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DEMİR YİĞİT Y, ÖZTAŞ T. Low- and High-Voltage Electrical Burns in Children: Ten Years of Experience. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1039637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Objective
Burn injuries are an important public health problem for all ages. Due to electrical burns high mortality and morbidity rates, their should be evaluated differently from burns from other sources. This study aims to determine factors associated with high- and low-voltage electrical burns in children.
Material and Methods
The records of 72 patients who were treated for electrical burns were analysed. Electrical burns were divided into two groups: low and high voltage. Demographic data, treatment, outcomes were compared between the two groups.
Results
The frequency of electrical burns was 1.5%. Low-voltage electrical burns were detected in 79.2% of the patients, and high-voltage electrical burns were detected in 20.8% of the patients. High-voltage burns were more common in rural residents (p < 0.05). Low-voltage electrical burns mostly occurred as a result of home accidents (89.5%), while high-voltage injuries were mostly caused by work accidents (66.6%), (p
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Affiliation(s)
| | - Tülin ÖZTAŞ
- UNIVERSITY OF HEALTH SCIENCES, DİYARBAKIR GAZİ YAŞARGİL HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, DEPARTMENT OF PEDIATRIC SURGERY
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Roberts C, Keilman A, Pearce J, Roberts A, Ching K, Kingsley J, Stephan A, Gross I, Ciener D, Augenstein J, Thomas A. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS): Pediatric Diabetic Ketoacidosis. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11098. [PMID: 33644303 PMCID: PMC7901255 DOI: 10.15766/mep_2374-8265.11098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/10/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Diabetic ketoacidosis (DKA) is a life-threatening illness which classically presents with polyuria, polydipsia, and polyphagia that can rapidly progress to severe dehydration and altered mental status from cerebral edema. Younger patients may present with subtle or atypical symptoms that are critical to recognize and emergently act upon. Such patients are often cared for by teams in the emergency department (ED) requiring multidisciplinary collaboration. METHODS This simulation case was designed for pediatric emergency medicine fellows and residents. The case was a 14-month-old male who presented to the ED with respiratory distress and dehydration. The team was required to perform an assessment, manage airway, breathing and circulation, and recognize and initiate treatment for DKA including judicious fluid administration and an insulin infusion. The patient developed altered mental status with signs of cerebral edema requiring the initiation of cerebral protection strategies. We created a debriefing guide and a participant evaluation form. RESULTS Forty-two participants completed this simulation across seven institutions including attendings, residents, fellows, and nurses. The scenario was rated by participants on a 5-point Likert scale and was generally well received (M = 5.0). Participants rated the simulation case as effective in teaching how to recognize (M = 4.8) and manage (M = 4.5) DKA with cerebral edema in a pediatric patient. DISCUSSION This simulation represents a resource for learners in the pediatric ED in the recognition and management of a toddler with DKA and can be adapted to learners at all levels and tailored to various learning environments.
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Affiliation(s)
- Cale Roberts
- Pediatrics Resident, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital
| | - Ashley Keilman
- Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
| | - Jean Pearce
- Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, Medical College of Wisconsin
| | - Alissa Roberts
- Assistant Professor, Department of Pediatrics, Division of Endocrinology and Diabetes, University of Washington School of Medicine and Seattle Children's Hospital
| | - Kevin Ching
- Associate Professor of Clinical Pediatrics, Division of Emergency Medicine, Weill-Cornell Medicine
| | - Jenny Kingsley
- Assistant Professor, Department of Anesthesia and Critical Care Medicine, Division of Pediatric Critical Care, Keck School of Medicine, University of Southern California and Children's Hospital of Los Angeles
| | - Alexander Stephan
- Assistant Professor, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, New York Presbyterian/Weill Cornell Medical Center
| | - Isabel Gross
- Assistant Professor of Pediatrics, Department of Pediatric Emergency Medicine, Yale University School of Medicine
| | - Daisy Ciener
- Program Director of Pediatric Emergency Medicine Fellowship and Assistant Professor of Clinical Pediatrics, Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center
| | - Julie Augenstein
- Base Hospital Medical Director, Quality and Safety Medical Director, and Attending Physician, Phoenix Children's Hospital; Clinical Assistant Professor of Child Health and Emergency Medicine, Mayo Clinic College of Medicine and Science and University of Arizona College of Medicine
| | - Anita Thomas
- Director of Pediatric Emergency Medicine Fellow Simulation and Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
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Sanseau E, Carr LH, Case J, Tay KY, Ades A, Yang K, Huang H, Bustin A, Good G, Gaines S, Augenstein J, Ciener D, Pearce J, Reid J, Stone K, Burns R, Thomas A. Pediatric Emergency Medicine Simulation Curriculum: Vitamin K Deficiency in the Newborn. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11078. [PMID: 33511273 PMCID: PMC7830750 DOI: 10.15766/mep_2374-8265.11078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 10/06/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The American Academy of Pediatrics recommends vitamin K prophylaxis at birth for all newborns to prevent vitamin K deficiency bleeding (VKDB). Despite a lack of evidence for serious harms, barriers to prophylaxis, including parental refusal, are rising, as are cases of VKDB. METHODS This simulation involved an infant presenting to the emergency department who decompensated due to a cerebral hemorrhage caused by VKDB and was treated by pediatric and emergency providers. The case was incorporated into the fellow and division monthly curricula, and participants completed postsimulation surveys. The patient required a secure airway, seizure management, vitamin K, and a fresh frozen plasma infusion upon suspicion of the diagnosis, plus a coordinated transfer to definitive care. The case included a description of the simulated case, learning objectives, instructor notes, an example of the ideal flow of the scenario, anticipated management mistakes, and educational materials. RESULTS The simulations were carried out with 48 total participants, including 40 fellows and eight attendings, from five different training institutions over 1 year. In surveys, respondents gave overall positive feedback. Ninety-four percent of participants gave the highest score on a Likert scale indicating that the simulation was relevant, and over 80% gave the highest score indicating that the experience helped them with medical management. DISCUSSION This simulation trained physicians how to recognize and treat a distressed infant with VKDB. The case was perceived to be an effective learning tool for both fellow and attending physicians.
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Affiliation(s)
- Elizabeth Sanseau
- Fellow, Pediatric Emergency Medicine, Children's Hospital of Philadelphia
| | - Leah H. Carr
- Fellow, Department of General Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia
| | - Jennifer Case
- Resident, Department of General Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital
| | - Khoon-Yen Tay
- Associate Professor, Clinical Pediatrics, Division of Emergency Medicine, Children's Hospital of Philadelphia
| | - Anne Ades
- Professor, Clinical Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia
| | - Kesi Yang
- Assistant Professor, Clinical Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia
| | - Hannah Huang
- Pharmacist, Department of General Pediatrics, Division of Emergency Medicine, Children's Hospital of Philadelphia
| | - Anna Bustin
- Residency Preceptor, Pharmacy Residency Program, and Clinical Pharmacy Specialist, Neonatal/Infant Intensive Care, Children's Hospital of Philadelphia
| | - Grace Good
- Simulation Specialist, Division of Emergency Medicine, Children's Hospital of Philadelphia
| | - Shannon Gaines
- Education Nurse Specialist, Division of Emergency Medicine, Children's Hospital of Philadelphia
| | - Julie Augenstein
- Assistant Professor, Clinical Pediatrics, Division of Emergency Medicine, Phoenix Children's Hospital
| | - Daisy Ciener
- Assistant Professor, Clinical Pediatrics, Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center
| | - Jean Pearce
- Assistant Professor, Clinical Pediatrics, Division of Emergency Medicine, Medical College of Wisconsin
| | - Jennifer Reid
- Associate Professor, Clinical Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
| | - Kimberly Stone
- Associate Professor, Clinical Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
| | - Rebekah Burns
- Associate Professor, Clinical Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
| | - Anita Thomas
- Assistant Professor, Clinical Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
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Pidaparti V, Keilman A, Case J, Thomas A. Pediatric Emergency Medicine Simulation Curriculum: Bacterial Tracheitis. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10946. [PMID: 32875092 PMCID: PMC7449579 DOI: 10.15766/mep_2374-8265.10946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 01/30/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Pediatric bacterial tracheitis is a rare but life-threatening upper airway infection with mortality rates estimated as high as 20%, typically affecting children between 6 months and 12 years old. Given such high mortality rates, we felt it was important to train medical personnel to evaluate and manage this condition. METHODS This simulation-based curriculum was developed for health care professionals involving the evaluation and management of an 8-year-old male with symptoms of fever, stridor, worsening barking cough, and increased work of breathing. Critical actions included identifying stridor and airway respiratory distress; monitoring and supporting airway, breathing, and circulation; administering racemic epinephrine and dexamethasone; and identifying and treating bacterial tracheitis as the underlying cause. Scenario-specific debriefing tools were put together to elicit scenario feedback and aid in formative learning. RESULTS The scenario was conducted with six fellows and 12 residents and medical students. Per the survey data, the case was rated as highly relevant (median = 5) and highly realistic (median = 5) by participants on a 5-point Likert scale. DISCUSSION Pediatric bacterial tracheitis is a low frequency, but high-risk scenario that was amenable to simulation as an educational modality and was well-received by participants. The debriefing tools were implemented as a means of helping instructors customize the scenario for learners based on respective educational backgrounds and learning styles.
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Affiliation(s)
- Vaidehi Pidaparti
- Resident, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital
| | - Ashley Keilman
- Assistant Professor, Department of Pediatric Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
| | - Jennifer Case
- Resident, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital
| | - Anita Thomas
- Assistant Professor, Department of Pediatric Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
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Shubin C, Iyer S, Pearce J, Lang B, Gross I, Ciener D, Mazor S, Keilman A, Thomas A. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS): Serotonin Syndrome. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10928. [PMID: 32733995 PMCID: PMC7385927 DOI: 10.15766/mep_2374-8265.10928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 01/10/2020] [Indexed: 05/28/2023]
Abstract
Introduction Serotonin syndrome is caused by an accumulation of serotonin in the body from drug interactions or overdose of serotonergic medications, including commonly used antidepressants. Symptoms can be life-threatening and encompass both neurologic and cardiovascular toxicity, including agitation, seizure, tachycardia, rhabdomyolysis, and hyperthermia. Methods This simulation case was developed for pediatric emergency medicine fellows and emergency medicine residents in the pediatric emergency department and can be altered to accommodate other learners. The case involved a 16-year-old male, represented by a low- or high-fidelity manikin, who presented with altered mental status/agitation after an overdose of antidepressant medication. The team of learners was required to perform a primary and a secondary assessment; manage airway, breathing, and circulation; and recognize and initiate treatment for serotonin syndrome. The patient had a seizure resulting in airway compromise requiring advanced airway support, as well as developed rhabdomyolysis requiring aggressive fluid hydration. We created a debriefing guide and a participant evaluation form. Results Fifty-seven participants across five institutions completed this simulation, which included residents, fellows, faculty, and students. The scenario was rated by participants using a 5-point Likert scale and was generally well received. Participants rated the simulation case as effective in learning how to both recognize (M = 4.9) and manage (M = 4.8) serotonin syndrome. Discussion This pediatric emergency simulation scenario can be tailored for a range of learner backgrounds and simulation environments. We used the participant evaluation form to improve future iterations of the simulation.
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Affiliation(s)
- Corinne Shubin
- Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
| | - Shweta Iyer
- Assistant Professor, Pediatrics and Emergency Medicine, Weill Cornell Medical College
| | - Jean Pearce
- Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, Medical College of Wisconsin
| | - Benjamin Lang
- Pediatrics Resident, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital
| | - Isabel Gross
- Clinical Instructor, Department of Pediatrics, Division of Emergency Medicine, Yale University School of Medicine and Yale New Haven Children's Hospital
| | - Daisy Ciener
- Assistant Professor, Clinical Pediatrics, Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center
| | - Suzan Mazor
- Director of Pediatric Toxicology, University of Washington School of Medicine and Seattle Children's Hospital; Associate Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
| | - Ashley Keilman
- Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
| | - Anita Thomas
- Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
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