Çocuklarda Çevresel Aciller

 Elektrik çarpmaları yüksek mortalite ve morbiditeyle seyreden sıklıkla çocuklarda evde ortamında kaza sonucu oluşan yaralanmalardır. Elektrik çarpmaları oldukça geniş bir klinik yelpazedeklinik bulgu verir, basit yanıklardan ciddi organ hasarına kadar varan tablolar görülebilir. Yaralanmanın şiddeti maruz kalınan elektrik akımının yoğunluğuna, cinsine, akıma maruz kalma süresine,akımın vücutta izlediği yola ve akıma maruz kalan dokunun direncine bağlı olarak değişmektedir.Olay yerinde arrest, bilinç kaybı, ciddi yanık gibi bulguları varlığında veya yüksek voltajlı elektrikçarpması durumunda hastalar, mutlaka yatırılarak çoklu sistem tutulumu, aritmi ve komplikasyonlaraçısından yakın izlenmelidir. Elektrik yaralanmaları, önlenebilir bir ölüm nedeni olması ve çoğunlukla evde kazası sonucu ortaya çıkması nedeniyle ev içi önlemlerin önemi büyüktür. Ayrıca ebeveynlere ve çocuk bakımı ile ilgilenenlere ilk yardım dersleri verilmesi, elektrik çarpmalarınınsonuçları ve önlemler konusunda eğitici ve bilgilendirici kılavuzların oluşturulması ve uygulanmasıgerekmektedir. Electrical injuries are accidents with high mortality and morbidity that often occur athome in children. Electrical injuries have a wide range of clinical presentation from mild burns to severe organ damage. The severity of the injury varies depending on the intensity of the electrical current, type, duration of exposure to the current, the path of the current in the body and the resistance ofthe tissue exposed to the current. In case of cardiac arrest, loss of consciousness, severe burns at thescene, or high voltage electrical injury, Patient should be hospitalized and closely monitored for multisystem involvement, arrhythmia, and complications. Since electrical injuries are a preventable cause ofdeath and mostly occur at home, domestic precautions are crucial. Also, first aid classes for parents andcaregivers, establishment and implication of educational and informative guidelines on the consequences of electrical injury and precautions are essential

Confirmation of Nasogastric Tube Placement via Bedside Ultrasound in a Pediatric Intensive Care Unit

Introduction: Nasogastric tube (NGT) placement is a common procedure in pediatric intensive care and requires accurate verification to avoid complications. Traditional methods such as auscultation and radiography pose limitations such as unreliability and radiation exposure. The aim of this study was to confirm the placement of NGT using bedside ultrasonography (USG). Methods: A prospective study was conducted in a tertiary pediatric intensive care unit (PICU) using bedside USG to confirm NGT positioning. The study included 46 patients, with procedures ranging from November 2023 to January 2024. Placement confirmation techniques included USG visualization and the air bolus method when necessary. Results: All 68 NGT insertions were successfully visualized using USG. The median age of patients was 18 months, with the most common admissions being pneumonia and septic shock. An air bolus was used in 13.2% of the cases to indirectly confirm placement. Conclusion: Bedside USG is an effective and safe alternative for confirming NGT placement in the PICU, minimizing the risk of radiation, and leveraging the benefits of immediate and accurate bedside assessment. This method can replace radiography as the new standard for NGT placement confirmation

Mortality Risk Factors among Critically Ill Children with Acute COVID-19 in PICUs: A Multicenter Study from Turkish Pediatric Critical COVID-19 and MIS-C Study Group

© 2022 Lippincott Williams and Wilkins. All rights reserved.Background: During the coronavirus disease 2019 (COVID-19) pandemic, the world has a large number of reported COVID-19 cases and deaths. Information on characteristics and mortality rate of pediatric intensive care unit (PICU) cases with COVID-19 remains limited. This study aims to identify the risk factors for mortality related to COVID-19 in children admitted to PICU. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 44 PICUs in Turkey. Children who were 1 month-18-year of age with confirmed COVID-19 admitted to PICU were included in the study. Children with multisystem inflammatory syndrome and asymptomatic for COVID-19 were excluded. Results: Of 335 patients with COVID-19, the median age was 6.8 years (IQR: 1.2-14) and 180 (53.7 %) were male, 215 (64.2 %) had at least one comorbidity. Age and gender were not related to mortality. Among 335 patients, 166 (49.5%) received mechanical ventilation, 17 (5.1%) received renal replacement therapy and 44 (13.1 %) died. Children with medical complexity, congenital heart disease, immunosuppression and malignancy had significantly higher mortality. On multivariable logistic regression analysis, organ failure index [odds ratio (OR): 2.1, 95 confidence interval (CI): 1.55-2.85], and having congenital heart disease (OR: 2.65, 95 CI: 1.03-6.80), were associated with mortality. Conclusions: This study presents detailed data on clinical characteristics and outcomes of patients with COVID-19 admitted to PICU in the first pandemic year in Turkey. Our study shows that having congenital heart disease is associated with mortality. In addition, the high organ failure score in follow-up predict mortality