• Journal of Trauma and Injury
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• 제33권3호
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• pp.170-174
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• 2020

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is considered an emerging adjunct therapy for profound hemorrhagic shock, as it can maintain temporary stability until definitive repair of the injury. However, there is limited information about the use of this procedure in children. Herein, we report a case of REBOA in a pediatric patient with blunt trauma, wherein the preoperative deployment of REBOA played a pivotal role in damage control resuscitation. A 7-year-old male patient experienced cardiac arrest after a motor vehicle accident. After 30 minutes of cardiopulmonary resuscitation, spontaneous circulation was achieved. The patient was diagnosed with massive hemoperitoneum. REBOA was then performed under ongoing resuscitative measures. An intra-aortic balloon catheter was deployed above the supraceliac aorta, which helped achieved permissive hypotension while the patient was undergoing surgery. After successful bleeding control with small bowel resection for mesenteric avulsion, thorough radiologic evaluations revealed hypoxic brain injury. The patient died from deterioration of disseminated intravascular coagulation. Although the patient did not survive, a postoperative computed tomography scan revealed neither remaining intraperitoneal injury nor peripheral ischemia correlated with the insertion of a 7-Fr sheath. Hence, REBOA can be a successful bridge therapy, and this result may facilitate the further usage of REBOA to save pediatric patients with non-compressible torso hemorrhage.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권2호
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• pp.146-153
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• 2020

Purpose: Alpha-1 antitrypsin deficiency (A1ATD) in one of the most common genetic causes of liver disease in children. We aimed to analyze the clinical characteristics and outcomes of patients with A1ATD. Methods: This study included patients with A1ATD from five pediatric hepatology units. Demographics, clinical findings, genetics, and outcome of the patients were recorded (n=25). Results: Eight patients (32.0%) had homozygous PiZZ genotype while 17 (68.0%) had heterozygous genotype. Patients with PiZZ genotype had lower alpha-1 antitrypsin levels than patients with PiMZ genotype (37.6±7.7 mg/dL vs. 66.5±22.7 mg/dL, p=0.0001). Patients with PiZZ genotype were diagnosed earlier than patients with PiMZ genotype, but this was not significant (13±6.8 months vs. 23.7±30.1 months, p=0.192). Follow-up revealed the death of one patient (12.5%) with a homozygous mutation, and revealed that one patient had child A cirrhosis, five patients (62.5%) had chronic hepatitis, and one patient (12.5%) was asymptomatic. Nine of the 17 patients with a heterozygous mutation had chronic hepatitis (52.9%), two (11.7%) had child A cirrhosis, and six (35.2%) were asymptomatic. Overall, 18 (72%) of the 25 children had liver pathology in the long-term. Conclusion: Although prevalence is rare, patients with liver disorders should be checked for alpha-1 antitrypsin levels. Moreover, long-term follow-up is essential because most patients have a liver pathology.

• 간호행정학회지
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• 제5권3호
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• pp.513-524
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• 1999

The shortage of nursing personnel was become one of the most serious problems in operating pediatric oncology nursing unit which was the first pediatric oncology nursing unit in Korea. The purpose of this study was to estimate the optimal number of nursing personnel by calculating nursing care hours. The subjects were 13 staff nurses and inpatients of pediatric oncology nursing unit at Seoul National University Hospital during the period of May 20, 1996, to June 2, 1996. The number of nurses' duty was 132, the number of patients treated was 1288 for these 2 weeks. The tools used for this study were pediatric patient classification indexes and direct & indirect care indexes. Each nurse measured the time that they spent for their activities by self record under the supervision of their nurse manager. The method used to calculate the number of nursing personnel was multiplication of the average number of nursing care hours per patient per day with the number of patients. Percentage, average, t-test, F-test were used for data analysis. The results of this study were as follows : 1) The distribution of patient class : Class I & II none, Class III 86.8%. Class IV 12.9% 2) Direct nursing care hours for a patient per shift according to patient classification: Class III : 27.64 minutes, Class IV : 54.64 minutes The average direct nursing service hours for a patient per shift(3 shift) was 31.54 minutes(94.62 m/day). The average indirect nursing service hours for each patient per duty(3 shift) is 21.3 minutes (63. 91 m/day). 3) The average nursing hours for a patient per duty was 52.80 minutes(2.64h/day). 4) The group of administering medications in direct care activities showed the highest percentage (38.9%). Checking vital signs among observation took the most time am.ong each direct care activity (6.88 minutes for a patient per duty). 5) Charting took the most time of each indirect care activity(52.53 minutes/ duty/nurse). 6) The average personal time per duty is 29.40 minutes, which 'was below 30 minutes of this hospital regulations. 7) The average nursing hours that a nurse provided for a duty was 8.60 hours, which meant that a nurse worked 1.10 hours overtime. 8) Standardizing to a 33 bed to a unit, 17 nurses were needed at the present nursing level.

• Child Health Nursing Research
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• 제24권1호
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• pp.27-36
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• 2018

Purpose: The purpose of this study was to develop a model for handoff education for nursing students based on simulation using video and to identify educational effects of a simulated situation in pediatric care units. Methods: Data were collected from May 1 to 30, 2016. Participants were 84 senior nursing students in Seoul (video group: 43, simulation group: 41). Both groups were given a lecture and pre-briefing on handoff education. The simulation group had nursing practice on resolving health issues for respiratory distress using a high-fidelity baby simulator. The video group watched a video recording of a scenario based simulation, and used a summarized handoff situation to practice patient handoff to another student. Results: There was no significant difference between the two groups for handoff self-confidence, problem solving ability, handoff competence (self-assessment of students), or learning satisfaction. Self-confidence increased significantly in both groups. Handoff competency evaluated by the instructor was higher in the video group compared to the simulation group (t=2.33, p=.022). Conclusion: Nursing student education for handoff practice utilizing a video in the pediatric unit was more cost effective. Therefore, it could be a useful educational method for students in learning patient handoff practices and helpful for related research.

• 대한치과마취과학회지
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• 제14권4호
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• pp.197-204
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• 2014

Children's fear and anxiety may interfere with dental treatment. If a child is very young, pharmacologic management may need to be provided during a dental procedure. Although sedation is an everyday practice in pediatric dentistry, it is not easy to achieve successful outcomes with sedation. Moreover, sedation of children can be associated with respiratory risks. Providers of pediatric sedation should be very cautious about adhering to the principles. This article reviews nicely the guidelines and references for pediatric sedation and supports a safe sedation with favorable treatment results.

• 대한장애인치과학회지
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• 제10권2호
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• pp.89-92
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• 2014

상악 전치부 완전탈구를 주소로 내원한 지적 장애를 동반한 뇌병변 장애를 가진 25세 환자에서 재식 후 구치부 bite block을 추가한 vacuum-formed splint을 이용한 교합 안정술을 통하여, 외상 치아의 동요도 감소 및 교합안정을 이루는데 도움이 될 것으로 사료 된다.

• 대한소아치과학회지
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• 제24권4호
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• pp.776-780
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• 1997

Patient with alveolar abscess due to dental caries with severe alveolar bone loss, severe tooth mobility, root resorption need extraction of tooth because it is impossible to carry out pulp treatment and restoration by using conventional method. Early loss of primary molar might cause masticatory interference, extrusion of opposing tooth, problem in maintaining space and interference on eruption of permanent tooth. Especially, early loss of primary second molar before the eruption of permanent first molar might cause space closure by mesially erupted permanent first molar and impaction of second premolar. In such a case, distal shoe space maintainer and removable space regaining appliance was the first choice of treatment. But, distal shoe space maintainer need precise adaptation and might cause chronic inflammation if the oral hygiene is poor. In a case using removable space regaining appliance, patient's cooperation is most important. If the distal root of primary second molar is comparably sound and alveolar abscess with alveolar bone loss is localized at mesial root, hemisection should be carried out for precise guide to eruption of the permanent first molar, restoration of masticatory fuction and solution to the discomfort of the patient

• 대한치과마취과학회지
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• 제11권2호
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• pp.172-176
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• 2011

For dental treatment of children with severe dental phobia, sedation or general anesthesia is usually selected for enhancement of cooperation. But in the case of mouth opening limitation due to temporomandibular disorders, general anesthesia administration is a challenge for anesthesiologist. Because airway management failure was concerned, awake fibroscopic intubation is selected first. But, skillful fibroscopic intubation is not easy in case of uncooprative children patients. In this report, we present two cases of pediatric patients with mouth opening limitation. In the first case, the patient was 52 months old and the maximum opening distance was 1.2 cm, and in the second case the patient was 38 months old and the maximum opening distance was 1.5 cm. Both patients showed severe dental phobia. After sevoflurane inhalation without any intravenous drug, we successfully performed intubation using a fibroscope.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제12권sup1호
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• pp.27-36
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• 2009

Some pediatric patients who can not eat orally depend on enteral tube feedings, and some patients require more nutrients and calories to achieve the catch-up growth. If a patient is counting on the parenteral nutrition, early initiation of enteral feeding, orally or enterally, is a very good for the intestinal mucosal maturity and motility. There are numerous kinds of formulas and supplements for the enteral feeding for neonates, infants, and children. Depending on the intestinal symptoms, allergic symptoms, requirement of special nutrients, we can choose regular infant formula (milk-based, soy-based), protein hydrolysate formula, amino acid hydrolysate formula, elemental formula. Proper use of these formulas would help for the pediatric patients to recover from their diseases, to facilitate the intestinal mucosal maturity and to achieve their goal of growth.

• Advances in pediatric surgery
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• 제16권1호
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• pp.37-42
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• 2010

Tracheal injury is a rare complication of endo-tracheal intubation. However in neonates, the rates of morbidity and mortality are high. Recommendations for treatment are based on the several reports of this injury and are individualized. Conservative management can be effective in some cases. We describe the case of a neonate who presented with subcutaneous emphysema after intubation in a neonatal intensive care unit. This patient suffered full VACTERL syndrome and had 1.7 mm diameter subglottic stenosis. Conservative management resulted in no further increase in subcutaneous emphysema and after 10 days the patient was stable.