Gülhan Kurtoğlu Çelik

The accuracy of mainstream end-tidal carbon dioxide levels to predict the severity of chronic obstructive pulmonary disease exacerbations presented to the ED.

INTRODUCTION The end-tidal carbon dioxide (ETCO2) measurement was considered as an essential tool for the assessment of several conditions in emergency medicine. However, the diagnostic role of capnography in dyspneic patients still remains unclear. We aimed to analyze the alteration of the ETCO2 levels in chronic obstructive pulmonary disease (COPD) exacerbations and its role in the decision-making process. METHODS All the individuals who were presented to the emergency department (ED) after COPD exacerbations were prospectively enrolled in the study. The patients were excluded if they refused to give informed consent, intubated after initial assessment, and had uncertain COPD diagnosis. The ETCO2 measurement using a mainstream capnometer was undertaken in the pretreatment and post-treatment period of COPD exacerbations. RESULTS A total of 102 patients were enrolled in the study. Pre-ETCO2 and post-ETCO2 levels were positively correlated with arterial partial carbon dioxide pressure levels (r=0.756, P<.001 and r=0.629, P<.001, respectively). The median pre-ETCO2 level was 32.0 (30.5-40.5) in discharged patients and 39.0 (31.0-53.5) in admitted patients. After the initial therapy in the ED was completed, the median post-ETCO2 level was found to be 32.0 (28.0-37.5) in discharged patients and 36.0 (32.0-52.0) in admitted patients. Although a statistically significant difference was observed in the pretreatment period (P=.043), no difference was observed in post-treatment period between ETCO2 levels (P=.107). CONCLUSION End-tidal carbon dioxide levels were higher in admitted patients when compared with discharged patients on arrival to the ED. ETCO2 measurement has very little contributions while evaluating patients with COPD exacerbation in the ED.

Herbal Weight Loss Pill Overdose: Sibutramine Hidden in Pepper Pill

Supposedly herbal weight loss pills are sold online and are widely used in the world. Some of these products are found to contain sibutramine by FDA and their sale is prohibited. We report a case of a female patient who presented to the emergency department after taking slimming pills. 17-year-old female patient presented to the emergency room with palpitations, dizziness, anxiety, and insomnia. She stated that she had taken 3 pills named La Jiao Shou Shen for slimming purposes during the day. Her vital signs revealed tachycardia. On her physical examination, she was restless, her oropharynx was dry, her pupils were mydriatic, and no other pathological findings were found. Sibutramine intoxication was suspected. She was given 5 mg IV diazepam for restlessness. After supportive therapy and observation in emergency department for 12 hours there were no complications and the patient was discharged home. Some herbal pills that are sold online for weight loss have sibutramine hidden as an active ingredient, and their sale is prohibited for this reason. For people who use herbal weight loss drugs, sibutramine excessive intake should be kept in mind at all times.

Concurrent Spontaneous Sublingual and Intramural Small Bowel Hematoma due to Warfarin Use

Introduction. We present a case of concurrent spontaneous sublingual and intramural small bowel hematoma due to warfarin anticoagulation. Case. A 71-year-old man presented to the emergency department complaining of a swollen, painful tongue. He was on warfarin therapy. Physical examination revealed sublingual hematoma. His international normalized ratio was 11.9. The computed tomography scan of the neck demonstrated sublingual hematoma. He was admitted to emergency department observation unit, monitored closely; anticoagulation was reversed with fresh frozen plasma and vitamin K. 26 hours after his arrival to the emergency department, his abdominal pain and melena started. His abdomen tomography demonstrated intestinal submucosal hemorrhage in the ileum. He was admitted to surgical floor, monitored closely, and discharged on day 4. Conclusion. Since the patient did not have airway compromise holding anticoagulant, reversing anticoagulation, close monitoring and observation were enough for management of both sublingual and spontaneous intramural small bowel hematoma.

Subcutaneous Emphysema, Pneumomediastinum, and Pneumorrhachis after Cocaine Inhalation

Introduction. The most prominent complications of cocaine use are adverse effects in the cardiovascular and central nervous systems. Free air in the mediastinum and subcutaneous tissue may be observed less frequently, whereas free air in the spinal canal (pneumorrhachis) is a very rare complication of cocaine abuse. In this report we present a case of pneumorrhachis that developed after cocaine use. Case. A 28-year-old male patient was admitted to the emergency department with shortness of breath, chest pain, and swelling in the neck and face which started four hours after he had sniffed cocaine. On physical examination, subcutaneous crepitations were felt with palpation of the jaw, neck, and upper chest area. Diffuse subcutaneous emphysema, pneumomediastinum, and pneumorrhachis were detected in the computed tomography imaging. The patient was treated conservatively and discharged uneventfully. Discussion. Complications such as pneumothorax, pneumomediastinum, and pneumoperitoneum that are associated with cocaine use may be seen due to increased intrathoracic pressure. The air then may flow into the spinal canal resulting in pneumorrhachis. Emergency physicians should know the possible complications of cocaine use and be prepared for rare complications such as pneumorrhachis.

The lucky patient who aspirated a needle

Foreign body aspiration is seen frequently in pediatric and geriatric patients, but it can also be seen in adults. Needle aspiration is a common problem in our country. Foreign body aspiration can lead to complete airway obstruction, asphyxia and death but sometimes symptoms may not be evident during the early period of aspiration and patients may present with complications afterwards. Early diagnosis is important in foreign body aspiration for prevention of mortality and complications. Suspicion aroused by patient history is the first step towards a diagnosis. Plain radiography and tomography may be used for imaging. Bronchoscopy is performed for diagnosis if there is uncertainty after imaging and may also be used for the treatment of diagnosed cases. In this article, we present a foreign body aspiration case that presented with difficulty and pain while swallowing, subsequently found to be the result of a needle that was stuck between the oropharynx and epiglottis.

Traumatic pseudocyst due to blunt trauma: Case report

Damage to lung parenchyma due to blunt thoracic trauma often appears as contusion or hematoma. Cavitary lung lesions or pseudocyst formation due to trauma is a rare phenomenon. In the literature traumatic pseudocysts are also known as pseudocystic hematomas, traumatic lung cavity and traumatic pneumotocel. Traumatic pseudocysts usually have good clinical prognosis, recover spontaneously with supportive treatment and do not require surgery. In this article, we present the case of 52 year old male who was brought to the emergency department after a fall from height and was diagnosed with lung contusions and traumatic cyst.

Rapid spontaneous redistribution of acute epidural hematoma.

Acute epidural hematoma is a neurosurgical emergency that requires early recognition and urgent operation. Radiologically significant or symptomatic acute traumatic epidural hematomas (AEDHs) are typically treated by rapid surgical decompression. Various authors have reported the resolution of AEDHs managed conservatively with perfect clinical and radiologic outcome. The rapid spontaneous resolution of EDH is an extremely rare phenomenon. Herein, we report on a case of AEDH that rapidly disappeared without surgical intervention and discuss possible mechanisms in review of the literature. Acute traumatic epidural hematoma (AEDH) is one of the most critical emergencies. The rapid spontaneous resolution of EDH is an extremely rare phenomenon, and to our knowledge, there are only 12 cases in the English medical literature that show the rapid disappearance of AEDH without surgical intervention [1–4]. Herein, we report on a case of AEDH that rapidly disappeared without surgical intervention and discuss possible mechanisms in review of the literature. A 26-year-old man was admitted to the emergency department after a fall from 7 m on his head an hour before the admission. Upon arrival, he complained of severe headache.Witnesses reported that he lost consciousness right after the fall for a brief period, but then he regained consciousness before the ambulance has arrived. On neurologic examination, he had mild confusion, with the Glasgow Coma Scale (GCS) score being 13 (eye 3, motor 6, verbal 4), and he had equal and reactive pupils. There was no disturbance in motor or sensory function; there was no cranial nerve paresis. Physical examination was unremarkable, except the swelling on his left temporal area, a probable hematoma. A computed tomographic (CT) scan of the head was performed an hour after the injury, and it revealed an AEDH of 8.5 mm at its maximum thickness with an overlying fracture in the left temporal bone and pneumocephalus. Therewas also an oblique fracture line inmastoid and squamous piece of the temporal bone. There was nomidline shift (Fig. 1). The patients blood test results were within the normal limits with no evidence of coagulopathy. During emergency follow-up, the patient vomited 4 times in an hour, and his confusion has gradually recovered to being fully alert. A second nonenhanced cranial tomography that was performed just 2 hours after the initial tomography revealed total disappearance of the epidural hemorrhage and pneumocephalus that had been seen on the previous CT scan (Fig. 2). The patient was managed conservatively in the intensive care unit for 2 days with ☆ This paper is written in US English. 0735-6757/

Tissue adhesives to secure peripheral intravenous catheters: A randomized controlled trial in patients over 65 years

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Evaluation of dynamic thiol/disulfide homeostasis in adult patients with community-acquired pneumonia

Introduction Peripheral venous catheterization is one of the most used medical procedures in hospitals worldwide. Recent researches state that using intravascular devices is a risk factor for both local and systemic complications. In this study, we aimed to test that addition of tissue adhesive to the insertion site of peripheral intravenous catheters (PIVC) in the emergency department (ED) would reduce the device failure rate at 6 h and 24 h following insertion. Material and methods We designed a single-site, two-arm, randomized, controlled trial. We inserted 115 PIVCs into 115 adult patients. Results PIVC device failure for the 6th hour follow up was 15.4% in the tissue adhesive group (95% CI: 4.1–26.7) vs. 25.6% with standard care group (95% CI: 11.9–39.3). There was no statistically significant difference between two groups (p = 0.33). The number of patients for 24 h follow-up was not enough and the obtained data could not be included in the study. Discussion In this study, the routine use of tissue adhesives in addition to standard care to reduce PIVC failure for patients 65 years or older in ED was not supported due to not clear benefits and cost effectivity. Conclusion Even though the routine use of tissue adhesives is not recommended according to the study results, it may be reasonable to use tissue adhesives for long term hospitalization expected patients to protect from related complications due to current literature.

The Evaluation of Neutrophil/Lymphocyte Rates and Monocyte Counts in Patients with Acute Coronary Syndrome

Background: Community-acquired pneumonia is an important cause of mortality and morbidity in all age groups. Oxidant and antioxidant mechanisms play an important role in the pathogenesis and mortality of community-acquired pneumonia. Objectives: In this study, the role of thiol/disulfide homeostasis in the diagnosis and prognosis of community-acquired pneumonia was investigated. Methods: This was a prospective, controlled, observational study involving 73 community-acquired pneumonia patients and 68 healthy volunteers. Results: The native thiol and total thiol, which are thiol/disulfide homeostasis components, were significantly lower in the community-acquired pneumonia group. It was also found that the native thiol was lower in the high-risk community-acquired pneumonia group and that the native thiol and total thiol were associated with the Pneumonia Severity Index, CRB65 (confusion, respiratory rate, blood pressure, ⩾65 years old), and CURB65 (confusion, uremia, respiratory rate, blood pressure, ⩾65 years old) scores. The thiol compound levels were also associated with the C-reactive protein and procalcitonin levels. However, there was no significant difference between the survivors and non-survivors in terms of the thiol/disulfide homeostasis parameters. Conclusion: This study demonstrated the important role that oxidative stress plays in the pathogenesis of community-acquired pneumonia. The thiol/disulfide homeostasis biomarkers especially the native thiol and index-1 levels were significantly lower in patients with community-acquired pneumonia. Further studies are needed to investigate the diagnostic and prognostic value of thiol/disulfide homeostasis parameters in community-acquired pneumonia.