Topical Ketoprofen Versus Placebo in Children Presenting With Ankle Sprain to the Emergency Department: A Randomized Controlled Study.

OBJECTIVE: Despite the favorable data concerning topical agents use in outpatient clinics, they are not commonly in emergency departments (EDs). The present study aimed to compare the effect of 2.5% topical ketoprofen (gel form) to placebo in children presenting with ankle sprain to the ED. STUDY DESIGN: Children between 7 and 18 years old presenting with ankle sprain composed the study population. Study patients were randomized into 2 study arms: 2.5% ketoprofen gel and placebo administered in a 5-cm area locally. Pain improvements at 15 and 30 minutes were measured by visual analog scale. RESULTS: Median pain reductions at 15 minutes for ketoprofen and placebo groups were 27.5 (16-39) and 5 (4-10), respectively. Median changes in pain intensity at 30 minutes for ketoprofen and placebo gel groups were 48 (43-52) and 9 (6-16), respectively. When compared 2 arms for the pain improvement at 15 and 30 minutes, the differences between 2 study drugs were 20 (13-28) and 35 (29-41), respectively. There were 7 (12.7%) rescue drug needs in the placebo group and 1 (1.7%) in the ketoprofen group (difference, 10.9%; 95% confidence interval, -6% to 7%; P = 0.83). There were no adverse effects in either group. CONCLUSIONS: Ketoprofen gel is superior to placebo in ceasing pain in children presenting with ankle sprain to the ED with a high safety profile.

Intravenous Dexketoprofen versus Intravenous Paracetamol for Dysmenorrhea: A Randomized Controlled Trial

BACKGROUND: Dysmenorrhea is one of the most common acute pain disorders among women of reproductive age. AIMS: To compare the effects of IV paracetamol with dexketoprofen in patients presenting with primary dysmenorrhea to the emergency department. STUDY DESIGN: Randomized controlled trial. METHODS: Patients over 18 years old presenting with pelvic pain related to menstruation were eligible for the study. Study patients received 1 g paracetamol or 50 mg dexketoprofen in 100 mL normal saline with a 4-5 minute infusion via the intravenous route. Pain intensity was measured by a visual analog scale at 15 and 30 minutes. Patients were randomized and assigned to either of two study arms via sealed envelopes. Study drugs were identical in color, and thus both personnel and patients were blinded to the study drug. The dexketoprofen group comprised 49 patients, and the paracetamol group had 50 patients in the final analysis. RESULTS: The mean age of the study subjects was 20.9±2.5 and the mean duration of the pain was 1.9±1.7 (median: 1, interquartile range: 1 to 2) hours. Both dexketoprofen (median change: 33, 95% CI: 24 to 38) and paracetamol (median change: 21, 95% CI: 12 to 32) effectively reduced the pain at 15 minutes, which was repeated at 30 minutes (median change: 63, 95% CI: 57 to 65 vs 55.5, 95% CI: 50 to 59, respectively). Pain improvement in the dexketoprofen group was better than in the paracetamol group at 15 (median difference: 8, 95% CI: 0 to 16, p=0.048) and 30 (median difference: 6, 95% CI: 1 to 12, p=0.028) minutes, which was statistically significant but not clinically significant. CONCLUSION: Dexketotoprofen has a better visual analogue scale score that is not clinically relevant compared to paracetamol.

Diagnostic Value and Effect of Bedside Ultrasound in Acute Appendicitis in the Emergency Department.

OBJECTIVE: Early and accurate diagnosis of acute appendicitis (AA) with ultrasound (US) can minimize the morbidity and mortality of the patients. In this regard, US can help emergency physicians (EPs) in the diagnosing process and clinical decision making for AA. Therefore, we primarily aimed to evaluate the effectiveness of point-of-care US (POCUS) in clinical decision making of EPs for the diagnostic evaluation for AA in the emergency department (ED). METHODS: The study sample consisted of patients aged > 18 years who presented to the ED with abdominal pain and underwent diagnostic evaluation for AA. All patients were examined initially with POCUS by EPs and then with radiology-performed US (RADUS) by radiologists. Pre- and post-POCUS median diagnostic certainty values (MDCVs) for AA were determined with visual analog scale (VAS) scores (0 = not present, 100 = certainly present) by POCUS performers. Definitive diagnoses were determined by surgery, pathologic evaluation of appendectomy specimens, or clinical follow-up results. The sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) for POCUS and RADUS together with pre- and post-POCUS VAS scores for MDCVs were compared. RESULTS: A total of 264 patients were included into the final analysis and 169 (64%) had a diagnosis of AA. The sensitivity, specificity, PLR, and NLR of US examinations were 92.3% (95% confidence interval [CI] = 87.2%-95.8%), 95.8% (89.5%-98.8%), 21.9 (8.4-57.2), and 0.08 (0.05-0.1) for POCUS and 76.9% (69.8-83%), 97.8% (84.9-99.7%), 36.4 (9.25-144.3), and 0.24 (0.18-0.31) for RADUS, respectively. Pre-POCUS and post-POCUS VAS scores for MDCVs were 60 (interquartile range [IQR] = 50-65) and 95 (IQR = 20-98), respectively (p = 0.000). CONCLUSION: Point-of-care ultrasonography, when performed in ED for the diagnosis of AA, has high sensitivity and specificity and had a positive impact on the clinical decision making of EPs.

Adropin levels and target organ damage secondary to high blood pressure in the ED.

BACKGROUND: High blood pressure is still a challenge for emergency physicians to discern the patients that require further analysis to establish the existence of acute hypertensive target organ damage (TOD). The present study aimed to reveal that adropin levels are useful for detecting TOD in patients presenting with high blood pressure. METHODS: Patients presenting with a blood pressure of more than 180/110 mm Hg were enrolled into the study. After a resting period of 15 minutes, patients' blood pressures were measured thrice at 5-minute intervals while the patients were sitting on a chair, and the average of these measurements was accepted as the baseline value. Blood samples were obtained for either adropin levels or possible TOD during the emergency department admission. RESULTS: A total of 119 patients were included in the study. The mean systolic and diastolic blood pressures of study patients were 204.8±23.2 and 108.3 ± 10.3, respectively, and 42% (n = 50) of the patients had TOD. Although the adropin levels were similar between the patients with or without TOD (TOD group = 195 pg/mL, interquartile range [IQR]: 178-201; no-TOD group = 196 pg/mL, IQR: 176-204 [P = .982]), it is significantly higher in normotensive patients (normotensive group = 289 pg/mL, IQR: 193-403) compared with the hypertensive ones (P < .001). CONCLUSIONS: Despite the significantly higher levels of adropin in normotensive patients compared with hypertensive ones, adropin could not be used as a decision tool for detecting TOD in patients presenting with high blood pressure to the emergency department.

The value of point-of-care ultrasound for detecting nail bed injury in ED.

OBJECTIVE: The aim of this study is to detect the value of point-of-care ultrasound (POCUS) for diagnosing a nail bed injury and fracture of distal phalanx in patients presenting with distal finger trauma to the emergency department (ED). METHODS: Patients, 18 to 65 years old, presenting with a blunt trauma of distal finger and diagnosed with subungual hematoma were eligible for the study. Subungual hematoma extending over more than 50%, fracture of distal phalanx, and disruption of periungual tissue or nail integrity were accepted as the indications for nail bed inspection. All the study patients underwent POCUS to detect the existence of a distal phalanx fracture or nail bed injury. X-ray was also obtained from all the patients. RESULTS: Nail bed was visualized in 45 patients. Squeezing and crush injury were the most reported trauma mechanism in study patients (66.7%). The sensitivity and specificity of POCUS in detecting nail bed injury were 93.4% (95% CI, 80%-99%) and 100% (95% CI, 74%-100%), respectively. The sensitivity was 100% (95% CI, 79%-100%), and specificity was 98.4% (95% CI, 91%-100%) for distal phalanx fracture. CONCLUSION: Point-of-care ultrasound is a promising tool in detecting the nail bed injury and distal phalanx fractures in patients presented with distal finger trauma. Further studies with bigger sample size are needed to reveal the diagnostic ability of POCUS before using it regularly in the ED.

Topical Ketoprofen Versus Placebo in Treatment of Acute Ankle Sprain in the Emergency Department.

BACKGROUND: Topical agents have been shown to be effective in soft tissue injuries and commonly used in outpatient clinics. However, the data regarding topical agents in the emergency department is insufficient, and they are not used often in the emergency department setting. The present study aimed to compare the effect of 2.5% topical ketoprofen (gel form) to placebo in patients presenting with ankle sprain to the emergency department. METHODS: Patients presenting with ankle sprain composed the study population. Study patients were randomized into 2 study arms: 2.5% ketoprofen gel and placebo administered over a 5-cm area locally. Pain alleviation was measured by visual analog scale at 15 and 30 minutes. A total of 100 patients were included in the final analysis. RESULTS: The median pain reduction in ketoprofen and placebo groups at 15 minutes was 27 (19.8-33.4) and 9 (7.6-17), respectively. The median pain reduction at 30 minutes for both groups was 42 (36-50.8) and 20 (17.6-24.4), respectively. Pain improvement either at 15 minutes (median difference: 16 [9-22]) or 30 minutes (median difference: 21 [15-27]) was better in the ketoprofen group than placebo. There were no adverse effects in either group. CONCLUSION: Ketoprofen gel was superior to placebo at 30 minutes in alleviating pain secondary to ankle sprain in the ED with a high safety profile. Further studies are needed concerning the effect of ketoprofen gel for long-term effects. LEVEL OF EVIDENCE: Level I, high quality prospective randomized study.

Ketoprofen gel improves low back pain in addition to IV dexketoprofen: a randomized placebo-controlled trial.

OBJECTIVE: Oligoanalgesia is common in emergency departments (EDs), and pain management is of concern for ED physicians. The aim of this study was to reveal the effect of ketoprofen gel in patients presenting with mechanical low back pain to the ED. METHOD: All the study patients received intravenous dexketoprofen additional to study drugs. After dexketoprofen, 2 g of 2.5% ketoprofen gel or placebo was administered to the site with pain and tenderness. Pain relief at 15 and 30 minutes was measured by visual analog scale scores. Rescue drug need and adverse effects were also recorded. RESULTS: A total of 140 patients were enrolled into the study. The mean age of the study patients was 35±12, and 56% (n=79) of them were male. The mean pain reduction at 30 minutes was 52±18 for ketoprofen gel and 37±17 for placebo, and ketoprofen gel was better than placebo at 30 minutes (mean difference, 16 mm; 95% confidence interval, 10-21). Ten patients (14%) in the placebo group and 2 patients (3%) in the ketoprofen gel group needed rescue drug (P=.35). CONCLUSION: Ketoprofen gel improves pain in patients presenting with mechanical low back pain to ED at 30 minutes in addition to intravenous dexketoprofen when compared to placebo.

Serum S100B as a Surrogate Biomarker in the Diagnoses of Burnout and Depression in Emergency Medicine Residents.

OBJECTIVES: Burnout syndrome is recognized as a major global problem among emergency healthcare workers as it causes prevalent fatigue, job separations, and disappointment. The objective of this study was to investigate the relationship of the glial marker S100B in sera of emergency physicians with burnout syndrome and depression. METHODS: This was a prospective observational study of emergency medicine residents in three distinct university-based departments of emergency medicine. S100B levels were measured before and after the shifts. In addition, the resident completed the Maslach Burnout Inventory (MBI) and the Beck Depression Inventory (BDI) prior to starting the shift. S100B levels were compared to the occurrence of burnout syndrome and depression as measured by the MBI and BDI. RESULTS: Forty-eight of 53 emergency medicine residents actively working in the three university-based EDs participated in the study. The majority of the sample had BDI scores compatible with severe depression (n = 37, 77.1%). The median scores of MBI for emotional exhaustion, depersonalization, and personal accomplishment were 29 (interquartile range [IQR] = 25 to 33), 14 (IQR = 12 to 18), and 26.5 (IQR = 22 to 31), respectively. S100B levels were found to correlate best with scores of BDI and emotional exhaustion in burnout syndrome. The difference between median S100B levels recorded in the residents with severe depression and moderate depression was found statistically significant (median [IQR] = 150 [145 to 151] vs. 135 [128 to 140]; p = 0.0005). This is also true for S100B levels detected before and after night shifts (median [IQR] = 146 [136.5 to 153.2] and 149.5 [139-158], respectively; difference = 3, 95% confidence interval = 2 to 4 [p = 0.001]). CONCLUSIONS: S100B levels correlate with depression scores and emotional exhaustion in burnout syndrome. The findings suggest that S100B can be used as a marker to screen emergency medicine residents and detect individuals with high risk for depression and burnout syndrome.

Comparison of intravenous pantoprazole and ranitidine in patients with dyspepsia presented to the emergency department: a randomized, double blind, controlled trial.

BACKGROUND: This study aimed to compare pantoprazole, a proton-pomp inhibitors (PPIs), and ranitidine, a H2 receptor antagonists (H2RA), in ceasing dyspeptic symptoms in the emergency department (ED). METHODS: This randomized, double-blinded study compared the effectiveness of 50 mg ranitidine (Ulcuran(®)) and 40 mg pantoprazole (Pantpas(®)), given in a 100 mL saline solution by an intravenous rapid infusion within 2-4 minutes in patients with dyspepsia presented to the ED. Pain intensity was measured at baseline, 30 and 60 minutes after the drug administration. RESULTS: A total of 72 patients were eligible for the study. Of these patients, 2 were excluded from the study because the initial visual analogue scale (VAS) scores were under 20 mm and 4 were excluded from the statistical analysis because of being diagnosed as having other causes of epigastric pain despite being allocated to one of the study groups. Thirty-three patients in the pantoprazole group and 33 patients in the ranitidine group were analyzed ultimately. The mean age of the patients was 36.6±15 years, and 26 (39.4%) patients were male. Both of the groups reduced pain effectively at 30 [27.6±28 (18 to 37) vs. 28.3±23 (20 to 37), respectively] and 60 minutes [39.6±39 (26 to 53) vs. 42.3±25 (33 to 51), respectively]. There were 13 (39.4%) patients in the pantoprazole group and 8 (24.2%) patients in the ranitidine group who required additional drug at the end of the study (P=0.186). CONCLUSION: Intravenous pantoprazole and ranitidine are not superior to each other in ceasing dyspeptic symptoms at 30 and 60 minutes in the ED.

Chest X-rays in detecting injuries caused by blunt trauma.

BACKGROUND: The appropriate sequence of different imagings and indications of thoracic computed tomography (TCT) in evaluating chest trauma have not yet been clarified at present. The current study was undertaken to determine the value of chest X-ray (CXR) in detecting chest injuries in patients with blunt trauma. METHODS: A total of 447 patients with blunt thoracic trauma who had been admitted to the emergency department (ED) in the period of 2009-2013 were retrospectively reviewed. The patients met inclusion criteria (age>8 years, blunt injury to the chest, hemodynamically stable, and neurologically intact) and underwent both TCT and upright CXR in the ED. Radiological imagings were re-interpreted after they were collected from the hospital database by two skilled radiologists. RESULTS: Of the 447 patients, 309 (69.1%) were male. The mean age of the 447 patients was 39.5±19.2 (range 9 and 87 years). 158 (35.3%) patients were injured in motor vehicle accidents (MVA). CXR showed the highest sensitivity in detecting clavicle fractures [95%CI 78.3 (63.6-89)] but the lowest in pneuomediastinum [95%CI 11.8 (1.5-36.4)]. The specificity of CXR was close to 100% in detecting a wide array of entities. CONCLUSION: CXR remains to be the first choice in hemodynamically unstable patients with blunt chest trauma. Moreover, stable patients with normal CXR are candidates who should undergo TCT if significant injury has not been ruled out.

The reliability of national videos related to the kidney stones on YouTube.

OBJECTIVE: Kidney stones are one of the most common disorders of the urinary tract. With increasing awareness, a larger proportion of patients are seeking medical knowledge from the Internet. In present study, the features, reliability and efficacy of videos on YouTube related to the treatment of kidney stones were evaluated. MATERIAL AND METHODS: In December 2014, YouTube was searched using keywords "nephrolithiasis"; "renal calculi"; "renal stones"; and "kidney stones" for videos uploaded containing relevant information about the disease. Only videos in Turkish were included in the study. Two physician viewers watched each video and classified them as useful, partially useful and useless according to European Association of Urology (EAU) Guidelines. The source, length, number of views, number of favourable opinions, and days since uploaded date of the all videos were evaluated. RESULTS: A total of 600 videos were analysed The median length of videos was 6.7±10.4 (median: 3, IQR: 0.03-58) minutes. Each video was viewed at an average of 2368 (min: 11, max: 97133) times. Most of the videos (32.8%) were created by academicians and physicians. Nearly half (47.4%) of the videos were uploaded in 2014. The majority of the videos (62.5%) contained information for treatment. Percutaneous nephrolithotomy and ureterorenoscopy were the most common treatment modalities (32.8% and 28.0%, respectively ) in these videos. A statistically significant difference was not detected between view numbers and source of videos (p=0.87). However, there was a statistically significant difference between usefulness to the viewers and source of videos. Hospital -based videos were detected to be more useful (p=0.000). CONCLUSION: As a result, videos that would be prepared in internet environment by professional individuals or organizations in a way which would attract attention and be easily comprehended by the public could contribute to the knowledge and education of our society about the stone disease which is commonly seen in our country.

Point-of-care ultrasonography for the management of shoulder dislocation in ED.

OBJECTIVE: Point-of-care ultrasonography (POCUS) is an easily available and noninvasive tool without radiation exposure that is also gaining a broad range of use in emergency departments. The aim of this study is to evaluate the value of POCUS in the diagnosis of shoulder dislocation by comparing with plain radiography. METHODS: This prospective observational study with a convenience sampling was conducted in emergency departments of 2 hospitals. Patients older than 15 years with possible shoulder dislocation during the physical examination composed the study population. All the study patients underwent POCUS evaluation to detect a shoulder dislocation or fracture before radiography, and the POCUS procedure was also achieved after the reduction attempt. RESULTS: A total of 103 patients were enrolled in the study. The mean age of study subjects was 33.9±15 years, and 80.6% (n=83) of them were male. The sensitivity and specificity of POCUS in identifying dislocation were 100% (95% confidence interval [CI], 96%-100%) and 100% (95% CI, 48%-100%), respectively. POCUS also confirmed reduction in 93 of 94 patients with a specificity of 100% (95% CI, 96%-100%). POCUS has a sensitivity of 100% (95% CI, 63%-100%) for excluding a shoulder fracture but a specificity of 84.2% (95% CI, 75%-91%). CONCLUSION: Point-of-care ultrasonography is an effective tool to either rule in or rule out shoulder dislocation in the emergency setting. Furthermore, it is a robust sensitive tool for excluding fractures but with false-positive results.

Comparison of Intravenous Morphine Versus Paracetamol in Sciatica: A Randomized Placebo Controlled Trial.

OBJECTIVE: The objective was to compare intravenous morphine and intravenous acetaminophen (paracetamol) for pain treatment in patients presenting to the emergency department with sciatica. METHODS: Patients, between the ages of 21 and 65 years, suffering from pain in the sciatic nerve distribution and a positive straight leg-raise test composed the study population. Study patients were assigned to one of three intravenous interventions: morphine (0.1 mg/kg), acetaminophen (1 g), or placebo. Physicians, nurses, and patients were blinded to the study drug. Changes in pain intensity were measured at 15 and 30 minutes using a visual analog scale. Rescue drug (fentanyl) use and adverse effects were also recorded. RESULTS: Three-hundred patients were randomized. The median change in pain intensity between treatment arms at 30 minutes were as follows: morphine versus acetaminophen 25 mm (95% confidence interval [CI] = 20 to 29 mm), morphine versus placebo 41 mm (95% CI = 37 to 45 mm), and acetaminophen versus placebo 16 mm (95% CI = 12 to 20 mm). Eighty percent of the patients in the placebo group (95% CI = 63.0% to 99%), 18% of the patients in the acetaminophen group (95% CI = 10.7% to 28.5%), and 6% of those in the morphine group (95% CI = 2.0% to 13.2%) required a rescue drug. Adverse effects were similar between the morphine and acetaminophen groups. CONCLUSION: Morphine and acetaminophen are both effective for treating sciatica at 30 minutes. However, morphine is superior to acetaminophen.

The Validity of YouTube Videos on Pediatric BLS and CPR.

BACKGROUND: There are few data regarding the validity of cardiopulmonary resuscitation (CPR) and basic life support (BLS) videos on YouTube in the medical literature, and those that do are only analyzing adult CPR videos. The present study aimed to determine the reliability and accuracy of pediatric CPR and BLS videos as to whether they are consistent with the 2010 CPR guidelines. MATERIALS AND METHODS: YouTube was scanned in January 2015 using the key words "Pediatric CPR Pediatric BLS" without any filters. The raw data collected in the study included sources that uploaded the videos, the record time, the number of viewers in the study period, and inclusion of human or mannequins. Furthermore, the contents of the videos were evaluated as to whether they are consistent with the 2010 resuscitation guidelines. All videos were seen by two independent researchers (emergency physicians) and scored between 0 and 8. RESULTS: In total, 1,200 videos were evaluated regarding the exclusion criteria, which yielded 232 eligible ones. Most of the videos were found to be uploaded by individuals with unspecified credentials (34.1%). Of the videos, 15.5% have content inconsistent with the 2010 guidelines. The median score of all the videos are not high enough (5 [interquartile range (IQR), 4-7]), and only one-third of the videos have optimal quality with scores of 7 or 8. The downloaded number of videos compatible with guidelines was significantly higher relative to the videos not compatible with the guidelines (15,389 [IQR, 881-31515] versus 477 [IQR, 108-3,797); p = 0.0001). The videos downloaded more than 10,000 times had a higher score than the others (median scores of 7 and 5, respectively; p = 0.0001). CONCLUSIONS: Moderate numbers of YouTube videos purporting to be about pediatric life support have optimal quality, and few of them are perfect. Furthermore, YouTube videos uploaded by news programs with an insufficient quality have the highest download rates.

YouTube as a source of information on varicose veins.

BACKGROUND: There has been little investigation of videos related to varicose veins in Internet media. This study aimed to investigate the characteristics and scientific accuracy of the videos related to varicose veins which were uploaded to the youtube.com website. METHODS: The YouTube site was searched in October 2014 using the keywords varicose vein, varicose veins, and varicosis with no filter. The contents of the reviewed videos were assigned to three groups as useful, partly useful, and not useful by using the criteria including the scientific contents of the videos, contemporariness and accuracy of the insight, and presentation of the data particularly regarding the visual features. The statistical analysis was based only on the videos rated as 'useful.' RESULTS: In total, 1519 (84.4%) of 1800 videos evaluated were excluded. Many of the sources uploading videos to the website were healthcare professionals (32.7% n = 92). Regarding the source of the upload, those from official institutions/associations were viewed statistically significantly more often than videos uploaded by all others (p = 0.001). The rated usefulness was significantly higher for videos uploaded by official institutions/associations (100%) than those uploaded by others (p = 0.01). CONCLUSIONS: Official institutions/associations should be encouraged to produce and upload videos including up-to-date and comprehensive information regarding the disease. Likewise, additional search tools would be useful to locate videos uploaded by academic figures and institutions.

Intravenous dexketoprofen vs placebo for migraine attack in the emergency department: A randomized, placebo-controlled trial.

OBJECTIVE: Migraine is a leading headache etiology that frequently presents to the emergency department (ED). In the present study, we aimed to determine the efficacy of dexketoprofen in aborting migraine headaches in the ED. METHODS: This prospective, randomized, double-blind study was conducted in an ED of a tertiary care hospital using allocation concealment. Patients were allocated into two arms to receive the study drug; 50 mg dexketoprofen in 50 ml saline and 50 ml saline as placebo. Change in pain intensity was measured by the visual analog scale at baseline, both at 30 and 45 minutes after the study medication was administered. Rescue medication requirement and pain relapse were also recorded by a telephone follow-up at 48 hours. RESULTS: A total of 224 patients (112 in each group) were included into the final analysis. Mean age of the study participants was 37 ± 11 (SD) and 25% (n = 56) of them were male. The median pain improvement at 45 minutes for patients receiving dexketoprofen was 55 (IQR: 49 to 60) and 30 (IQR: 25 to 35) for those receiving placebo. The mean difference between the two groups at 45 minutes was 21.4 (95% CI: 14.4. to 28.5). Rescue drugs were needed in 22.3% of patients who received dexketoprofen compared to 55.4% in patients who received placebo (dif: 33.1%; 95% CI: 20% to 45%). There were no adverse events reported in either group during the study period. CONCLUSION: Intravenous dexketoprofen is superior to placebo in relieving migraine headaches in the ED. It may be a suitable therapy with minimum side effects in patients presenting with a migraine headache to the ED.

Prognosis of Critically ill patients in the ED and value of perfusion index measurement: a cross-sectional study.

OBJECTIVE: Critically ill patients have high mortality and admission rates requiring early recognition and a rapid management. In the present study, we evaluated the prognostic parameters in these patients and the value of perfusion index measurement as a novel tool for accomplishing emergency department (ED) triage. METHODS: Seven hundred seventy patients admitted to the critical care area of the ED in a month composed the study population. Perfusion index and vital signs (blood pressure, pulse rate, body temperature, pulse oximeter, and respiration rate) of the study patients were recorded to the study form. The communication data, admitting time, comorbidities, capillary refilling time, and blood gas analysis findings if obtained were recorded. Outcome of patients at the end of the ED period such as discharge, admission to the hospital, and death were also recorded. Outcome of patients at 15th and 30th days was identified by telephone call follow-up or from hospital records. RESULTS: Two hundred seventy-eight patients (36.1%) were admitted to the hospital, 454 patients (59%) were discharged, 3 patients (0.4%) died in the ED, 25 patients (3.2%) were transferred to another hospital, and 10 patients (1.3%) refused treatment and left the ED. Sixty patients (7.8%), 39 (5.1%) of whom had died in 15 days' period, were dead at the end of 30-day follow-up period. Respiratory rate and pulse oximetry were significant parameters in hospital admission. Systolic blood pressure, diastolic blood pressure, pulse rate, respiratory rate, pulse oximetry, lactate levels in blood gas analysis, and ED length of stay were significant variables in 30-day mortality rate. Patients who were admitted to the hospital had higher rates of fever and diabetes. Patients who had died in the 30-day follow-up period had higher rates of diabetes and malignancy. In logistic regression analysis, the predictors of hospital admission were hypotension, fever, and pulse oximetry, whereas the predictors of 30-day mortality were systolic blood pressure, respiratory rate, pulse oximetry, and presence of malignancy. CONCLUSIONS: Perfusion index as a novel triage instrument was found to be an insignificant tool in predicting hospital admission and mortality of critically ill patients in the ED. However, diabetes and malignancy were found to be independent factors in determining the prognosis of these patients in addition to vital signs and should be considered by ED physicians either in triage field or inside the ED.

Ketamine may be related to minor troponin elevations in children undergoing minor procedures in the ED.

OBJECTIVE: Ketamine is a dissociative anesthetic agent that has an increased frequency of usage in the last years particularly in emergency departments. In the present study, we aimed to determine whether ketamine is related to myocardial injury in children undergoing minor procedures. METHOD: Children younger than 18 years undergoing procedural sedation secondary to minor trauma composed the study population. Patients were administered ketamine with a dose of 1.5 mg/kg via intravenous route. QT interval was measured by Bazett's formula, and QT dispersion was determined by taking the average of 3 different QT intervals. High-sensitive troponin levels were measured before and 3 hours after the ketamine administration. RESULTS: A total of 30 patients were included into the study. Study subjects had a median age of 2 years (interquartile range, 1-4 years). There were 2 patients among the study patients who had troponin elevations 3 hours after the ketamine administrations. High-sensitive troponin levels of these 2 at the time of preketamine, 3, 5, and 24 hours after the ketamine administration were as follows: 5, 29, 15, and 5 ng/L and 3, 44, 41, and 4 ng/L, respectively. There was no difference before and after the ketamine administration for the corrected QT intervals and QT dispersions. CONCLUSION: Ketamine may be related to minor troponin elevations in children undergoing procedural sedation without a permanent cardiac dysfunction.

Effect of harmless acute pancreatitis score, red cell distribution width and neutrophil/lymphocyte ratio on the mortality of patients with nontraumatic acute pancreatitis at the emergency department.

BACKGROUND: Harmless acute pancreatitis score (HAPS), neutrophile/lymphocyte ratio and red blood cell distribution width (RDW) are used to determine the early prognosis of patients diagnosed with nontraumatic acute pancreatitis in the emergency department (ED). METHODS: Patients diagnosed with acute pancreatitis (K 85.9) in the ED according to the ICD10 coding during one year were included in the study. Patients with chronic pancreatitis and those who had missing data in their files were excluded from the study. Patients who did not have computed tomography (CT) in the ED were not included in the study. RESULTS: Ultimately, 322 patients were included in the study. The median age of the patients was 53.1 (IQR=36-64). Of the patients, 68.1% (n=226) had etiological causes of the biliary tract. The mortality rate of these patients within the first 48 hours was 4.3% (n=14). In the logistic regression analysis performed by using Balthazar classification, HAPS score, RDW, neutrophile/lymphocyte ratio, age, diabetes mellitus and systolic blood pressure, the only independent variable in determining mortality was assigned as Balthazar classification (OR: 15; 95% CI: 3.5 to 64.4). CONCLUSIONS: HAPS, neutrophile/lymphocyte ratio and RDW were not effective in determining the mortality of nontraumatic acute pancreatitis cases within the first 48 hours. The only independent variable for determining the mortality was Balthazar classification.