Transcutaneous Electrical Nerve Stimulation (TENS) for the Treatment of Renal Colic in the ED: A Randomized, Double-Blind, Placebo-Controlled Trial.

STUDY OBJECTIVE: To determine the analgesic efficacy of TENS treatment in patients with renal colic in the emergency department (ED). METHODS: This double-blind, randomized controlled trial was conducted in a tertiary care ED. Patients with a definitive diagnosis of renal colic were assigned (1:1) as randomized to receive the real TENS with frequency 100 Hz, pulse width 200 microseconds, voltage 2 mA, or placebo with sham TENS. Pain intensity was measured using visual analog scales (VAS) at baseline, after 15 and 30th minutes. RESULTS: A total of 100 patients were included in the final analysis: 50 patients treated with real TENS and 50 patients treated with sham TENS. VAS scores in both groups were similar at baseline. The mean reduction in VAS score at 15 min was 33.3 ± 17.6 (95% Confidence interval (CI): 28.3 to 38.3) for the real TENS group and 14.9 ± 11.6 (95% CI 11.6 to 18.2) for the sham TENS group (mean difference: 18.4 (95% CI: 12.5 to 24.4, P < 0.0001). The mean reduction in VAS score at 30 min was 63.7 ± 21.1 (95% CI: 57.7 to 69.7) for the real TENS group and 14.9 ± 16.2 (95% CI: 19.5 to 10.3) for the sham TENS group (mean difference: 48.8, 95% CI: 41.4 to 56.3, P < 0.0001). Four patients (8%) in the real TENS group and 24 patients (48%) in the sham TENS group required the rescue medication after 30th minutes. CONCLUSIONS: TENS is effective for acute pain treatment in renal colic patients in the ED. TENS therapy could be a treatment option for renal colic.

Comparison of Intravenous Paracetamol, Dexketoprofen Trometamol, or Topical Lidocaine Use for Pain Relief in Scorpion Stings: A Placebo-Controlled, Randomized Study.

INTRODUCTION: After a scorpion sting, patients commonly present to hospitals with pain. Our study sought to compare the analgesic efficacy of IV paracetamol, IV dexketoprofen trometamol, topical lidocaine, and placebo in patients reporting pain after presenting with a history of scorpion sting. METHODS: This double-blind, randomized, placebo-controlled study was conducted in the emergency department of a tertiary hospital. Adult patients who presented with the complaint of pain after a scorpion sting and did not have systemic findings were randomly assigned to 1 of the following 4 groups: IV paracetamol, IV dexketoprofen trometamol, topical lidocaine, and placebo. The visual analog scale scores were measured at the time of presentation to the emergency department and at 30 and 60 min to determine the pain intensity. RESULTS: The study included 106 patients, of whom 30 were in the paracetamol group, 26 in the dexketoprofen trometamol group, 25 in the topical lidocaine group, and 25 in the placebo group. We did not find a different analgesic effect among the groups in the first 30 min (P=0.185). IV paracetamol, dexketoprofen trometamol, and topical lidocaine did not show different analgesic effects in the first 60 min (P>0.05). IV paracetamol and dexketoprofen trometamol were found to provide a more effective analgesia than the placebo at 60 min (P<0.05). The analgesic effects of topical lidocaine and placebo did not differ (P=0.330). CONCLUSIONS: IV paracetamol and IV dexketoprofen trometamol provided analgesia in the first 60 min, similar to topical lidocaine but superior to placebo.

Comparison of non-invasive CPAP with mask use in carbon monoxide poisoning.

BACKGROUND: Carbon monoxide (CO) is one of the major causes of poisoning worldwide. We aimed to investigate the efficacy of the continuous positive airway pressure (CPAP) use in CO poisoning. METHODS: After CO poisoning, one group of patients was treated with a non-rebreather mask (NRB) and another group using the CPAP mode of mechanical ventilation (CPAP). All patients received at least 90 minute treatment. The carboxyhemoglobin saturation (SpCO) levels of all patients were measured from the fingertips with a portable CO-oximeter at 0, 30, 60 and 90 min. The rates of changes in the serially measured SpCO values were obtained using the Wilcoxon signed-rank test. RESULTS: A total of 45 patients (24 in NRB and 21 in CPAP group) completed the study. The median initial SpCO levels were 24% (21-33) in NRB group, 25% (21-32) in CPAP group, with no statistically significant difference (p 0.323). At the 30th, 60th, and 90th minutes of treatment, significantly lower values were obtained from CPAP than NRB (p < 0.001). The COHb half-life was decreased significantly by CPAP [105(70-190) vs 45(30-120), p < 0.001]. In CPAP group, the fastest decline in the SpCO level was observed for the interval of 0-30 min [Median difference: 8(3-14), p < 0.001]. CONCLUSIONS: CPAP lowered the amount of CO in the blood faster than the mask; therefore, it may be effective in the treatment of CO poisoning.

Prevalence of attention deficit hyperactivity disorder (ADHD) in children presenting with foreign body ingestion.

BACKGROUND: Foreign body ingestion is a common condition in children. We aimed to compare the incidence of attention deficit hyperactivity disorder (ADHD) symptoms in children that ingested foreign bodies with healthy children. METHODS: The study group consisted of 3- to 17-year-old pediatric patients admitted to the emergency department after foreign body ingestion, and the control group was formed with children having similar demographic and cultural characteristics that presented to the same department for non-traumatic causes. After initial intervention and stabilization, we administered the Conners' Parent Rating Scales-Revised (CPRS-R) to both groups. RESULTS: The study group consisted of 53 patients with a mean age of 7.83 ±â€¯4.36 and the control group comprised 47 children with a mean age of 7.72 ±â€¯3.48 years. There were no statistically significant differences between the study and control groups in terms of age, gender, and parental education levels (p > 0.05 for each). The foreign objects most ingested by children were coins (32.1%), followed by needles (15.1%) and beads (9.4%), and all the patients recovered without complications and were discharged. All the CPRS-R subscale scores were significantly higher in the study group than in the control group (p < 0.001). The parental education levels of the study group were not significantly correlated with DSM-IV hyperactivity-impulsivity and DSM-IV total. CONCLUSION: We found that the incidence of ADHD symptoms may be high in children referred to emergency services after accidentally ingesting foreign bodies.

Hoeing machine accident: a case report.

CONTEXT: Agricultural accidents are a prominent cause of mortality and morbidity in the literature despite few studies. The machines and equipments used in this sector frequently cause agricultural accidents. One of these, the hoeing machine, can cause tragic and severe injuries. ISSUE: We present a case of subtotal leg amputation that occurred after a hoeing machine accident in 2015 in Malatya, eastern Turkey. We monitored the patient and started initial therapies according to advanced trauma life support in the emergency service. However, his right leg was severely injured and had to be amputated. LESSONS LEARNED: Hoeing machine accidents lead to physical disabilities due to extreme injury and amputation.

Side Effects Related to BNT162b2 and CoronaVac Vaccine Requiring Emergency Department Visit.

Background Currently, the most effective method in the fight against coronavirus disease 2019 (COVID-19) is vaccination against the disease. However, there are hesitations among society concerning the safety and side effects of COVID-19 vaccines. We aimed to determine the observed side effects that require an emergency room visit after taking the BNT162b2 and CoronaVac vaccines. Methods This prospective observational study was conducted with patients who presented to the emergency department due to vaccine-related complications after COVID-19 vaccination. The patients' symptoms at the time of presentation, time from vaccination to the onset of symptoms, and dose of the vaccine administered were determined. In addition, the demographic characteristics of the patients, whether they had a history of COVID-19 infection, and their vital signs at the time of presentation were recorded. The variables were compared according to the type of vaccine administered. Results The study included 182 patients who presented to the emergency department over a 6-month period. It was determined that 166 of these patients (91.2%) had received the BNT162b2 vaccine and 16 (8.8%) had received the CoronaVac vaccine. The majority of the patients did not have a history of COVID-19 infection (70.3%), and most presented to the hospital with complications after the second dose (61%). The onset of vaccine-related symptoms was mostly within 1 to 12 hours (39%). The majority of patients (97.8%) were discharged from the emergency department. The most common symptoms after vaccination were fatigue ( n = 70), followed by muscle/joint pain ( n = 52), headache ( n = 33), and fever ( n = 32). The rate of dizziness was found to be statistically significantly higher in the CoronaVac vaccine group than in the BNT162b2 vaccine group ( p = 0.008). There was no statistically significant difference between the two vaccine groups in relation to the remaining symptoms ( p > 0.005). Conclusion There were no serious complications related to the BNT162b2 or CoronaVac vaccine. The most common symptom after both vaccines was fatigue; therefore, the BNT162b2 and CoronaVac vaccines can be safely administered.

Violence toward emergency physicians: A prospective-descriptive study.

BACKGROUND: The highest rate of workplace violence occurs in the health sector, although most cases remain unreported. Emergency services face the majority of these incidents for many reasons, such as the patient profile, long waiting time, and overcrowding. We aimed to determine the characteristics and causes of violence toward emergency physicians. METHODS: The acts of violence toward emergency physicians over a one-year period were prospectively recorded. After a violent incident took place, a third party separately interviewed the physician exposed to the violent behavior and the perpetrator who displayed this behavior. We examined the perpetrator's reasons for violence, their demographic characteristics, and the medical complaints of patients involved in such events to determine the characteristics and causes of violence. RESULTS: Of the violent acts investigated, 85.1% were verbal, and most were directed toward male doctors by the young male relatives of the patients. More than half of the violent acts occurred within the 15 minutes of presentation to emergency service (60.5%) and at off-hours (69.4%). Concerning the health insurance, 20.4% of the cases were covered by the free green card system, and a small number of the perpetrators of violence lived in rural areas (38.2%). The most common reason for violent behavior was the patients' or their relatives' dissatisfaction with the examination or treatment method (38.2%). CONCLUSIONS: Appropriate communication should be established with the patients, and they should be adequately informed about the treatments and interventions to be performed in order to prevent possible acts of violence.

Childhood horse and donkey bites; a single tertiary health center experience in a rural area.

BACKGROUND: The aim of this study was to examine the characteristics of patients presenting to a pediatric emergency department in a rural province of Turkey due to horse and donkey bites and to analyze whether these features differ from those of more common animal bites in rural areas. MATERIALS AND METHODS: The records of patients presenting to the pediatric emergency department of a tertiary hospital due to horse and donkey bites over a 3-year period were examined retrospectively. Demographic data, month of presentation, animal species involved (horse or donkey), the body area bitten, treatment applied to the wound site, whether tetanus and rabies vaccinations were administered, and whether or not antibiotics were prescribed on discharge from the emergency department were recorded from these files. RESULTS: The annual incidence of horse and donkey bites was determined as 7.8/100,000. Thirty-six patients, 24 (66.7%) boys and 12 (33.3%) girls, with a mean age of 95.6 ± 33.9 (48-190) months, were included in the study. Twenty-six patients (72.2%) were bitten by donkeys, and 10 (27.8%) by horses. Bites were most common in September (30.6%). The most commonly bitten areas were the back and/or upper extremities. Rabies vaccination was administered in all cases. Amoxicillin-clavulanic acid was prescribed in 28 (77.8%) cases. CONCLUSION: Horse and donkey bites are frequently observed in rural areas. The inhabitants of such areas should therefore be educated concerning horse and donkey bites. Health workers encountering such bites should behave in the same way as in more common animal bites in terms of patient management. Our results will be instructive for other developing countries similar to Turkey.

Evaluation of Factors Related to Mortality Caused by Firearm Injury: A Retrospective Analysis from Malatya, Turkey.

BACKGROUND: Firearm related injuries continue to increase throughout the world and they become the first or second cause of mortality in worldwide. The present study aimed to determine the factors that affect mortality in firearm injuries. METHODS: The patients which were admitted to emergency service between January 2011 and December 2015 due to firearm injuries, were reviewed from hospital records. The patients were evaluated in terms of their age, sex, event time, admission time, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), the reason of event, type of weapon, the region of the body that injured, department in which they were hospitalized, hospitalization duration and the relation between these parameters and mortality. RESULTS: A total of 174 patients (86.8% male, 13.2% female) were identified. The mean age of patients was 35.2 years and 30 patients (17.2%) died. Among the cases, 137 were attempted homicide (78.7%), 23 were accidents and the remaining 14 were suicides. The suicidal cases had significantly higher mortality rate than other causes (P=0.003). The most frequently used weapon was pistols (73.6%) and the events took place between 18.00 and 24.00 (36.2%) hours mainly. The injuries were mostly on extremities, however many of deaths were seen after head- neck injuries and the mortality rate of head and neck injuries was significantly higher than other regions (P<0.001). The mean of hospitalization duration was 9.1 days and it was 10.2 ± 11.7 days for survivors, 4 ± 7.3 days for died subjects. The hospitalization duration of died patients was significantly shorter than survivors (P=0.042). The GCS of died patients (4.4 ± 1.7) was significantly lower than those of survivors (13.3 ± 2.8) (P<0.001). The ISS score of died patients (49.7 ± 24.1) was significantly higher than those of survivors (13.6 ± 10.6) (P<0.001). CONCLUSION: It was determined that GCS, ISS, length of hospitalization, injuries due to suicide attempt, the department of hospitalization, injuries to head-neck regions affected mortality significantly.

Steel rod impalement injuries involving the spine: A case report and literature review.

Steel rod impalements, mostly experienced by construction workers due to falls from heights, are known entities, but only some individuals unfortunately suffer spinal cord injury. The management of the spine involved injuries is challenging due to the lack of guidelines, various clinical presentations resulting from different trajectories, and high risk of infection. We report a case of steel rod impalement involving the spinal canal and review the literature to enhance the management strategies and to identify the risk factors for possible complications, particularly infection. A 37-year-old male construction worker presented to our emergency department due to falling onto a concrete reinforcing steel rod that penetrated through his perineum to the L4 vertebra. Examination revealed paralysis and sensory loss of the left foot. The rod was removed in the operating room (closed removal) under general anesthesia, followed by laparotomy. Rectal laceration was primarily repaired, and colostomy was performed. In a separate session, laminectomy was performed. At 3 months post-discharge, the patient was ambulatory with armrest based on the same motor examination performed on presentation This case is a good example of careful preoperative planning, multidisciplinary involvement, and appropriately sequenced interventions resulting in an acceptable outcome for an injury with high morbidity and mortality and demonstrates the feasibility and potential benefits of closed removal of the rod in an operating room just before laparotomy. The presence of an intestinal perforation increases the infection risk, but infections can still be prevented in this setting. Shorter time intervals between the incidence and surgery may reduce the infection rate.

Falls from height: A retrospective analysis.

BACKGROUND: Emergency services manage trauma patients frequently and falls from height comprise the main cause of emergency service admissions. In this study, we aimed to analyse the demographic characteristics of falls from height and their relationship to the mortality. METHODS: A total of 460 patients, who admitted to the Emergency Department of Inonu University between November 2011 and November 2014 with a history of fall from height, were examined retrospectively. Demographic parameters, fall characteristics and their effect to mortality were evaluated statistically. RESULTS: The study comprised of 292 (63.5%) men and 168 (36.5%) women patients. The mean age of all patients was 27±24.99 years. Twenty-six (5.6%) patients died and the majority of them were in ≥62 years old group. The highest percentage of falls was at 0-5 years age group (28.3%). People fell mainly from 1.1-4 metres(m) level (46.1%). The causes of falls were ordered as unintentional (92.2%), workplace (8.1%) and suicidal (1.7%). Skin and soft tissue injuries (37.4%) were the main traumatic lesions. CONCLUSION: Age, fall height, fall place, lineer skull fracture, subarachnoidal hemorrhage, cervical fracture, thoracic vertebra fracture and trauma scores had statistically significant effect on mortality. The casualties died because of subarachnoid hemorrhage mostly.

Unexpected lumbar abscess due to scarification wet cupping: a case report.

OBJECTIVE: This case presents a rare cause of lumbar abscess. METHODS: A 51-year-old male patient was admitted to the emergency department with a complaint of lumbar pain. Spinal magnetic resonance imaging revealed a lumbar abscess. RESULTS: The abscess was treated with drainage of the abscess and antibiotic. CONCLUSION: Scarification wet cupping therapy should be taken into consideration as a rare cause of lumbar abscesses in patients who present with skin findings indicative of scarification. Scarification wet cupping therapy practitioners must pay attention to hygienic measures.