• Journal of Trauma and Injury
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• 제36권3호
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• pp.295-297
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• 2023

Penetrating gallbladder injuries are uncommon in the pediatric population. The treatment varies according to the severity of the injury and the patient's hemodynamics. We present the case of an 11-year-old male with an accidental pellet gunshot wound to the right upper abdomen that resulted in a grade III liver laceration and damage to the anterior gallbladder wall. The patient underwent laparoscopic cholecystectomy with drain placement. Postoperative radiography of the surgical specimen confirmed the presence of the pellet in the gallbladder. The patient recovered uneventfully and was discharged home on postoperative day 3. Laparoscopic cholecystectomy is a feasible treatment option for penetrating gallbladder injuries in hemodynamically stable patients.

• 대한소아치과학회지
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• 제42권3호
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• pp.264-269
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• 2015

차아염소산나트륨은 가장 자주 쓰이는 근관 세척제이지만, 그 독성과 부작용에 대해서는 많이 인식되어 있지 않다. 본 증례는 근관 치료 중 차아염소산나트륨이 치근단 조직으로 압출되어 심각한 합병증이 발생하였기에 이를 보고하는 바이다. 만 5세의 남자 환자에서 근관 치료 중 차아염소산나트륨이 치근단 조직으로 유입되어 갑작스런 통증 및 부종, 주위 조직의 피하출혈 그리고 근관 내의 지속적 출혈을 보였다. 환자는 입원치료를 받았고, 진통제와 항생제를 처방받았다. 근단공이 넓은 미성숙 영구치와 유치, 치근흡수, 천공이 일어난 치아에서는 근관 치료 시 차아염소산나트륨이 압출되지 않도록 더욱 각별한 주의가 필요하다. 합병증이 발생하였을 때에는 적절한 환자의 관리와 약물치료가 필요하다.

• Child Health Nursing Research
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• 제3권2호
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• pp.131-141
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• 1997

The purpose of this study was to propose for protection of childhood injury or accident and to provide safety measures. Data was collected from 2,052 who visited emergency room of E University Hospital during 1 year period from January to December, 1996. The results were as follows : 1. The most common type of accident was fall down (53.4%). 2. Male patients outnumbered female by the ratio of 1.68 : 1. 3. The highest incidence rate of accidents were observed in children between 1-3 years age group(34.9%). 4. Accidents were seasonally more frequent in spring(28.2%). 5. Accidents mainly took place at home (63%). 6. The time of accidental occurrence appeared to be predominantly high during a day 8 : 00 PM to 0 : 00 AM (35.l%). 7. The most frequent involved part of body was head and face (74%). 8. Most patients discharged from the hospital in good condition(85.4%). Through clinical analysis, in the relation to accident, there were statistically significant difference in sex, age, season, injury place(all p=0.000).

• 대한장애인치과학회지
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• 제7권1호
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• pp.29-32
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• 2011

상부위장관 이물질의 섭취는 대부분 위장관에서 자연적으로 배출되지만, 20% 정도에서는 내시경 또는 수술적 제거의 적응증이 된다. 특히 치과치료중 소아가 삼킬 수 있는 여러 가지 기구 중 bur 등은 예리하고 길이가 길기 때문에 생리적 협착 부위에서 걸려 자연배출이 힘들 수 있다. 또한시간이 지날수록 식도벽에 고착되고 궤양 등의 합병증을 일으켜 내시경으로 제거하기가 어렵기 때문에 소아가 삼켰을 경우 신속한 대처가 필요하겠다.

• Advances in pediatric surgery
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• 제3권1호
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• pp.47-53
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• 1997

Accidental ingestion of caustic substance is one of the common problems among children around the world. Acid intake accounts for a mere 5% of all reported cases of corrosive ingestion in the West. Because of the esophageal sparing effect of acid, clinically significant esophageal involvement after acid ingestion occurs in only 6 to 20 percent of the instances. Despite effort of prevention, 7% to 15% of children sustaining caustic esophageal burns develop esophageal strictures. If balloon dilatation or bougie dilatation fails to resolve the esophageal strictures, successful outcome following replacement by colon or stomach has been reported in children. But the complications and morbidity following these operations are still relatively high. Seven patients with corrosive-acid induced esophageal strictures who were operated upon at the Department of Pediatric Surgery, Seoul National University Children's Hospital from 1991 to 1995 were reviewed. Primary resection and anastomosis was performed in all of 7 patients. The stricture involved short segments of the esophagus at the level of the lower cervical and the upper thoracic vertebra. The operations were approached through a left cervical incision or a left thoracotomy. In one patient, operative repair of anastomotic leakage was done, and three patients required re-resection of anastomotic strictures postoperatively, and one patient required a third operation(reversed gastric tube) due to an anastomotic stricture. The other anastomotic leaks, strictures or pulmonary complications were resolved with conservative treatment. In conclusion, primary resection and anastomosis of the esophagus was performed successfully on the 6 of 7 children with acid induced corrosive esophageal strictures. This approach is physiologic, especially in children who should have a long life expectancy, and recommended for the treatment of short-segment acid induced corrosive esophageal strictures.

• 대한간호학회지
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• 제43권5호
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• pp.595-604
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• 2013

Purpose: The purpose of this study was to identify risk factors for pediatric inpatients falls. Methods: The study was a matched case-control design. The participants were 279 patients under the age of 6 who were admitted between January 1, 2004 and December 31, 2009. Through chart reviews, 93 pediatric patients who fell and 186 ones who did not fall were paired by gender, age, diagnosis, and length of stay. Five experts evaluated the 38 fall risk factors selected by the researchers. Results: In a general hospital, pediatric patients with secondary diagnosis, tests that need the patient to be moved, intravenous lines, hyperactivity, anxiolytics, sedatives and hypnotics, and general anesthetics showed significance for falls on adjusted-odds ratios. Conditional logistic regression analysis was performed to elucidate the factors that influence pediatric inpatient falls. The probability of falls increased with hyperactivity and general weakness. Patients who didn't have tests that required them to be moved and intravenous line had a higher risk of falls. Conclusion: These findings provide information that is relevant in developing fall risk assessment tools and prevention programs for pediatric inpatient falls.

• 치위생과학회지
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• 제14권2호
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• pp.264-268
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• 2014

There are a lot of dental emergency situation. Especially on disabled or pediatric patient with negative behavior, accidental aspiration or ingestion of foreign body (ex: dental instrument) is one of the common accidents in dental procedure. Dentists and dental hygienists must have knowledge about the precaution and be ready to deal with foreign body aspiration during dental treatment, especially on the disabled. This is a case of an accident during the dental treatment of 14-year-old female patient with cerebral palsy. During scaling, prolonged retained primary tooth which had resorbed roots was fell into left bronchi. So we tried to remove the crown by endotracheal approach. Most ingested foreign bodies pass through the gastrointestinal tract spontaneously, but some of them need endoscopic or surgical removal. Moreover aspiration into broncho-trachea can be more serious events and must be treated as emergency situation.

• Clinical and Experimental Pediatrics
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• 제63권5호
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• pp.184-188
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• 2020

Background: Many critically ill patients require transfer to a higher-level hospital for complex medical care. Despite the publication of the American Academy of Pediatrics guidelines for pediatric interhospital transportation services and the establishment of many pediatric transport programs, adverse events during pediatric transport still occur. Purpose: To determine the incidence of adverse events occurring during pediatric transport and explore their complications and risk factors. Methods: This prospective observational study explored the adverse events that occurred during the interhospital transport of all pediatric patients referred to the pediatric intensive care unit of Ramathibodi Hospital between March 2016 and June 2017. Results: There were 122 pediatric transports to the unit. Adverse events occurred in 25 cases (22%). Physiologic deterioration occurred in 15 patients (60%). Most issues (11 events) involved circulatory problems causing patient hypotension and poor tissue perfusion requiring fluid resuscitation or inotropic administration on arrival at the unit. Respiratory complications were the second most common cause (4 events). Equipment-related adverse events occurred in 5 patients (20%). The common causes were accidental extubation and endotracheal tube displacement. Five patients had both physiologic deterioration and equipment-related adverse events. Regarding transport personnel, the group without complications more often had a physician escort than the group with complications (92% vs. 76%; relative risk, 2.4; P=0.028). Conclusion: The incidence of adverse events occurring during the transport of critically ill pediatric patients was 22%. Most events involved physiological deterioration. Escort personnel maybe the key to preventing and appropriately monitoring complications occurring during transport.

• 임상간호연구
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• 제25권2호
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• pp.142-150
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• 2019

Purpose: The aim of this study was to evaluate the efficiency of the Humpty Dumpty Falls Scale as one of the falls risk assessment tools, and also to evaluate risk factors as predictors of falls in pediatric patient populations. Methods: In a retrospective, case-control design with data from the electronic medical records of 13 pediatric patients who fell and 1,941 who did not fall before matching and 429 who did not fall after matching by gender, age, diagnosis, and length of stay. Results: All the variables showed no significant differences after matching. At the cutoff score of 13, sensitivity, specificity, negative and positive predictive values were 92.3%, 37.1%, 99.9%, and 0.01%, respectively. The area under the Receiver Operating Characteristics was 0.597. The results from the logistic regression showed that the pediatric inpatient population who had higher risk scores was significantly associated with falls. The odds ratios ranged from 1.31 to 4.71 with 90% confidence interval. Conclusion: The saturation impairments criterion as one of the diagnostic parameter was negatively associated with falls, but the relative risk score was higher than the other criteria. Therefore, it seems that the diagnostic parameter seems to be required to verify results through large sample studies.

• Clinical and Experimental Pediatrics
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• 제58권4호
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• pp.136-141
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• 2015

Purpose: Continuous intravenous access is imperative in emergency situations. Ultrasound-guided internal jugular vein (IJV) catheterization was investigated in critically ill pediatric patients to assess the feasibility of the procedure. Methods: Patients admitted to the pediatric intensive care unit between February 2011 and September 2012 were enrolled in this study. All patients received a central venous catheter from attending house staff under ultrasound guidance. Outcome measures included successful insertion of the catheter, cannulation time, number of cannulation attempts, and number and type of resulting complications. Results: Forty-one central venous catheters (93.2%) were successfully inserted into 44 patients (21 males and 23 females; mean age, $6.54{\pm}1.06$ years). Thirty-three patients (75.0%) had neurological disorders. The right IJV was used for catheter insertion in 34 cases (82.9%). The mean number of cannulation attempts and the mean cannulation time was $1.57{\pm}0.34$ and $14.07{\pm}1.91$ minutes, respectively, the mean catheter dwell time was $14.73{\pm}2.5$ days. Accidental catheter removal was observed in 9 patients (22.0%). Six patients (13.6%) reported complications, the most serious being catheter-related sepsis, which affected 1 patient (2.3%). Other complications included 2 reported cases of catheter malposition (4.6%), and 1 case each of arterial puncture (2.3%), pneumothorax (2.3%), and skin infection (2.3%). Conclusion: The results suggest that ultrasound-guided IJV catheterization can be performed easily and without any serious complications in pediatric patients, even when performed by visiting house staff. Therefore, ultrasound-guided IJV catheterization is strongly recommended for critically ill pediatric patients.