Turkish Journal of Emergency Medicine最新文献

Acute pancreatitis is one of the severe complications of hypertriglyceridemia, which needs to be recognized early to provide appropriate treatment. Hypertriglyceridemia-induced pancreatitis has several causes, in which in vitro fertilization (IVF) is a rare etiology that is becoming increasingly popular. We report a 33-year-old female patient with a history of hypertension who has failed an IVF cycle and started a new IVF procedure 1 month before admission. She was diagnosed with severe triglyceridemia-induced acute pancreatitis with extremely high serum triglycerides (TGs) levels (18,547 mg/dL). We combined plasmapheresis and intravenous (IV) insulin and significantly reduced blood TG over a short time. She was discharged with a TG level of 366.7 mg/dL on the 10^th day. It is essential to monitor serum TG levels in plasma before, during, and after this therapy, especially in the 1^st month after initiating IVF. Although plasmapheresis combined with IV insulin is not officially recommended for acute triglyceridemia-induced pancreatitis, the therapy can be considered in cases with extremely high serum TG levels.

The evaluation of adult patients suspected of ST-segment elevation myocardial infarction (STEMI) includes a focused history and examination, 12-lead electrocardiogram (ECG), and cardiac serum marker analysis. The ECG plays a pivotal role in the early diagnosis and management of STEMI. A number of ECG entities in this patient population will present with ST-segment elevation and other electrocardiographic abnormalities which can mimic STEMI. In this article, we review the most frequent STEMI mimic patterns, highlight their ECG characteristics, and compare these individual ECG entities to the electrocardiographic abnormalities present with STEMI.

Objectives: It is crucial to promptly identify high-mortality patients in emergency departments and initiate their treatment as soon as possible. Although many parameters have been studied to select patients with high mortality, no comprehensive evaluation exists in previous literature on these parameters in critically ill patients, regardless of patient groups. The aim of this study is to evaluate the Glasgow Coma Scale (GCS), quick Sepsis-related Organ Failure Assessment (qSOFA), blood gas base excess (BE), and blood gas lactate in predicting mortality in critically ill patients admitted to the emergency department.

Methods: This prospective observational cohort study included adult patients with Emergency Severity Index 1-2 (critically ill) admitted to the emergency department. All patients were evaluated by the physician within 10 min, and blood gas samples were taken. The data collection forms recorded the patients' GCS and qSOFA scores at the time of first evaluation by the physician. The qSOFA score assessment was performed in all patients with ESI levels 1 and 2, regardless of whether infective pathology was suspected. Blood gas BE and lactate values were also from laboratory test results. Patients or their relatives were contacted by phone at the end of the 1^st month to obtain information about the clinical condition (survival or mortality).

Results: A total of 868 patients were included, with 163 deaths observed within 30 days. GCS score, qSOFA score, and lactate value were significant in predicting mortality within 30 days. While the BE value was significant for predicting 30-day mortality for values equal to or below the lower limit of -1.5 (P < 0.001), it was not significant for values equal to or above the upper limit of +3 (P > 0.05). The most successful prediction model for predicting 30-day mortality was found to be qSOFA with a cutoff value of ≥1.

Conclusion: In emergency departments, each of the GCS, qSOFA scores, BE, and lactate values can be used independently as a practical mortality prediction model in critically ill patients. Among these four models, qSOFA is the most successful practical mortality prediction model in critically ill patients.

The presence of the stomach in the thorax is called gastrothorax. If excessive dilatation occurs due to a valve mechanism in the stomach which then is herniated into the thorax, it is called tension gastrothorax and the situation can be life-threatening. In late presentation, congenital diaphragmatic hernias or traumatic diaphragmatic hernias, if the stomach located in the thorax is severely distended, it can be confused with tension pneumothorax or pleural effusion/empyema. We presented tension gastrothorax in two patients with distended stomach in the thorax, in which tension pneumothorax and pleural effusion/empyema-like images were created, based on plain X-rays taken at the first admission in the emergency department, which may cause diagnostic confusion. The tension gastrothorax can cause mediastinal shift, which can lead to respiratory distress and eventually cardiac arrest secondary to obstructive shock. In case of mediastinal shift, it should reduce the tension of the stomach located in the thorax by inserting a nasogastric catheter, and if this fails, by aspiration with a needle.

Objectives: Ascending to altitudes >2500 m may lead to acute mountain sickness (AMS).

Methods: The demographics, height, weight, body mass index (BMI), smoking, and alcohol consumption of 104 healthy controls were collected in Chengdu (500 m). Heart rate (HR), saturation of pulse oxygen (SpO2), and AMS-related symptoms were collected in Hoh Xil (4200 m). A headache with Lake Louise score ≥3 was defined as AMS.

Results: The incidence of AMS was 60.58%. AMS group had a lower SpO2 and higher HR than non-AMS group. Alcohol consumption seemed a risk factor for AMS. There was no difference in the BMI, age, height, weight, and smoking between AMS and non-AMS groups. The most common AMS symptom was headache, followed by dyspnea, insomnia, dizziness, lassitude, and anorexia. Women were prone to suffer from dizziness. The value of SpO2 and HR was improved both in AMS and non-AMS groups after hypoxia acclimatization, and the value showed greater improvement in AMS group. Oxygen therapy decreased the AMS-induced tachycardia, which had no any effect on SpO2 and symptom alleviating time.

Conclusion: Lower SpO2 and higher HR following exposure to high altitude were associated with AMS susceptibility. The anthropometric data changes were larger in AMS group than non-AMS group before and after hypoxia acclimatization.

The clinical policy of the Emergency Medicine Association of Türkiye (EMAT) provides guidance on the use of tranexamic acid (TXA) in emergency settings. TXA, an antifibrinolytic drug, is used to control bleeding by inhibiting plasminogen. Its applications have expanded from hemophilia and severe menstrual bleeding to include various forms of trauma and surgery-related bleeding. Despite its potential benefits, the use of TXA in emergency settings must be carefully evaluated due to its associated risks, including venous thromboembolism. This policy aimed to offer evidence-based recommendations on the indications and contraindications of TXA in different clinical scenarios encountered in the emergency departments. The guidelines were developed using the "Grading of Recommendations, Assessment, Development, and Evaluations" approach, incorporating systematic literature reviews, and expert consensus from the EMAT Research Committee. This document focuses on critical clinical questions regarding the efficacy and safety of TXA in situations such as gastrointestinal bleeding, multitrauma, traumatic brain injury, nontraumatic intracranial hemorrhage, hemoptysis, and epistaxis. By addressing these issues, the policy seeks to assist emergency physicians in making informed decisions about the use of TXA, ultimately aiming to improve the patient outcomes.

Objectives: In the realm of acute pain management within emergency departments (EDs), the prevalent reliance on systemic analgesics, notably opioids, presents challenges due to associated risks and suboptimal efficacy. The emerging alternative of ultrasound-guided nerve blocks (USGNBs) has shown promise in prospective studies. However, the safety and efficacy of USGNBs when performed by emergency medicine practitioners remain largely unexplored, necessitating this study to address the research gap. The primary objectives of this study were to assess the efficacy of Emergency physician-performed USGNBs and changes in patient-reported pain (pre- and postnerve block) at 15 and 30 min. In addition, the time taken to perform nerve blocks, type of nerve block, frequency, indications, procedure time, and complications were all studied.

Methods: Conducted at a Tertiary Care Teaching Hospital in Pune, India, this single-center, retrospective observational study aimed to evaluate the effectiveness of USGNBs in the ED context. A retrospective analysis covered 274 emergency practitioner-performed USGNBs recorded from January 2022 to December 2023. Participants included consecutive ED patients consenting to nerve blocks, with practitioners utilizing bupivacaine (0.25%) and ropivacaine (0.25%) based on individual preferences. The study systematically recorded patient demographics, block types, indications, complications, and pre- and postpain scores on a Numerical Rating Scale.

Results: The study demonstrated a significant reduction in pain scores post-USGNB, with an average decrease of 2.9 ± 1.08 at 15 min and 5.8 ± 1.39 at 30 min. Commonly performed blocks included the femoral nerve, fascia iliaca, and serratus anterior, with notable pain relief in fracture management cases. Procedural durations varied, ranging from 2 to 12 min, while four complications were reported, including diaphragmatic paresis and arterial punctures during interscalene nerve block and fascia iliac compartment blocks, respectively.

Conclusion: This extensive study in an academic ED setting supports the proficiency of emergency practitioners in performing USGNBs. The findings emphasize the transformative potential of USGNBs in academic ED pain management, showcasing notable pain reduction and minimal complications. These results advocate for the integration of advanced pain relief techniques into emergency medicine training programs, contributing to a comprehensive approach to acute pain management.

This case report describes a 32-year-old male who underwent ketamine procedural sedation and experienced a generalized tonic-clonic seizure. Despite its rapid onset and favorable tolerance profile, this case emphasizes the potential convulsive side effects of ketamine, which is commonly used for procedural sedation. While ketamine has shown promise in treating acute pain, refractory status epilepticus, and treatment-resistant depression and schizophrenia, it is associated with side effects such as hallucinations, visual disturbances, dizziness, nausea, and vomiting. The patient in this case received a carefully titrated dose of 40 mg of ketamine intravenously and underwent successful shoulder reduction while under sedation. However, within 60 s of receiving the ketamine, the patient experienced a 60-s seizure that was stopped with the administration of 5 mg of diazepam intravenously. The patient was hospitalized for further evaluation, including an electroencephalography (EEG) that showed no abnormalities. This case highlights the need for health-care professionals to be aware of the potential convulsive side effects of ketamine and to carefully monitor patients who receive ketamine sedation.

Objectives: Cerebral venous thrombosis (CVT) is a rare type of stroke. Functional outcome (FOC) in CVT can be affected by different factors, and recanalization is an important determinant. This study aimed to identify the FOC predictors including recanalization in patients with CVT.

Methods: This retrospective study reviewed electronic charts of patients with CVT admitted to the King Fahd Hospital of the University, a teaching and referral hospital between January 2012 and March 2023. Demographic and other clinicoradiological characteristics were noted. Factors affecting FOC were investigated using the Chi-square test, odds ratios (ORs), and 95% confidence interval (CI).

Results: Out of 64 patients, 78% achieved good FOC. Age was significantly higher in patients having poor FOC as compared to those having good FOC (P ≤ 0.001). Women had more likelihood to be functionally independent as compared to men (OR = 1.35, 95% CI = 1.01-1.80, P = 0.02). Altered consciousness (OR = 2.94, 95% CI = 1.23-6.99, P = 0.01), venous hemorrhagic infarction (OR = 3.26, 95% CI = 1.36-7.82, P = 0.008), and nonrecanalization (OR = 1.44, 95% CI = 0.97-2.14, P = 0.02) were significantly associated with poor FOC. Hereditary thrombophilia (OR = 0.60, 95% CI = 0.31-1.12, P = 0.03) and infections (OR = 0.59, 95% CI = 0.31-1.12, P = 0.01) were associated with less likelihood of good FOC. Age ≥50 years (P = 0.01) and illness of more than 1-month duration (P = 0.01) were associated with nonrecanalization.

Conclusion: Older age, male sex, presence of venous hemorrhagic infarction, and nonrecanalization can predict poor FOC in CVT. The recanalization process can be affected by late presentation, and the plausible reason could be a delay in therapeutic anticoagulation. Further prospective and multicenter studies are needed to determine the predictors of FOC and to understand the process of recanalization in CVT.

Objective: We aimed to determine the role of plasma alpha- and beta-synuclein levels and other routine inflammatory parameters in the diagnosis, outcome, and mortality of acute ischemic stroke (AIS).

Methods: In our study, serum alpha- and beta-synuclein levels and clinical data were prospectively evaluated in 93 subjects (43 controls and 50 AIS patients) admitted to the emergency department. The outcome status and prognostic classification were performed according to the modified Rankin Scale (mRS) scores on the 30^th day from hospital admission.

Results: The mean age of the subjects was 70.6 ± 11 years. Thirty-eight percentage were female. Plasma α-synuclein levels in the AIS group (33.6 ± 8.5 ng/mL) were significantly higher than those in the control group (4.22 ± 2.1 ng/mL) (P < 0.001). Plasma β-synuclein levels in the AIS group (13.07 ± 2.7 ng/mL) were significantly higher than those in the control group (2.17 ± 1.4 ng/mL) (P < 0.001). There was no significant difference in alpha- and beta-synuclein levels between the subgroups formed according to the 30^th-day results of the patients using the mRS scores (P = 0.813 and 0.812, respectively).

Conclusion: The serum alpha- and beta-synuclein concentrations of patients with AIS at admission were significantly higher than the healthy control group. At admission, serum alpha- and beta-synuclein levels do not have definitive clinically predictive value in predicting stroke progression and outcome in patients with AIS.