Arif Alper Cevik

Interrelation between the Poisoning Severity Score, carboxyhaemoglobin levels and in-hospital clinical course of carbon monoxide poisoning

The aim of the present study is to evaluate the relationship between the Poisoning Severity Score (PSS) and carboxyhaemoglobin (COHb) levels in patients with carbon monoxide poisoning (COP) using outcome as the measure. The study was designed as a retrospective chart review of patients with final diagnosis of COP. Correlation of PSS and COHb levels at presentation was evaluated with collected data. Majority of the cases were grade 1 (minor) PSS (134 cases, 73.6%) and 93.4% of these patients made a complete recovery. There were six deaths (mortality 3.3%) and six in‐hospital major complications (IHMCs) (3.3%) (please specify whether the complications were in the patients who died). There is moderate correlation between PSS and outcome (p < 0.001, r = 0.493). Grade 3 (severe) PSS was significantly different from other grades for outcome (six mortalities and three IHMCs). Patients classified as grade 3 and patients who died had a significantly higher mean age (p < 0.05, 41.8 ± 23.6 and p < 0.01, 60.1 ± 20.3, respectively). Mean COHb level of grade 3 (33.2 ± 13.9%) was significantly higher than that of other grades (p < 0.05). COHb levels according to outcome were not different (? within the patients in grade 3). Decreased level of consciousness, acidosis, tachycardia, high glucose and leucocyte levels showed significant relation with higher PSS, COHb level and adverse outcome. We conclude that the PSS is a reliable guide in COP. Value of the PSS in COP may be enhanced if additional factors and investigations are included.

The role of erythropoietin in hemorrhagic shock-induced liver and renal injury in rats.

IntroductionThe aim of the present study was to evaluate the role of erythropoietin (EPO) in liver and renal injury following hemorrhagic shock (HS) after inhibition of tyrosine kinase activity in rats..MethodsForty-eight Sprague-Dawley rats were assigned to six groups: (I) HS alone; (II) HS followed by retransfusion; (III) EPO and genistein followed by HS; (IV) EPO and genistein followed by HS, followed by retransfusion; (V) HS followed by EPO and genistein; and (VI) HS followed by EPO and genistein, followed by retransfusion. HS was induced for 60 minutes after withdrawal of 30% of the calculated total blood volume of each rat from the left femoral artery. Blood and tissue samples (from the kidney and liver) were obtained 60 minutes after HS in Group I, III, and V; blood and tissue samples were obtained 60 minutes after retransfusion in Group II, IV, and VI. In Group III and IV, EPO was given 60 minutes before HS, and genistein 30 minutes before HS. In Group V and VI, EPO and genistein were given 30 minutes after HS.ResultsLiver and renal injury were significantly attenuated with EPO and genistein administration.ConclusionThese results suggest that EPO is effective in attenuating liver and renal injury in HS, even with inhibition of tyrosine kinase activity with genistein.

Elevated lactate level and shock index in nontraumatic hypotensive patients presenting to the emergency department.

Background The aim of our study was to evaluate the effect of lactate level (LL) and shock index (SI) on the outcome in nontraumatic hypotensive patients in the emergency department, and also to show the significance of the combined usage of these two parameters. Methods This is a prospective, observational study. Elevated and normal LL (ELL and NLL), elevated and normal SI (ESI and NSI), and a combination of these two parameters (lactate–SI group 1: ELL and ESI, lactate–SI group 2: ELL or ESI, and lactate–SI group 3: NLL and NSI) were evaluated for primary (mortality) and secondary outcome measures. Results A total of 131 patients who fulfilled the inclusion criteria were analysed. Of the patients with ELL, 34.78% were mechanically ventilated (P<0.001), 31.88% received vasoactive drugs (P<0.001), and 68.1% were hospitalized (P<0.01). The mortality rate among patients with ELL was 50.72% (P<0.001). Of the patients with ESI, 39.42% died (P<0.01). Use of mechanical ventilation in the emergency department was higher in lactate–SI group 1 [36.1%, P<0.0001, sensitivity: 100.0%, negative predictive value (NPV): 100.0%]. Vasoactive drug use was higher in lactate–SI group 1 (32.8%, P<0.0001, sensitivity: 100.0%, NPV: 100.0%). Lactate–SI group 1 showed a higher hospitalization rate (67.8%, P>0.05). In-hospital mortality in lactate–SI group 1 was higher (54.1%, P<0.0001, sensitivity: 100.0%, NPV: 100.0%). Conclusion The combination of both parameters is effective in predicting these outcome measures with higher sensitivities and NPVs. Further studies on the subject are required.

An Analysis of Patients That Underwent Computed Tomography Pulmonary Angiography with the Prediagnosis of Pulmonary Embolism in the Emergency Department

Introduction. The purpose of this study is to analyze the frequency of other diagnoses and findings in patients that were diagnosed with or not diagnosed with PE following the CTPA in the ED and to analyze the relationship between diagnosis and D-dimer. Instrument and Method. This study involves all patients that presented to the ED that underwent CTPA with the prediagnosis of PE. The items considered in this study were their reason for presenting to the ED and pretest clinical risks for PE, D-dimer, and CTPA results. Findings. Of the 696 cases, the most common cause was shortness of breath (59.3%). The CTPA showed that 145 (20.83%) patients were suffering from PE. Among the remaining cases, 464 (66.66%) patients had pathological findings other than PE and 87 (12.5%) patients were reported as normal. The most common pathological results other than PE found in CTPA were atelectasis in 244 (39.9%) and ground glass in 165 (23.7%), as well as nonpulmonary results in 70 (10.05%) patients. The differences in D-dimer results of patients diagnosed with PE, patients diagnosed with another pathology, and patients with normal CTPA results were statistically significant (P < 0.001). Conclusion. CTPA scanning, performed on the basis of assessment scoring, helps in discovering other fatal pathologies in addition to PE.

Factors Affecting Mortality and Complications in Mushroom Poisonings Over a 20 Year Period: A Report from Central Anatolia

SUMMARY Objectives Mushroom poisoning (MP) is one of the worlds leading seasonal and regional health problems. The aim of this study was to analyze the relationship between clinical factors and outcomes of mushroom poisoning. Methods The study was conducted in the emergency department. The patients who presented between January 1st, 1991 and December 31, 2010 were retrospectively reviewed. Results 599 MP cases were enrolled into the statistical analysis. The elderly group had a higher rate of mortality (8.8%) and complications (12.3%) (p=0.005) (OR 3.98, 95% CI: 1.9291 to 8.2290; p=0.0002). The patients who presented in summer had a higher rate of mortality (9.5%) and complications (11.9%) (p≤0.001). (OR: 3.83, 95% CI 1.7068 to 8.6074, p=0.0011). The rate of mortality and complications in patients who had eaten self-harvested wild mushrooms (WM) was 6.8%, while those who purchased WM had a mortality and complication rate of 15.2% (p=0.016), (Purchased WM OR 2.46, 95% CI 1.1609 to 5.2353, p=0.0189). The rate of mortality and complications in the patients who presented with gastrointestinal symptoms was 9.9% (OR: 3.98, 95% CI 1.5503 to 10.2679; p=0.0041). Conclusions Factors such as being elderly, summer season, purchased WM, and gastrointestinal symptoms were significantly associated with mortality and complications in our study.

An Evaluation of Complications in Ultrasound-Guided Central Venous Catheter Insertion in the Emergency Department

SUMMARY Objectives In emergency departments, emergency physicians frequently have to perform central venous access. In cases where peripheral venous access is not possible, central venous access is required for dialysis, fulfillment of urgent fluid need, or central venous pressure measurement. This study was carried out to evaluate the emergence of complications in the process of and in the 15 days following the insertion of central venous catheter under ultrasound guidance in the emergency department. Methods For this study, patients who presented to the emergency department over a period of eight months with an urgent need for central catheter were examined prospectively. Age, gender, and accompanying diseases of patients as well as the type, time, duration, and indication of the venous access were recorded. Furthermore, the amount of experience of the physician was taken into consideration. Results In the emergency department, physicians performed ultrasound-guided central venous catheter insertion for 74 patients (40 men and 34 women). For access, internal jugular vein was used in 65 (87.8%) patients, and femoral vein was used in 9 (12.2%) patients. The reason for access was urgent dialysis need in 55 (74.3%), CVP measurement in 3 (4.1%), fluid support due to severe hypovolemia in 6 (8.1%), and difficulty of peripheral venous access in 10 (13.5%) patients. None of the patients developed complications in the process of or after the insertion. Patients did not have infections related to the catheter in 15 days following the insertion. Conclusions Central venous access is frequently required in emergency departments. The risk of complication is little if any in ultrasonographyguided access carried out under appropriate conditions.

A Rare Cause of Acute Abdominal Pain: Splenic Infarct (Case Series)

SUMMARY Splenic infarcts are rare cases. It may not be noticed in the emergency department because the clinical picture is likely to mimic various acute abdominal pains. The splenic infarct is often the result of systemic thromboembolism associated with cardiovascular disorders. The aim of this study is to present an evaluation of the patients that presented to the emergency department (ED) with abdominal pain and were diagnosed with splenic infarct.

A Rare Cause of Acute Abdominal Pain: Spelnic Infarct (Case Series)

SUMMARY Splenic infarcts are rare cases. It may not be noticed in the emergency department because the clinical picture is likely to mimic various acute abdominal pains. The splenic infarct is often the result of systemic thromboembolism associated with cardiovascular disorders. The aim of this study is to present an evaluation of the patients that presented to the emergency department (ED) with abdominal pain and were diagnosed with splenic infarct.

The Cause of Abdominal Pain after Dialysis

A 56-year-old woman presented to the emergency department with a sudden onset of nausea, vomiting, abdominal pain, and distension. Her symptoms started after dialysis and progressively worsened. Upon admission, a physical examination revealed a heart rate 96 beats/min, a blood pressure of 70/40 mmHg, left quadrant tenderness, rebound, and rigidity. Her hemoglobin level was 4.4 gr/dL and her platelet count was normal. Activated prothrombin time was high and the INR was 7.69. A computed tomographic scan without contrast was performed (Figure 1). (see page 39 for diagnosis).

Low perfusion index affects the difference in glucose level between capillary and venous blood

Aim In emergency cases, finger stick testing is primarily used to check the blood glucose value of patients since it takes longer to obtain the venous value. In critical patients, under conditions that cause an increase in metabolic state and level of stress, there occurs considerable difference in glucose levels between capillary and venous measurements. This study aimed to investigate the comparability of capillary and venous glucose values, according to the perfusion index level obtained with the Masimo Radical-7® device, in critical patients aged 18 years and over. Method We conducted this prospective and observational study in the emergency department of the Eskisehir Osmangazi University hospital between November 3, 2008 and February 2, 2009. Results The blood glucose of 300 critical patients was checked by finger stick in the emergency unit. The participants with normal vital signs had perfusion index between 0 and 5; the results obtained by the two methods were more consistent for perfusion index values of 6 and over. The results were most consistent in aged participants with normal vital sign findings and low perfusion index and in young patients with high perfusion index. In the cases where at least one of the vital signs was abnormal, the glucose values obtained by the two methods were more consistent when the perfusion index was 6 or over. In this group, independently from the perfusion index value, the consistency was higher in younger patients compared with aged patients. Conclusion In the emergency department, perfusion index value measured by Masimo Radical-7 and capillary blood glucose levels can serve in blood sugar management in critically ill patients.