Basak Bayram

Prognostic Value of the Neutrophil-Lymphocyte Ratio in Patients With ST-Elevated Acute Myocardial Infarction.

The predictive value of leukocyte counts has been reported in patients with acute myocardial infarction (AMI). We aimed to evaluate the predictive value of the total leukocyte count and neutrophil–lymphocyte (N/L) ratio for mortality due to AMI. A total of 522 patients with acute ST-elevated MI were included in the study. The study population was divided into tertiles based on admission N/L ratio values. High (n = 174) and low N/L (n = 348) ratio groups were defined as patients having values in the third tertile (>5.77) and lower 2 tertiles (≤5.77), respectively. The high N/L ratio group had a significantly higher incidence of in-hospital cardiovascular mortality (13.8% vs 4.6%, P < .001). An N/L ratio >5.77 was found to be an independent predictor of in-hospital cardiovascular mortality (hazard ratio: 3.78, 95% confidence interval: 1.71-8.30, P = .001). A high N/L ratio is a strong and independent predictor of in-hospital cardiovascular mortality of AMI with ST elevation.

Effects of terlipressin in a rat model of severe uncontrolled hemorrhage via liver injury

BACKGROUND Animal experiments and clinical studies have shown that vasopressin infusion in cases of uncontrolled hemorrhagic shock is a promising treatment. However, there are only a few studies regarding the application of terlipressin in hemorrhagic cases. This study was designed to evaluate the effects of terlipressin vs controlled fluid resuscitation on hemodynamic variables and abdominal bleeding in a rat model of uncontrolled hemorrhage via liver injury. METHODS A total of 21 average weight 250 ± 30 g Wistar rats were used. A midline celiotomy was performed, and approximately 65% of the median and left lateral lobes were removed with sharp dissection. After creation of the liver injury, rats were randomized into 1 of 3 resuscitation groups, the control group, Lactated Ringers (LR) group, and terlipressin group, with 7 rats in each group. Blood samples were taken from rats for arterial blood gas analysis. At the end of the experiments, free intraperitoneal blood was collected on preweighed pieces of cotton, and the amount of free blood was determined by the difference in wet and dry weights. RESULTS In response to resuscitation, the terlipressin group demonstrated a significant elevation in mean arterial pressure (MAP). Blood loss was greater in the LR group compared with the control group (12.8 ± 1.9 mL vs 8.2 ± 0.7 mL, P < .05). At the end of the experiments, 5 rats in the control group, 5 in the LR group, and 2 in the terlipressin group died. The average survival rates were 28.6%, 28.6%, and 71.4%, respectively. CONCLUSIONS Compared with the control group, intravenous terlipressin bolus after liver injury contributed to an increase in MAP and survival rates without increasing abdominal bleeding.

Traumatic pneumorrhachis: a rare entity of trauma

A 35-year-old man was transferred comatose to a level-1 trauma center after being struck by a train. His vital signs were stable upon arrival. His physical examination revealed a Glasgow Coma Scale score of 3, extensive scalp laceration, and raccoon eyes, with normal findings for other systems. He was subsequently intubated, and computed tomography (CT) of the head and cervical spine as well as thorax and abdomen was performed. Cranial CT showed dislocated fracture of the left parietal bone, traumatic subarachnoidal hemorrhage, and pneumocephalus; CT of the cervical spine showed air in the spinal canal. Thoracic and abdominal CTs were normal. His hemoglobin levels were stable during follow-up. After consultation with neurosurgery, he was transferred to the intensive care unit, where he remained comatose in the following hours and died the next day as a result of severe head trauma. Pneumorrhachis (PR) is an exceptional radiological finding consistent with air in the spinal canal. Although the main cause is trauma, others are described in the literature and can be classified as traumatic and non-traumatic [1]. Traumatic causes are rare, and PR with trauma is associated with extreme trauma. It is an incidental finding and usually clinically nonspecific. PR in the presence of trauma is a marker of severe injury. Another classification can be described as epidural (intraspinal, epidural air) and intradural (intraspinal air within subdural or subarachnoid space) PR [2]. Differentiation can be difficult in some cases. Diagnosis is usually made by CT, but plain radiographs can detect large volumes of intraspinal air. In our case, air that entered the body via the cranial fracture was forced caudally into the spinal canal through the foramen magna as a result of increased intracranial pressure. Because of its rarity, management of PR is controversial and usually conservative. The causes of PR need to be treated on an individual basis, while PR most often reabsorbs spontaneously.

Bibliometric analysis of top 100 most-cited clinical studies on ultrasound in the Emergency Department

STUDY OBJECTIVE We identify and characterize the most highly cited articles related to ultrasonographic evaluations occurring in the emergency department. METHOD We retrieved the top 100 articles in terms of citations pertaining to ultrasonographic evaluations in the emergency department from the Scopus database. We determined the number of citations of each article, the number of citations per year, the number of Google Scholar citations, the ultrasonographical study fields, the number of patients evaluated in each study, and the specialties of the researchers conducting the studies and ultrasonographies. We then used the ANOVA test to compare the multivariate groups. RESULTS The median citation number of the articles in the Scopus database was 115 (range: 75-681), and the number of citations per year was 7.5 (range: 3.8-40.1). Focused assessment with sonography in trauma and non-traumatic abdominal ultrasonography were conducted in 32 and 13 studies, respectively. The primary authors were emergency medicine specialists in 46 studies. We found that vascular and lung ultrasonography studies were characterized by the largest number of citations per year. CONCLUSION The most frequently cited studies conducted in the emergency department pertaining to the use of ultrasonography included a wide range of topics, and approximately half of the primary authors of these studies were emergency medicine specialists.

Propafenone-induced cardiac arrest: full recovery with insulin, is it possible?

Propafenone may cause mental depression, mania, convulsion, metabolic acidosis, hypotension, prolonged QRS, atrioventricular block, and cardiac arrest if it is taken at a dose greater than recommended. There is no standard specific treatment or antidote for a propafenone overdose, and life-supporting treatments are applied in these cases. In this case report, we report a case of a 15-year-old female patient who experienced cardiac arrest after an oral propafenone overdose. She was successfully treated using cardiopulmonary resuscitation, which took approximately 1.5 hours. Dopamine infusion, sodium bicarbonate, and insulin treatment were also administered to the patient. Highdose insulin treatment may be an effective treatment of propafenone poisoning. Propafenone is a class IC antiarrhythmic agent that can be used to treat paroxysmal atrial fibrillation, paroxysmal supraventricular tachycardia, and ventricular arrhythmia [1]. Hypotension, long QRS duration, atrioventricular block, convulsion, and cardiac arrest may occur after a propafenone overdose. The survival rate of patients who require cardiovascular resuscitation as a result of cardiac arrest is low [2,3]. Propafenone poisoning is a rare yet life-threatening situation, and there is no specific procedure and/or antidote used for treatment. Supportive treatments for the symptoms and conditions of the patient are recommended. Gastric lavage, a method of gastrointestinal decontamination, is not recommended, except in cases of overdose because it can increase the risk of convulsion. Activated charcoal can be used with the constraint of protecting airway patency if the time passed after poisoning is sufficient [4]. If there is no response to intravenous fluid treatment in cases of propafenone poisoning monitored for cardiac activity, alternate methods can be used, including vasopressive drug administration for hypotension, sodium bicarbonate administration for a prolonged QRS duration and metabolic acidosis, cardiopulmonary resuscitation (CPR), transient ☆ The authors report no declarations of interest. 0735-6757/

Novel biochemical marker for differential diagnosis of seizure: ischemia-modified albumin

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Retrospective evaluation of patients with elevated digoxin levels at an emergency department

INTRODUCTION Differential diagnosis of seizure is critical in patients presented to emergency department (ED) with altered mental status or loss of consciousness. Although electroencephalogram is important for the diagnosis of seizures, its use in EDs is limited. The level of ischemia-modified albumin (IMA) increases in conditions of ischemic distress such as acute coronary syndrome, pulmonary embolism, and mesenteric ischemia. No studies exist in literature regarding the increase of IMA levels parallel to increased seizure activity in adults. The aim of the study was to investigate the diagnostic value of IMA in adult patients presented to ED with seizures. METHODS Forty patients presented to ED with seizure, and 40 control patients of similar age and sex as the study group were enrolled in this study. Initial and fourth-hour levels of IMA and albumin were measured. Groups were compared in terms of sociodemographic data and details regarding their seizures as well as initial and fourth-hour levels of IMA. RESULTS Mean levels of IMA were 61.5 IU/mL and 18.5 IU/mL (P < .001) initially and 56.7 IU/mL and 15.4 IU/mL (P < .001) at the fourth hour; levels were higher in the study group compared with control group. Ischemia-modified albumin/albumin ratios in study and control groups were 1555.3 IU/g and 462.4 IU/g (P < .001) initially and 1431.4 IU/g and 383.6 IU/g (P < .001) at the fourth hour, respectively. CONCLUSION Blood IMA level and IMA/albumin ratio significantly increase in adult patients who experienced seizures. Ischemia-modified albumin may be considered as a useful biomarker in the differential diagnosis of seizure.

Successful Treatment of Propafenone Intoxication With Intravenous Lipid Emulsion

Objectives We investigated the demographic characteristics, clinical and laboratory findings, treatment strategies and clinical outcomes of patients presenting at emergency department (ED) with digoxin levels at or above 1.2 ng/ml. Materials and methods The demographic and clinical characteristics of patients with serum digoxin levels at or above 1.2 ng/ml admitted to an ED between January 2010 and July 2011 were investigated in this cross-sectional descriptive study. Patients with ECG and clinical findings consistent with digoxin toxicity and no additional explanation of their symptoms were evaluated for digoxin toxicity. Results In this study 137 patients were included, and 68.6% of patients were women with mean age 76.1 ± 12.2. There was no significant difference between gender and digoxin intoxication. The mean age of intoxicated group was significantly higher than the non-intoxicated group (P = 0.03). The most common comorbidities were congestive heart failure (n = 91) and atrial fibrillation (n = 74). The most common symptoms were nausea, vomiting and abdominal pain. The levels of hospitalization and mortality in this group were significantly higher. Conclusion Digoxin intoxication must be suspected in patients present in the ED, particularly those with complaints that include nausea and vomiting, as well as new ECG changes; serum digoxin levels must be determined.

Massive pulmonary embolism and cardiac arrest; thrombolytic therapy in a patient with recent intracranial surgery and glioblastoma multiforme.

Severe cardiac effects, including cardiac arrest, are a rare complication of high‐dose propafenone intake. Among patients who experience cardiac arrest, the survival rate is low. This report presents the case of a young female patient who developed cardiac arrest linked to propafenone intake. While spontaneous circulation was restored with cardiopulmonary resuscitation, vital signs did not recover despite supportive treatment. However, after the administration of intravenous lipid emulsion (ILE), vital signs and cardiac functions resolved and the patient survived. This case is the second to describe the successful use of ILE for propafenone intoxication. However, as all of the findings of this patient were clearly linked to propafenone, we believe the benefits of ILE were more clearly defined in this case than in the other.

Workplace violence against physicians in Turkey’s emergency departments: a cross-sectional survey

Treatment options for pulmonary embolism are increasing, but the scale of the treatments and their availability in the emergency department (ED) are limited. Thrombolytic therapy remains the most commonly used treatment in patients who present a massive pulmonary embolism in the ED. However, systemic thrombolysis is contraindicated in certain cases, such as a known intracranial tumor or a history of cranial surgery.In this case report, we report a 63-year-old man with a history of intracranial surgery due to glioblastoma multiforme 20 days prior to being admitted to the ED. Multidetector-row computed tomography angiography revealed embolisms in both main pulmonary arteries.There was a progression of cardiac arrest while preparing for catheterization; thus, cardiopulmonary resuscitation was initiated.After administering 10 minutes of cardiopulmonary resuscitation, a50-mg alteplase bolus was given. Within minutes, a pulse has returned. No complications associated with the thrombolytic therapy were observed.Our aim was to discuss the management of massive pulmonary embolism with a contraindication to systemic thrombolytic therapy.