• Archives of Plastic Surgery
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• 제38권6호
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• pp.761-764
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• 2011

Purpose: Pediatric facial laceration takes a huge part of patients visiting emergency room and generates social attention for its proper emergency care. So much more attention should be paid to the proper treatment at emergency care unit, and furthermore, thorough survey of background information of the pediatric facial laceration may offer more proper prevention. Methods: According to annual reports of 2009 and 2010, out of 5149 facial laceration patients who were given primary medical care at our clinic, 1452 patients were aged under 15 years old. Retrospective analysis of each pediatric facial lacerations were evaluated according to gender, age, periodic table, cause of injury, place of injury, sites of injury and so on. Results: Pediatric facial laceration was found to occur mostly at 1 year old as they learn to walk and explore their environment. Evaluated analysis revealed that pediatric facial accidents occurred mostly on forehead region (75%), on Sundays, from 5 p.m. to 8 p.m., at home (61.5%). Most common cause of injury was collision (54.5%). Conclusion: In large group of pediatric facial laceration cases provided us with an surprising fact that accidents most commonly occur under parental supervision. This fact gives an actual understanding regarding pediatric facial laceration and more realistic approach in its prevention strategy.

• Perspectives in Nursing Science
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• 제7권1호
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• pp.65-74
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• 2010

Purpose: The purpose of this study was to investigate the guardian's experience about tepid massage of children who visited Pediatric Emergency Room (PER). Methods: Data for this study was collected from August 1 to September 30, 2009 using questionnaires of 300 guardians who visited a PER. All data analyses were done using the SPSS 17.0 program and statistical data on frequency and percentage were obtained. $x^2$ test was done as well. Results: The results of this study were as follows: 73.7% of the guardians were doing the tepid massage, and 40% of them were doing the tepid massage when guardians thought that their children had a fever. 8.6% of them were incorrectly doing the tepid massage on their children such as using ice or alcohol. 90.5% of the children's condition changed when they had the tepid massage applied. Only 48% of the guardians got information about tepid massage, and 52.8% of the guardians got this information from the medical team. There were significant differences according to the education background about tepid massage (p<.001) and past hospital admissions history. There were differences according to whether their child had experience with febrile seizure(p=.085) and having more than one child at home (p=.085). Conclusion: This study revealed that the guardians were incorrectly doing the tepid massage on their children. The results of this study suggest that it is necessary to develop certain emergency nursing processes on accurate information and management strategies about tepid massage, and further studies on the effects of this kind education intervention are necessary.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제21권4호
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• pp.297-305
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• 2018

Purpose: There is a lack of scholarly reports on pediatric emergency department (PED) exposure to hyperbilirubinemia. We aimed to describe the epidemiology of hyperbilirubinemia in patients presenting to a PED over a three-year period. Methods: This was a retrospective cohort study, completed at an urban quaternary academic PED. Patients were included if they presented to the PED from 2010 to 2012, were 0 to 18 years in age, and had an elevated serum bilirubin for age. A chart review was completed to determine the incidence of hyperbilirubinemia, etiology, diagnostic work up and prognosis. The data set was stratified into four age ranges. Results: We identified 1,534 visits where a patient was found to have hyperbilirubinemia (0.8% of all visits). In 47.7% of patients hyperbilirubinemia was determined to have arisen from an identifiable pathologic etiology (0.38% of all visits). First-time diagnosis of pathologic hyperbilirubinemia occurred in 14% of hyperbilirubinemia visits (0.11% of all visits). There were varying etiologies of hyperbilirubinemia across age groups but a male predominance in all (55.0%). 15 patients went on to have a liver transplant and 20 patients died. First-time pathologic hyperbilirubinemia patients had a mortality rate of 0.95% for their initial hospitalization. Conclusion: Hyperbilirubinemia was not a common presentation to the PED and a minority of cases were pathologic in etiology. The etiologies of hyperbilirubinemia varied across each of our study age groups. A new discovery of pathologic hyperbilirubinemia and progression to liver transplant or death during the initial presentation was extremely rare.

• Journal of Trauma and Injury
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• 제27권4호
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• pp.178-185
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• 2014

Purpose: The aim of this study was to assess the clinical efficacy of combined treatment with local anesthesia and ketamine procedural sedation for pediatric facial laceration repair in the Emergency Department (ED). Methods: Patients aged 1 to 5 years receiving ketamine for facial laceration repair were prospectively enrolled in a double-blind, randomized, and controlled study at an ED. All patients were to receive intravenous ketamine (2 mg/kg). The local anesthesia group (LA group) received a local anesthetic along with ketamine, whereas the no local anesthesia group (NLA group) received only ketamine. The total time of sedation, the patients' movements and groans, adverse events, and the satisfaction ratings of physicians, nurses, and parents were recorded. Results: A total of 186 patients were randomized (NLA group: 90, LA group: 96). The total time of sedation (30.5 minutes for the NLA group, 32.6 minutes for the LA group; p=0.660), patients' groans (26 (28.9%) versus 23 (24.0%); 0.446) and movements (27 (30%) versus 35 (36.5%); p=0.350) was not affected by the addition of local anesthesia. Other adverse events were similar between the two groups. Also, the satisfaction ratings of physicians (median 4 for the NLA group versus 4 for the LA group (p=0.796)), nurses (2 versus 2.5 (p=0.400)), and parents (4 versus 4 (p=0.199)) were equivalent between the two groups. Conclusion: In this study, we found that local anesthesia was not required along with ketamine sedation for pediatric facial laceration repair.

• 대한소아치과학회지
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• 제44권2호
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• pp.243-255
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• 2017

심폐소생술(cardiopulmonary resuscitation, CPR)은 심장의 기능이 정지하거나 호흡이 멈추었을 때 인공적으로 혈액을 순환시키고 호흡을 보조해 주는 응급처치이다. 심폐소생술은 기본생명구조술(basic life support, BLS)과 전문소생술(advanced life support, ALS)로 나눌 수 있다. 기본생명구조술은 주요 조직으로 혈류 공급을 강제적으로 하기 위한 흉부압박과 호흡정지 환자에게 구조호흡(rescue breathing) 그리고 심실세동을 개선해 주기 위한 자동제세동기(automated external defibrillator, AED)이 포함된다. 전문소생술의 범주는 성인을 대상으로 하는 고급생명구조술(advanced cardiovascular life support, ACLS)과 소아를 대상으로 하는 소아고급생명구조술(pediatric advanced life support, PALS)이 있다. 치과 치료에 극심한 공포를 가지며, 여러 이유로 치과 진료에 협조를 얻기 어려운 소아를 대상으로 하는 치료환경에서는 약물을 이용한 진정법이 고려된다. 이는 심정지를 포함한 응급상황이 발생할 가능성이 증가하는 이유가 된다. 소아고급생명구조술은 기본생명구조술을 포함하며, 심정지에 이를 수 있는 원인을 호흡, 순환장애 그리고 심인성으로 나누어 대처하는 체계적인 방법을 제시한다. 소아는 성인에 비해 심인성의 원인은 낮지만, 해부학적인 약점으로 인해 호흡이나, 순환장애에 의한 심정지의 가능성은 높다. 따라서, 스트레스를 많이 받은 아이를 치료하거나 진정법을 시행하는 소아치과의사는 소아고급생명구조술을 익힘으로써 응급상황에 적절히 대처할 수 있는 역량을 갖출 수 있으리라 사료된다.

• Advances in pediatric surgery
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• 제10권2호
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• pp.142-144
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• 2004

A one day old female infant was brought to the emergency room suffering from shortness of breath. An x-ray revealed the gastrointestinal tract in the right thoracic cavity. An emergency operation demonstrated eventration of the diaphragm, and a plication was performed. The baby was discharged without complication and has been followed up in the out patient clinic. Congenital diaphragmatic eventuation requiring emergency operation is rare.

• Clinical and Experimental Pediatrics
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• 제51권10호
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• pp.1058-1064
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• 2008

목적: 심정지 등 중증 소아 환자에서 빠른 정맥로 확보를 통한 수액과 약물의 투여는 매우 중요한 술기이다. 저자들은 중증 소아 환자를 주로 담당하는 소아과와 응급의학과 전공의들의 골강내 주사 교육 경험 정도를 알아보고 이들에게 골강내 주사의 이론과 실습 교육을 시행하여 골강내 주사에 대한 기본 지식과 수행도, 자신감 정도를 교육 전후로 평가하여 전공과별 교육 효과의 차이를 알아보고자 하였다. 방법: 2008년 5월에서 6월까지 세 개 대학병원의 소아과와 응급의학과 전공의를 대상으로 골강내 주사에 대한 이론 및 실습 교육을 실시하였다. 실습은 반자동 드릴 형태의 EZ-IO 제품을 이용하여 이루어졌으며 교육 전후 골강내 주사에 대한 지식, 수행 경험, 골수 천자 검사 경험 및 수행 자신감 등에 대한 설문을 시행하였다. 실습 후 골강내 주사 삽입 술기를 평가하였다. 결 과: 소아과와 응급의학과 전공의 각각 45명과 22명이 골강내 주사 교육에 참여하였다. 교육 전 설문 결과 응급의학과 전공의들이 통계적으로 유의하게 골강내 주사 교육 경험이 풍부했으며(P<0.001) 소아과 전공의들이 통계적으로 유의하게 골수 천자 검사 경험이 많았다(P<0.001). 교육 전후 골강내 주사의 기본 지식에 대한 질문의 정답률을 비교하였을 때 교육 후 유의한 정답률이 유의하게 상승하였다(P<0.001). 골강내 주사 1차 시도 시 전체 전공의의 성공률은 88.7%였으며 두 군 간에 성공률의 차이는 없었으나 소아과 전공의들의 골강내 주사 총 수행 시간이 응급의학과에 비해 유의하게 짧았다(P=0.001). 두 군 모두에서 교육 후 골강내 주사 수행에 대한 자신감이 상승하였으며 두 군 간의 유의한 차이는 없었다. 결 론: 전공의 대상의 비교적 짧은 시간의 골강내 주사 이론 및 실습 교육을 통해 교육 후 골강내 주사에 대한 지식 정도와 골강내 주사 수행 시 자신감에서 유의한 교육 효과가 관찰되었다. 중증 소아 환자를 주로 담당하는 소아과 및 응급의학과 전공의들에게 골강내 주사 교육의 기회가 더 많이 주어져야 할 것으로 생각한다.

• Journal of Trauma and Injury
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• 제27권3호
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• pp.63-70
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• 2014

Purpose: In children, mild traumatic brain injuries (TBI) account for 70~90% of head injuries. Without guidelines, many of these children may be exposed to excess radiation due to unnecessary imaging. The purpose of this study was to evaluate the impact of a mild TBI guideline in imaging of pediatric patients. Methods: The medical records of all children who had head computed tomography and were admitted to our hospital with a TBI with Pediatric Glasgow Coma Scale and Glasgow Coma Scale of 14 to 15 were retrospectively reviewed and compared with PECARN Rule. Results: A total of 1260 children were included and all children checked with head computed tomography. 61 pediatrics had CT positive and presented skull fracture 40, hemorrhage 8, hemorrhagic contusion 7, and diffuse axonal injury 1. Also, 4 patients diagnosed both skull fracture and brain haemorrhage and 1 patient diagnosed both haemorrhage and haemorrhagic contusion. Conclusion: There are many pediatric traumatic patients who exposed to radiation due to CT. But, the most of results were negative. So, consider to follow the CT guideline for children and many do not require brain CT.

• 대한치과마취과학회지
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• 제13권3호
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• pp.103-110
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• 2013

Background: Recently the use of sedation by pediatric dentists in Korea is increased. This study describes training programs about sedation practices in Korean pediatric dentistry residency program. Methods: A questionnaire was filled in by participants of Korean Academy of Pediatric Dentistry on 17th-18th August, 2008. Also the data about sedation practices of the training institution is collected by phone call. Results: Seventy two percent of respondents used sedation. Most of them used sedation with agents under 25% of their patients. Distribution of ages in patients sedated with agents was 3 years, 4-5 years, under 2 years, 6-10 years, and more than 10 years. Determinative factors of using sedation were behavior management, number of visiting, amount of treatment and general condition, and oral route was the most favorable route. Sixty six percent of them have failed on sedation, and thity percent of them have rarely failed on sedation. Only fifty percent of dentists using sedation completed the cardiopulmonary resuscitation course. Conclusions: For safety, dentists using sedation need to be educated about emergency equipment and management. Especially medication dose, use frequency and the detail related to treatment procedure should be discussed carefully. Also putting a patient under general anesthesia and taking emergency measures should be discussed with Korean Dental Society of Anesthesiology.

• 대한한방소아과학회지
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• 제17권1호
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• pp.117-129
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• 2003

We made a clinical analysis of 135 pediatric patients who visited Emergency Room of Dongguk University Oriental Hospital, during 1 year from March 2002 to February 2003. The results were as follows ; 1. Whether they received medical examination and treatment or not : new patients were 95(70.4%) and pediatric patients who received medical examination and treatment were 40(29.6%). 2. Seasonal distribution: Spring(March, April, May) was 45(33.3%), Summer(June, July, August) was 35(25.9%), Autumn(September, October, November) was 32(23.7%) and Winter(December, January, February) was 23(17.0%). 3. The time interval between onset and arrival : within 6 hours were 68(50.4%), 6-12 hours were 14(10.4%), 12-24 hours were 26(9.3%), 24-48 hours were 17(12.6%), 48-72 hours were 6(4.4), over 72 hours were 4(3.0%). 4. Whether they went through other hospitals or not : pediatric patients who didn't go through other hospitals were 105(77.8%), pediatric patients who went through other hospitals were 30(22.2%). 5. Systemic distribution of diseases: Infectious diseases were 1(0.7%), Physique diseases were 4(3.0%), Digestive diseases were 73(54.1), Nervous also Mental diseases were 32(23.7%), Cardiovascular diseases were 2(1.5%), Skin disorders were 1(0.7%), Respiratory diseases were 22(16.3%). 6. Medical care : Acupuncture and moxibustion were 1(0.7%), moxibustion and medication were 1(0.7%), acupuncture, moxibustion and medication were 1(0.7%), venesection was 24(17.8% ), venesection and medication were 17(12.6%), consultation was 16(11.9%), medication was 44(32.6%), acupuncture was 3(2.2%), acupuncture and medication were 14(10.4%) and transferred out patients were 14(10.4%). 7. Revisit: revisit patients were 30(22.2%).