Turkish Journal of Emergency Medicine最新文献

IgA nephropathy is a renal-limited form of systemic vasculitis, and pulmonary manifestations are uncommon. An initial presentation with severe diffuse alveolar hemorrhage (DAH) or pulmonary-renal syndrome is rare and only confined to a few case reports. Herein, we present a young male admitted with acute-onset dyspnea, hemoptysis, and rapidly progressive renal failure. With an initial diagnosis of an immune-mediated pulmonary-renal syndrome, he was treated with high-dose corticosteroids and therapeutic plasmapheresis along with intensive organ support (including hemodialysis, red cell transfusion, and high-flow oxygen). After a detailed laboratory evaluation and kidney biopsy, IgA nephropathy was diagnosed. The patient continued to worsen with persistent DAH and died. IgA nephropathy-associated severe DAH or pulmonary-renal syndrome is rare but increasingly recognized. The condition is difficult to diagnose early and has no proven disease-targeted therapy.

Objectives: Pulmonary embolus (PE) is a form of venous thromboembolism associated with increased morbidity and mortality if not diagnosed and treated early. Variations in clinical presentation make the diagnosis challenging. The gold standard for diagnosing PE is a computed tomography pulmonary angiogram (CTPA). Physicians show a low threshold for over-investigating PE. The evaluation of patients with suspected PE should be efficient, including but not limited to the use of risk stratification methods. This study aims to assess the adherence to the recommended diagnostic pathways of ordering CTPAs in patients with suspected PE.

Methods: This retrospective cohort study included patients above 18 years of age who received a CTPA for a suspected PE in the emergency department (ED) of a hospital between 2015 and 2019. Patient demographic data, chief complaint, variables of the Wells and pulmonary emboli rule-out criteria scores, pregnancy status, investigations, and the patient's final PE diagnosis were extracted from the hospital electronic medical records. Diagnostic pathways that took place were compared to the internationally recommended pathway.

Results: Four hundred and eighty-six patients were included in this study. The mean age was 51.01 (±19.5) years, and 377 (69.3%) patients were female. The recommended PE diagnostic pathway to order CTPA was incorrectly followed in 288 patients (59.3%). Seventy-five (15.4%) patients received an unnecessary CTPA. D-dimer test was ordered unnecessarily in 144 patients (29.6%). The overall prevalence of PE in our population was 9.47% (n: 46). Out of the 75 unnecessarily ordered CTPAs, 2 (2.7%) showed PE, while CTPAs ordered using the correct pathway showed 31 (10.9%) PEs.

Conclusion: Our study revealed that approximately two-thirds of all CTPA requests did not adhere to the recommended PE clinical decision pathway. There was a significant improper and unnecessary utilization of CTPA imaging and D-dimer testing. Improvements seem imperative to enhance physicians' clinical approach to PE diagnosis.

Objectives: Ultrasound (US) airway indexes were frequently compared with other scoring systems such as Mallampati score and Cormack - Lehane classification system, but to the best of our knowledge never with LEMON. Here, in this study, we evaluated the accuracy of some recommended airway US parameters in terms of screening difficult airway using the LEMON criteria as a reference.

Methods: This was a cross-sectional diagnostic accuracy study in which people with at least 18 years old coming to the emergency departments for any reason who had consent for participation, were enrolled with the simple random sampling method. Hyo-mental distance (HMD), skin to epiglottis distance (EP), and peri-epiglottic space to epiglottis to vocal cord ratio (PEP/E. VC) were the US indexes that were calculated in all participants. Using a preprepared checklist, measured US parameters were recorded. For each participant, the LEMON score variables were also assessed and recorded, and the cutoff point for considering as a difficult airway case, based on LEMON score, was 2. Demographic characteristics of the participants were also registered.

Results: A total of 299 cases with a mean age of 41.1 years (95% confidence interval [CI]: 39.3-42.9), were participated. Based on LEMON score ≥2, 20 participants (6.7%) were categorized in difficult airway group. Comparison of the PEP/E. VC (P = 0.007) and EP distance (P = 0.049) of the participants based on LEMON score showed a statistically significant difference; but comparison of the means of HMD in the two groups was not statistically significant (P = 0.144). The median of EP of the participants was 7.70 mm (interquartile range [IQR]: 6.70-9.40). The best cutoff point of EP distance for evaluating a difficult airway was 12.27 mm and more with the sensitivity of 35% and the specificity of 86.96% (accuracy = 0.614; 95% CI: 0.492-0.736). The median of PEP/E. VC was 1.01(IQR: 0.79-1.23). The best cutoff point of PEP/E. VC for evaluating a difficult airway was 0.88 and less with the sensitivity of 70% and the specificity of 67.38% (accuracy = 0.701; 95% CI: 0.583-0.818).

Conclusion: As per our results, PEP/E. VC and EP distance measured with sonography can be used in distinguishing the difficult airway, using the LEMON criteria as the reference. However, further studies are needed to use PEP/E. VC and EP distance as a part of reliable indexes.

[This corrects the article on p. 213 in vol. 4.].

Vasmol, a commonly used hair dye, is becoming apparent as one of the major causes of suicidal poisoning in India. The toxic components in the dye include paraphenylenediamine, sodium ethylenediaminetetraacetic acid, resorcinol, and propylene glycol. Acute poisoning by consumption of dye leads to characteristic angioedema of the cervicofacial region along with multiorgan dysfunction. Early intervention with tracheostomy can be lifesaving in such cases and helps in preventing the morbidity and mortality associated with it.

The ST-segment elevation (STE) myocardial infarction (MI)/non-STEMI (NSTEMI) paradigm has been the central dogma of emergency cardiology for the last 30 years. Although it was a major breakthrough when it was first introduced, it is now one of the most important obstacles to the further progression of modern MI care. In this article, we trace why a disease with an established underlying pathology (acute coronary occlusion [ACO]) was unintentionally labeled with a surrogate electrocardiographic sign (STEMI/NSTEMI) instead of pathologic substrate itself (ACO-MI/non-ACO-MI or occlusion MI [OMI]/non-OMI [NOMI] for short), how this fundamental mistake caused important clinical consequences, and why we should change this paradigm with a better one, namely OMI/NOMI paradigm.