Suat Zengin

Role of inferior vena cava and right ventricular diameter in assessment of volume status: a comparative study: ultrasound and hypovolemia.

OBJECTIVE Ultrasonography has been suggested as a useful noninvasive tool for the detection and follow-up for hypovolemia. Two possible sonographic markers as a surrogate for hypovolemia are the diameters of the inferior vena cava (dIVC) and the right ventricle (dRV). The goal of this study was to evaluate IVC and RV diameters and diameter changes in patients treated for hypovolemia and compare these findings with healthy volunteers. METHODS Fifty healthy volunteers and 50 consecutive hypovolemic patients were enrolled in the study. The dIVC, both during inspiration (IVCi) and expiration (IVCe), was measured in hypovolemic patients both before and after fluid resuscitation, and they were also measured in healthy volunteers during the time they participated in the study. The dIVC, in hypovolemic patients both before and after fluid resuscitation, was measured ultrasonographically by M-mode in the subxiphoid area. The dRV was measured ultrasonographically by B-mode in the third and fourth intercostals spaces. RESULTS The average diameters of the IVCe, IVCi, and dRV in hypovolemic patients upon arrival were significantly lower compared with healthy volunteers (P = .001). After fluid resuscitation, there was a significant increase in the mean diameters of the IVCe, IVCi, and RV in hypovolemic patients (P = .001). CONCLUSIONS The results indicate that the dIVC and dRV are consistently low in hypovolemic subjects when compared with euvolemic subjects. Bedside serial measurements of dIVC and dRV could be a useful noninvasive tool for the detection and follow-up of patients with hypovolemia and evaluation of the response to the treatment.

Effects of music therapy on pain and anxiety in patients undergoing port catheter placement procedure

BACKGROUND Patients scheduled to invasive medical procedures experience high levels of anxiety, which may lead to increased perceptions of pain and vital sign instability throughout. AIMS To examine the effect of a music intervention (MI) on stress hormones, physiologic parameters, pain, and anxiety state before and during port catheter placement procedures (PCPPs). METHODS We conducted a prospective, randomized, controlled study in 100 oncology patients, who were randomly assigned to an MI group (n=50) or a control group (n=50). The effects of music were assessed by determination of serum cortisol and adrenocorticotropic hormone (ACTH) levels, heart and respiratory rate (HR, RR) and systolic and diastolic blood pressure (SBP, DBP), on arrival in the surgical intervention room, as well as immediately prior to and immediately after the PCPP, in both groups. Furthermore, pain and anxiety levels were identified using visual analogue scale and state-trait anxiety inventory scales. RESULTS On arrival, there were no differences between the patients in terms of serum cortisol and ACTH levels, HR, RR, SBP, DBP and anxiety levels. There were significant reductions in hormone levels (p<0.05 for all), HR (p<0.001), RR (p<0.001), SBP (p<0.05) and DBP (p<0.05), immediately prior to and immediately after the PCPP in participants in the MI group compared to those in the control group. Furthermore, music led to a significant reduction in pain (p<0.05) and anxiety scores (p<0.05) in the MI group compared to control group. CONCLUSION During invasive medical procedures, MI significantly decreases stress hormone levels, physiological parameters, acute procedural pain and anxiety.

Chronic Carbon Monoxide Exposure Increases Electrocardiographic P-wave and QT Dispersion

We investigated the association between chronic carbon monoxide (CO) exposure and electrocardiographic maximum/minimum P-wave duration (Pmax/Pmin), P-wave dispersion (Pd), maximum/minimum QT interval (QTmax/QTmin), and QT and corrected QT dispersion (QTd/cQTd), which are known as predictors of atrial fibrillation, ventricular arrhythmias, and sudden death. We obtained electrocardiograms of 48 apparently healthy male indoor barbecue workers (age mean ± SD; 33.6 ± 9.4) who were working in various restaurants for at least 3 yr and 51 age-matched healthy men (age mean ± SD; 35.1 ± 6.7). Average working time of the indoor barbecue workers in their jobs was 15.6 ± 7.1 yr. P-wave parameters were analyzable in 39 barbecue workers and 40 control subjects and QT intervals were analyzable in 44 barbecue workers and 47 control subjects. Clinical characteristics of indoor barbecue workers and the control group were comparable in terms of age, sex, body mass index, blood pressure, heart rate, Pmin, and QTmin. However, COHb levels, Pmax, Pd, QTmax, QTd, and cQTd measurements were higher in indoor barbecue workers than in the control group (6.48 ± 1.43 vs. 2.19 ± 1.30, p < .001; 106.15 ± 7.47 vs. 101.50 ± 6.62, p < .005; 30.51 ± 7.59 vs. 24.50 ± 6.77, p < .001; 406.59 ± 17.64 vs. 390.85 ± 13.15, P < .001; 48.40 ± 8.87 vs. 34.89 ± 5.85, P < .001; 53.64 ± 9.14 vs. 37.77 ± 6.71, P < .001, respectively). In Pearson correlation analysis there were significant correlations between COHb level and Pd, QTmax, QTd, and cQTd (r = .315 P < .005; r = .402, P < .001, r = .573, P < .001, r = .615, P < .001, respectively). In conclusion, the present study is the first to assess and find an association between chronic CO exposure and electrocardiographic Pd and QTd/cQTd.

Myocarditis after black widow spider envenomation

The black widow spider (BWS), which is a member of the arthropod family, is widely distributed on earth. Black widow spider bites can cause a wide variety of signs or symptoms in humans, but the cardiovascular manifestations are relatively rare except hypertension/hypotension and bradycardia/tachycardia. We report on a 65-year-old man who experienced myocarditis after BWS envenomation, which is extremely rare. He complained of chest pain after the BWS bite, and electrocardiography (ECG) was consistent with a 0.5-mm ST-segment elevation in leads II, aVF, and V3 through V6 and accompanying augmentation in T-wave amplitude in leads V3 through V6 without reciprocal changes. Creatine kinase-MB, troponin-I, and aspartate aminotransferase levels peaked at 98 IU/L, 6.1 ng/mL, and 62 U/L, respectively. His ECG readings and cardiac enzymes returned to normal with supportive treatment, and he was discharged with complete recovery. To the best of our knowledge, the present case is the third in the literature reporting myocarditis and the first reporting ST-segment elevation and accompanying augmentation in T-wave amplitude after BWS envenomation. In addition to usual measures, we recommend ECG and cardiac-specific enzyme followup for every patient envenomated by BWS for potentially fatal cardiac involvement.

Leech bites: massive bleeding, coagulation profile disorders, and severe anemia

Leeches have been in use for centuries, especially in plastic and reconstructive surgery wound and flap healing, in venous insufficiencies, and in the treatment of many disorders such as hemorrhoids and varicosity. With this study, we aimed to discuss coagulation disorder due to uncontrolled leech bites, consequent excessive skin hemorrhage, and anemia requiring blood transfusion. A 65-year-old male patient was referred to the emergency department because of excessive intractable bleeding that had occurred after leech bites. On physical examination, a total of 130 bites were detected on various regions of the body. In the laboratory findings of the patient, hemoglobin and hematocrit levels were extremely low, and prothrombin time, international normalized ratio, and partial thromboplastin time were markedly increased. The patient received a total of 8 units of fresh frozen plasma and 6 units of erythrocyte suspension. Bleeding stopped by decreasing after the transfusion of fresh frozen plasma. Although the complications due to leech injuries are rare, they may be an important cause of morbidity and mortality when an injury or prolonged bleeding in an internal region occurs. Prolonged skin hemorrhages rarely cause anemia, and deaths are caused by intractable hemorrhages. However, a coagulation disorder and consequent intractable hemorrhage have not been reported previously in the literature. In conclusion, it should be known that uncontrolled, blind, and excessive leech use causes severe hemorrhage and excessive blood loss, causing significant morbidity and mortality. Therefore, the awareness of either physicians or people using or recommending alternative medicine should be raised on this subject.

Benefits of cardiac sonography performed by a non-expert sonographer in patients with non-traumatic cardiopulmonary arrest.

UNLABELLED The purpose of this study was to evaluate a rapid cardiac ultrasound assessment performed by trained non-expert sonographers integrated into the advanced cardiac life support (ACLS). MATERIAL AND METHODS This study was prospectively performed in 179 patients (104 males and 75 females) who underwent cardiopulmonary resuscitation (CPR) in an emergency department (ED) during two calendar years (2013 and 2014). Two senior doctors, who had received emergency cardiac ultrasonography training, performed cardiac ultrasound through the apical, subxiphoid, or parasternal windows. Ultrasound evaluation and pulse controls were performed simultaneously. SPSS 18.0 was used for statistical analysis. RESULTS A total of 63.7% (114) of the cardiopulmonary arrest incidents occurred out of the hospital. Only 13 patients had a femoral pulse during the initial evaluation, while 166 showed no femoral pulse. Initial monitoring showed a regular rhythm in 53 patients, ventricular fibrillation in 18 patients, and no rhythms in 108 patients. The first evaluation with ultrasound detected an effective heart rate in 26 patients and ventricular fibrillation in 14 patients, while no effective heart rate was observed in 139 patients. In addition, ultrasound revealed pericardial tamponade in seven patients and right ventricular enlargement in four cases. Global hypokinesia was detected in four patients and hypovolemia was observed in another four patients. CONCLUSION The use of real-time ultrasonography during resuscitation with real-time femoral pulse check can help facilitate the distinguishing of pea-type arrest, ascertain the cause of the arrest, infer a suitable treatment, and optimize medical management decisions regarding CPR termination.

Patient and relative complaints in a hospital emergency department: a 4-year analysis

Bulgular Sonuclar, dort yilda tibbi bakim, personel tutumu, bekleme suresi ve mali sebeplerle ilgili acil servise karsi yapilmis 54 sikâyetin oldugunu ortaya cikardi. Şikâyetcilerin, %75.9’u (n=41) erkek, %24.1’i (n=13) kadindi. Şikâyetlerin buyuk bir kismi (%29.7-%20.4) tibbi bakim ve davranis problemlerine bagliydi. Cogu sikâyet yesil kodlu hastalar icin yapilmisti (%55.6). Şikâyetlerin cogu acil doktorlari hakkindaydi (%38.9). Şikâyet sikligi; her 1.000 basvuruya 0.18 idi.

An assessment of oxidant/antioxidant status in patients with snake envenomation

Objective The aim of this study is to investigate the antioxidant status (TAS), oxidant status (TOS) and oxidative stress index (OSI) in patients with snake envenomation and to learn more about the pathophysiology of snake envenomation. Method Between May 2009 and October 2010, 47 patients were admitted to our emergency department with snake bites, and as a control group 20 healthy volunteers were enrolled in this study. Serum, plasma, and erythrocyte components were prepared for all patients on admission and at the control after 1 month. Serum TOS/TAS levels were measured. Results No correlation was observed among age, gender and the levels of TAS, TOS and OSI. TAS, TOS and OSI levels were higher in snake envenomation patients upon arrival at the emergency department than in the healthy control group. Upon admission, all levels of patients with snake envenomation were higher than the control levels taken after 1 month. Conclusions Serum TAS, TOS and OSI levels increase in snake envenomation patients. The results obtained in this study indicate that the snake bite was associated with a shift to an oxidative state, and oxidative stress plays an important role in the pathophysiology of snake envenomation.

Prolonged bleeding due to a medicinal leech bite: another treatment method, primary suture.

Medicinal leeches have been used in the treatment of many diseases for thousands of years. A 25-year-old man presented to our emergency department with bleeding from right and left side of his neck. He had applied leeches10 h previously to both sides of his neck to treat acne. The bleeding was not controlled by applying pressure with sterile gauze upon the wounds. Homeostasis was achieved by primary suture under local anaesthesia. Prolonged bleeding can be seen following medical leech application. In such cases, bleeding can be controlled by primary suture.

Acute spontaneous spinal subdural haematoma presenting as paraplegia and complete recovery with non-operative treatment

Spontaneous spinal subdural haematoma (SSDH) with no underlying pathology is a very rare condition. Only 20 cases have been previously reported. It can be caused by abnormalities of coagulation, blood dyscrasia, or trauma, underlying neoplasm, and arteriovenous malformation. It occurs most commonly in the thoracic spine and presents with sudden back pain radiating to the arms, legs or trunk, and varying degrees of motor, sensory, and autonomic disturbances. Although the main approach to management is surgical decompression, conservative management is used as well. We report the case of a 57-year-old man who presented with sudden severe low back pain followed by rapid onset of complete paraplegia. Magnetic resonance imaging (MRI) revealed an anterior subdural haematoma from T9 to L1 with cord compression. Corticosteroid treatment was administered. The patient showed substantial clinical improvement after 7 days of bed rest and an intense rehabilitation programme. An MRI scan and a computed tomography angiogram did not reveal any underlying pathology to account for the subdural haematoma.