Seizures, Meds, and Vtach: A Journey to a Brugada Diagnosis.

ABSTRACT: Sudden cardiac arrest of cardiac etiology is rare in children and adolescents and most often occurs with exertion. Conversely, syncope is a common pediatric emergency department complaint but rarely is associated with a serious underlying cardiac disorder. This report describes a case of the channelopathy Brugada syndrome (BrS) as a cause of sudden cardiac arrest in a febrile preadolescent child taking medications known to affect cardiac conduction. The patient received cardiopulmonary resuscitation and was successfully defibrillated. Initial electrocardiogram (ECG) demonstrated findings consistent with BrS. Confirmatory electrophysiologic testing was performed, and an implantable cardiac defibrillator was placed. Pediatric emergency specialists must recognize both the importance of ECG in the workup of syncope and be familiar with the specific ECG findings suggestive of BrS. Ventricular arrhythmias that occur at rest should raise the suspicion of this genetic cardiac channelopathy, regardless of age.

CPR Blitzkrieg: Training 500 High School Students in less than 48 hours.

BACKGROUND Many states, including Arkansas, require CPR training before high school graduation. METHODS We modified the American Heart Association's CPR in Schools curriculum to deliver CPR and AED training with maximal individual practice. RESULTS 520 students were trained over a two-day period at Little Rock Central High School. Three students were unable to effectively participate due to physical limitations. The model was later applied at the five other district public high schools. CONCLUSIONS Training large numbers of students in a time-compressed formal is feasible with a highly dedicated, practiced instructor team. This model may be applicable to workplace settings.

Effects of smoking abstinence on adult smokers with and without attention deficit hyperactivity disorder: results of a preliminary study.

RATIONALE: Individuals with attention deficit hyperactivity disorder (ADHD) smoke at higher rates than the general population; however, little is known about the mechanisms underlying this comorbidity. OBJECTIVE: This study evaluated the effects of overnight abstinence on withdrawal symptoms and cognitive performance in adult smokers with and without ADHD. MATERIALS AND METHODS: Individuals smoking > or = 15 cigarettes per day were recruited from the community and underwent an evaluation to establish a diagnosis of ADHD (n = 12) or not (n = 14). Withdrawal symptoms, mood, craving, cognitive performance, and smoking cue reactivity were measured during two laboratory sessions-in a 'Satiated' condition participants smoked up to and during the session while in an 'Abstinent' condition, participants were required to be smoking abstinent overnight and remain abstinent during the session. RESULTS: The effects of abstinence on ADHD and non-ADHD smokers did not differ for withdrawal symptom severity, mood, craving or cue reactivity. Significant Group x Condition interactions were observed for measures of attention and response inhibition on the Conners' CPT. For reaction time (RT) variability and errors of commission, the ADHD group exhibited greater decrements in performance after overnight abstinence compared to the non-ADHD group. The effects of abstinence on other cognitive measures (e.g., rapid visual information processing task, cued Go/No-Go task) did not differ between the two groups. CONCLUSION: This preliminary study is the first to systematically evaluate the effects of acute smoking abstinence in adult smokers diagnosed with ADHD. Individuals with the disorder may smoke at higher rates due to greater worsening of attention and response inhibition after abstinence.

Improving attention-deficit/hyperactivity disorder treatment outcomes through use of a collaborative consultation treatment service by community-based pediatricians: a cluster randomized trial.

OBJECTIVE: To test whether adoption of a collaborative consultative service model results in improved patient outcomes. DESIGN: Twelve pediatric practices were randomly assigned to receive access to collaborative consultative services or to a control group. SETTING: Community-based pediatric offices. PARTICIPANTS: Fifty-two pediatricians and their 377 patients with attention-deficit/hyperactivity disorder (ADHD). Intervention A collaborative consultative service promoting the use of titration trials and periodic monitoring during medication maintenance. Main Outcome Measure Physician practice behaviors and child ADHD symptomatology. RESULTS: Using self-report of pediatricians, the collaborative consultative service increased the use of evidence-based practices by pediatricians, but no difference in children's ADHD symptomatology was observed between the groups. However, many pediatricians did not fully use the collaborative consultative services. Those children who actually received collaborative consultative services showed significant behavioral improvement compared with children not receiving these services. CONCLUSIONS: When actually implemented by pediatricians, the collaborative consultative service appears to be an effective method for facilitating evidence-based treatment procedures for ADHD and use of these procedures appear to improve children's outcomes. Barriers to implementation of collaborative consultative service in pediatric practice need to be further understood.