Family experiences during resuscitation at a children's hospital emergency department.

INTRODUCTION: Family presence (FP) during resuscitation is a timely and controversial topic. Family members are becoming part of the resuscitation process. Study objectives included: (1) describe experiences of family members whose children underwent resuscitation in a children's hospital emergency department; (2) identify critical information about family experiences to improve circumstances for future families; and (3) assess mental and health functioning of family members. METHODS: This descriptive, retrospective study involved a 1-hour audio-taped interview of 10 family members using the Parkland Family Presence During Resuscitation/Invasive Procedures Unabridged Family Survey (FS) and investigator-developed questions. Mental and health functioning were assessed using the Brief Symptom Inventory, the Short Form Health Survey version 2, and the Post Traumatic Stress Disorder Scale. Seven family members were present during resuscitation, and three were not present. RESULTS: Five thematic categories were identified: (1) It's My Right to Be There; (2) Connection and Comfort Make a Difference; (3) Seeing is Believing; (4) Getting In; and (5) Information Giving. Family members voiced that it was their right to be present, indicating they had a special connection to the child. Seeing or not seeing the events of the resuscitation affected family members' ability to believe the outcome. Measures of mental and health functioning were similar to population norms. DISCUSSION: Instituting guidelines that facilitate FP may provide mechanisms to ensure that the needs of patients, family members, and health care providers are met during a stressful event.

Alteration in regulation of inflammatory response to influenza a virus and endotoxin in suckling rat pups: a potential relationship to sudden infant death syndrome.

Data increasingly implicate a possible role of immune and inflammatory responses to infection in sudden infant death syndrome (SIDS). We have previously described a dual challenge model that results in pathology, organ damage, vascular collapse and unexplained death similar to that seen in SIDS. In this study, we examined changes in inflammatory cytokine mRNA in the lung and liver and regulation of pathways associated with nitric oxide production. Our data suggest that priming of the immune system by mild viral infection disturbs normal inflammatory response to endotoxin. This results in an increased nitric oxide synthase production, most likely the cause of liver pathology and clotting abnormalities.

Munchausen syndrome by proxy: a case report.

Munchausen syndrome by proxy is difficult to diagnose unless healthcare providers are astute to its clinical features and management. A case is presented to educate nurses and advanced practice nurses, of the nursing, medical, legal, and social complexities associated with Munchausen syndrome by proxy. This article also provides a brief review of the definition of Munchausen syndrome by proxy, its epidemiology, common features of the perpetrator, implications for healthcare personnel, and the legal and international ramifications of Munchausen syndrome by proxy.

Synergistic effect of influenza a virus on endotoxin-induced mortality in rat pups: a potential model for sudden infant death syndrome.

Sudden infant death syndrome is the most common cause of postneonatal infant mortality in the developed world. It is a diagnosis of exclusion with peak age of incidence between 2 and 6 mo. Fifty to 63% of these infants have a preexisting upper respiratory tract infection before death. We hypothesized that the immature immune system may be altered by a primary infection, preventing a protective response after secondary challenge. To mimic dual infection, we used a nonlethal strain of a rat-adapted influenza A virus and a sublethal dose of endotoxin to establish a model that results in pathology and death in 12-d-old rat pups similar to that seen in infants dying of sudden infant death syndrome. Mortality only occurred when specific criteria such as timing between infectious insults and developmental age of the pup were met. Results suggest that mortality is caused by a rapid systemic shock event rather than lung-specific damage. Gross pathologic findings such as lung petechiae and liquid blood around the heart on necropsy were consistent with those seen in infants dying of sudden infant death syndrome. Histopathologic lesions including subendocardial hemorrhage and mild cortical thymocyte necrosis were found with greater severity and frequency in dually challenged animals. Macrophage subpopulation in rat-adapted influenza A virus-inoculated animals was significantly elevated in the spleen at the time of death. Our model suggests that the developing immune system can be primed to respond in an exaggerated way to a second immune challenge resulting in unexpected death.