Beata Rybojad

Esophageal Foreign Bodies in Pediatric Patients: A Thirteen-Year Retrospective Study

We discuss clinical symptoms and radiological findings of variable esophageal foreign bodies as well as therapeutic procedures in Caucasian pediatric patients. A retrospective study of 192 cases of suspected esophageal foreign bodies between 1998 and 2010 was conducted. Data were statistically analyzed by chi-square test. A foreign body was removed from a digestive tract of 163 children aged 6 months to 15 years (mean age 4.9). Most objects were located within cricopharyngeal sphincter. Dysphagia occurred in 43%, followed by vomiting (29%) and drooling (28%). The most common objects were coins. Plain chest X-rays demonstrated aberrations in 132 cases, and in doubtful situations an esophagram test was ordered. In the group of thirty-seven patients whose radiograms were normal, esophagoscopy revealed fifteen more objects, which were eventually successfully removed. No major complications occurred. Esophagram should be a second X-ray examination if an object is not detected in plain chest X-ray. We recommend a rigid esophagoscopy under general anesthesia in doubtful cases as a safe treatment for pediatric patients.

Disturbance in Venous Outflow From the Cerebral Circulation Intensifies the Release of Blood-Brain Barrier Injury Biomarkers in Patients Undergoing Cardiac Surgery

OBJECTIVE Disturbances in venous outflow from the cerebral circulation may result in brain injury. Severe increases in brain venous pressure lead to brain ischemia and, subsequently, brain edema and intracranial hemorrhages. The purpose of this study was to determine the effect of changes in jugular venous bulb pressure (JVBP) on plasma blood brain-barrier biomarkers concentration and disturbances in arteriovenous total and ionized magnesium (a-vtMg and a-viMg) in brain circulation in patients undergoing coronary artery bypass grafting surgery (CABG) with cardiopulmonary bypass (CPB). DESIGN Prospective observational study. SETTING Department of Cardiac Surgery at a Medical University Hospital. PARTICIPANTS Ninety-two adult patients undergoing elective CABG with CPB under general anaesthesia were studied. METHODS Central venous pressure (CVP) was measured using a pulmonary artery catheter. The right jugular vein was cannulized retrogradely for jugular venous bulb pressure (JVBP) measurement. Concentrations of plasma S100β protein, matrix metalloproteinase 9 (MMP-9), creatine kinase isoenzyme BB (CK-BB) a-vtMg and a-viMg were measured as the markers of blood-brain barrier dysfunction. All of them were analyzed in comparison with JVBP during surgery and the early postoperative period. RESULTS Elevated JVBP was noted after CPB and after surgery. Its increase above 12 mmHg intensified release of S100β, MMP-9 and CK-BB as well as disorders in a-vtMg and a-viMg. CVP correlated with JVBP, S100β, and MMP-9. Moreover, JVBP correlated with S100β and MMP-9. CONCLUSIONS Cardiac surgery increased JVBP, and JVBP elevated above 12 mmHg intensified an increase in biomarkers of plasma blood-brain barrier disruption.

Risk factors for otolaryngological foreign bodies in Eastern Poland.

Objective To identify the sociodemographic characteristics and risk factors associated with suspected foreign bodies in the ear, nose, throat, airway, and esophagus among Polish children. Study Design Case series with chart review. Setting Tertiary care medical center. Subjects and Methods A retrospective analysis of the medical records of patients hospitalized for a suspected foreign body (FB) between 1998 and 2008 was conducted. Data regarding place of residence, presence of siblings, parents’ educational status, seasonality, psychomotor development, age, and sex were collected and statistically analyzed. Results Of the 1011 patients with suspected foreign body insertion, 849 (84%) had a positive diagnosis. Of the confirmed foreign bodies, 96 were found in the tracheobronchial tree, 142 were found in the esophagus, and 611 were located in the external auditory canals, nasopharyngeal passage, tonsils, auricles, or lips. Sociodemographically, 596 of the children came from urban areas, with a preponderance of males (55%). Objects were removed more frequently in summer and autumn (60%). Children with siblings (53%) predominated. The majority of patients (52%) had parents with an elementary education. Food was the most frequent foreign body in children under 3 years of age. Patients with delayed psychomotor development constituted 1.6% of the analyzed population. Conclusions Being male, 1 to 3 years of age, belonging to an urban family with siblings, and having parents with an elementary education increased the risk of foreign body insertion. Training caregivers about proper nutrition and safety rules when playing with children can reduce the risk of accidents related to foreign body insertion.

Plasma magnesium concentration in patients undergoing coronary artery bypass grafting

[b]Introduction[/b]. Magnesium (Mg) plays a crucial role in cell physiology and its deficiency may cause many disorders which often require intensive treatment. The aim of this study was to analyse some factors affecting preoperative plasma Mg concentration in patients undergoing coronary artery bypass grafting (CABG). [b]Materials and method[/b]. Adult patients scheduled for elective CABG with cardio-pulmonary bypass (CPB) under general anaesthesia were studied. Plasma Mg concentration was analysed before surgery in accordance with age, domicile, profession, tobacco smoking and preoperative Mg supplementation. Blood samples were obtained from the radial artery just before the administration of anaesthesia. [b]Results. [/b]150 patients were studied. Mean preoperative plasma Mg concentration was 0.93 ± 0.17 mmol/L; mean concentration in patients - 1.02 ± 0.16; preoperative Mg supplementation was significantly higher than in patients without such supplementation. Moreover, intellectual workers supplemented Mg more frequently and had higher plasma Mg concentration than physical workers. Plasma Mg concentration decreases in elderly patients. Patients living in cities, on average, had the highest plasma Mg concentration. Smokers had significantly lower plasma Mg concentration than non-smokers. [b]Conclusions. [/b]1. Preoperative magnesium supplementation increases its plasma concentration. 2. Intellectual workers frequently supplement magnesium. 3. Smoking cigarettes decreases plasma magnesium concentration.

Are there any differences in medical emergency team interventions between rural and urban areas? A single‐centre cohort study

OBJECTIVE To compare interventions of medical emergency teams in urban and rural areas with particular emphasis on response time and on-site medical rescue activities. DESIGN A retrospective analysis of ambulance call reports from two emergency medical service substations: one in the city and the other in a rural area. SETTING Two emergency medical service substations: one in the city and the other in a rural area. PARTICIPANTS Medical emergency teams. RESULTS Interventions in the city were associated with a substantially shorter response time in comparison to rural areas. In the city, the distances were generally less than 10 km. In the rural area, however, such short distances accounted for only 7.2% of events, while 33.8% were over 30 km. Medical emergency teams more often acted exclusively on-site or ceased any interventions in rural areas. Compared with the city, actions in the rural setting were associated with significantly increased use of cervical collars and decreased use of intravenous access. The presence of a physician in the team raised the probability of pharmacotherapy. CONCLUSION The relationship between medical emergency teams activities and the location of intervention shows the real diversity of the functioning of emergency medical service within a city and rural areas. Further research should aim to improve the generalisability of these findings.

Nursing Activities in the Prevention and Treatment of Perioperative Complications After Airway Foreign Body Removal in Pediatric Patients

PURPOSE 1) To evaluate postanesthesia complications after bronchoscopy performed for a suspected foreign body (FB) in the pediatric population and 2) To propose an algorithm of nursing activities for management of this problem. DESIGN A retrospective descriptive design was used. METHODS A chart review of 155 children who underwent rigid bronchoscopy for FB removal was conducted. FINDING Complications occurred in 78% of children: 43% of them experienced desaturation below 90% requiring oxygen therapy. Therapy ranged from oxygen administration via blow-by nasal cannula or face mask (89%) to positive pressure ventilation via bag-mask (23%). Seven percent of the population required intubation and admission to intensive care unit (all were less than 2 years of age). CONCLUSIONS Our results suggest special attention to the children less than 2 years of age as serious respiratory failure may occur after FB removal. The algorithm for nurses was created to manage children after bronchoscopy.

Management of myasthenic crisis in a child.

Myasthenia gravis is an autoimmune disorder of peripheral nervous system, leading to fluctuating muscle weakness. It is caused by circulating antibodies that block acetylcholine nicotinic postsynaptic receptors at the postsynaptic neuromuscular junction. Myasthenic crisis is a life-threatening complication, which is defined as weakness from acquired myasthenia gravis. In this paper we described a 15-year-old boy who was admitted to the Paediatric Intensive Care Unit due to myasthenic crisis. He had suffered not only from myasthenia gravis but also hypothyroidism, cerebral palsy and epilepsy. The patient required mechanical ventilation and was successfully treated with both plasmapheresis and intravenous immunoglobulins. He recovered from the crisis and then thymectomy was performed. Perioperative period and anaesthesia passed uncomplicated. Discharged home from the hospital after 2.5 month-treatment, for the last 4 years, he has only come on scheduled outpatient medical appointments. This case reveals that myasthenic crisis, albeit rare, may occur in male adolescents. In such cases multidisciplinary care followed by surgery becomes a procedure of choice. Concomitant medical problems, if well controlled, do not affect the results of outcome of the underlying disease.

Should the family witness cardiopulmonary resuscitation? Perceptions of health professionals in Poland

1Department of Emergency Medicine, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland 2Chair and Department of Family Medicine, First Faculty of Medicine, Medical University of Lublin, Lublin, Poland 3Division of Teaching and Outcomes of Education, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland 4Department of Emergency Medical Services, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland 5Polish Medical Air Rescue, Poland

Neuroinfection or Suicide Attempt? Difficult Diagnosis If Lack of Anamnesis

ABSTRACT Neuroinfection often begins with nonspecific symptoms followed by respiratory and circulatory systems failure, seizures, and loss of consciousness. On the other hand, central nervous system depression may be caused by overdose of medications and without pre-hospital history it may be difficult to diagnose appropriately. We report on a case of a teenager who attempted suicide with an overdose of olanzapine. She ingested 150 mg, which caused neuroinfection-like symptoms. She was treated with an initial diagnosis of encephalitis. Dynamically changing clinical status finally guided attending physicians to a suspicion of a suicide attempt. Based on this case we stress that a clear history of suicidal overdose ingestion is important for quick and appropriate treatment.

Hospitalization of a child in the Neonatal Intensive Care – parents’ experiences

Abstract Introduction. Significant progress in the perinatal and intensive care therapy resulted in a meaningful increase of survival of extremely immature, and burdened with severe diseases neonates. Although infants are the patients of the Neonatal Intensive Care Unit, the needs of their parents should also be noticed and realized. The aim of the study was the analysis of the parents’ experiences of children hospitalized in the NICU. Material. The research material comprises 39 written contributions of parents of children hospitalized in the NICU. Method. A qualitative analysis of the text was used. Quotes of parents were classified in three categories: emotions, thoughts and support. Results. Fear, happiness, joy, uncertainty, stress and shock are the most frequently emotions appearing in the parents’ reports. The most frequently mentioned areas of cognitive reactions of parents include: realization of child’s mortality, realizing problems of the premature birth, search for the guilty, and the reformulation of looking at the world. Parents often described support they received, but also pointed to the areas where support lacked. Conclusion: As a result of intense emotions, both positive and negative tint that parents experience at birth of a premature or sick child, multi-disciplinary care is necessary in order to reduce the negative effects of experienced emotions. Support, including information support for parents of critically ill newborns is a key skill in the practice of doctors taking care of children hospitalized in NICU. Psychological support is an essential element of the holistic care of the neonate’s family.