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Introduction:Cardiopulmonary resuscitation (CPR) is a dynamic and memorizing process that is fully defined by guidelines. This process requiring urgent approach can only be achieved through repetitive training and practice. It is aimed to determine whether there are differences of knowledge between these trainings before and after, or whether the repeated training periodically increases the knowledge and skills of trained practitioners.Methods:CPR trainings were given to pediatric health and diseases assistant physicians by advanced cardiac life certified trainer. Pre-training, post-training and 6 months after the training, 20 questions were prepared based on the 2015 American Heart Association guide assessment questions were applied.Results:The most correct answers were given to the evaluation questions made immediately after the training (average number of correct answers 16.06±2.50) and the least correct answers were given to the evaluation questions made before training (average number of correct answers 8.41±2.26). Six months after the training, although the number of correct answers of the participants decreased significantly after the post-training; it was found that the scores in the sixth month were still considerably higher than before the training (average number of correct answers 12.76±3.30). There was a significant difference between the correct answers given to pre-training evaluation questions according to the duration of work in emergency, between physicians who have never worked yet and physicians with experience of working in the emergency department for 5 months and more (p=0.024). A significant difference was found between the first year assistant and the third year assistant (p=0.024) and between the first year assistant and the fourth year assistant (p=0.017) in terms of the number of correct answers to the pre-training evaluations questions.Conclusion:Theoretical and practical training in small groups increases the level of knowledge and skills about CPR.

Introduction:Upper gastrointestinal bleeding is an important emergency problem that can occur at any age in childhood and requires urgent treatment for the underlying cause. Etiological causes of gastrointestinal bleeding vary by age and geographic region. In this study; we aimed to investigate the demographic characteristics, etiological causes, endoscopic intervention results, and the relationship between analgesic/antipyretic drug use and bleeding in patients admitted to the pediatric emergency department with upper gastrointestinal bleeding.Methods:The records of patients aged 1 month to 18 years who presented to our pediatric emergency department with upper gastrointestinal bleeding between January 2017 and 2019 were retrospectively reviewed. Demographic features, complaints at admission, etiological reasons, endoscopy findings, diagnoses, and antipyretic/analgesic drug use were recorded.Results:There were 108 patients presenting with upper gastrointestinal bleeding, and 53.7% of the patients were male. The mean age was 76.7±58.3 months. Hematemesis was present in 100 patients. Symptoms of the patients; vomiting was present in 82.4%, upper respiratory tract infection in 36.1%, fever in 29.6%, and abdominal pain in 25.9%. There were 52 patients with a history of antipyretic and/or analgesic drug use. An endoscopic examination was performed in 74 patients. In patients who underwent endoscopic examination; pathological changes were detected in 26 of 32 patients who used drugs and 30 of 42 patients who did not use drugs.Conclusion:In patients presenting to the pediatric emergency department with upper gastrointestinal bleeding, the bleeding is usually acute and self-limiting, but requires prompt diagnosis and treatment. Approximately half of the patients in our study had a history of antipyretic/analgesic drug use in etiology. When the endoscopic findings of drug users and non-users were compared, no statistically significant difference was observed in terms of pathological findings.

Introduction:Vomiting is an important symptom that limits oral intake and may result in hospitalizations and prolonged hospital stays for intravenous fluid therapy. In our study, we aimed to compare the rates of hospital revisit and hospitalization due to vomiting within seven days of admission in children with acute gastroenteritis in two groups who received and did not receive intramuscular ondansetron.Methods:Files of patients aged 6 months-15 years (without dehydration) diagnosed with acute gastroenteritis (ICD A09) in our pediatric emergency clinic between December 2015-February 2016 (non-ondansetron period) and December 2019-February 2020 (intramuscular ondansetron period) were analyzed retrospectively. The patients included in the study were evaluated in two groups, the first group receiving a single dose of intramuscular ondansetron and the second group not receiving ondansetron treatment. Our primary aim was to determine the rates of readmission and hospitalization in the first 7 days of both groupsResults:It was determined that 21% of the patients who received ondansetron and 28% of the group who did not receive ondansetron were admitted to the emergency department due to vomiting in the first 7 days. In comparison of both groups, 5% of group I patients and 13% of group II patients needed intravenous fluids (odds ratio =0.3; 95% confidence interval =0.19-0.59) at repeated admission and required hospitalization in the emergency department.Conclusion:Intramuscular ondansetron treatment reduces the rate of hospital readmission, hospitalization and intravenous fluid requirement during re-admission in children with acute gastroenteritis with vomiting.

Introduction:The management of the patient who applied to the emergency department with corrosive substance exposure varies according to the characteristics of the substance and the clinical conditions of the patient. In this study; demographic and clinical characteristics, patient management strategies and prognosis of the children presenting with corrosive substance ingestion are presented.Methods:Cases who applied with corrosive substance intake and were under the age of 18 were included in the study. Demographic data of the patients, characteristics of the substance, presence of intraoral lesions or any symptoms or signs, treatment and prognosis, radiographs and hospital stay were examined. Drool scores were calculated.Results:One hundred-ten patients were included. The mean age of the patients was 41±13 months and 56 (50.9%) were male. 53% of the patients were asymptomatic at presentation. The most common symptom was nausea-vomiting, the most common finding was hyperemia in the oropharynx. The mean Drool score of the patients was 8.9±1.7. Seventy-seven patients (70%) took alkaline, 33 patients (30%) took acidic substances; 45 patients sodium hydroxide, 27 patients sodium hypochlorite, 26 patients took hydrochloric acid. Findings were mostly observed in hydrochloric acid and sodium hydroxide intake. Endoscopy was performed in 3 of the patients. The mean Drool score of the patients who underwent endoscopy was 6.7. No complications were observed in any of the patients in the follow-up.Conclusion:Ingestion of corrosive substances is one of the important and preventable causes of emergency department admissions with chemical poisoning. There is usually accidental and small amount of intake in early childhood. Patients may be asymptomatic or rarely present with severe symptoms. It is important to know the chemical content of the ingested substance in order to predict the risk of damage to the gastrointestinal tract and respiratory system and to provide appropriate management in emergency services.

Introduction:This study aimed to evaluate the neuroimaging results and associated characteristics of patients admitted to a pediatric emergency department for their first afebrile seizures.Methods:Patients admitted to the Emergency Room of University of Health Sciences Turkey, Ankara Dr. Sami Ulus Children’s Hospital between January 1, 2016 and December 31, 2019, with a diagnosis of first afebrile seizure were included in this study. Patients in this study included children without prior neurological or chronic disease and no history of drug use. The medical files of the patients were examined retrospectively.Results:In our study group, 55% were male (n=22) and 45% were female (n=18). The median age was 4.50 (0.25-17.00) years. The median seizure duration was 5.0 (0.03-30.0) minutes. Physical examinations performed in the emergency department yielded unremarkable findings in 80% (n=32) of the patients. A computed tomography scan detected a specific pathology in 10% (n=4) of the patients and magnetic resonance imaging was used in 12.5% (n=5) of the patients. There was no significant difference in terms of gender, age, and seizure duration between patients with and without pathology detected in neuroimaging (p>0.05).Conclusion:On evaluating patients admitted to the emergency department with their first afebrile seizures, 85% had normal neuroimaging findings. Variables such as gender, age, and seizure duration were not associated with the presence or absence of pathology in neuroimaging.

Introduction:In this study, we aimed to reveal the demographic data and the trauma characteristics of the patients with orthopedic trauma, which is common in childhood.Methods:In our study, 117 forensic cases aged 0-18 years, who applied to the Pediatric Emergency Department of University of Health Sciences Turkey, Tepecik Training and Research Hospital between 01.01.2016 and 31.12.2016, were consulted to the orthopedics and traumatology. The demographic characteristics of the patients, the way of applying to the emergency service, the type of trauma, the characteristics of the injury that occurred, additional consultations required from other clinics, radiological imagings other than direct radiography, and hospitalization of the patients were evaluated.Results:35.9% (n=42) of the patients included in our study were girls and the average age of girls were 9.09 (±6.04) years, and the average age of boys were 11.82 (±5.05) years. It was observed that the most common injury region was upper limbs with 52.1%. There was an increase in the number of blunt traumas, penetrating device injuries and gunshot injuries at older ages. It was observed that 45.3% (n=53) of the patients were consulted to other clinics besides the orthopedics and traumatology. When the patients were consulted, it was seen that they were consulted predominantly for surgical branches, especially neurosurgery (n=38, 32.4%) and pediatric surgery (n=28, 23.9%).Conclusion:In the majority of the forensic cases in children age group who are in need of orthopedics and traumatology consultation in the emergency department, injury occurs as a result of falling from height. Especially after the age of 14 years, it was seen that blunt trauma and sharp object injuries came into prominence in forensic cases related to orthopedics and traumatology clinic.

Introduction:Adrenaline is an important medication used in the treatment of various diseases. The nebulized form of adrenaline is used in respiratory diseases. The aim of this study was to evaluate the effects of nebulized adrenaline treatment on cardiac rhythm.Methods:Children, who were admitted to the hospital and received nebulized adrenaline treatment, were included in the study. The patients were followed up in terms of development of new findings and monitored in terms of the presence of new symptoms. Vital findings were recorded before nebulized adrenaline treatment and at 15, 60 and 120 minutes of treatment.Results:In this study, 48 patients were evaluated. There was no significant difference between the pre- and post-treatment levels in terms of vital signs (p>0.05). When electrocardiography were compared before and after treatment, there was no statistically significant difference in p averaging, QRS duration, QTc interval, p wave dispersion, QT and QTc dispersion.Conclusion:Nebulized adrenaline therapy is an effective, cheap, well tolerated and safe medication for respiratory diseases. Nebulized adrenaline treatment can be used safely at the recommended doses.

Air can be detected in various anatomical regions during the course of several diseases. This accumulation of air is often seen as pneumothorax and subcutaneous emphysema. Rarely extraordinary regions such as skull base and spinal region can be involved. In the majority of the patients, it is caused by trauma, iatrogenic factors and Valsalva maneuver. Supportive treatment is generally sufficient. A 14-year-old boy with psychosis who developed extensive air in the scull base, the neck, the orbita, mediastinum, abdomen, retroperitoneum, spinal canal, scrotum and head of the femur was presented. In the course of psychiatric disorders, in the case of excessive shouting and self-harm as a result of squeezing the throat, beside subcutaneous emphysema, air existing in the various anatomical regions of the body should be kept in mind.

The use of synthetic cannabinoids is a major health problem in all over the world as well as in our country. These products are synthetic substances created via mixture of cannabinoids and various plants. They are easy to access, inexpensive and undetectable on routine toxicological screening, leading to common use in the adolescent age group. In addition to physical effects, such as nausea, vomiting, sweating, tachycardia, hypertension, chest pain and altered consciousness, psychoactive effects, such as agitation, anxiety, altered perception, hallucinations and panic attacks, are also seen. Here, we present an adolescent patient with bradycardia and acute altered consciousness after bonzai use.

Introduction: Carbon monoxide poisoning is one of the most important causes of morbidity and mortality. There is increasing evidence supporting the important role of mean platelet volume (MPV) as a marker of hypoxia and inflammation. In this study, we aimed to determine changes in MPV values in pediatric patients with carbon monoxide poisoning. Methods: We retrospectively evaluated children who were diagnosed with carbon monoxide poisoning in our hospital between January 2005 and 2014. Results: We included 228 children with carbon monoxide poisoning (49% male) in this retrospective, controlled study. The mean age of the patients was 88±56 months. Control group consisted of 200 age-matched healthy children. There was no statistically significant difference in MPV levels between the study and control groups (8.43±1.1 fL and 8.26±0.7 fL, respectively). No correlation of MPV and platelet count with carboxyhemoglobin (COHb) was found. Conclusion: In our study, it was determined that MPV value was not a helpful parameter for predicting the diagnosis of acute carbon monoxide poisoning in childhood. The difference between the MPV values and the lack of significance and the absence of correlation between MPV value and COHb level led to the fact that MPV was not a guide indicating the clinical severity of the condition.

Epinephrine plays an integral role in the treatment of several life treating diseases. It can be administered at different doses and through different routes of administration. Nebulized L-epinephrine has been described as a safe treatment method. There is a significant difference in doses between nebulization and parenteral administration of epinephrine. Medication errors can result in death due to the use of high-dose epinephrine with parenteral administration. Here we report a child patient who was accidentally exposed to an approximately 30-fold higher dose of intravenous epinephrine. However, the patient did not develop permanent damage. Medication errors are common in pediatric inpatients, and efforts to reduce them are needed.

Aim: This study aims to evaluate the general characteristics of patients with acute carbon monoxide poisoning in childhood.Materials and Methods: Medical reports of 240 patients with carbon monoxide poisoning who were admitted to the Pediatric Emergency Department between January 2005 and 2013 (mean age, 82.5±56 months; 115 boys, 125 girls) were retrospectively analyzed. Demographic features of patients, sources of exposure, clinical signs, blood carboxyhemoglobin levels, laboratory findings, and treatment methods were evaluated.Results: Approximately half of the poisonings were observed in winter (December and January). Among the sources of exposure to carbon monoxide gas, the stove was found to be the most common source. Majority of patients suffered from fainting and headaches, whereas 16% of patients had no active complaints. The average of the initial blood carboxyhemoglobin level was 14.9±10%, and 14.2% of patients had a level of >25%. All patients underwent normobaric oxygen therapy, and 21.7% of them underwent hyperbaric oxygen treatment.Conclusion: Unexpected deaths because of carbon monoxide poisoning gradually increase, particularly in winter. Carbon monoxide poisoning should be considered in the patients presenting with suspicious findings, particularly in winter. Blood carboxyhemoglobin levels are useful for diagnosis.