Şervan Gökhan

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 role of ultrasonography in the diagnosis of metacarpal fractures

INTRODUCTION The aim of this study was to evaluate the efficiency of ultrasonography (USG) in identifying metacarpal bone fractures in patients admitted to the emergency department (ED) with hand injury. MATERIALS AND METHODS Patients who were admitted to a training and research hospitals ED during the study period with hand trauma and had suspected metacarpal fractures were included in the study. They were examined for metacarpal fracture by USG and x-ray. Hand radiographs reviewed by an emergency physician were considered to be the criterion standard diagnostic tool. Ultrasonography results were compared to x-ray results. RESULTS Ninety-eight ultrasound examinations were performed on 96 adult patients who were enrolled in the study. The mean age of the patients was 30.1±11.8 years; 79.2% of the patients were male. Right hand injury was observed in 69.4% of the cases. Forty metacarpal fractures were detected in 38 patients on x-ray. We found a sensitivity of 92.5% (95% confidence interval [CI], 78.5-98), a specificity of 98.28% (95% CI, 89.5-99.9), a positive predictive value of 97.37% (95% CI, 84.5-99.8), and a negative predictive value of 95% (95% CI, 85-98) for USG to detect metacarpal fractures when compared to x-ray imaging. CONCLUSIONS Under the light of these results, we suggest that USG may be an option for detecting metacarpal fractures and prevent unnecessary x-ray imaging examinations in patients presenting to the ED with hand trauma.

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

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.

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

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.

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

Amac: Akut koroner sendromlar, dunyada ve ulkemizde tum olum sebepleri icerisinde en ust sirada yer almaktadir. Bu calismada tam kan sayimi parametrelerinin akut koroner sendromlarin klinik seyrinde prediktif acidan degerli olup olmadigini arastirmak amaclanmistir. Materyal ve Metot: Calisma, yillik hasta sayisi 150.000 olan bir Egitim ve Arastirma Hastanesi Acil Tip Klinigi’nde 01.02.2017-31.07.2017 tarihleri arasinda tek merkezli prospektif olarak gerceklestirildi. Calisma icin Lokal Klinik Arastirmalar Etik Kurulu’ndan etik onayi alindi. Hastalarin demografik ozellikleri, tam kan parametreleri, notrofil / lenfosit orani (NLR), GRACE risk skorlari kayit altina alindi. Hastalarin hastanede kalis sureleri, hastane ici mortaliteleri ve 6 aylik mortaliteleri takip edildi. Bulgular: Calismadaki hastalarin %77,27’ u erkek, %22,73’ si kadindi. Yas ortalamasi 61±12 idi. Tum gruplar icerisinde NLR degerleri (p=0,009), monosit sayilari (p<0,001) arasinda hastane ici mortalite acisindan anlamli fark saptandi. NLR degerleri (p=0,045), monosit sayilari (p=0,026) arasinda da 6 aylik mortalite acisindan anlamli fark saptandi. Hastane ici mortalite acisindan NLR duzeyi dusuk grup ile diger gruplar arasinda anlamli fark saptanmistir (p=0,006), Bu calismada NLR alt gruplari arasinda 6 aylik mortalite acisindan anlamli fark saptanmamistir (p=0,131). GRACE skoru ve NLR arasinda zayif (p<0,001; rho=0,393) korelasyon saptandi. Sonuc: Akut koroner sendrom nedeniyle acil servislerde takip edilen hastalarda tam kan parametreleri ve NLR gibi parametreler klinik karar verme surecinde ve hastalarin prognozunu ve mortalitelerini ongormede yardimci olabilir.