Ayşen Aydın Kaçar, E. Aksay, B. Bayram, Emre Kıran, Bahar Elif Güldalı
Hyperlactatemia has been recognized as a significant prognostic indicator in critically ill patients. Nonetheless, there remains a gap in understanding the specific risk factors contributing to increased mortality among undifferentiated emergency department (ED) patients presenting with elevated lactate levels. The objective of the study is to investigate potential risk factors for 30-day in-hospital mortality in ED patients with hyperlactatemia. All nontraumatic adult presentations to the ED who had a lactate level of ≥2.5 mmol/L were included. Comorbidities, vital signs, lactate levels, lactate clearance, lactate normalization, and final diagnosis were compared with 30-day in-hospital mortality. A 30-day in-hospital mortality rate of 10.4% was observed in 979 patients. The mortality rate was higher in hypotensive patients (odds ratio [OR] 4.973), in nursing home patients (OR 5.689), and bedridden patients (OR 3.879). The area under the curve for the second lactate level (0.804) was higher than the first lactate level (0.691), and lactate clearance (0.747) for in-hospital mortality. A second lactate level >3.15 mmol/l had a sensitivity of 81.3% in predicting in-hospital mortality. The OR for mortality was 6.679 in patients without lactate normalization. A higher mortality rate was observed in patients with acute renal failure (OR 4.305), septic shock (OR 4.110), and acute coronary syndrome (OR 2.303). A second lactate measurement more accurately predicts in-hospital mortality than lactate clearance and the first lactate level in ED patients. Nursing home patients, bed-ridden patients, hypotensive patients on initial ED presentation, patients without lactate normalization, and patients with a final diagnosis of acute renal failure, septic shock, and acute coronary syndrome had a higher mortality rate.
{"title":"Identifying high-risk undifferentiated emergency department patients with hyperlactatemia: Predictors of 30-day in-hospital mortality","authors":"Ayşen Aydın Kaçar, E. Aksay, B. Bayram, Emre Kıran, Bahar Elif Güldalı","doi":"10.4103/tjem.tjem_34_24","DOIUrl":"https://doi.org/10.4103/tjem.tjem_34_24","url":null,"abstract":"\u0000 \u0000 \u0000 Hyperlactatemia has been recognized as a significant prognostic indicator in critically ill patients. Nonetheless, there remains a gap in understanding the specific risk factors contributing to increased mortality among undifferentiated emergency department (ED) patients presenting with elevated lactate levels.\u0000 \u0000 \u0000 \u0000 The objective of the study is to investigate potential risk factors for 30-day in-hospital mortality in ED patients with hyperlactatemia.\u0000 \u0000 \u0000 \u0000 All nontraumatic adult presentations to the ED who had a lactate level of ≥2.5 mmol/L were included. Comorbidities, vital signs, lactate levels, lactate clearance, lactate normalization, and final diagnosis were compared with 30-day in-hospital mortality.\u0000 \u0000 \u0000 \u0000 A 30-day in-hospital mortality rate of 10.4% was observed in 979 patients. The mortality rate was higher in hypotensive patients (odds ratio [OR] 4.973), in nursing home patients (OR 5.689), and bedridden patients (OR 3.879). The area under the curve for the second lactate level (0.804) was higher than the first lactate level (0.691), and lactate clearance (0.747) for in-hospital mortality. A second lactate level >3.15 mmol/l had a sensitivity of 81.3% in predicting in-hospital mortality. The OR for mortality was 6.679 in patients without lactate normalization. A higher mortality rate was observed in patients with acute renal failure (OR 4.305), septic shock (OR 4.110), and acute coronary syndrome (OR 2.303).\u0000 \u0000 \u0000 \u0000 A second lactate measurement more accurately predicts in-hospital mortality than lactate clearance and the first lactate level in ED patients. Nursing home patients, bed-ridden patients, hypotensive patients on initial ED presentation, patients without lactate normalization, and patients with a final diagnosis of acute renal failure, septic shock, and acute coronary syndrome had a higher mortality rate.\u0000","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141702617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Publications and literature related to emergency medicine (EM) have been consistently increasing. There are 4048 studies in total in the EM journals published until the present day in Türkiye in the Web of Science (WoS) database. Our aim is to define the bibliometric features of scientific studies published in EM journals in Türkiye, to gain insights into the trends of the literature. We retrospectively analyzed the bibliometric data of scientific studies published in EM journals in Türkiye until today on the WoS database related to the EM field. The bibliometrix package of R statistical software was used in the bibliometric analyses in the study. A total of 4048 scientific studies from Türkiye indexed on the WoS database from 10,263 authors in four different journals were analyzed. Among these, 3681 (90.9%) were articles, 188 (4.7%) were reviews, 97 (2.4%) were editorial material, 60 (1.5%) were letters, and 5 (0.1%) were corrections. Average number of citations per study was 3.6, with the most cited study having 2016 citations. The most frequent title’s words were emergency, patient, and acute. This study shows that there is an increasing trend in the number of EM publications and citations in Türkiye with the first most cited study having 2016 citations, and the top contributing countries were Türkiye, Iran, and India. The results of this study may be useful in understanding the historical and prospective development of EM, including the identification of general information about its publications, differentiation of the top-cited ones, and presentation of a bibliometric analysis of scientific activity to date.
{"title":"A bibliometric analysis of publications on emergency medicine in Türkiye","authors":"Mustafa Can Güzelce, Ertuğ Orhan, Sefer Özgür","doi":"10.4103/tjem.tjem_5_24","DOIUrl":"https://doi.org/10.4103/tjem.tjem_5_24","url":null,"abstract":"\u0000 \u0000 \u0000 Publications and literature related to emergency medicine (EM) have been consistently increasing. There are 4048 studies in total in the EM journals published until the present day in Türkiye in the Web of Science (WoS) database. Our aim is to define the bibliometric features of scientific studies published in EM journals in Türkiye, to gain insights into the trends of the literature.\u0000 \u0000 \u0000 \u0000 We retrospectively analyzed the bibliometric data of scientific studies published in EM journals in Türkiye until today on the WoS database related to the EM field. The bibliometrix package of R statistical software was used in the bibliometric analyses in the study.\u0000 \u0000 \u0000 \u0000 A total of 4048 scientific studies from Türkiye indexed on the WoS database from 10,263 authors in four different journals were analyzed. Among these, 3681 (90.9%) were articles, 188 (4.7%) were reviews, 97 (2.4%) were editorial material, 60 (1.5%) were letters, and 5 (0.1%) were corrections. Average number of citations per study was 3.6, with the most cited study having 2016 citations. The most frequent title’s words were emergency, patient, and acute.\u0000 \u0000 \u0000 \u0000 This study shows that there is an increasing trend in the number of EM publications and citations in Türkiye with the first most cited study having 2016 citations, and the top contributing countries were Türkiye, Iran, and India. The results of this study may be useful in understanding the historical and prospective development of EM, including the identification of general information about its publications, differentiation of the top-cited ones, and presentation of a bibliometric analysis of scientific activity to date.\u0000","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141690874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.4103/tjem.tjem_231_23
Nejah F. Ellouze, D. Hazra, Suad Al Abri
Despite documented cases of baclofen toxicity in individuals with kidney disease, the drug is widely prescribed for various medical conditions, primarily spasticity, hiccups, and multiple sclerosis. Baclofen, a gamma-aminobutyric acid derivative, relies on renal excretion, rendering those with impaired kidney function susceptible to toxicity – a concern often underestimated by health-care providers. Adverse reactions, including single or double doses, are well documented in addition to multi-dose toxicity. This report discusses a case of baclofen-induced neurotoxicity in an end-stage renal disease patient undergoing dialysis, highlighting the subsequent management with continuous venovenous hemodialysis. In addition, it provides a comprehensive review of existing literature on baclofen toxicity in cases of renal insufficiency. Strikingly, the literature lacks clear guidelines regarding baclofen safety, dose adjustments, or renal function thresholds for contraindication. This contribution aims to augment understanding of this critical issue, emphasizing the need for heightened awareness and careful consideration of baclofen use in patients with kidney disease.
{"title":"Baclofen-induced neurotoxicity in a dialysis patient managed with continuous venovenous hemodialysis: A case report and literature review","authors":"Nejah F. Ellouze, D. Hazra, Suad Al Abri","doi":"10.4103/tjem.tjem_231_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_231_23","url":null,"abstract":"\u0000 Despite documented cases of baclofen toxicity in individuals with kidney disease, the drug is widely prescribed for various medical conditions, primarily spasticity, hiccups, and multiple sclerosis. Baclofen, a gamma-aminobutyric acid derivative, relies on renal excretion, rendering those with impaired kidney function susceptible to toxicity – a concern often underestimated by health-care providers. Adverse reactions, including single or double doses, are well documented in addition to multi-dose toxicity. This report discusses a case of baclofen-induced neurotoxicity in an end-stage renal disease patient undergoing dialysis, highlighting the subsequent management with continuous venovenous hemodialysis. In addition, it provides a comprehensive review of existing literature on baclofen toxicity in cases of renal insufficiency. Strikingly, the literature lacks clear guidelines regarding baclofen safety, dose adjustments, or renal function thresholds for contraindication. This contribution aims to augment understanding of this critical issue, emphasizing the need for heightened awareness and careful consideration of baclofen use in patients with kidney disease.","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141701358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alp Şener, M. Pekdemir, M. Islam, E. Aksay, S. Karahan, G. Aksel, N. Doğan, Berkant Öztürk, Muhammet Hacımustafaoğlu, Çağrı Türkücü, S. Eroğlu, Yusuf Yürümez, Nuray Aslan, Necip Gökhan Güner, N. User, Hüseyin Aldemir, A. S. Girişgin, S. Koçak, Sami Ataman, Ayhan Özhasenekler, Gül Pamukçu Günaydın, M. Sayhan, Ömer Salt, Satuk Buğra Han Bozatlı, E. Arslan, F. Yılmaz, Ramazan Sivil, Özlem Köksal, V. Durak, Fatma Özdemir, Mahmut Taş, Yenal Karakoç, Ö. Avınca, Y. Arık, A. Melekoğlu, Özgür Çevrim, Özlem Yiğit, Cem Oktay, Süleyman İbze, S. Satar, Müge Gülen, Selen Acehan, Erhan Altunbaş, Melis Efeoğlu Saçak, Emir Ünal, Erdem Çevik, Dilay Satılmış, Hande Asan, Yunus Karaca, Melih Imamoğlu, Vildan Özer, A. Demircan, Ayfer Keleş, Gultekin Kadi, O. Delice, S. Utlu, Senol Arslan, Neslihan Yücel, Ş. Gürbüz, Hüseyin Burak Ayhan, Abdullah Şen, Mahmut Yaman, M. Günalp, S. Genç, A. Baydın, Fatih Çalışkan, Şeyma Arzu Temür, Murat Ersel, S. Yalçınlı, Enver Özçete, B. Erbil, Elif Ozturk Ince, M. A. Karaca, Murat Çetin, Mehme
There is no sufficient data to provide a clear picture of out-of-hospital cardiac arrest (OHCA) across Türkiye. This study is the first to present the prognostic outcomes of OHCA cases and the factors associated with these outcomes. The study was conducted in a prospective, observational, multicenter design under the leadership of the Emergency Medicine Association of Turkey Resuscitation Study Group. OHCA cases aged 18 years and over who were admitted to 28 centers from Türkiye were included in the study. Survived event, return of spontaneous circulation (ROSC), survival to hospital discharge, and neurological outcome at discharge were investigated as primary outcomes. One thousand and three patients were included in the final analysis. 61.1% of the patients were male, and the average age was 67.0 ± 15.2. Cardiopulmonary resuscitation (CPR) was performed on 86.5% of the patients in the prehospital period by emergency medical service, and bystander CPR was performed on only 2.9% by nonhealth-care providers. As a result, the survived event rate was found to be 6.9%. The survival rate upon hospital discharge was 4.4%, with 2.7% of patients achieving a good neurological outcome upon discharge. In addition, the overall ROSC and sustained ROSC rates were 45.2% and 33.4%, respectively. In the multiple logistic regression analysis, male gender, initial shockable rhythm, a shorter prehospital duration of CPR, and the lack of CPR requirement in the emergency department were determined to be independent predictors for the survival to hospital discharge. Compared to global data, survival to hospital discharge and good neurological outcome rates appear to be lower in our study. We conclude that this result is related to low bystander CPR rates. Although not the focus of this study, inadequate postresuscitative care and intensive care support should also be discussed in this regard. It is obvious that this issue should be carefully addressed through political moves in the health and social fields.
{"title":"Prospective, multicenter, Turkish out-of-hospital cardiac arrest study: TROHCA","authors":"Alp Şener, M. Pekdemir, M. Islam, E. Aksay, S. Karahan, G. Aksel, N. Doğan, Berkant Öztürk, Muhammet Hacımustafaoğlu, Çağrı Türkücü, S. Eroğlu, Yusuf Yürümez, Nuray Aslan, Necip Gökhan Güner, N. User, Hüseyin Aldemir, A. S. Girişgin, S. Koçak, Sami Ataman, Ayhan Özhasenekler, Gül Pamukçu Günaydın, M. Sayhan, Ömer Salt, Satuk Buğra Han Bozatlı, E. Arslan, F. Yılmaz, Ramazan Sivil, Özlem Köksal, V. Durak, Fatma Özdemir, Mahmut Taş, Yenal Karakoç, Ö. Avınca, Y. Arık, A. Melekoğlu, Özgür Çevrim, Özlem Yiğit, Cem Oktay, Süleyman İbze, S. Satar, Müge Gülen, Selen Acehan, Erhan Altunbaş, Melis Efeoğlu Saçak, Emir Ünal, Erdem Çevik, Dilay Satılmış, Hande Asan, Yunus Karaca, Melih Imamoğlu, Vildan Özer, A. Demircan, Ayfer Keleş, Gultekin Kadi, O. Delice, S. Utlu, Senol Arslan, Neslihan Yücel, Ş. Gürbüz, Hüseyin Burak Ayhan, Abdullah Şen, Mahmut Yaman, M. Günalp, S. Genç, A. Baydın, Fatih Çalışkan, Şeyma Arzu Temür, Murat Ersel, S. Yalçınlı, Enver Özçete, B. Erbil, Elif Ozturk Ince, M. A. Karaca, Murat Çetin, Mehme","doi":"10.4103/tjem.tjem_73_24","DOIUrl":"https://doi.org/10.4103/tjem.tjem_73_24","url":null,"abstract":"\u0000 \u0000 \u0000 There is no sufficient data to provide a clear picture of out-of-hospital cardiac arrest (OHCA) across Türkiye. This study is the first to present the prognostic outcomes of OHCA cases and the factors associated with these outcomes.\u0000 \u0000 \u0000 \u0000 The study was conducted in a prospective, observational, multicenter design under the leadership of the Emergency Medicine Association of Turkey Resuscitation Study Group. OHCA cases aged 18 years and over who were admitted to 28 centers from Türkiye were included in the study. Survived event, return of spontaneous circulation (ROSC), survival to hospital discharge, and neurological outcome at discharge were investigated as primary outcomes.\u0000 \u0000 \u0000 \u0000 One thousand and three patients were included in the final analysis. 61.1% of the patients were male, and the average age was 67.0 ± 15.2. Cardiopulmonary resuscitation (CPR) was performed on 86.5% of the patients in the prehospital period by emergency medical service, and bystander CPR was performed on only 2.9% by nonhealth-care providers. As a result, the survived event rate was found to be 6.9%. The survival rate upon hospital discharge was 4.4%, with 2.7% of patients achieving a good neurological outcome upon discharge. In addition, the overall ROSC and sustained ROSC rates were 45.2% and 33.4%, respectively. In the multiple logistic regression analysis, male gender, initial shockable rhythm, a shorter prehospital duration of CPR, and the lack of CPR requirement in the emergency department were determined to be independent predictors for the survival to hospital discharge.\u0000 \u0000 \u0000 \u0000 Compared to global data, survival to hospital discharge and good neurological outcome rates appear to be lower in our study. We conclude that this result is related to low bystander CPR rates. Although not the focus of this study, inadequate postresuscitative care and intensive care support should also be discussed in this regard. It is obvious that this issue should be carefully addressed through political moves in the health and social fields.\u0000","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141692607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ali Rıza Karabacak, İbrahim Ulaş Özturan, Ömer Faruk Şefoğlu, N. Doğan, E. Yaka, Serkan Yılmaz, M. Pekdemir
This study aimed to compare the effects of Macintosh-type and hyperangulated video laryngoscopy (VL) blades on dental force during endotracheal intubation (ETI) using Glidescope and McGrath VL devices. In this randomized, crossover, manikin study conducted at a university emergency medicine (EM) program, 65 EM trainees included interns and residents performed 520 intubations using four different VL blades (GlideScope VL with Macintosh-type Mac T3 and hyperangular Lo Pro T3 blades and McGrath VL Macintosh-type MAC 4 and hyperangular McGrath X3 blades) in normal and difficult airway scenarios. The primary outcome of this study was the dental pressure (Newton) exerted during ETI. The secondary outcomes included c-spine motion (degree), intubation success (%), duration (seconds), successful glottic view (%), and intubator comfort (7-point Likert). Significant differences were observed in dental force (H(3) = 11.7, P = 0.008), c-spine motion (H(3) = 8.34, P = 0.039), duration (H(3) = 16.56, P = 0.001), and comfort (H(3) = 174.96, P < 0.001) across blade types. Glidescope LoPro T3 provided a significant lower dental force (adjusted P = 0.01), less c-spine motion (adjusted P = 0.031), and shorter intubation duration (adj P < 0.01) than the McGrath Mac 4. First attempt success and intubator comfort were significantly better with all Glidescope blades (z score of 3.7 and 4.7) than with McGrath blades (z score of-4.1 and-4.4). The Glidescope LoPro T3 blade demonstrated advantages in dental force, c-spine motion, and intubation duration compared with McGrath Mac 4. Overall, the Glidescope blades provided superior comfort and higher first attempt success rates.
本研究旨在比较麦氏型和超切角视频喉镜（VL）刀片对使用 Glidescope 和 McGrath VL 设备进行气管插管（ETI）时牙力的影响。 在一项在大学急诊医学（EM）课程中进行的随机、交叉、人体模型研究中，包括实习生和住院医师在内的 65 名急诊医学学员在正常和困难气道情况下使用四种不同的 VL 刀片（GlideScope VL 配有 Macintosh 型 Mac T3 和超角 Lo Pro T3 刀片，McGrath VL 配有 Macintosh 型 MAC 4 和超角 McGrath X3 刀片）进行了 520 次插管。本研究的主要结果是 ETI 期间施加的牙压力（牛顿）。次要结果包括脊柱运动（度）、插管成功率（%）、持续时间（秒）、成功声门视野（%）和插管舒适度（7 点 Likert）。 不同刀片类型在牙力（H(3) = 11.7，P = 0.008）、c-脊柱运动（H(3) = 8.34，P = 0.039）、持续时间（H(3) = 16.56，P = 0.001）和舒适度（H(3) = 174.96，P < 0.001）方面存在显著差异。与 McGrath Mac 4 相比，Glidescope LoPro T3 的牙合力明显更低（调整后 P = 0.01），C-脊柱运动更少（调整后 P = 0.031），插管持续时间更短（调整后 P < 0.01）。所有 Glidescope 插管刀的首次尝试成功率和插管舒适度（z 评分为 3.7 和 4.7）均明显优于 McGrath 插管刀（z 评分为 4.1 和 4.4）。 与 McGrath Mac 4 相比，Glidescope LoPro T3 刀片在牙力、脊柱运动和插管持续时间方面更具优势。总体而言，Glidescope刀片提供了更好的舒适度和更高的首次尝试成功率。
{"title":"Comparison of dental force applied during endotracheal intubation with hyper-angulated and macintosh-type video laryngoscopy blades used by emergency medicine trainees: A randomized cross-over manikin study","authors":"Ali Rıza Karabacak, İbrahim Ulaş Özturan, Ömer Faruk Şefoğlu, N. Doğan, E. Yaka, Serkan Yılmaz, M. Pekdemir","doi":"10.4103/tjem.tjem_18_24","DOIUrl":"https://doi.org/10.4103/tjem.tjem_18_24","url":null,"abstract":"\u0000 \u0000 \u0000 This study aimed to compare the effects of Macintosh-type and hyperangulated video laryngoscopy (VL) blades on dental force during endotracheal intubation (ETI) using Glidescope and McGrath VL devices.\u0000 \u0000 \u0000 \u0000 In this randomized, crossover, manikin study conducted at a university emergency medicine (EM) program, 65 EM trainees included interns and residents performed 520 intubations using four different VL blades (GlideScope VL with Macintosh-type Mac T3 and hyperangular Lo Pro T3 blades and McGrath VL Macintosh-type MAC 4 and hyperangular McGrath X3 blades) in normal and difficult airway scenarios. The primary outcome of this study was the dental pressure (Newton) exerted during ETI. The secondary outcomes included c-spine motion (degree), intubation success (%), duration (seconds), successful glottic view (%), and intubator comfort (7-point Likert).\u0000 \u0000 \u0000 \u0000 Significant differences were observed in dental force (H(3) = 11.7, P = 0.008), c-spine motion (H(3) = 8.34, P = 0.039), duration (H(3) = 16.56, P = 0.001), and comfort (H(3) = 174.96, P < 0.001) across blade types. Glidescope LoPro T3 provided a significant lower dental force (adjusted P = 0.01), less c-spine motion (adjusted P = 0.031), and shorter intubation duration (adj P < 0.01) than the McGrath Mac 4. First attempt success and intubator comfort were significantly better with all Glidescope blades (z score of 3.7 and 4.7) than with McGrath blades (z score of-4.1 and-4.4).\u0000 \u0000 \u0000 \u0000 The Glidescope LoPro T3 blade demonstrated advantages in dental force, c-spine motion, and intubation duration compared with McGrath Mac 4. Overall, the Glidescope blades provided superior comfort and higher first attempt success rates.\u0000","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141699922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Botulism, caused by Clostridium botulinum, continues to pose a significant threat to public health. This review explores the historical context and contemporary relevance of botulism, emphasizing its potential lethality and evolving medical applications. In recent years, the use of botulinum toxin in medical procedures, particularly in cosmetic and therapeutic applications, has increased the risk of iatrogenic botulism. The rise in iatrogenic cases underscores the importance of vigilance among health-care providers, especially those in emergency departments, where prompt diagnosis and intervention are critical. This review underscores the necessity for health-care professionals to consider botulism in the differential diagnosis of patients presenting with relevant symptoms, given the potential severity of the condition.
{"title":"The enemy at the gate: Botulism","authors":"Ömer Taşkın, A. Akpınar","doi":"10.4103/tjem.tjem_80_24","DOIUrl":"https://doi.org/10.4103/tjem.tjem_80_24","url":null,"abstract":"\u0000 Botulism, caused by Clostridium botulinum, continues to pose a significant threat to public health. This review explores the historical context and contemporary relevance of botulism, emphasizing its potential lethality and evolving medical applications. In recent years, the use of botulinum toxin in medical procedures, particularly in cosmetic and therapeutic applications, has increased the risk of iatrogenic botulism. The rise in iatrogenic cases underscores the importance of vigilance among health-care providers, especially those in emergency departments, where prompt diagnosis and intervention are critical. This review underscores the necessity for health-care professionals to consider botulism in the differential diagnosis of patients presenting with relevant symptoms, given the potential severity of the condition.","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141711476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Internal thoracic artery (ITA) injuries associated with sternal fractures can lead to shock. Several studies have documented injuries resulting in hemorrhagic shock, yet there is limited reporting on obstructive shock. Opinions differ regarding which is superior between transcatheter arterial embolization (TAE) and open thoracotomy. We report the case of an 80-year-old female patient presented with blunt chest trauma when driving. Her vital signs were normal. However, ultrasonography revealed a hypoechoic anterior mediastinal lesion. Her blood pressure decreased immediately before undergoing a computed tomography (CT) scan. The CT scan showed a sternal fracture, anterior mediastinal extravasation, and dilation of the inferior vena cava. TAE was performed on both internal thoracic arteries, and the patient was transferred to a hospital where an open thoracotomy could be performed. The patient was treated conservatively and discharged without sequelae. Obstructive shock caused by an ITA injury with a sternal fracture can be successfully treated using TAE.
{"title":"Obstructive shock induced by internal thoracic artery injury with traumatic sternal fracture","authors":"Halleluyah Konno, Masakazu Nitta, Norihiro Watanabe, Mitsuyuki Miyazato, Akane Horiuchi","doi":"10.4103/tjem.tjem_253_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_253_23","url":null,"abstract":"\u0000 Internal thoracic artery (ITA) injuries associated with sternal fractures can lead to shock. Several studies have documented injuries resulting in hemorrhagic shock, yet there is limited reporting on obstructive shock. Opinions differ regarding which is superior between transcatheter arterial embolization (TAE) and open thoracotomy. We report the case of an 80-year-old female patient presented with blunt chest trauma when driving. Her vital signs were normal. However, ultrasonography revealed a hypoechoic anterior mediastinal lesion. Her blood pressure decreased immediately before undergoing a computed tomography (CT) scan. The CT scan showed a sternal fracture, anterior mediastinal extravasation, and dilation of the inferior vena cava. TAE was performed on both internal thoracic arteries, and the patient was transferred to a hospital where an open thoracotomy could be performed. The patient was treated conservatively and discharged without sequelae. Obstructive shock caused by an ITA injury with a sternal fracture can be successfully treated using TAE.","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141699537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yunus Emre Güzel, Nese Çolak, Ahmet Can Okuv, Sefer Teymuroğlu, Muhammet İkbal Teke
Several scoring systems are used to predict prognosis in acute pancreatitis (AP), but their predictive success varies. This study compares the validity of the commonly used Bedside Index of Severity in AP (BISAP) score with the newly developed WL score and the Chinese Simple Scoring System (CSSS) score in predicting mortality and unfavorable prognostic outcomes in AP patients. This retrospective descriptive study included all AP patients presenting to the emergency department from June 2, 2019, to June 2, 2022. Patient demographics, vital signs, laboratory values, and imaging findings were recorded, and WL, CSSS, and BISAP scores were calculated. The effectiveness of these scores in predicting adverse outcomes and mortality was compared. Among 357 patients, 53.2% were male, with a median age of 62 years (interquartile range: 48–75). Area under the curve (AUC) values for 7-day outcomes were 0.956 for WL, 0.759 for CSSS, and 0.871 for BISAP; for 30-day outcomes, AUC values were 0.941 for WL, 0.823 for CSSS, and 0.901 for BISAP; and for poor prognostic outcomes, AUC values were 0.792 for WL, 0.769 for CSSS, and 0.731 for BISAP. In AP patients, WL, CSSS, and BISAP scores are effective predictors of unfavorable prognosis and mortality. WL score outperforms the CSSS and BISAP scores in predicting 7-day and 30-day mortality and poor prognosis. After WL, BISAP is the second-best system for predicting mortality. For predicting unfavorable prognoses, CSSS is the second-best system after WL. The simplicity of calculating the WL score based on four laboratory parameters makes it a preferable choice.
{"title":"Comparing prognostic scoring systems in acute pancreatitis: Bedside Index of Severity in Acute Pancreatitis, WL, and Chinese Simple Scoring System Scores","authors":"Yunus Emre Güzel, Nese Çolak, Ahmet Can Okuv, Sefer Teymuroğlu, Muhammet İkbal Teke","doi":"10.4103/tjem.tjem_14_24","DOIUrl":"https://doi.org/10.4103/tjem.tjem_14_24","url":null,"abstract":"\u0000 \u0000 \u0000 Several scoring systems are used to predict prognosis in acute pancreatitis (AP), but their predictive success varies. This study compares the validity of the commonly used Bedside Index of Severity in AP (BISAP) score with the newly developed WL score and the Chinese Simple Scoring System (CSSS) score in predicting mortality and unfavorable prognostic outcomes in AP patients.\u0000 \u0000 \u0000 \u0000 This retrospective descriptive study included all AP patients presenting to the emergency department from June 2, 2019, to June 2, 2022. Patient demographics, vital signs, laboratory values, and imaging findings were recorded, and WL, CSSS, and BISAP scores were calculated. The effectiveness of these scores in predicting adverse outcomes and mortality was compared.\u0000 \u0000 \u0000 \u0000 Among 357 patients, 53.2% were male, with a median age of 62 years (interquartile range: 48–75). Area under the curve (AUC) values for 7-day outcomes were 0.956 for WL, 0.759 for CSSS, and 0.871 for BISAP; for 30-day outcomes, AUC values were 0.941 for WL, 0.823 for CSSS, and 0.901 for BISAP; and for poor prognostic outcomes, AUC values were 0.792 for WL, 0.769 for CSSS, and 0.731 for BISAP.\u0000 \u0000 \u0000 \u0000 In AP patients, WL, CSSS, and BISAP scores are effective predictors of unfavorable prognosis and mortality. WL score outperforms the CSSS and BISAP scores in predicting 7-day and 30-day mortality and poor prognosis. After WL, BISAP is the second-best system for predicting mortality. For predicting unfavorable prognoses, CSSS is the second-best system after WL. The simplicity of calculating the WL score based on four laboratory parameters makes it a preferable choice.\u0000","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141691233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Posterior reversible encephalopathy syndrome (PRES) is a neuroradiological syndrome, clinically present by impaired consciousness, headache, visual disturbances, and seizures, and radiologically brain edema. Cases of PRES induced by blood transfusion are rarely documented. We report this case to increase the awareness of treating physicians for the possible complications of rapid blood transfusion. A 29-year-old man presented with polytrauma and was in hemorrhagic shock. He was transfused with multiple transfusions. Later, he was found to have quadriplegia with minimal movement of fingers in the left hand. His computed tomography showed cerebral edema in multiple cerebral regions. We propose that the etiology in this case is that rapid blood transfusion induced acute rise in hemoglobin which led to PRES. The influences of blood transfusion on blood flow, blood viscosity, and endothelial dysfunction lead to blood-brain barrier dysfunction, which can result in PRES.
{"title":"Posterior Reversible Encephalopathy Syndrome (PRES) following blood transfusion in a polytrauma victim, an atypical occurrence.","authors":"Erum Shariff, Nehad Mahmoud Soltan","doi":"10.4103/tjem.tjem_30_24","DOIUrl":"10.4103/tjem.tjem_30_24","url":null,"abstract":"<p><p>Posterior reversible encephalopathy syndrome (PRES) is a neuroradiological syndrome, clinically present by impaired consciousness, headache, visual disturbances, and seizures, and radiologically brain edema. Cases of PRES induced by blood transfusion are rarely documented. We report this case to increase the awareness of treating physicians for the possible complications of rapid blood transfusion. A 29-year-old man presented with polytrauma and was in hemorrhagic shock. He was transfused with multiple transfusions. Later, he was found to have quadriplegia with minimal movement of fingers in the left hand. His computed tomography showed cerebral edema in multiple cerebral regions. We propose that the etiology in this case is that rapid blood transfusion induced acute rise in hemoglobin which led to PRES. The influences of blood transfusion on blood flow, blood viscosity, and endothelial dysfunction lead to blood-brain barrier dysfunction, which can result in PRES.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11299845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: The objective of this study was to devise a low-cost indigenous gelatin-based vascular phantom and to compare this newly constructed phantom with a commercially available phantom.
Methods: This was a randomized crossover study conducted at a tertiary care hospital of India. The aim of the study was to develop a prototype low-cost gelatin-based vascular phantom and compare it with a commercially available phantom. Gelatin, psyllium husk, corn starch, antiseptic liquid, food-coloring agent, latex balloons, and metallic containers were used to prepare the gelatin phantom. The newly prepared gelatin model was labeled "Model A" and the commercially available gelatin model was labeled "Model B." Emergency medicine residents (n = 34) who routinely perform ultrasound (USG)-guided invasive procedures were asked to demonstrate USG-guided in-plane and out-of-plane approach of needle-tracking in both the models and fill out a questionnaire on a Likert scale (1-5). An independent supervisor assessed the image quality.
Results: The cost of our phantom was USD 6-8 (vs. USD 1000-1200 for commercial phantom). The participants rated the ease of performance and tissue resemblance as 4 (interquartile range [IQR]: 4-5) for both the models "A" and "B." The supervisor rated the overall performance as 4 (IQR: 3-4) for both the models. In all the parameters assessed, model A was noninferior to model B.
Conclusion: The indigenously developed vascular phantom was noninferior to the commercially available phantom in terms of tissue resemblance and overall performance. The cost involved was a fraction of that incurred with the currently available commercial model. The authors feel that gelatin-based models can be easily prepared in resource-constraint settings which may be used for USG-guided training and medical education in low- and middle-income countries.
{"title":"Comparing commercial versus low-cost gelatinous phantoms for ultrasound-guided needle tracking: A randomized crossover trial, among emergency medicine residents.","authors":"Prawal Shrimal, Nirmal Thakur, Bharath Gopinath, Prakash Ranjan Mishra, Ranjan Rajalekshmi, Sanjeev Bhoi, Praveen Aggarwal, Nayer Jamshed, Ashish Datt Upadhyay","doi":"10.4103/tjem.tjem_206_23","DOIUrl":"10.4103/tjem.tjem_206_23","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to devise a low-cost indigenous gelatin-based vascular phantom and to compare this newly constructed phantom with a commercially available phantom.</p><p><strong>Methods: </strong>This was a randomized crossover study conducted at a tertiary care hospital of India. The aim of the study was to develop a prototype low-cost gelatin-based vascular phantom and compare it with a commercially available phantom. Gelatin, psyllium husk, corn starch, antiseptic liquid, food-coloring agent, latex balloons, and metallic containers were used to prepare the gelatin phantom. The newly prepared gelatin model was labeled \"Model A\" and the commercially available gelatin model was labeled \"Model B.\" Emergency medicine residents (<i>n</i> = 34) who routinely perform ultrasound (USG)-guided invasive procedures were asked to demonstrate USG-guided in-plane and out-of-plane approach of needle-tracking in both the models and fill out a questionnaire on a Likert scale (1-5). An independent supervisor assessed the image quality.</p><p><strong>Results: </strong>The cost of our phantom was USD 6-8 (vs. USD 1000-1200 for commercial phantom). The participants rated the ease of performance and tissue resemblance as 4 (interquartile range [IQR]: 4-5) for both the models \"A\" and \"B.\" The supervisor rated the overall performance as 4 (IQR: 3-4) for both the models. In all the parameters assessed, model A was noninferior to model B.</p><p><strong>Conclusion: </strong>The indigenously developed vascular phantom was noninferior to the commercially available phantom in terms of tissue resemblance and overall performance. The cost involved was a fraction of that incurred with the currently available commercial model. The authors feel that gelatin-based models can be easily prepared in resource-constraint settings which may be used for USG-guided training and medical education in low- and middle-income countries.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11100574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141065661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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