Anıl Er

Early predictors of unresponsiveness to high‐flow nasal cannula therapy in a pediatric emergency department

High‐flow nasal cannula (HFNC) is a new treatment option for pediatric respiratory distress and we aimed to assess early predictive factors of unresponsiveness to HFNC therapy in a pediatric emergency department (ED).

Luc abscess: an extraordinary complication of acute otitis media

Luc abscess is an uncommon suppurative complication of otitis media. Unfamiliarity of this complication leads to delayed diagnosis and treatment. This abscess is usually benign. Infection in the middle ear spreads via anatomic preexisting pathways, and this process results with subperiosteal pus collection. Conservative treatment with drainage under empirical wide spectrum antibiotic is efficient. Here,we present a 9-year-old boy who had left facial swelling after a period of otalgia, diagnosed as Luc abscess without mastoiditis.

Acute Traumatic Coagulopathy: The Value of Histone in Pediatric Trauma Patients

Objective: Acute traumatic coagulopathy occurs after trauma with impairment of hemostasis and activation of fibrinolysis. Some endogenous substances may play roles in this failure of the coagulation system. Extracellular histone is one such molecule that has recently attracted attention. This study investigated the association between plasma histone-complexed DNA (hcDNA) fragments and coagulation abnormalities in pediatric trauma patients. Materials and Methods: This prospective case-control study was conducted in pediatric patients with trauma. Fifty trauma patients and 30 healthy controls were enrolled. Demographic data, anatomic injury characteristics, coagulation parameters, computerized tomography findings, trauma, and International Society on Thrombosis and Haemostasis disseminated intravascular coagulation (ISTH DIC) scores were recorded. Blood samples for hcDNA were collected and assessed by enzyme-linked immunosorbent assay. Results: Thirty-two patients had multiple trauma, while 18 patients had isolated brain injury. hcDNA levels were significantly higher in trauma patients than healthy controls (0.474 AU and 0.145 AU, respectively). There was an association between plasma hcDNA levels and trauma severity. Thirteen patients had acute coagulopathy of trauma shock (ACoTS). ACoTS patients had higher plasma histone levels than those without ACoTS (0.703 AU and 0.398 AU, respectively). Plasma hcDNA levels were positively correlated with the ISTH DIC score and length of stay in the intensive care unit and were negatively correlated with fibrinogen level. Conclusion: This study indicated that hcDNA levels were increased in pediatric trauma patients and associated with the early phase of coagulopathy. Further studies are needed to clarify the role of hcDNA levels in mortality and disseminated intravascular coagulation.

The use of cerebral and somatic regional tissue oxygen saturation in monitoring of critically ill children who were admitted to the pediatric emergency department: A prospective descriptive study

Objective: Heart rate, respiratory rate, arterial blood pressure, pulse oximetry, urine ouput, and lactate level are the most important parameters in the follow-up of the critically ill child who is admitted to the pediatric emergency department. The aim of this study is to determine if there is an advantage of follow-up with cerebral and splanchnic regional tissue saturation (rSO2) over routine monitoring systems in children who applied to the pediatric emergency department with manifestations of acute respiratory failure or shock. Method: Children admitted to pediatric emergency department between May 2014 and March 2016 with acute respiratory failure or shock were prospectively included into this study. The cerebral and splanchnic rSO2 levels were recorded via NIRS monitor (INVOS 510°C cerebral/ somatic oximetre Covidien, Mansfield, MA, USA) in addition to conventional monitoring parameters (heart rate, respiratory rate, pulse oxymeter, and arterial blood pressure). Prez-, and post-treatment values of the patients were compared with Wilcoxon Signed Rank test. Statistical significance was accepted as p<0.05 for all tests. Results: Fifteen children were included into this study. The median age of the patients was 16.0 (10.0-66.0) months. The respiratory rate and hearth rate decreased significantly (p=0.02 and p=0.03, respectively) whereas SpO2 and splanchnic rSO2 increased (p=0.01 and p=0.04, respectively). A significant difference was not seen in cerebral rSO2 and cerebral/splanchnic rSO2 ratio (p<0.05). Conclusion: In this study, we showed that the splanchnic rSO2 values in critically ill children increased after the treatment.

Is lung ultrasonography a useful method to diagnose children with community-acquired pneumonia in emergency settings?

Background: Lung ultrasonography is a new method for diagnosing community-acquired pneumonia. Lung ultrasonography has some advantages over chest X-ray, such as lack of ionizing radiation risk, bedside performance, and cost-effectiveness. Objectives: In this study, we aimed to determine the feasibility of lung ultrasonography in emergency settings in children with community-acquired pneumonia. Methods: The study included patients younger than 18 years of age with suspicion of community-acquired pneumonia. On the first evaluation, patients with positive clinical and/or chest X-ray findings were defined to have community-acquired pneumonia, and this was accepted as the gold standard. The chest X-rays were evaluated by the chief of the pediatric emergency department, who was blinded to the patients and the lung ultrasonography results. Lung ultrasonography was performed by another pediatric emergency physician who was also blinded to the chest X-ray results and clinical findings such as fever, respiratory distress, rales, and wheezing. Results: Of the 91 patients enrolled, 71 (78.0%) were diagnosed with community-acquired pneumonia based on clinical and chest X-ray findings. The median (interquartile range) duration of the lung ultrasonography procedure was 4.0 (3.5–6.0) min. Shred sign, air bronchogram, and hepatization were significantly more frequent in the patients with community-acquired pneumonia (p < 0.01, p < 0.01, and p = 0.01, respectively). Sensitivity and specificity of lung ultrasonography were 78.5% (67.1–87.4) and 95.2% (76.1–99.8), respectively. Conclusion: Lung ultrasonography is a useful diagnostic method for children with suspicion of community-acquired pneumonia.

An intoxication mimicking brain death: baclofen

Baclofen is a derivative of gamma-aminobutyric acid, used mainly for the treatment of muscle spasticity. Baclofen overdose can result in severe respiratory depression, autonomic disturbances, seizures and coma. Here we report a 15-year-old girl who was found unresponsive, intubated and admitted to the PICU. On initial presentation, her Glasgow Coma Score was 3, with fixed dilated pupils. EEG revealed cerebral bioelectric activity and ground amplitudes significantly lower than normal. Supportive treatments were administered. On the 2nd PICU day, she regained consciousness and was able to follow commands. She was extubated and discharged on hospital day 3. Conclusively emergency physicians should consider baclofen overdose in children presenting with acute loss of consciousness, flaccidity, and hyporeflexia.

Are cytokines and cortisol important predictors for the severity of pediatric croup: a case control study

Üzüm Ö, Çağlar A, Küme T, Sayıner A, Er A, Akgül F, Ulusoy E, Yılmaz D, Duman M. Are cytokines and cortisol important predictors for the severity of pediatric croup: A case control study. Turk J Pediatr 2017; 59: 281-287. The aim of this study is to investigate the role of cytokines (TNF-α, IL-6, IL-10, and PAF), cortisol, and IgE in the pathogenesis of croup and the factors determining its clinical severity. Patients diagnosed with croup at the Pediatric Emergency Department were included and thirty healthy children were included as a control group. Patients` demographic characteristics, clinical findings, recurrent croup history, and patient-family atopy history were recorded. Patients were grouped according to the Westley croup scoring system. Blood samples were taken from the control group and the patients for cytokines and cortisol. Respiratory pathogens were studied with PCR. Sixty-nine pediatric cases who were diagnosed as croup were included in the study (34 mild, 31 moderate, 4 severe). Group comparisons were made in terms of mild and moderate/severe groups. In the moderate/severe group, IL-10 and cortisol levels were higher than the mild group. The moderate/severe cortisol levels between 12:00 am-6:00 pm were found to be higher. PAF and TNF-alpha levels were detected to be higher in patients with a history of atopy. Viral agents were isolated in 45 patients; rhinovirus PCR tests were positive in 22 patients. In this study, rhinovirus was the most common etiology for croup. Increased levels of IL-10 and cortisol in the moderate/severe group indicate that different systemic and local mechanisms may play a role in the pathogenesis of croup.

Cerebral oxygen saturation monitoring in pediatric cardiopulmonary resuscitation patients in the emergency settings: a small descriptive study

Çağlar A, Er A, Ulusoy E, Akgül F, Çitlenbik H, Yılmaz D, Duman M. Cerebral oxygen saturation monitoring in pediatric cardiopulmonary resuscitation patients in the emergency settings: A small descriptive study. Turk J Pediatr 2017; 59: 642-647. Near infrared spectroscopy (NIRS) is a new technology for monitoring cardiopulmonary resuscitation (CPR). The use of NIRS has advantages in monitoring cerebral oxygenation in cardiac arrest patients. The aim of this study was to describe cerebral regional oxygen saturation (CrSO < sub > 2 < /sub > ) values in a small cohort of pediatric out-of-hospital cardiac arrest patients and to determine if there is an association with CrSO < sub > 2 < /sub > and return of spontaneous circulation (ROSC). All the out-of-hospital cardiac arrest patients admitted to our pediatric emergency department were included in this prospective study. All patients were monitored through NIRS in addition to standard monitoring during CPR. All cerebral rSO < sub > 2 < /sub > measurements were obtained with an INVOS 5100C cerebral/somatic oximeter. Cardiopulmonary resuscitation was performed according to the Pediatric Advanced Life Support 2010 guidelines. The patients were classified as ROSC and non - ROSC. Ten patients were included in this study. The median age of patients was 40.0 (14.0-88.2) months. Three (30%) of the 10 patients achieved sustained ROSC. Abrupt increase in cerebral regional oxygen saturation (CrSO < sub > 2 < /sub > ) was observed in all 3 of these patients. Minimum values of the CrSO < sub > 2 < /sub > were significantly lower and the percentage of median time with CrSO < sub > 2 < /sub > under 30% of CrSO < sub > 2 < /sub > were significantly higher in the non - ROSC group (p=0.02). Our study indicated that the patients in the non - ROSC group have lower minimum CrSO < sub > 2 < /sub > value. Additionally, abrupt increase of CrSO < sub > 2 < /sub > during CPR could be an indicator for ROSC.

Efficacy of early noninvasive ventilation in three cases of nonfatal drowning with pulmonary oedema in the paediatric emergency department

Drowning is still one of the most important causes of the preventable mortality worldwide. Some patients should be treated with noninvasive ventilation immediately in the emergency department (ED). The practice of noninvasive ventilation has been increased recently in the paediatric ED. We present here three nonfatal drowning patients with pulmonary oedema and hypoxia who were successfully treated with noninvasive ventilation in the paediatric emergency department. All of the patients had aspirated sea water during swimming. In addition, two of the patients had aspirated water during snorkeling. Noninvasive ventilation was applied to the patients immediately in paediatric emergency service. All of the patients clinical and radiological findings recovered rapidly. There are limited reports about use of noninvasive ventilation in nonfatal drowning cases in the paediatric emergency department. We emphasize that the early application of noninvasive ventilation should be a preventive method for reducing the morbidity of nonfatal drowning cases. (Hong Kong j.emerg.med. 2016;23:42-46)