A Rare Cardiotoxicity: Butane Inhalation

The number of cases of voluntary inhalation of volatile substances is increasing all over the world and in our country. This is a social health problem that can be encountered in different socioeconomic and cultural levels. The number of applications to pediatric emergency services cannot be underrated because the age of first use of such illegal substances has decreased gradually. Inhalation of volatile substances can cause pathologies in a very broad spectrum, including sudden death. In this paper, we report a case of cardiac arrest developing after lighter fluid inhalation

A Case of Fatal Malignant Hyperthermia During Pes Equinovarus Surgery in a Child

Malignant hyperthermia (MH) is a genetic syndrome characterized by hyperthermia, tachycardia, acidosis, and muscle rigidity, often triggered by depolarizing muscle relaxants such as volatile anesthetics and/or succinylcholine. MH usually develops following anesthesia induction, but may occur during and after a surgical intervention. A 4.5-year-old boy was admitted to the pediatric intensive care unit considering MH due to persistent fever, tachycardia and end-tidal carbon dioxide elevation which developed during pes equinovarus surgery. In the follow-up, hypercapnia, fever and refractory metabolic acidosis recurred. Despite the administration of dantrolene sodium and supportive treatments, the patient died. This case is presented to remind the possibility of MH which may be fatal in patients receiving general anesthesia and to emphasize the follow-up and treatment of the patients with MH in pediatric intensive care unit

The Performance of the Pediatric Trauma Score in a Pediatric Emergency Department: A Prospective Study

Introduction: The aim of this study was to assess the efficacy of the Pediatric Trauma Score (PTS) in predicting significant trauma in patients presenting with blunt trauma to a high-level pediatric emergency department. Methods: Patients younger than 15 years of age presenting to the pediatric emergency department of the Tepecik Training and Research Hospital with acute high-energy blunt trauma were analyzed prospectively. The PTS was calculated on arrival at the pediatric emergency department. The patients were classified into two groups as follows: patients with a PTS of ≤8 comprised the significant trauma group, while patients with a PTS of >8 made up the non- significant trauma group. Results: Two-hundred-thirteen children with a mean age of 6.1±3.9 years (range: 10 days-15 years) were included in the study. The frequency of coagulation testing and thorax computed tomography in the pediatric emergency department, need for critical interventions and therapies in the pediatric emergency department, rate of hospitalization, need for transfer to the pediatric intensive care unit, mechanical ventilation, operation, blood transfusion, and mortality rate were statistically higher in the significant trauma group (p<0.05). PTS ≤8 exhibited a sensitivity of 56.2% and a specificity of 90.8% for hospitalization (AUROC: 0.682; 95% confidence interval: 0.610-0.755). The PTS was significantly correlated with length of hospital stay (r=-0.493; p<0.001) and length of observation in the pediatric emergency department (r=-0.442; p<0.01). Conclusion: PTS on arrival at a high-level pediatric emergency department is a good predictor of the need for critical interventions/therapies and mortality in children with high-energy blunt trauma. However, its accuracy is moderate for the prediction of hospitalization

Successful Decompressive Craniectomy in a Child with Severe Head Trauma

In developed countries, trauma is the most common cause of mortality and morbidity in children. Severe traumatic brain injury is the most important cause of death in these patients. The main goal of treatment is to provide airway, respiratory and circulatory support and to prevent increased intracranial pressure. An 8-year-old girl with a severe traumatic brain injury due to traffic accident was admitted. The patient had a Glasgow Coma scale score of 8. She was intubated and provided respiratory and hemodynamic support. Cranial tomography showed bilateral diffuse frontal hemorrhagic contusion areas, traumatic subarachnoid hemorrhage, a slim subdural hemorrhage, basal cistern effacement, and severe brain edema with a midline shift to the left of 1 cm. Mannitol, 3% sodium chloride and phenytoin were given to the patient. At the 4th hour of the follow-up in pediatric intensive care, decompressive craniectomy was performed because the patient developed clinical herniation findings. The patient was extubated on the 3rd day and discharged on the 13th day. She did not have any neurological sequelae at 6 months of follow-up. Decompressive craniectomy should be considered without delay in children with severe head trauma with neurological deterioration or intracranial pressure elevation refractory to medical treatment and in those with herniation

A Rare Cause of Metabolic Acidosis Fatal Transdermal Methanol Intoxication in an Infant

WOS: 000380870300009PubMed ID: 26196361Oral methanol intoxication is common, but dermal intoxication is rare. We report a previously healthy 19-month-old female infant admitted to the emergency department (ED) with vomiting and tonicclonic seizure. On physical examination, she was comatose and presented signs of decompensated shock with Kussmaul breathing. Her left thigh was edematous, with purple coloration. Methanol intoxication was suspected due to high anion gap metabolic acidosis (pH, 6.89; HCO3, <3 meq/L) and exposure to spirit-soaked bandages (%96 methanol) for 24 hours and 3 days. The patient's serum methanol level was 20.4 mg/dL. She was treated with fomepizole and continuous venovenous hemodialysis (CVVHD) in the pediatric intensive care unit, and methanol levels decreased to 0 mg/dL after 12 hours. During follow-up, massive edema and subarachnoid hemorrhage in the occipital lobe were detected by computed tomography of the brain. The patient died after 7 days. Although methanol intoxication occurs predominantly in adults, it must be considered in children with high-anion gap metabolic acidosis. This case report demonstrates that fatal transdermal methanol intoxication can occur in children, and it is the second report in the English literature of transdermal methanol intoxication in an infant