Faruk Güngör

Comparison of Intravenous Morphine Versus Paracetamol in Sciatica: A Randomized Placebo Controlled Trial.

OBJECTIVE The objective was to compare intravenous morphine and intravenous acetaminophen (paracetamol) for pain treatment in patients presenting to the emergency department with sciatica. METHODS Patients, between the ages of 21 and 65 years, suffering from pain in the sciatic nerve distribution and a positive straight leg-raise test composed the study population. Study patients were assigned to one of three intravenous interventions: morphine (0.1 mg/kg), acetaminophen (1 g), or placebo. Physicians, nurses, and patients were blinded to the study drug. Changes in pain intensity were measured at 15 and 30 minutes using a visual analog scale. Rescue drug (fentanyl) use and adverse effects were also recorded. RESULTS Three-hundred patients were randomized. The median change in pain intensity between treatment arms at 30 minutes were as follows: morphine versus acetaminophen 25 mm (95% confidence interval [CI] = 20 to 29 mm), morphine versus placebo 41 mm (95% CI = 37 to 45 mm), and acetaminophen versus placebo 16 mm (95% CI = 12 to 20 mm). Eighty percent of the patients in the placebo group (95% CI = 63.0% to 99%), 18% of the patients in the acetaminophen group (95% CI = 10.7% to 28.5%), and 6% of those in the morphine group (95% CI = 2.0% to 13.2%) required a rescue drug. Adverse effects were similar between the morphine and acetaminophen groups. CONCLUSION Morphine and acetaminophen are both effective for treating sciatica at 30 minutes. However, morphine is superior to acetaminophen.

Pre-Test and Post-Test Applications to Shape the Education of Phlebotomists in A Quality Management Program: An Experience in A Training Hospital

Summary Background: After the introduction of modern laboratory instruments and information systems, preanalytic phase is the new field of battle. Errors in preanalytical phase account for approximately half of total errors in clinical laboratory. The objective of this study was to share an experience of an education program that was believed to be successful in decreasing the number of rejected samples received from the Emergency Department (ED). Methods: An education program about laboratory procedures, quality requirements in the laboratory, patient and health-care worker safety was planned by the quality team to be performed on 36 people who were responsible for sample collection in the ED. A questionary which included 11 questions about the preanalytic phase was applied to all the attendees before and after training. The number of rejected samples per million was discovered with right proportion account over the number of accepted and rejected samples to laboratory after and before the training period. Results: Most of the attendees were nurses (n: 22/55%), with over 12 years of experience in general and 2-4 years experience in the ED. Knowledge level of the attendees was calculated before training as 58.9% and after training as 91.8%. While the total rate of sample rejection before training was 2.35% (sigma value 3.37-3.50), the rate after training was 1.56% (sigma value 3.62-3.75). Conclusions: Increasing the knowledge of staff has a direct positive impact on the preanalytic phase. The application of a pre-test was observed to be a feasible tool to shape group specific education programs.

Effect of Focused Bedside Ultrasonography in Hypotensive Patients on the Clinical Decision of Emergency Physicians

We assessed the effect of focused point of care ultrasound (POCUS) used for critical nontraumatic hypotensive patients presenting to the emergency department of our hospital on the clinical decisions of the physicians and whether it led to the modification of the treatment modality. This prospective clinical study was conducted at the Emergency Department of Antalya Training and Research Hospital. Nontraumatic patients aged 18 and older who presented to our emergency department and whose systolic blood pressure was <100 mmHg or shock index (heart rate/systolic blood pressure) was >1 were included in the study. While the most probable preliminary diagnosis established by the physician before POCUS was consistent with the definitive diagnosis in 60.6% (n = 109) of 180 patients included in the study, it was consistent with the definitive diagnosis in 85.0% (n = 153) of the patients after POCUS (p < 0.001). POCUS performed for critical hypotensive patients presenting to the emergency department is an appropriate diagnostic tool that can be used to enable the physicians to make the accurate preliminary diagnosis and start the appropriate treatment in a short time.

The Effectiveness of Using Luer-Lok (Bd Vacutainerî) In Reducing Hemolysis Rates in Busy Emergency Departments

Introduction: In busy emergency departments, errors made during the pre-analytical phase can cause delayed diagnosis and treatment, and prolonged follow-up periods. The most common error in the pre-analytical phase is hemolysis in blood samples. In this study, we aimed to assess the effectiveness of the Luer-Lok (BD Vacutainer®) method of taking samples in avoiding hemolysis. Materials and Methods: The study was conducted at the emergency department of a tertiary healthcare facility on patients that register at level 1 or 2 of the Emergency Severity Index triage algorithm. Three sets of prospective observations were made, each lasting for five days. In the first period, hemolysis rates were determined. Following a training course on appropriate blood sampling techniques during the second period, hemolysis rates were determined again while Luer-Lok (BD Vacutainer®) was being used. Taking and processing of samples were carried out by the same personnel throughout the study. Assessment of hemolysis was performed by those that were blind to sampling. All the samples were analyzed at the laboratory located inside the emergency department. Results: In total, 2,027 blood samples were sent to the emergency laboratory for analysis. The hemolysis rate was 8.1% in the first period, 5.5% in the second and 1.4% in the third. The difference in rates between the first and second periods was not statistically significant (p=0.0793). The hemolysis rate in the third period was significantly lower compared to the other two periods (p=0.0001). Conclusion: Using Luer-Lok (BD Vacutainer®) may be effective in reducing hemolysis rates in busy emergency departments.

The value of point-of-care ultrasound for detecting nail bed injury in ED.

OBJECTIVE The aim of this study is to detect the value of point-of-care ultrasound (POCUS) for diagnosing a nail bed injury and fracture of distal phalanx in patients presenting with distal finger trauma to the emergency department (ED). METHODS Patients, 18 to 65 years old, presenting with a blunt trauma of distal finger and diagnosed with subungual hematoma were eligible for the study. Subungual hematoma extending over more than 50%, fracture of distal phalanx, and disruption of periungual tissue or nail integrity were accepted as the indications for nail bed inspection. All the study patients underwent POCUS to detect the existence of a distal phalanx fracture or nail bed injury. X-ray was also obtained from all the patients. RESULTS Nail bed was visualized in 45 patients. Squeezing and crush injury were the most reported trauma mechanism in study patients (66.7%). The sensitivity and specificity of POCUS in detecting nail bed injury were 93.4% (95% CI, 80%-99%) and 100% (95% CI, 74%-100%), respectively. The sensitivity was 100% (95% CI, 79%-100%), and specificity was 98.4% (95% CI, 91%-100%) for distal phalanx fracture. CONCLUSION Point-of-care ultrasound is a promising tool in detecting the nail bed injury and distal phalanx fractures in patients presented with distal finger trauma. Further studies with bigger sample size are needed to reveal the diagnostic ability of POCUS before using it regularly in the ED.