Aim of the study Successful cardiopulmonary resuscitation and early defibrillation are critical in survival after in‐ or out‐of‐hospital cardiopulmonary arrest. The scope of this multi‐centre study is to (a) assess skills of paediatric healthcare providers (HCPs) concerning two domains: (1) recognising rhythm abnormalities and (2) the use of defibrillator devices, and (b) to evaluate the impact of certified basic‐life‐support (BLS) and advanced‐life‐support (ALS) training to offer solutions for quality of improvement in several paediatric emergency cares and intensive care settings of Turkey. Methods This cross‐sectional and multi‐centre survey study included several paediatric emergency care and intensive care settings from different regions of Turkey. Results A total of 716 HCPs participated in the study (physicians: 69.4%, healthcare staff: 30.6%). The median age was 29 (27‐33) years. Certified BLS‐ALS training was received in 61% (n = 303/497) of the physicians and 45.2% (n = 99/219) of the non‐physician healthcare staff (P < .001). The length of professional experience had favourable outcome towards an increased self‐confidence in the physicians (P < .01, P < .001). Both physicians and non‐physician healthcare staff improved their theoretical knowledge in the practice of synchronised cardioversion defibrillation (P < .001, P < .001). Non‐certified healthcare providers were less likely to manage the initial doses of synchronised cardioversion and defibrillation: the correct responses remained at 32.5% and 9.2% for synchronised cardioversion and 44.8% and 16.7% for defibrillation in the physicians and healthcare staff, respectively. The indications for defibrillation were correctly answered in the physicians who had acquired a certificate of BLS‐ALS training (P = .047, P = .003). Conclusions The professional experience is significant in the correct use of a defibrillator and related procedures. Given the importance of early defibrillation in survival, the importance and proper use of defibrillators should be emphasised in Certified BLS‐ALS programmes. Certified BLS‐ALS programmes increase the level of knowledge and self‐confidence towards synchronised cardioversion‐defibrillation procedures.

Introduction: Paroxysmal nonepileptic events are episodic changes in behavior, sensation, or consciousness that are similar to epileptic seizures but not associated with abnormal ictal brain electrophysiological discharges. Here, a case treated as epileptic seizure was presented in order to draw attention to paroxysmal nonepileptic events in differential diagnosis.Case: A 4 years old girl sent to our hospital with the diagnose of status epilepticus due to change in her consciousness, contractions and abnormal movements in her body, arms and legs those started after taking 6 spoonfull syrup of Peditus® (Containing 120 mg paracetamol, 50 mg guaifenesin, 6.25 mg pyrilamine maleate, 5 mg phenylephrine hcl in 5 ml scale) and 5 Medikinet® 10 mg capsules (10 mg methylphenidate hydrochloride in 1 capsule). She was conscious and cooperate and has involuntary snake-like movements throughout her body on admission. The patient's movement disturbances thought as methylphenidate-induced choreoathetosis responded to given haloperidol treatment and any sign of poisoning were not observed in the patient's follow up. Conclusion:Chorea side effects were observed in our patient but not any poisoning symptoms, who received a toxic dose of methylphenidate for her age. This suggests that methylphenidate, a central nervous system stimulant, may have therapeutic, toxic dose limits and side effects profile those associated with individual pharmacogenetic variations. Accurate distinction of chorea from drug-related paroxysmal nonepileptic events will ensure early effective treatment of patients and to protect patients from unnecessary drug risks.

Objectives Noninvasive capnography (NICG) devices can measure oxygen saturation, end-tidal carbon dioxide (EtCO2), respiratory rate, heart rate values and integrated pulmonary index (IPI). This study aimed to evaluate patients who were monitored using NICG for various indications in a pediatric emergency department and to determine its contribution to patient management in the pediatric emergency department (PED). Methods In this study, children aged <18 years who had been monitored with a NICG at the PED in our university between August 2018-May 2019 were evaluated. Of them 48 patients' file records and monitored capnography parameters such as heart rate, respiratory rate, blood pressure, capillary refill time, Glasgow Coma Score, SpO2, EtCO2, IPI recorded in the forms were reviewed. Results Patients most often presented to the emergency room due to seizures (35.4%), change in consciousness (22.9%), other neurological reasons (18.8%) with %50 were female. Seizure treatment(16.7%), circulatory–respiratory support(16.7%), and antiedema treatments(6.3%) were required for 39.5% patients as life-saving interventions, and 72.9% patients were hospitalized. Patients with low IPI(<8) values at the beginning and decreasing IPI (<8) measurements within monitoring period needed more life-saving treatments(p=0.005 and p=0.001, respectively). Low IPI values of the patients during monitoring showed a significant difference in the decision to be hospitalized(p=0.048). Conclusions The results of the present study indicate that monitoring with NICG in the pediatric emergency room can be an important early indicator in establishing clinical prediction. The study particularly points out that the IPI value can be a guide in decisions regarding life-saving treatment and hospitalization. Among the capnographic data of these patients who had a change in consciousness IPI values those measured at the beginning and within the monitorizarion period showed a significant correlation with low GCS (<8) (r=0.478, p=0.001 and r=0.456, p=0.02, respectively). Prospective comprehensive large scale studies are needed to examine the use of NICG and IPI in routine PED practice for various indications.

Purpose: Successful resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. This study aimed to determine the knowledge, skills, and attitudes of the pediatric healthcare professionals about the defibrillator use and to offer solutions if there was room for improvement. Procedures: This was a multicenter survey study. Findings: The study included 716 healthcare professionals with an average age of 30.1 ± 5.8 years; 50% (n=358) were pediatric residents and 41.3% (n=296) had less than three years of professional experience. Self-declared level of knowledge about defibrillation/cardioversion was low-to-medium for 66.5% (n=476); 60.8% (n=435) had never practiced these procedures and 22.2% (n=159) had never received any training about defibrillator use. There was a significant relationship between professional experience and the proportion of participants who correctly responded to the first-shock dose for defibrillation but not for cardioversion. Conclusion: Professional experience is crucial in the correct defibrillator use. However, the defibrillation/cardioversion procedures are prone to errors since they are not commonly applied in day to day practice. An ideal approach to improve the experience of personnel could be to use practical training with case-based simulations and to educate the personnel about the features of the defibrillators available in their clinics.

Introduction:The most important purpose in neonatal pain management is to minimize the pain felt by newborns and to help the newborn cope with pain. This study planned to examine the effects of two non-pharmacological methods, using pacifiers or maternal holding, on neonates' pain admitted to the outpatient clinic (OC) and hospitalized in the Neonatal Intensive Care Unit (NICU). Material and Method: Ninety newborns (30 used pacifier, 30 maternal holding,30 control) who applied to the OC and 60 newborns (30 used pacifiers, 30 control) admitted to the NICU were prospectively included in this study. The Neonatal Infant Pain Scale (NIPS) was used to evaluate behavioral responses to pain perception. Physiological parameters of newborns and their duration of crying were also evaluated. Results: When the NIPS scores were analyzed in OC group during and after the procedure, the lowest score was found in the group using pacifiers (p<0.001). As for the NICU patients, both during and after the procedure, NIPS scores were found to be significantly lower in the pacifier users (p<0.001). It was observed that giving pacifiers and maternal holding had positive effects on physiological parameters and duration of crying in OC patients (p<0.05). No significant difference in the NIPS score was found between OC and NICU group. Conclusion: This study showed that giving pacifiers and maternal holding during the procedure of blood sampling decreased the NIPS score, restored the changes in physiological parameters and decreased the duration of crying.