Coexistence of Brugada and Wolff Parkinson White syndromes: A case report and review of the literature.

A 31-year-old male patient presented with complaints of palpitations, dizziness, and recurrent episodes of syncope. A 12-lead electrocardiogram (ECG) revealed manifest ventricular preexcitation, which suggested Wolff Parkinson White syndrome. In addition, an incomplete right bundle branch block and a 3-mm ST segment elevation ending with inverted T-waves in V2 were consistent with coved-type (type 1) Brugada pattern. An electrophysiological study was performed, and during the mapping, the earliest ventricular activation with the shortest A-V interval was found on the mitral annulus posterolateral site. After successful radiofrequency catheter ablation of the accessory pathway, the Brugada pattern on the ECG changed, which prompted an ajmaline provocation test. A type 1 Brugada ECG pattern occurred following the administration of ajmaline. Considering the probable symptom combinations of these 2 coexisting syndromes and the presence of recurrent episodes of syncope, programmed ventricular stimulation was performed and subsequently, ventricular fibrillation was induced. An implantable cardioverter-defibrillator was implanted soon after.

The coexistence of Wolff-Parkinson-White syndrome (WPW) and atrioventricular nodal reentrant tachycardia (AVNRT).

Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common type of reentrant paroxysmal supraventricular tachycardia that occurs in the presence of dual AV nodal physiology. Wolff-Parkinson-White (WPW) syndrome is another type of supraventricular tachycardia characterized by short PR intervals, delta waves and wide QRS complexes on the surface electrocardiogram (ECG), reflecting atrioventricular pre-excitation. Uncommonly, AV nodal reentry and accessory pathways can coexist. In this case report, we present a patient who had frequent episodes of palpitation and syncope and recently presented to the emergency department (ED) with the complaint of dizziness. We performed successful radiofrequency (RF) catheter ablation of mitral annulus posterolateral accessory pathway and AVNRT which was the cause of the second tachycardia induced during the same session.

Comparison of Conventional Radiography and Digital Computerized Radiography in Patients Presenting to Emergency Department.

OBJECTIVES: To compare the differences between conventional radiography and digital computerized radiography (CR) in patients presenting to the emergency department. METHODS: The study enrolled consecutive patients presenting to the emergency department who needed chest radiography. Quality score of the radiogram was assessed with visual analogue score (VAS-100 mm), measured in terms of millimeters and recorded at the end of study. Examination time, interpretation time, total time, and cost of radiograms were calculated. RESULTS: There were significant differences between conventional radiography and digital CR groups in terms of location unit (Care Unit, Trauma, Resuscitation), hour of presentation, diagnosis group, examination time, interpretation time, and examination quality. Examination times for conventional radiography and digital CR were 45.2 and 34.2 minutes, respectively. Interpretation times for conventional radiography and digital CR were 25.2 and 39.7 minutes, respectively. Mean radiography quality scores for conventional radiography and digital CR were 69.1 mm and 82.0 mm. Digital CR had a 1.05 TL cheaper cost per radiogram compared to conventional radiography. CONCLUSIONS: Since interpretation of digital radiograms is performed via terminals inside the emergency department, the patient has to be left in order to interpret the digital radiograms, which prolongs interpretation times. We think that interpretation of digital radiograms with the help of a mobile device would eliminate these difficulties. Although the initial cost of setup of digital CR and PACS service is high at the emergency department, we think that Digital CR is more cost-effective than conventional radiography for emergency departments in the long-term.

[Impact of the practice of "Extended Focused Assessment with Sonography for Trauma" (e-FAST) on clinical decision in the emergency department]. / Acil serviste "Genisletilmis Acil Travma Ultrasonografisi" uygulamalarinin klinik karar üzerine etkisi.

BACKGROUND: We aimed to show the sensitivity of Extended Focused Assessment with Sonography for Trauma (e-FAST) for detection of pneumothorax, hemothorax and intraabdominal injury. We also investigated the relationship between e-FAST and need for invasive treatment. METHODS: This study included patients who experienced multiple trauma. The emergency physician, who had no clinical information about the patient, performed e-FAST. Findings on a supine chest X-ray and invasive interventions were recorded. The results of abdomen and thorax computed tomography (CT) were reviewed (the size of the pneumothorax was scored). RESULTS: Compared with CT, the sensitivities of e-FAST for intraabdominal injury and hemothorax were 54.5% and 71%, respectively. The patients with hemothorax and intraabdominal injuries were not identified with e-FAST, didn't need for invasive intervention. Pneumothorax diagnosis was established in 27 patients with e-FAST (sensitivity 81.8%) from among 33 (30.8%) pneumothorax patients. According to the grading on CT, pneumothoraces less than 1 cm in width and not exceeding the midcoronal line in length were not identified. e-FAST was positive for all patients performed with tube thoracostomy. CONCLUSION: e-FAST can be used with high sensitivity for determination of pneumothorax requiring invasive procedure. It has low sensitivity in the diagnosis of intraabdominal injury and hemothorax; however, e-FAST can predict the need for invasive procedures.

Are emergency department visits really a teachable moment? Smoking cessation promotion in emergency department.

OBJECTIVE: To compare the effectiveness of smoking cessation counseling in the emergency department (ED) versus in outpatient clinics (OCs) setting. METHODS: Over a 3-month period, smokers and recent quitters presenting to ED or OCs were questioned about their smoking habits and desire to quit. They also completed the Fagerstrom Test for Nicotine Dependence (FTND) questionnaire and Prochaska's stages of change (PSC) survey. Standardized 5 min counseling session was carried out, and stop smoking pamphlet and phone number of the hospital's smoking cessation unit were given. One month after initial counseling, patients were telephoned, FTND, PSC, desire to quit, and daily cigarette consumption were asked. Data from those unable to be contacted within 6 weeks were excluded from analysis. RESULTS: Of the 392 patients (197 ED, 195 OC) counseled initially, 340 (87%) were reached for telephone follow-up. Counseling was effective in both groups: FTND and PSC scores had improved, and daily cigarette consumption decreased significantly (17.17-12.49 cigs/day; P=0.000). Smokers counseled in the ED were found more inclined to stop smoking compared with smokers who counseled in OCs, after 1 month of the intervention (95% confidence interval=14.7-7.5%; P=0.051). Only one patient (0.6%) from the ED and 10 (6.6%) from the OC attended the smoking cessation program. CONCLUSION: ED-based counseling for smoking cessation was as effective as that performed in the OC setting. Referral of smokers from the ED to a smoking cessation program was unsuccessful in our patient population.