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the boy in striped pajamas study guide questions and answersWe can't connect to the server for this app or website at this time. There might be too much traffic or a configuration error. Try again later, or contact the app or website owner. Prior purchases do not qualify toward the minimum purchase requirement. Assessorial Fees may apply. Offer is subject to change without notice. The PALS Provider Manual is for use by a single student and provides information needed before, during, and after class. If you are a student, please confirm with your Training Center that this is the appropriate product for your training. This includes personnel inThe PALS Provider Manual is for use by a single student and provides information needed before, during, and after class. If you are a student, please confirm with your Training Center that this is the appropriate product for your training. This includes personnel inDallas, TX 75231 Unauthorized use prohibited.Dallas, TX 75231 Unauthorized use prohibited. This classroom, Instructor-led course uses a series of videos and simulated pediatric emergencies to reinforce the important concepts of a systematic approach to pediatric assessment, basic life support, PALS treatment algorithms, effective resuscitation, and team dynamics. The goal of the PALS Course is to improve the quality of care provided to seriously ill or injured children, resulting in improved outcomes.Locate a Training Center By claiming CAPCE credit, the claimant acknowledges the following: I understand that the American Heart Association as a requirement of CAPCE accreditation will submit a record of my course completions to the CAPCE AMS. I further understand that my course completion records may be accessed by or shared with such regulators as state EMS offices, training officers, and NREMT on a password-protected, need-to-know basis. If your profession is not listed here, please contact your HR department or licensing board with any questions.http://mzd.cieszyn.pl/userfiles/bose-quietcomfort-3-acoustic-noise-cancelling-headphones-manual.xml
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The American Heart Association is accredited by the Accreditation Council for Continuing Medical Education and does not determine participants to receive credit or number of credits per course. By continuing to browse this site you are agreeing to our use of cookies. Over the past decade, the percent of cardiac arrests occurring in an ICU setting has increased (87 to 91 in 2000 to 2003 to 94 to 96 in 2004 to 2010). 4 While rates of survival from pulseless electrical activity and asystole have increased, there has been no change in survival rates from in-hospital ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT). Conversely, survival from out-of-hospital cardiac arrest (OHCA) has not improved as dramatically over the past 5 years. In 2000, the AHA began collaborating with other resuscitation councils throughout the world, via the International Liaison Committee on Resuscitation (ILCOR), in a formal international process to evaluate resuscitation science. This process resulted in the publication of the International Consensus on CPR and ECC Science With Treatment Recommendations (CoSTR) in 2005 and 2010. 7, 8 These publications provided the scientific support for AHA Guidelines revisions in those years. In 2011, the AHA created an online evidence review process, the Scientific Evidence Evaluation and Review System (SEERS), to support ILCOR systematic reviews for 2015 and beyond. This new process includes the use of Grading of Recommendations Assessment, Development, and Evaluation (GRADE) software to create systematic reviews that will be available online and used by resuscitation councils to develop their guidelines for CPR and ECC. The drafts of the online reviews were posted for public comment, and ongoing reviews will be accessible to the public ( ).http://www.wings.lv/userfiles/bose-radio-cd-owner-s-manual.xml The AHA process for identification and management of potential conflicts of interest was used, and potential conflicts for writing group members are listed at the end of each Part of the 2015 AHA Guidelines Update for CPR and ECC. For additional information about this systematic review or management of the potential conflicts of interest, see “Part 2: Evidence Evaluation and Management of Conflicts of Interest” in this supplement and the related article “Part 2: Evidence Evaluation and Management of Conflict of Interest” in the 2015 CoSTR publication. 9, 10 This update to the 2010 AHA Guidelines for CPR and ECC for pediatric advanced life support (PALS) targets key questions related to pediatric resuscitation. Areas of update were selected by a group of international pediatric resuscitation experts from ILCOR, and the questions encompass resuscitation topics in prearrest care, intra-arrest care, and postresuscitation care. The ILCOR Pediatric Life Support Task Force experts reviewed the topics addressed in the 2010 Guidelines for PALS and, based on in-depth knowledge of new research developments, formulated 18 questions for further systematic evaluation. 11 Three questions that address pediatric basic life support appear in “Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality.” Beginning with the publication of the 2015 CoSTR, the ILCOR evidence evaluation process will be continuous, rather than “batched” into 5-year cycles. The goal of this continuous evidence review is to improve survival from cardiac arrest by shortening the time between resuscitation science discoveries and their application in resuscitation practice. As additional resuscitation topics are prioritized and reviewed, these Guidelines may be updated again. When the evidence supports sufficient changes to the Guidelines or a change in sequence or treatments that must be woven throughout the Guidelines, then the Guidelines will be revised completely.https://www.becompta.be/emploi/3gx-mrs-manual Because the 2015 AHA Guidelines Update for CPR and ECC represents the first update to the previous Guidelines, recommendations from both this 2015 Guidelines Update and the 2010 Guidelines are contained in the Appendix. If the 2015 ILCOR review resulted in a new or significantly revised Guidelines recommendation, that recommendation will be labeled as New or Updated. As with all AHA Guidelines, each 2015 recommendation is labeled with a Class of Recommendation (COR) and a Level of Evidence (LOE). This update uses the newest AHA COR and LOE classification system, which contains modifications of the Class III recommendation and introduces LOE B-R (randomized studies) and B-NR (nonrandomized studies) as well as LOE C-LD (limited data) and LOE C-EO (consensus of expert opinion). These PALS recommendations are informed by the rigorous systematic review and consensus recommendations of the ILCOR Pediatric Task Force, and readers are referred to the complete consensus document in the 2015 CoSTR. 12, 13 In the online version of this document, live links are provided so the reader can connect directly to the systematic reviews on the SEERS website. These links are indicated by a superscript combination of letters and numbers (eg, Peds 397 ). We encourage readers to use the links and review the evidence and appendixes, including the GRADE tables. Pediatric Early Warning Scores Peds 818 In-hospital pediatric cardiac or respiratory arrest can potentially be averted by early recognition of and intervention for the deteriorating patient. The use of scoring systems might help to identify such patients sufficiently early so as to enable effective intervention. 2015 Evidence Summary There is no evidence that the use of PEWS outside of the pediatric ICU setting reduces hospital mortality. In 1 observational study, PEWS use was associated with a reduction in cardiac arrest rate when used in a single hospital with an established medical emergency team system.http://astucesvoyages.com/images/boss-ch1-super-chorus-pedal-manual.pdf 22 2015 Recommendation—New The use of PEWS may be considered, but its effectiveness in the in-hospital setting is not well established (Class IIb, LOE C-LD). Fluid Resuscitation in Septic Shock Peds 545 This update regarding intravenous fluid resuscitation in infants and children in septic shock in all settings addressed 2 specific therapeutic elements: (1) Withholding the use of bolus fluids was compared with the use of bolus fluids, and (2) noncrystalloid was compared with crystalloid fluids. Early and rapid administration of intravenous fluid to reverse decompensated shock, and to prevent progression from compensated to decompensated shock, has been widely accepted based on limited observational studies. 23 Mortality from pediatric sepsis has declined in recent years, during which guidelines and publications have emphasized the role of early rapid fluid administration (along with early antibiotic and vasopressor therapy, and careful cardiovascular monitoring) in treating septic shock. 24, 25 Since the 2010 Guidelines, a large randomized controlled trial of fluid resuscitation in pediatric severe febrile illness in a resource-limited setting found intravenous fluid boluses to be harmful. 26 This new information, contradicting long-held beliefs and practices, prompted careful analysis of the effect of fluid resuscitation on many outcomes in specific infectious illnesses. 2015 Evidence Summary Specific infection-related shock states appear to behave differently with respect to fluid bolus therapy. Evidence was not considered to be specific to a particular setting, after determining that “resource-limited setting” is difficult to define and can vary greatly even within individual health systems and small geographic regions. The evidence regarding the impact of restricting fluid boluses during resuscitation on outcomes in pediatric septic shock is summarized in Figure 1. There were no studies for many specific combinations of presenting illness and outcome.http://victorylimo1.com/wp-content/plugins/formcraft/file-upload/server/content/files/1627262243ba62---breitling-hercules-instruction-manual.pdf In the majority of scenarios, there was no benefit to restricting fluid boluses during resuscitation. Download figure Download PowerPoint Figure 1. Evidence for the use of restrictive volume of intravenous fluid resuscitation, compared with unrestrictive volume, by presenting illness and outcome. Benefit indicates that studies show a benefit to restricting fluid volume, No Benefit indicates that there is no benefit to restricting fluid volume, and Harm indicates that there is harm associated with restricting fluid volume. The most important exception is that in 1 large study, restriction of fluid boluses conveyed a benefit for survival to both 48 hours and 4 weeks after presentation. This study was conducted in sub-Saharan Africa, and inclusion criteria were severe febrile illness complicated by impaired consciousness (prostration or coma), respiratory distress (increased work of breathing), or both, and with impaired perfusion, as evidenced by 1 or more of the following: a capillary refill time of 3 or more seconds, lower limb temperature gradient, weak radial-pulse volume, or severe tachycardia. In most scenarios, there was no benefit to noncrystalloids over crystalloids. In patients with Dengue shock, a benefit was conferred in using noncrystalloid compared with crystalloid fluid for the outcome of time to resolution of shock. 31 Download figure Download PowerPoint Figure 2. Evidence for the use of noncrystalloid intravenous fluid resuscitation, compared with crystalloid, by presenting illness and outcome. Benefit indicates that studies show a benefit to the use of noncrystalloid intravenous fluid resuscitation compared with crystalloid, and No Benefit indicates that there is no benefit to the use of noncrystalloid intravenous fluid resuscitation compared with crystalloid.www.e-mogilev.com/uploads/files/briggs-stratton-engine-maintenance-manual.pdf When caring for children with severe febrile illness (such as those included in the FEAST trial 26 ) in settings with limited access to critical care resources (ie, mechanical ventilation and inotropic support), administration of bolus intravenous fluids should be undertaken with extreme caution because it may be harmful (Class IIb, LOE B-R). Providers should reassess the patient after every fluid bolus (Class I, LOE C-EO). Either isotonic crystalloids or colloids can be effective as the initial fluid choice for resuscitation (Class IIa, LOE B-R). This recommendation takes into consideration the important work of Maitland et al, 26 which found that fluid boluses as part of resuscitation are not safe for all patients in all settings. This study showed that the use of fluid boluses as part of resuscitation increased mortality in a specific population in a resource-limited setting, without access to some critical care interventions such as mechanical ventilation and inotrope support. The spirit of this recommendation is a continued emphasis on fluid resuscitation for both compensated (detected by physical examination) and decompensated (hypotensive) septic shock. Moreover, emphasis is also placed on the use of individualized patient evaluation before the administration of intravenous fluid boluses, including physical examination by a clinician and frequent reassessment to determine the appropriate volume of fluid resuscitation. The clinician should also integrate clinical signs with patient and locality-specific information about prevalent diseases, vulnerabilities (such as severe anemia and malnutrition), and available critical care resources. Practitioners have often tried to blunt this bradycardia with prophylactic premedication with atropine. 2015 Evidence Summary The evidence regarding the use of atropine during emergency intubation has largely been observational, including extrapolation from experience with elective intubation in the operating suite.http://kraljicabih.com/wp-content/plugins/formcraft/file-upload/server/content/files/16272623a37701---breitling-intruder-manual.pdf It may be reasonable for practitioners to use atropine as a premedication in specific emergency intubations when there is higher risk of bradycardia (eg, when giving succinylcholine as a neuromuscular blocker to facilitate intubation) (Class IIb, LOE C-LD). This new recommendation applies only to the use of atropine as a premedication for infants and children during emergency intubation. Prearrest Care of Infants and Children With Dilated Cardiomyopathy or Myocarditis Peds 819 Optimal care of a critically ill infant or child with dilated cardiomyopathy or myocarditis should avert cardiac arrest. While significant global experience exists with the care of these patients, the evidence base is limited. The ILCOR systematic review ultimately restricted its analysis to patients with myocarditis and did not include the use of ventricular assist devices. 2015 Evidence Summary No literature was identified evaluating best prearrest management strategies (including anesthetic technique) for infants and children with dilated cardiomyopathy or myocarditis. Optimal outcomes from ECMO are achieved in settings with existing ECMO protocols, expertise, and equipment. Intra-arrest Care Updates Extracorporeal CPR for In-Hospital Pediatric Cardiac Arrest Peds 407 The 2010 AHA PALS Guidelines suggested the use of ECMO when dealing with pediatric cardiac arrest refractory to conventional interventions and when managing a reversible underlying disease process. End-Tidal CO 2 Monitoring to Guide CPR Quality Peds 827 High-quality CPR is associated with improved outcomes after cardiac arrest. Animal data support a direct association between ETCO 2 and cardiac output. Capnography is used during pediatric cardiac arrest to monitor for ROSC as well as CPR quality.http://gennarimaq.com.br/wp-content/plugins/formcraft/file-upload/server/content/files/162726247f3957---breitling-instruction-manuals.pdf The 2010 Guidelines recommended that if the partial pressure of ETCO 2 is consistently less than 15 mm Hg, efforts should focus on improving CPR quality, particularly improving chest compressions and ensuring that the victim does not receive excessive ventilation. 2015 Evidence Summary There is no pediatric evidence that ETCO 2 monitoring improves outcomes from cardiac arrest. One pediatric animal study showed that ETCO 2 -guided chest compressions are as effective as standard chest compressions optimized by marker, video, and verbal feedback for achieving ROSC. 45 A recent study in adults found that ETCO 2 values generated during CPR were significantly associated with chest compression depth and ventilation rate. 46 2015 Recommendation—New ETCO 2 monitoring may be considered to evaluate the quality of chest compressions, but specific values to guide therapy have not been established in children (Class IIb, LOE C-LD). Although there are factors associated with better or worse outcomes, no single factor studied predicts outcome with sufficient accuracy to recommend termination or continuation of CPR. Invasive Hemodynamic Monitoring During CPR Peds 826 Children often have cardiac arrests in settings where invasive hemodynamic monitoring already exists or is rapidly obtained. If a patient has an indwelling arterial catheter, the waveform can be used as feedback to evaluate chest compressions. 2015 Evidence Summary Adjusting chest compression technique to a specific systolic blood pressure target has not been studied in humans. Two randomized controlled animal studies showed increased likelihood of ROSC and survival to completion of experiment with the use of invasive hemodynamic monitoring. 56, 57 2015 Recommendation—New For patients with invasive hemodynamic monitoring in place at the time of cardiac arrest, it may be reasonable for rescuers to use blood pressure to guide CPR quality (Class IIb, LOE C-EO).BARSUGO.COM/ckfinder/userfiles/files/briggs-stratton-engine-3_5-hp-manual.pdf Specific target values for blood pressure during CPR have not been established in children. Vasopressors During Cardiac Arrest Peds 424 During cardiac arrest, vasopressors are used to restore spontaneous circulation by optimizing coronary perfusion and to help maintain cerebral perfusion. However, they also cause intense vasoconstriction and increase myocardial oxygen consumption, which might be detrimental. 2015 Evidence Summary There are no pediatric studies that demonstrate the effectiveness of any vasopressors (epinephrine, or combination of vasopressors) in cardiac arrest. Two pediatric observational out-of-hospital studies 58, 59 had too many confounders to determine if vasopressors were beneficial. One adult OHCA randomized controlled trial 60 showed epinephrine use was associated with increased ROSC and survival to hospital admission but no improvement in survival to hospital discharge. 2015 Recommendation—New It is reasonable to administer epinephrine in pediatric cardiac arrest (Class IIa, LOE C-LD). Amiodarone and Lidocaine for Shock-Refractory VF and pVT Peds 825 The 2005 and 2010 Guidelines recommended administering amiodarone in preference to lidocaine for the management of VF or pVT. This recommendation was based predominantly on pediatric case series or extrapolation from adult studies that used short-term outcomes. 2015 Evidence Summary New pediatric observational data 61 showed improved ROSC with the use of lidocaine as compared with amiodarone. Use of lidocaine compared with no lidocaine was significantly associated with an increased likelihood of ROSC. The same study did not show an association between lidocaine or amiodarone use and survival to hospital discharge. 2015 Recommendation—New For shock-refractory VF or pVT, either amiodarone or lidocaine may be used (Class IIb, LOE C-LD). The Pediatric Cardiac Arrest Algorithm ( Figure 3 ) reflects this change. Download figure Download PowerPoint Figure 3. Pediatric Cardiac Arrest Algorithm—2015 Update. Energy Doses for Defibrillation Peds 405 The 2015 ILCOR systematic review addressed the dose of energy for pediatric manual defibrillation during cardiac arrest. One small observational study of IHCA 65 showed no benefit in achieving ROSC with a specific energy dose for initial defibrillation. Only 1 small study of therapeutic hypothermia in survivors of pediatric asphyxial cardiac arrest 71 showed an improvement in mortality at hospital discharge, but with no difference in neurologic outcomes. Continuous measurement of temperature during this time period is recommended (Class I, LOE B-NR). For infants and children remaining comatose after IHCA, there is insufficient evidence to recommend cooling over normothermia. In a larger observational study of 1427 pediatric IHCA and OHCA victims who survived to pediatric ICU admission, 77 after adjustment of confounders, the presence of normoxemia (defined as a Pa o 2 60 mm Hg or greater and less than 300 mm Hg) when compared with hyperoxemia (Pa o 2 greater than 300 mm Hg) after ROSC was associated with improved survival to pediatric ICU discharge. 2015 Recommendations—New It may be reasonable for rescuers to target normoxemia after ROSC (Class IIb, LOE B-NR). Because an arterial oxyhemoglobin saturation of 100 may correspond to a Pa o 2 anywhere between 80 and approximately 500 mm Hg, it may be reasonable—when the necessary equipment is available—for rescuers to wean oxygen to target an oxyhemoglobin saturation of less than 100, but 94 or greater. The goal of such an approach is to achieve normoxemia while ensuring that hypoxemia is strictly avoided. Ideally, oxygen is titrated to a value appropriate to the specific patient condition. One small observational study of both pediatric IHCA and OHCA 74 demonstrated no association between hypercapnia (Pa co 2 greater than 50 mm Hg) or hypocapnia (Pa co 2 less than 30 mm Hg) and outcome. However, in an observational study of pediatric IHCA, 76 hypercapnia (Pa co 2 50 mm Hg or greater) was associated with worse survival to hospital discharge. 2015 Recommendation—New It is reasonable for practitioners to target a Pa co 2 after ROSC that is appropriate to the specific patient condition, and limit exposure to severe hypercapnia or hypocapnia (Class IIb, LOE C-LD). One of these studies 91 associated post-ROSC hypotension (defined as a systolic blood pressure less than fifth percentile for age) after IHCA with lower likelihood of survival to discharge with favorable neurologic outcome. When appropriate resources are available, continuous arterial pressure monitoring is recommended to identify and treat hypotension (Class I, LOE C-EO). Postresuscitation Use of EEG for Prognosis Peds 822 Early and reliable prognostication of neurologic outcome in pediatric survivors of cardiac arrest is essential to enable effective planning and family support (whether it be to continue or discontinue life-sustaining therapy). 2015 Evidence Summary Observational data from 2 small pediatric studies 94, 95 showed that a continuous and reactive tracing on an EEG performed in the first 7 days after cardiac arrest was associated with a significantly higher likelihood of good neurologic outcome at hospital discharge, while an EEG demonstrating a discontinuous or isoelectric tracing was associated with a poorer neurologic outcome at hospital discharge. There are no data correlating EEG findings with neurologic outcome after hospital discharge. 2015 Recommendation—New EEGs performed within the first 7 days after pediatric cardiac arrest may be considered in prognosticating neurologic outcome at the time of hospital discharge (Class IIb, LOE C-LD) but should not be used as the sole criterion. Predictive Factors After Cardiac Arrest Peds 813 Several post-ROSC factors have been studied as possible predictors of survival and neurologic outcome after pediatric cardiac arrest. These include pupillary responses, the presence of hypotension, serum neurologic biomarkers, and serum lactate. 2015 Evidence Summary Four observational studies supported the use of pupillary reactivity at 12 to 24 hours after cardiac arrest in predicting survival to discharge, 49, 53, 95, 96 while 1 observational study found that reactive pupils 24 hours after cardiac arrest were associated with improved survival at 180 days with favorable neurologic outcome. 97 Several serum biomarkers of neurologic injury have been considered for their prognostic value. Two small observational studies found that lower neuron-specific enolase and S100B serum levels after arrest were associated with improved survival to hospital discharge and with improved survival with favorable neurologic outcome. 97, 98 One observational study found that children with lower lactate levels in the first 12 hours after arrest had an improved survival to hospital discharge. 99 2015 Recommendation—New The reliability of any 1 variable for prognostication in children after cardiac arrest has not been established. Practitioners should consider multiple factors when predicting outcomes in infants and children who achieve ROSC after cardiac arrest (Class I, LOE C-LD).It may be reasonable for practitioners to use atropine as a premedication in specific emergent intubations when there is higher risk of bradycardia (eg, when giving succinylcholine as a neuromuscular blocker to facilitate intubation) (Class IIb, LOE C-LD).Practitioners should consider multiple factors when predicting outcomes in infants and children who achieve ROSC after cardiac arrest (Class I, LOE C-LD).For more information, see the 2010 AHA Guidelines for CPR and ECC, “ Part 14: Pediatric Advanced Life Support.” 2010 Family Presence During Resuscitation Whenever possible, provide family members with the option of being present during resuscitation of an infant or child (Class I, LOE B).Part 12: pediatric advanced life support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. This article has been reprinted in Pediatrics. Survival trends in pediatric in-hospital cardiac arrests: an analysis from Get With The Guidelines-Resuscitation. Interdisciplinary ICU cardiac arrest debriefing improves survival outcomes. Duration of cardiopulmonary resuscitation and illness category impact survival and neurologic outcomes for in-hospital pediatric cardiac arrests. Ratio of PICU versus ward cardiopulmonary resuscitation events is increasing. Epidemiology and outcomes from out-of-hospital cardiac arrest in children: the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. A quantitative analysis of out-of-hospital pediatric and adolescent resuscitation quality. Part 6: paediatric basic and advanced life support: 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Part 10: Paediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Lang E, Morley PT, Aickin R, Billi JE, Eigel B, Ferrer JME, Finn JC, Gent LM, Griffin RE, Hazinski MF, Maconochie IK, Montgomery WH, Morrison LJ, Nadkarni VM, Nikolaou NI, Nolan JP, Perkins GD, Sayre MR, Travers AH, Wyllie J, Zideman DA. Part 2: evidence evaluation and management of conflicts of interest: 2015 International Liaison Committee on Resuscitation Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science and Treatment Recommendations. Resuscitation. 2015. In press. Google Scholar 11. Kleinman ME, Chameides L, Schexnayder SM, Samson RA, Hazinski MF, Atkins DL, Berg MD, de Caen AR, Fink EL, Freid EB, Hickey RW, Marino BS, Nadkarni VM, Proctor LT, Qureshi FA, Sartorelli K, Topjian A, van der Jagt EW, Zaritsky AL. Part 14: pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Part 6: pediatric basic life support and pediatric advanced life support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Maconochie IK, de Caen AR, Aickin R, Atkins DL, Biarent D, Guerguerian AM, Kleinman ME, Kloeck DA, Meaney PA, Nadkarni VM, Ng KC, Nuthall G, Reis AG, Shimizu N, Tibballs J, Veliz Pintos R; on behalf of the Pediatric Basic Life Support and Pediatric Advanced Life Support Chapter Collaborators. Part 6: pediatric basic life support and pediatric advanced life support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation. 2015. In press. Crossref Google Scholar 14. Anwar-ul-Haque, Saleem AF, Zaidi S, Haider SR. Experience of pediatric rapid response team in a tertiary care hospital in Pakistan. Hunt EA, Zimmer KP, Rinke ML, Shilkofski NA, Matlin C, Garger C, Dickson C, Miller MR. Transition from a traditional code team to a medical emergency team and categorization of cardiopulmonary arrests in a children’s center. Sharek PJ, Parast LM, Leong K, Coombs J, Earnest K, Sullivan J, Frankel LR, Roth SJ. Kotsakis A, Lobos AT, Parshuram C, Gilleland J, Gaiteiro R, Mohseni-Bod H, Singh R, Bohn D; Ontario Pediatric Critical Care Response Team Collaborative. Implementation of a multicenter rapid response system in pediatric academic hospitals is effective. Hanson CC, Randolph GD, Erickson JA, Mayer CM, Bruckel JT, Harris BD, Willis TS. A reduction in cardiac arrests and duration of clinical instability after implementation of a paediatric rapid response system. Zenker P, Schlesinger A, Hauck M, Spencer S, Hellmich T, Finkelstein M, Thygeson MV, Billman G.