Late-presenting Congenital Diaphragmatic Hernia: Case Report

Congenital diaphragmatic hernia (CDH) is a developmental defect of the diaphragm. It becomes evident as a result of the entrance of the abdominal organs into the chest cavity. Generally, respiratory symptoms appear in the first few hours or days of life in affected newborns. Events diagnosed after one month are considered as late-onset CDH and these constitute 5-25% of all diaphragmatic hernia cases. In late diagnosed cases, left posterolateral CDH is seen most commonly (79.4%), and 65% of patients show symptoms within one year. The most common symptom and evidence are vomiting and dyspnea. During the infancy period, respiratory complaints are seen frequently while in the older ones gastrointestinal complaints are seen more often. In this article, we present a case of a 9-year-old patient who presented with the complaint of cough only and was diagnosed with diaphragmatic hernia. The patient was admitted to our emergency department with a preliminary diagnosis of pneumonia. In the physical examination of the patient, it became evident that breath sounds were decreased in the left hemithorax. Chest X-ray showed left hemithorax opacity and suspicious intestinal appearance. The patient was diagnosed with diaphragm hernia after ultrasonograhphy and thorax tomography. The patient was transferred to the pediatric surgery department and operated. Patients with CDH may not always be diagnosed at an early stage and may come up with different clinical symptoms at different ages. It is more difficult to diagnose in late-onset cases and it is important to make differential diagnosis. This case report was presented due to rarity of late onset CDH with only complaint of cough

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

Job Satisfaction and Fear of Covid-19 among Emergency Service Physicians in Pandemic Era

Introduction: An important part of the employees who are fighting against Covid-19 on the front line are emergency physicians (EP).&nbsp;Material and methods: In our study, we evaluated the fear of Covid-19 and job satisfaction of adult and pediatric emergency physicians in the western part of Turkey from their perspective at the beginning and in the fourth month of the pandemic. It was observed that the satisfaction of the physicians with the working conditions in the 4th month of the pandemic was higher than it was before the pandemic.&nbsp;Results: Physicians' scores regarding fear of Covid-19 at the beginning of the pandemic were higher than in the fourth month of the pandemic. Being female, having children, and age was determined as factors that increased the fear of Covid-19.&nbsp;Conclusions: Despite the high fear of Covid-19, the reason for the high satisfaction because of the arrangements made at the beginning of the pandemic stemmed from the heavy workload normal conditions that before the pandemic. The high rate of emergency service use by patients who do not need emergency service resources is the most important reason for these heavy working conditions. We think that studies should be conducted to increase the awareness of patients on this issue, necessary sanctions should be imposed, working conditions of the emergency services should be improved, and working in these services should be made attractive. Arrangements to be made considering the data about the satisfaction of the physicians will help them feel safe and reduce their fear of Covid-19 and other diseases.</p

Çocuklarda Kayısı Çekirdeği Yenmesi Sonrası Siyanür Zehirlenmesi

Cyanide is one of the strongest and lethal poisons. Cyanide leads to tissue hypoxia and lactic acid accumulation. Hydroxocobalamin is a safe, fast and effective antidote that could be used, especially in children. In this paper, we presented four cases of cyanide poisoning caused by apricot seed ingestion. Three of the patients were transferred to the paediatric intensive care unit, and hydroxocobalamin was given, and their conditions improved rapidly. This study aimed to draw attention to cyanide poisoning caused by apricot seed ingestion and to hydroxocobalamin use as an antidote.Siyanür en güçlü ve en ölümcül zehirlerden biridir. Siyanür doku hipoksisine ve laktik asid oluşumuna neden olur. Hidroksikobalamin, özellikle çocuklarda kullanılabilecek güvenli, hızlı ve etkin bir antidottur. Biz bu yazıda kayısı çekirdeği alımına bağlı siyanür zehirlenmesi olan dört olgu sunduk. Üç hastamızda ciddi zehirlenme bulguları ile çocuk yoğun bakım ünitesine alındı ve andidot olarak hidroksikobalamin verilerek, hızlı düzelme sağlandı. Amacımız; kayısı çekirdeği yenmesine bağlı siyanür zehirlenmesine ve antidot olarak hidroksikobalamin kullanımına dikkat çekmekti

Cholelithiasis Developing after Rapid Weight Loss in an Adolescent

Gallbladder and bile duct stones are rarely diagnosed conditions during childhood. However, the number of diagnosed patients has begun to increase due to widespread use of ultrasound in recent years. Hemolytic disease, inflammatory bowel disease, parasites, parenteral nutrition, diabetes, cystic fibrosis, metabolic diseases, chronic liver disease, rapid weight loss, and drug use may lead to cholelithiasis. In this paper, we present a 16-year-old girl who had lost weight due to improper diet and was admitted to the pediatric emergency room with the complaints of vomiting and abdominal pain, and then, was diagnosed with cholestasis and cholelithiasis

The use of Pleth Variability Index (PVI) for the assessment of patients with dehydration in the pediatric emergency department

Objective:There is not a non-invasive, valid, and reliable criterion yet that can be used to determine the degree of dehydration and responsiveness to fluid treatment. In the literature, Pleth Variability Index (PVI) has been studied as one of the additional tools that can be used to determine the degree of dehydration. Studies on this topic have been conducted mainly on patients who are connected to mechanical ventilators. This study was conducted to assess the feasibility of PVI measurement in paediatric patients who breathe spontaneously, are dehydrated moderately and need fluid repletion.Materialand Methods:For this purpose, PVI, blood gas (pH, HCO3, lactate), and body weights of the patients were measured before and after fluid replacement. The delta (Δ) values were calculated by taking the difference between the values before and after fluid therapy, and the correlation was examined.Results:After one hour of fluid treatment, weight, physical examination, blood gas (bicarbonate, lactate, pH) values improved significantly compared to pre-fluid levels, and high PVI values were found to decrease significantly. However, no significant correlation was found between PVI change (ΔPVI) and other variables (Δ kilo, pH, lactate, bicarbonate), which are used to determine the degree of dehydration.Conclusion:According to the findings of our study, PVI alone does not provide adequate and reliable data in children who are dehydrated moderately and breathe spontaneously.Keywords:Pediatric, Dehydration, Pleth Variability Index</p

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

Çocuklarda Yüksek Akım Nazal Kanül Oksijen Tedavisine Yanıtsızlığı Belirleyen Faktörler: Prospektif Çok Merkezli Çalışma

Giriş : Yüksek akım nazal kanül (YANK) oksijen tedavisi, akut solunum sıkıntısı olan çocuklarda kolay uygulanabilir bir tedavi seçeneğidir. Literatürde YANK oksijen tedavisinin entübasyon oranını, solunum sayısı, kalp tepe atım sayısını azalttığını ve klinik skorlarda iyileşme sağladığını gösteren çok sayıda çalışma mevcuttur. YANK oksijen tedavisine %6-19 oranında tedavi başarısızlığı bildirilmektedir. Bu çalışmada YANK oksijen tedavisine yanıtsızlığı öngören faktörlerin belirlenmesi amaçlanmaktadır.Gereç-Yöntem : Bu çalışmaya Eylül 2017- Eylül 2018 tarihleri arasında Türkiye’nin 7 farklı ilinden 9 çocuk acil ve 7 çocuk yoğun bakım ünitesi katılmıştır. YANK oksijen tedavisi uygulanan hastalara ait demografik bilgiler, başvuru anında ve YANK oksijen tedavisi sırasında vital bulgular, oksijen saturasyonu, S/F oranı, klinik skor (modified respiratory distress score ve pediatric respiratory severity score), laboratuvar ve görüntüleme sonuçları, uygulanan medikal tedaviler ve YANK oksijen tedavisine yanıt durumu değerlendirilmiştir. Veriler prospektif olarak toplanmıştır. Başka bir solunum destek tedavisine geçiş yanıtsızlık olarak değerlendirilmiştir.Bulgular : Toplam 475 veri kayıt formu değerlendirilmiştir. Doksan dokuz form veri eksikliği nedeniyle değerlendirme dışında bırakılmıştır. Kalan 356 hastaya ait veri kayıt formları incelenmiştir. Ekstübasyon sonrası YANK oksijen tedavisi uygulanan 20 hasta çalışmaya dahil edilmemiştir. Çalışmaya dahil edilen 356 hastanın 216’sı (%60.7) erkek ve ortanca yaş 9 aydır (ÇAA=4-27ay). Hastaların %39.0’ına akut bronşiolit (n=139), %36.2’sine atipik/viral pnömoni (n=129), %26.8’ine bakteriyel pnömoni (n=88) tanısıyla YANK oksijen tedavisi uygulanmıştır. Kırk altı (%12.9) hastada prematür doğum ve 143 (%40.2) hastada tekrarlayan hışıltı atağı öyküsü saptanmıştır. Hastaların %62.9’undan (n=224) solunum virüs PCR paneli çalışılmıştır. Bu hastaların 101’inde (%45.1) tek etken pozitifliği saptanırken 36 hastada ko-enfeksiyon gösterilmiştir. En sık görülen etkenler RSV ve rhinovirüstür. Başvurudan sonra ortanca YANK oksijen başlama süresi 2 saat (ÇAA= 30dk-6 sa) ve median tedavi uygulama süresi 48 saattir (ÇAA=24-96 sa). Tedavi sonrasında hastaların solunum sayısında (SS) belirgin azalma, oksijen saturasyonu (SpO₂) ve SF oranında istatistiksel anlamlı artış saptanmıştır (p&lt;0.001). Otuzyedi (%9.9) hastada tedaviye yanıt alınamamıştır. Median yanıtsızlık süresi 6.5 saattir (ÇAA=3.0-19.5sa). Tedaviye yanıt alınamayan hastalarda, başvuruda SpO₂, S/F oranı ve kan gazında pH daha düşük ve pCO₂’nin daha yüksek olduğu saptanmıştır (p=0.005, p=0.008, p=0.012 ve p=0.039 sırayla). Tedavi komplikasyonu olarak 2 hastada lokal cilt lezyonu ve 2 hastada pnömotoraks izlenmiştir. Yanıtsız hastaların 5’i mortalite ile sonuçlanmıştır. Sonuç : Çalışmamızda YANK oksijen tedavisine yanıtsızlık oranı %9.9 olarak saptanmıştır. Tedaviye yanıt alınamayan hastalarda, başvuruda SpO₂ ve SF oranının, kan gazında pH’nın daha düşük, pCO₂’nin ise yüksek olduğu bulunmuştur. Tedavi başlangıcında bu bulguları olan hastalar daha yakın takip edilmeli ve bir üst tedavi basamağına geçiş acısından dikkatli olunmalıdır.</p