Murat Özsaraç

Ketamine With and Without Midazolam for Emergency Department Sedation in Adults: A Randomized Controlled Trial

STUDY OBJECTIVE We assess whether midazolam reduces recovery agitation after ketamine administration in adult emergency department (ED) patients and also compared the incidence of adverse events (recovery agitation, respiratory, and nausea/vomiting) by the intravenous (IV) versus intramuscular (IM) route. METHODS This prospective, double-blind, placebo-controlled, 2×2 factorial trial randomized consecutive ED patients aged 18 to 50 years to 4 groups: receiving either 0.03 mg/kg IV midazolam or placebo, and with ketamine administered either 1.5 mg/kg IV or 4 mg/kg IM. Adverse events and sedation characteristics were recorded. RESULTS Of the 182 subjects, recovery agitation was less common in the midazolam cohorts (8% versus 25%; difference 17%; 95% confidence interval [CI] 6% to 28%; number needed to treat 6). When IV versus IM routes were compared, the incidences of adverse events were similar (recovery agitation 13% versus 17%, difference 4%, 95% CI -8% to 16%; respiratory events 0% versus 0%, difference 0%, 95% CI -2% to 2%; nausea/vomiting 28% versus 34%, difference 6%, 95% CI -8% to 20%). CONCLUSION Coadministered midazolam significantly reduces the incidence of recovery agitation after ketamine procedural sedation and analgesia in ED adults (number needed to treat 6). Adverse events occur at similar frequency by the IV or IM routes.

Glass Foreign Body in Soft Tissue: Possibility of High Morbidity Due to Delayed Migration

BACKGROUND Soft tissue foreign bodies (FBs) are a common occurrence in emergency departments (EDs). Some FBs cause complications, whereas others are asymptomatic and remain undetected for months or years. CASE REPORT A 32-year-old man presented to the ED with complaints of back pain in the area of a subcutaneous lump that had migrated toward the midline, nearly 25 cm from its former location, over the previous 2 weeks. Twelve years previously, after falling onto a glass door that shattered, he had gone to a local ED and had his wound sutured, but no X-ray studies were taken. Within a few months, he noticed a lump near his scapula, but he did not relate it to the fall and it did not bother him much. Physical examination revealed a normal neurological examination and a palpable mass in the right paraspinal area at the level of the tenth thoracic vertebra. An X-ray study showed a 34-mm-long sharp density in the vicinity of the spinal canal near T10. Efforts lasting almost 2 h to identify and remove the foreign body were unsuccessful. The following day, a 4 × 6 × 34 mm sharp glass fragment was removed in the operating room under fluoroscopy. CONCLUSIONS Retained soft-tissue foreign bodies may migrate very late and can cause high morbidity or mortality. It is important to be diligent in the search for foreign bodies, using ultrasound, computed tomography scan, or magnetic resonance imaging in cases in which initial plain radiographs are negative.

Comparison of skin effects of immediate treatment modalities in experimentally induced hydrofluoric acid skin burns.

Hydrofluoric acid (HF) burns cause immediate damage and painful long‐term sequellae. Traditionally, chelating agents have been used as the initial treatment for such burns. We have introduced epidermal growth factor (EGF) into an HF model to compare EGF with Ca2+ and Mg2+ treatments; 40 Sprague Dawley rats were divided into five groups. Each rat suffered a 6 × 4 cm2 burn induced by 40% HF. Group 1 had no treatment, group 2 had saline injected beneath the burn, group 3 received magnesium sulphate injections, group 4 received calcium gluconate and group 5 received EGF. Specimens were evaluated via planimetry and biopsy at intervals of 4, 8, 24 and 72 hours. Fluid losses were significantly less in the Mg2+ and EGF groups. The EGF group had the smallest burn area, least oedema, least polymorphonuclear granulocyte (PMN) infiltration, most angiogenesis and highest fibroblast proliferation of any group (P < 0·005). EGF limited HF damage morphologically and histologically more effectively than Ca2+ or Mg2+. This finding indicates that HF treatment via growth factors may be an improvement over chelation therapy.

Acute Hepatitis Associated with Thymus Vulgaris Oil Ingestion; Case Report

SUMMARY Many plants traditionally used in folkloric medicine can cause poisoning. Typically known as “thyme”, “Thymus Vulgaris” continues to be one of the most commonly used folkloric herbs in Turkey. Here, we report a case of toxic hepatitis due to the ingestion of concentrated thyme oil. The patient was reported to have ingested a total of 25 ml of thyme oil which was routinely sold in the local market. The total dose was taken in two consecutive days in different amount. The pa tient then developed nausea, vomiting and diarrhea, and he was subsequently admitted to the emergency unit, with high transaminase levels. He was placed on observation unit for two days. His elevated aminotransferase levels and symptoms gradually decreased during the observation period. Thyme, which is known to be a nonpoisonous plant, is one of the most commonly used herbs; however, plants similar to thyme are not necessarily as harmless as they seem to be.