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Predicting outcome in hypoxic-ischemic brain injury.

机译:预测缺氧缺血性脑损伤的结果。

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Predicting the neurologic outcome of children after a hypoxic-ischemic event continues to be a challenge for intensivists and pediatric neurologists. Nevertheless, with accurate history taking, serial neurologic examination, and some ancillary studies, the clinician can predict accurately whether a child will die or have profound neurologic damage. Aggressive resuscitation should be offered to all children when found in CPA. A simple ingestion might have led to this clinical scenario, and complete neurologic recovery may be possible if effective resuscitation is implemented. In cases of drowning, several factors, if present, are consistent with profound neurologic sequelae or death. These include prolonged submersions with asystole, delayed onset of CPR, no spontaneous respirations on arrival to the emergency department, and low initial pH value. The options of withdrawal of life support or a DNR status should be offered to families of children who have survived a devastating hypoxic-ischemic event but who are in a PVS. If brain-death criteria have been fulfilled, the patient must then be disconnected from life support after organ donation has been discussed with the family.
机译:预测缺氧缺血事件后儿童的神经系统结局仍然是强化医生和儿科神经科医生的挑战。尽管如此,通过准确的病史记录,连续的神经系统检查以及一些辅助研究,临床医生可以准确地预测孩子是否会死亡或严重的神经系统损害。在CPA中发现的所有儿童都应进行积极的复苏。简单的摄入可能导致这种临床情况,并且如果实施有效的复苏,则可能完全恢复神经系统。在溺水的情况下,如果存在多种因素,则与严重的神经系统后遗症或死亡相符。这些包括长时间浸没在心搏停止,CPR发作延迟,到达急诊室后没有自发呼吸以及初始pH值低。应该为在严重的缺氧缺血性事件中幸存但处于PVS中的儿童家庭提供撤回生命支持或DNR身份的选择。如果满足脑死亡标准,则在与家人讨论器官捐赠后,必须将患者从生命支持中断开。

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