Önder Tomruk

Intravenous administration of metoclopramide by 2 min bolus vs 15 min infusion: does it affect the improvement of headache while reducing the side effects?

Objective: To determine the therapeutic effect (alleviation of vascular type headache) and side effects of a slow intravenous metoclopramide infusion over 15 min compared with those effects of a bolus intravenous metoclopramide infusion over 2 min in the treatment of patients with recent onset vascular type headache. Material and methods: All adults treated with metoclopramide for vascular type headache were eligible for entry into this clinical randomised double blinded trial. This study compared the effects of two different rates of intravenous infusion of metoclopramide over a period of 13 months at a university hospital emergency department. During the trial, side effects and headache scores were recorded at baseline (0 min), and then at 5, 15, 30 and 60 min. Repeated measures analysis of variance was used to compare the medication’s efficacy and side effects. Results: A total of 120 patients presenting to the emergency department met the inclusion criteria. Of these, 62 patients (51.7%) were given 10 mg metoclopramide as a slow intravenous infusion over 15 min (SIG group) and 58 patients (48.3%) were given 10 mg metoclopramide intravenous bolus infusion over 2 min (BIG group). 17 of the 58 patients in the BIG group (29.3%) and 4 of the 62 patients (6.5%) in the SIG group had akathisia (p = 0.001). There were no significant differences between the BIG and SIG groups in terms of mean headache scores (p = 0.34) and no adverse reactions in the study period. Metoclopramide successfully relieved the headache symptom(s) of patients in both the BIG and SIG groups. Conclusion: Slowing the infusion rate of metoclopramide is an effective strategy for the improvement of headache and reducing the incidence of akathisia in patients with vascular type headache.

First aid: level of knowledge of relatives and bystanders in emergency situations

Bystanders who are able to provide immediate first aid to patients who require emergency care can make a big difference in the outcome. Thus, first-aid training should be made available to as many people as possible. The aims of this study were to assess the level of first-aid knowledge among bystanders in emergency situations and to identify factors that affected this level of knowledge. At Dokuz Eylul University Emergency Service between February 1 and February 15, 2002, 318 bystanders were given a questionnaire. The first part of the questionnaire was concerned with demographic characteristics and factors that would affect first-aid knowledge level. The second part consisted of 16 multiple choice questions about first aid. Bystanders answered an average of 7.16±3.14 questions correctly. Bystanders who had graduated from a university, were health care personnel, had taken a first-aid course, had a first-aid certificate, or had a driver’s license were considered to be more successful.

Neuroprotective Effects of Raloxifene on Experimental Spinal Cord Injury in Rats

Introduction:The aim of this study was to evaluate the possible beneficial effect of raloxifene on cytokine production and ultrastructure of the spinal cord after spinal cord injury (SCI) in an animal model. Methods:Forty-eight male, adult Wistar Albino rats were divided into 4 groups for this study: A (only laminectomy), B (trauma; laminectomy + spinal trauma), C (raloxifene group; laminectomy + spinal trauma + raloxifene treated) and D (vehicle group; laminectomy + spinal trauma + vehicle treated). SCI was achieved by compression of the spinal cord horizontally and extradurally for 1 minute with an aneurysm clip (Sugita no: 07-934-11, closing pressure of 1.37-1.72 N). Spinal cords were extirpated at T7–T12 level, and tissue samples of the spinal cord samples were gathered for tumor necrosis factor &agr; (TNF-&agr;)/protein and interleukin (IL)-1&bgr;/protein measurements at first and sixth hours. Spinal cords harvested at sixth hour were evaluated for ultrastructural changes. Results:Both TNF-&agr;/protein and IL-1&bgr;/protein levels in the samples harvested 6 hours after surgery in the group B (62.70 ± 6.67 pg/mg and 11.25 ± 1.37 pg/mg, respectively) were higher than those taken from group A (P = 0.002 and P = 0.041, respectively). Furthermore, TNF-&agr;/protein and IL-1&bgr;/protein levels in the samples of animals treated with raloxifene (23.27 ± 5.27 pg/mg and 6.09 ± 0.77 pg/mg, respectively) were significantly lower than those taken from group B (P = 0.002 and P = 0.002, respectively). In the trauma group, electron microscopic examinations revealed deformities inside the cells and severe edema in neuropil. Raloxifene seemed to attenuate these ultrastructural changes at sixth hour after SCI. Conclusion:A single dose of 3.0 mg/kg of raloxifene intraperitoneally given 30 minutes after the induction of SCI reduced the production of TNF-&agr; and IL-1&bgr; 6 hours after SCI and attenuated ultrastructural changes in a rat model.

The efficacy of single-dose 5-fluorouracil therapy in experimental caustic esophageal burn

INTRODUCTION Accidental ingestion of caustic substances may cause serious problems in children. Approximately 20% of caustic ingestions result in esophageal stricture formation, resulting from excessive collagen synthesis to the extracellular matrix by fibroblasts. Recent studies showed that a single application of 5-fluorouracil (5-FU) is a very effective inhibitor of fibroblast proliferation and differentiation for prolonged periods. Using an experimental model, we investigated the efficacy of single-dose 5-FU on stricture formation after caustic esophageal burn. MATERIALS AND METHODS Forty Wistar-Albino rats were divided randomly into 4 equal groups: group 1 (sham-operated group), the esophagus was uninjured and untreated; group 2 (control group), the esophagus was injured and left untreated; group 3 (intraperitoneal treatment group), the esophagus was injured and treated immediately after the burn injury with a single intraperitoneal dose (20 mg/kg) of 5-FU; group 4 (local treatment group), the esophagus was injured and treated immediately after the burn injury with a single intraesophageal application of 5-FU at a concentration of 25 mg/mL. Caustic esophageal burn was produced by instilling 10% NaOH in the distal esophagus. The distal esophagi were harvested at 28 days postoperatively. Histologic sections were assessed by measuring the stenosis index (SI) and histopathologic damage score. Hydroxyproline (HP) levels in the tissues were determined biochemically. RESULTS There were significant reductions in the SI (P < .05), histopathologic damage score (P < .05), and HP level (P < .05) in the intraperitoneal treatment group when compared with the control group. No significant differences in the SI and histopathologic damage score were detected between the control and local treatment groups (P > .05), whereas significant reduction in the HP level was determined between these groups (P < .05). CONCLUSION A single intraperitoneal dose of 5-FU had a preventive effect on stricture formation after caustic esophageal burn. This observation suggests that 5-FU may prevent this undesirable complication in the clinical setting. Clinical studies are now required to verify this form of treatment. Local intraesophageal application of 5-FU immediately after the burn injury was not effective. Further investigations are required to determine the appropriate timing of application of 5-FU at the local site of injury.

A Comparison of Dexmedetomidine, Moxonidine and Alpha-Methyldopa Effects on Acute, Lethal Cocaine Toxicity.

Background: The treatment of cocaine toxicity is an important subject for emergency physicians. We investigated the effects of dexmedetomidine, moxonidine and alpha-methyldopa on acute cocaine toxicity in mice. Objectives: The aim of this study was to evaluate the effects of dexmedetomidine, moxonidine and alpha-methyldopa in a mouse model of acute cocaine toxicity. Materials and Methods: We performed an experiment consisting of four groups (n = 25 each). The first group received normal saline solution, the second group received 40 µg/kg of dexmedetomidine, the third group received 0.1 mg/kg of moxonidine and the fourth group received 200 mg/kg of alpha-methyldopa, all of which were intraperitoneally administered 10 minutes before cocaine hydrochloride (105 mg/kg). All animals were observed for seizures (popcorn jumping, tonic-clonic activity, or a loss of the righting reflex) and lethality over the 30 minutes following cocaine treatment. Results: The ratio of animals with convulsions was lower in all treated groups when compared to the control (P < 0.001). Furthermore, 68% (n = 17) of animals in the dexmedetomidine group, 84% (n = 21) of the alpha-methyldopa group, 92% (n = 23) of the moxonidine group and 100% (n = 25) of the control group showed evidence of seizure activity (P = 0.009). Cocaine-induced lethality was observed in 12% (n = 3) of the dexmedetomidine group, 48% (n = 12) of the alpha-methyldopa group, 52% (n = 13) of the moxonidine group, and 72% (n = 18) of the control group (P < 0.001). All treatments prolonged the time to seizure, which was longest in the dexmedetomidine group (P > 0.05). In addition, the time to lethality was also longer in the same group (P < 0.001). Conclusions: The present study provides the first experimental evidence in support of dexmedetomidine treatment for cocaine-induced seizures. Premedication with dexmedetomidine reduces seizure activity in a mouse model of acute cocaine toxicity. In addition, while dexmedetomidine may be effective, moxonidine and alpha-methyldopa did not effectively prevent cocaine-induced lethality.

Effect of End-Tidal Carbon Dioxide Measurement on Resuscitation Efficiency and Termination of Resuscitation

SUMMARY Objectives In this study, the value of end-tidal carbon dioxide (ETCO2) levels measured by capnometry were evaluated as indicators of resuscitation effectiveness and survival in patients presenting to the emergency department with cardiopulmonary arrest. Methods ETCO2 was measured after 2 minutes of compression or 150 compressions. ETCO2 values were measured in patients that were intubated and in those who underwent chest compression. The following parameters were recorded for each patient: demographic data, chronic illness, respiration type, pre-hospital CPR, arrest rhythm, arterial blood gas measurements, ETCO2 values with an interval of 5 minutes between the measurement and the estimated time of arrest, time to return to spontaneous circulation. Results Cardiac arrest developed in 97 cases, including 56 who were out of the hospital and 41 who were in the hospital. Fifty of these patients returned to spontaneous circulation, and just one of these had an initial ETCO2 value below 10 mmHg. The mean of the final ETCO2 levels was 36.4±4.46 among Patients who Return to Spontaneous Circulation (RSCPs) and 11.74±7.01 among those that died. In all rhythms; Asystole, pulseless electrical activity (PEA) and VF/VT; Overall, RSCPs had higher ETCO2 levels than the cases who died. Among the PEA patients undergoing in-hospital arrests and those asystolic patients undergoing out of hospital arrest, the ETCO2 values of the RSCPs were significantly higher than those of the cases who died. Conclusions ETCO2 levels predicted survival as well as the effectiveness of CPR for patients who received CPR and were monitored by capnometry in the emergency department. As a result, we believe that it would be suitable to use capnometry in all units where the CPR is performed.

Can mean platelet volume levels of trauma patients predict severity of trauma

Abstract In this study, we aimed to evaluate the mean platelet voulme (MPV) levels of trauma patients who were admitted to our emergency department. Of the total 232 trauma patients, 40 females and 192 males over the age of 18 years were included in this study. Of them, 102 patients were mild trauma [Glasgow Coma Scale (GCS) 15–13)], 40 patients were moderate (GCS 12–9) and 90 patients were severe trauma (GCS 8–3) patients. We also calculated the Revised Trauma Score (RTS) of the patients. MPV levels were evaluated with GCS and RTS values. The control group was constituted of 100 healthy adults. Mean initial MPV value of GCS 15–13 patients was 8.25 fL, 8.25 fL in GCS 12–9 patients and 8.47 fL, in GCS 8–3 patients. Trauma severity was significantly related with initial MPV (iMPV) levels (p < 0.05), initial Hb (iHb) levels (p < 0.05), initial white blood count (iWBC) (p < 0.05) and initial platelet (iPlt) levels (p < 0.05). Severity of trauma was related with control MPV (kMPV) levels (p < 0.05), control Hb (kHb) (p < 0.05), control WBC (kWBC) (p < 0.05), control Plt (kPlt) levels (p < 0.05). MPV levels (p < 0.05), Hb levels (p < 0.05), WBC levels (p < 0.05), Plt levels (p < 0.05) were significantly different between trauma group and healthy group. IMPV and control kMPV levels were not related (p = 0.149). But kHb – iHb levels (p < 0.05), kWBC – iWBC levels (p < 0.05), kPlt – iPlt levels (p < 0.05), kGCS – iiGCS (p < 0.05) were related to each other. We found a correlation between iMPV and iWBC levels (p < 0.05, r = −0.342). Similarly, there was a correlation between severity of trauma and iMPV level (p < 0.05, r = −0.224). We determined a significant correlation between iMPV and iPlt levels (p < 0.05, r = −0.246). There was not a correlation between kMPV and kWBC (p > 0.05, r = 0.124). kMPV and kPlt levels (p < 0.05, r = −0.174) were correlated. RTS was statistically related with GCS (p < 0.05). Similarly, RTS was related with iMPV (p < 0.05), iWBC(p < 0.05) and iPlt (p < 0.05) values, but there was not a relation with iHb (p > 0.05). We found correlations between iMPV– trauma severity (p < 0.05, r = −0.224), iMPV – RTS (p < 0.05, r = 0.134), iMPV – iWBC (p < 0.05 r = −0.342), iMPV – iPlt (p < 0.05, r = −0.246). Control RTS (seventh day of hospitalization) values were not related to kMPV (p > 0.05), kHB (p > 0.05), kWBC (p > 0.05) and kPlt(p > 0.05). There was a correlation between kRTS and kMPV (p < 0.05, r = −0.169). Similarly, kMPV – kHb (p < 0.05, r = −0.141), kMPV – kPlt (p < 0.05, r = −0.174) were correlated. KMPV and kPlt were not correlated (p < 0.05, r = 0.124). Initial RTS and seventh day RTS values were significantly different (p < 0.05). MPV may be helpful for emergency physicians for predicting the severity of trauma.

Effects of postgraduate emergency training among general practitioners working in emergency units in Denizli, Turkey

IntroductionEmergency medicine is characterised by rapid decisionmaking to help patients in life-threatening situations. For this purpose, special qualifications are necessary. The aim of our study was to evaluate the emergency medicine knowledge obtained during an obligatory postgraduate emergency medicine training programme that has been recently applied among Turkish physicians.MethodsThe training targeted all general practitioners (GPs) working in emergency units in the city hospitals, city-wide primary healthcare centres, public health offices, emergency services and private hospitals. Over an 8-month period between September 2004 and April 2005, seven individual groups of approximately 45 physicians were formed. Each group undertook an identical 5-day training programme and every participant completed identical pre-and post-training tests.ResultsTwo-hundred and ninety-eight physicians participated in the training programme. The majority of participants were male (n=224, 75.2%), aged between 35 and 39 years (n=127, 42.6%), had been in the medical professional for 11 to 15 years (n=121, 40.7%), and were employed in city hospitals (n=102, 34.2%). Surprisingly, the majority of GPs had never participated in a postgraduate training programme before (n=166, 55.7%). Mean post-test scores of the participants were significantly higher than the pre-test scores (89.70%±12.41% vs 43.15%±10.47%, respectively; P<0.001). Mean pretest scores were significantly higher in the emergency services subgroup (51%, P=0.001) and in the subgroup of participants that had previously undertaken two or more postgraduate training courses (47.9%, P=0.004) compared with the mean pre-test scores of the other subgroups. However post-test scores were not statistically different between the groups.ConclusionsThis postgraduate emergency medicine training programme appears to be effective in improving physicians’ knowledge regarding emergencies. Any developing emergency medicine system in Turkey should include continuous, up-to-date, standardised educational programmes for emergency professionals. These may include postgraduate workshops to improve the knowledge and skill levels of emergency professionals.

AKUT PULMONER EMBOLİDE KLİNİK VE LABORATUVAR DEĞERLERİ İLE TROMBÜS YERLEŞİM YERİ ARASINDAKİ İLİŞKİNİN ARAŞTIRILMASI

Amac: Bu calismada, acil serviste akut pulmoner emboli (PE) tanisi konulan 132 hastanin, basvuru anindaki klinik ve laboratuvar degerleri ile trombus yerlesim yeri arasinda anlamli bir iliski olup olmadigini arastirmayi hedefledik Gerec ve Yontem: Acil servise, Ocak 2013- Ocak 2015 tarihleri arasinda akut pulmoner emboli tanisi konularak tetkik ve tedavisi yapilan 132 hasta, retrospektif olarak incelendi. Hastalar, 65 yas alti ve ustu iki gruba ayrildi. Klinik skorlama amaci ile Well’s ve Cenevre skorlama sistemleri kullanildi. Hastane kayitlarindan hastalarin tum bulgulari, geriye donuk olarak ayrintili olarak incelendi. Bulgular: 65 yas ustu kadinlarda PE, istatistiksel olarak anlamli fazla bulundu (p=0.03). Immobilite, inme, koroner arter hastaligi, kalp yetmezligi, yasli grupta, PE insidansi anlamli yuksek saptandi (sirasiyla p=0.001, p=0.017, p=0.012, p=0.036). PE, cerrahi operasyon ve travma genc grupta anlamli yuksek saptandi (p=0.015, p=0.024). Well’s skorlamasinin yuksek olasilikli pulmoner emboli tahmin orani Cenevre skoruna gore anlamli oranda fazlaydi (p<0.001). Cenevre skorlamasi genc grupta anlamli dusuk bulunmustur (p=0.015). Serum D-Dimer degeri 500 μg/ml uzerinde Wells skorunun klinik olasiliginin artmasi arasinda anlamli fark bulunmustur (p=0.022). Major travmali olgularda proksimal yerlesimli trombus anlamli bulundu (p=0.022). Serum D-Dimer duzeyi artisi ile proksimal yerlesimli emboli orani, distal yerlesimli emboliye oranla anlamli olarak artmis bulundu (p=0.043). Well’s skoru yuksek olan hastalarda pulmoner embolinin proksimal yerlesimi distale gore istatistiksel olarak anlamli fazlaydi (p=0.004). Cenevre skoru yuksek olan hastalarda pulmoner embolinin proksimal yerlesimi distale gore istatistiksel olarak anlamli, fazlaydi (p=0.007). Sonuc: Calismamizin sonuclarina gore, PE hastalarinda, riskler acisindan major travma, laboratuvar acisindan D-Dimer yuksekligi, Wells skor yuksekligi, Cenevre skoru yuksekligi trombusun proksimal yerlesimine isaret etmektedir. Konu ile ilgili olarak, daha net sonuclara varabilmek icin daha fazla ileriye donuk kapsamli calismalar yapilmasi gerektigini dusunmekteyiz.