Countless tests, endless hours of studying, and bottomless pots of coffee - the first two years of medical school are unlike anything most people will ever experience. As the pressure mounts, so does your stress level. We have compiled 10 tips to not only help you survive the grueling didactic portion of medical school, but to ensure you thrive as you embark on your career in emergency medicine.
A 6-year-old female presented with a two-day history of abdominal pain after being referred by her pediatrician for evaluation of "splenomegaly." The patient had been complaining of constipation for the past six days along with a few episodes of nausea and vomiting. On physical examination, a firm, non-tender mass was palpated extending at least 10 cm below the left costal margin.
Almost immediately, emergency physicians know what to do with most abnormal lab results. If a patient’s hemoglobin is 4.5 g/dL, they need a transfusion. If their troponin is 12.3 ng/ml, they are having cardiac infarction. If their lactic acid is 7.5 mmol/L, something terrible is going on. What if the only abnormality they have on their blood work is bandemia? Does it matter if their bands are 6%, 15%, or 32%? Or, are they all treated equally?
Pediatric cardiopulmonary arrest (PCA) is a rare event; it occurs out-of-hospital in about 8.04 per 100,000 person-years compared to 126.52 per 100,000 person-years in adults [1]. As expected, the mortality is high; one study found one month survival of pediatric out-of-hospital cardiac arrest (OHCA) to be 10.5%, while another study found survival to discharge of pediatric in-hospital cardiac arrest (IHCA) to be 31.3% [2,3]. Achieving higher rates of survival is dependent on many factors in the chain of survival, but the performance of good quality cardiopulmonary resuscitation (CPR) has been shown to be directly associated with survival. In this article, we will define quality CPR in the pediatric patient, review some studies linking certain aspects of CPR with survival in PCA, and review some adjuncts to improve CPR performance.
