Turkish Journal of Emergency Medicine最新文献

Oral lacerations are common complications of seizures and account for 92% of all oral injuries. Seizures are relatively commonly associated with chronic alcohol consumption. It is already known that provoked seizures can occur after a sudden cessation of prolonged alcohol intoxication. Meanwhile, chronic alcohol consumption can disrupt the blood coagulation process on several levels. This report aims to present a case of generalized tonic-clonic seizure in a man with chronic alcoholism and acquired coagulopathy who suffered severe tongue injury during a seizure. A 45-year-old man was brought to the emergency department after a first-in-life generalized tonic-clonic seizure. He gave information that he bit his tongue during the seizure. Shortly afterward, the patient had another generalized seizure during which he stopped breathing and was intubated. On admission, the patient was sedated, intubated, and on mechanical ventilation, with no signs of focal neurological deficit. A detailed physical examination revealed massive tongue swelling, which was significantly moved forward. Laboratory tests revealed coagulopathy (INR 2,10) severe thrombocytopenia with a platelet count of 50x109/L. Electrolyte values were in the reference range. According to the maxillofacial surgeon's recommendation, he was treated conservatively, and after 2 weeks, he was clinically stable with a significant reduction of lingual hematoma and without new epileptic events. In our case, decreased platelet count and probable platelet dysfunction associated with chronic alcohol consumption and tongue bite during generalized tonic-clonic seizure played a significant role in developing lingual hematoma. These fast-developing lingual hematomas can lead to possible airway obstruction; therefore, careful observation and timely intubation are mandatory to prevent possible fatal complications.

Objective: This study aimed to evaluate the association between neurological outcome and gray-white ratio (GWR) in brain computed tomography (CT) in patients with return of spontaneous circulation (ROSC) who were brought to the emergency department (ED) due to out-of-hospital cardiac arrest (OHCA).

Methods: This study has a retrospective design. Patients with ROSC who were brought to the ED due to OHCA and who underwent brain CT in the first 24 h were included in the study. Demographic data, brain CT results (intensities of gray matter and white matter in Hounsfield units and calculated GWR), and hospital outcome were recorded. The cerebral Performance Categories (CPC) score was used as the outcome of the study.

Results: A total of 160 patients were included in the study. 55% of the patients were male and the median age was 75.5. The median brain CT time of the patients was 120 min. 16.3% of the patients were in the good neurological outcome group. When attenuation values and GWRs of the patients were compared according to CPC of patients (good-poor), no statistically significant difference was detected in any parameter except MC2 attenuation (P > 0.05 for all values). The patients were separated into groups geriatric and nongeriatric and GWRs were compared. GWRs were lower in the geriatric groups (P < 0.05 for all values).

Conclusion: Although it is emphasized in the literature that detection of low GWR in brain CT can help the clinical decision process in patients surviving comatose arrest, we think that it is not valid for especially in geriatric patients and in patients who underwent early brain CT after ROSC.

Hyperkalemia is a common, life-threatening medical situation in chronic renal disease patients in the emergency department (ED). Since hyperkalemia does not present with any specific symptom, it is difficult to diagnose clinically. Hyperkalemia causes broad and dramatic medical presentations including cardiac arrhythmia and sudden death. Hyperkalemia is generally determined through serum measurement in the laboratory. Treatment includes precautions to stabilize cardiac membranes, shift potassium from the extracellular to the intracellular, and increase potassium excretion. The present article discusses the management of hyperkalemia in the ED in the light of current evidence.

Oligoanalgesia, the undertreatment of trauma-related pain using standard analgesics in prehospital and emergency departments, has been extensively documented as one of the major challenges affecting the effective treatment of trauma-related pain. When administered in low doses, methoxyflurane has been highlighted by numerous medical works of literature to provide an effective, nonopioid, nonnarcotic treatment alternative to standard analgesics for prehospital and emergency department use. Low-dose methoxyflurane has been associated with fast-pain relief in adult patients manifesting moderate-to-severe pain symptoms. This systematic review and meta-analysis aimed to assess the clinical implication of low-dose methoxyflurane use in prehospital and emergency departments in adult patients with moderate-to-severe trauma-related pain. Moreover, the review aimed at assessing the risk stratification associated with using low-dose methoxyflurane in prehospital and emergency departments. The systematic review and meta-analysis performed a comprehensive search for pertinent literature assessing the implications and risks of using low-dose methoxyflurane in adult patients exhibiting moderate-to-severe trauma-related pain in prehospital settings. A comparison between the use of low-dose methoxyflurane and standard-of-care analgesics, placebo, in prehospital settings was reported in four clinically conducted randomized controlled trials (RCTs). These RCTs included the STOP! trial, InMEDIATE, MEDIATA, and the PenASAP trials. A meta-analysis comparing the time taken to achieve first pain relief on initial treatment of patients with moderate-to-severe trauma-related pain favored the use of low-dose methoxyflurane to the standard-of-care analgesics (mean difference = -6.63, 95% confidence interval = -7.37, -5.09) on time taken to establish effective pain relief. Low-dose methoxyflurane has been associated with superior and faster pain relief in prehospital and emergency departments in adult patients exhibiting moderate-to-severe trauma-related pain compared to other standard analgesics.

Xylazine is a type of sedative commonly used in veterinary medicine. It acts on the central alpha-2 receptor and suppresses norepinephrine release from the peripheral nerve terminal. It is also reported to have action on cholinergic, serotogenic, H2-histamine, dopaminergic, and opioid receptors. Once administered in animals, it causes hypotension, bradycardia, central nervous system depression, and respiratory depression. The effect will start within minutes after absorption and last up to 4 h depending on the dosage given. Till date, it is only exclusively used in animals as approved by the Food and Drug Administration. Human intoxication is uncommon, and no specific antidote is available. Naloxone, a competitive opioid receptor antagonist, was postulated to have an antidotal effect on xylazine. We report two cases of accidental human injection with xylazine. Naloxone was administered in one of the cases. Acute hypertension and mydriasis were observed; however, no apparent reversal of toxidrome was seen. This finding reveals the question regarding the efficacy and benefit of naloxone usage in xylazine intoxication. General management remains supportive of care focusing on ventilation and hemodynamics. Attending physicians should be aware of potential xylazine intoxication incidents in the area of livestock or veterinary activities.

Anterior shoulder dislocation (ASD) is the most common type of dislocation presented to the emergency department (ED) with severe pain and limitation of range of movement. Procedural sedation and analgesia are commonly used for ASD, but regional techniques are gaining popularity. Interscalene brachial plexus block is effective but has several limitations. Suprascapular nerve block (SSNB) has been explored for this indication. The SSNB is commonly performed using the posterior approach in a sitting position and can be technically difficult in dislocated patients. Recently, anterior subomohyoid approach performed in the lower neck has been described but has not yet been reported in the ED. We, hereby, report our experience of using low-volume ultrasound-guided anterior SSNB for procedural analgesia in 10 patients with ASD.

Mucormycosis is a progressive and life-threatening disease that has been increasingly reported in patients infected by coronavirus diseases 2019 (COVID-19). We describe a case of rhino-orbital mucormycosis with central nervous system involvement resulting in bilateral blindness and intracranial extension in a patient with uncontrolled diabetes mellitus (DM) and mild COVID-19 infection. A 35-year-old obese male, recently diagnosed with DM, presented to the emergency department suffering from dizziness, headache, speech difficulty, and facial weakness. His glycosylated hemoglobin was 10.4% and his reverse transcriptase-polymerase chain reaction (PCR) test came positive for COVID-19. Ocular examination revealed left eye proptosis, ophthalmoplegia, and lid edema with no ocular movement. Imaging studies showed pansinusitis and periorbital and orbital cellulitis with intracranial involvement. Histopathology and biopsy examination confirmed mucormycosis. Medical management included glucose control and liposomal amphotericin B therapy. Septoplasty and functional endoscopic sinus surgery was performed as emergency procedures. The patient survived with bilateral blindness. In this case, we described the importance of considering mucormycosis in COVID-19 patients with uncontrolled diabetes, particularly those presenting with sinusitis, headache, and orbital edema symptoms. Despite intensive antifungal therapy and surgical intervention, it is a serious opportunistic fungal infection associated with long-term complications.

Monkeypox (MPXV) is an emerging zoonotic disease carrying a global health threat. Using a multi-disciplinary approach, we review the current MPXV virus infection outbreak including virology, prevention, clinical presentation, and disaster management. MPXV is caused by a double-stranded deoxyribonucleic acid virus. Despite its clinical similarities with smallpox, it is less severe with low mortality. Human-to-human transmission occurs through prolonged direct or close contact, or through blood, body fluids, or mucosal lesions. Risk groups include frontline health workers who care for MPXV patients, household members of an infected patient, and men who have sex with men. Skin lesions are usually, but not always, at the same stage. They may affect the face followed by the distal extremities with fewer lesions on the trunk (centrifugal distribution). Lesions may involve the mouth, genitalia, conjunctiva, and rectum. The majority of cases are mild. Nevertheless, the disease may have long-term effects on the skin, the neurological system, and the eye. Vaccination against MPXV is available but meanwhile should be limited to those who are at high risk. Those vaccinated against smallpox (usually older than 40 years) might be immune against MPXV. Infectious diseases are without borders. If proper action is not taken, there is considerable risk that MPXV will be entrenched worldwide. Our world has a delicate balance between animals, environment, and humans reflecting the need for a "one globe, one health approach" to address this risk. Following the principles of disaster management and using the lessons we have learned from the COVID-19 pandemic will reduce the impact of the MPXV outbreak.

Envenomation from snakebites (SBs) is a significant public health hazard globally. The venomous SB is associated with moderate-to-severe pain. Weak opioids such as tramadol or acetaminophen are commonly used for pain management but often provide inadequate analgesia. We hereby report our experience of using ultrasound-guided selective superficial peroneal, sural, and saphenous nerve blocks for pain management following SBs in nine patients. The selective peripheral nerve blocks are achieved with a small amount of local anesthesia and without loss of motor functions.