Exercise and myocardial tolerance to ischaemia-reperfusion.

UNLABELLED: It is well established that both short-term (1-5 days) and long-term (weeks to months) high intensity exercise (i.e. 70-75%VO2max) provides cardioprotection against ischaemia-reperfusion injury. However, it is unclear if moderate intensity exercise will also provide cardioprotection. AIM: Therefore, these experiments compared the protective effects of moderate vs. high intensity exercise in providing defense against ischaemia-reperfusion injury. METHODS: Male Sprague-Dawley rats were randomly assigned to one of three-experimental groups: (1) sedentary (control); (2) moderate intensity treadmill exercise (60 min day(-1) at approximately 55%VO2max); or (3) high intensity treadmill exercise (60 min day(-1) at approximately 75%VO2max). Hearts were exposed to 20 min of global ischaemia followed by 30 min reperfusion in an isolated working heart preparation. RESULTS: Compared with sedentary rats, both moderate and high intensity exercised rats maintained a higher (P < 0.05) percentage of pre-ischaemia cardiac output and cardiac work (cardiac output x systolic blood pressure) during reperfusion. No differences in the percent recovery of cardiac output and heart work existed (P > 0.05) between the two exercise groups. CONCLUSIONS: These data reveal that both moderate and high intensity exercise training provide equivalent protection against ischaemia-reperfusion injury.

Drug withdrawal symptoms in children after continuous infusions of fentanyl.

The purpose of this research was to determine the extent to which critically ill infants exhibited signs and symptoms of narcotic withdrawal after receiving continuous infusions of fentanyl. The convenience sample consisted of 12 pediatric intensive care unit (PICU) patients under 25 months of age who received fentanyl infusions for at least 24 hours. Drug withdrawal symptoms were monitored using the Neonatal Abstinence Score Tool (NAST), which assigns a score to each behavior indicative of withdrawal. A score of 8 or greater indicates Neonatal Abstinence Syndrome (NAS). Scoring began 4 hours after discontinuation of fentanyl and was conducted once per hour for 8 hours. Six subjects had a NAST score exceeding 8; these infants frequently exhibited tremors with or without stimulation, increased muscle tone, insomnia, and increased respiratory rate and effort. There were significant correlations between fentanyl dosage and NAST score (r = .76, p < 0.01), between length of infusion of fentanyl and NAST score (r = .70, p < 0.05), and between chloral hydrate dosage and NAST score (r = .62, p < 0.05). These findings suggest the need for an observation protocol and a possible weaning regimen after fentanyl is discontinued.

A statewide evaluation of pediatric prehospital and hospital emergency services.

OBJECTIVE: To evaluate the extent of pediatric emergency training and the availability of pediatric equipment and patient care protocols in the prehospital and hospital settings. DESIGN: Statewide surveys developed by the North Carolina Provisional Committee on Pediatric Emergency Medical Services and by the Office of Emergency Medical Services. SETTING AND PARTICIPANTS: Surveys were mailed to all 572 prehospital Emergency Medical Service (EMS) agencies and separately to all 125 acute-care hospitals in North Carolina. INTERVENTIONS: None. MEASUREMENTS/MAIN RESULTS: Surveys were returned by 335 (58.6%) of the prehospital providers, including all 45 paramedic and 14 advanced-intermediate provider agencies. One hundred (80%) of the acute-care hospitals returned surveys. Only 10.8% of the prehospital EMS agencies provided more than 10 hours of basic training in pediatric emergency care; 18% provided more than 5 hours of continuing education in pediatric emergencies over a 3-year period. Pediatric-specific equipment was available in many prehospital vehicles, although some deficiencies were noted. Written pediatric management, bypass, and helicopter transport protocols were absent in most prehospital programs. Paramedic programs generally were much better in all areas, although deficiencies were present. Only 14% of the responding hospitals had more than 20 pediatric beds; 13% reported seeing more than 100 patients per day in the emergency department. Deficiencies were identified in pediatric patient care protocols, triage and transport agreements, pediatric training of nurses and physicians, and equipment. Equipment deficiencies were more marked in the intensive care units than in the emergency departments. CONCLUSIONS: These survey data are inexpensive to obtain and demonstrate EMS system deficiencies. The survey information provides a baseline measurement that can lead to measurable, targeted changes in the state's EMS system for children.