzation and sedation of the ventilated trauma patient.

Sedation and analgesia will be required in the mechanically ventilated pediatric trauma patient. Adequate provision of both has a number of beneficial physiologic and psychologic effects. There are a number of categories of sedatives available for use.

Diuretic therapy of heart failure in infants and children.

Diuretics are the mainstay of traditional therapy for congestive heart failure. The syndrome of heart failure is now understood to involve complex interactions of neurohumoral substances released in response to poor cardiac function. Developmental changes during infancy and childhood will affect both the activation of systemic neurohumoral responses and the pharmacokinetic and pharmacodynamic actions of diuretics.

Renal replacement therapies in pediatric multiorgan dysfunction syndrome.

Both peritoneal dialysis (PD) and continuous hemodiafiltration (CHDF) techniques are used in children who develop acute renal failure as part of multiorgan dysfunction syndrome (MODS). An important goal of renal support in MODS is treatment and prevention of fluid overload. This report describes an experience with PD and CHDF in children with MODS and presents an analysis of fluid balance for each modality.

The pediatric sedation unit: a mechanism for pediatric sedation.

Objectives: We have created a pediatric sedation unit (PSU) in response to the need for uniform, safe, and appropriately monitored sedation and/or analgesia for children undergoing invasive and noninvasive studies or procedures in a large tertiary care medical center. The operational characteristics of the PSU are described in this report, as is our clinical experience in the first 8 months of operation.

Methods: A retrospective review of quality assurance data was performed.

Optimal sedation of mechanically ventilated pediatric critical care patients.

Objective: To derive a target range of optimal sedation for the COMFORT Scale and to prospectively test that target range against intensivist assessment of adequacy of sedation.

Design: Serial prospective agreement cohort studies.

Setting: Twelve-bed pediatric intensive care unit in an urban academic teaching hospital.