Concomitant Substance Use Increases the Toxic Effect of synthetic cannabinoid (Bonsai): A Prospective Study.

OBJECTIVE: In this study, we aimed to contribute to the literature by evaluating bonsai and additional drugs. MATERIALS AND METHODS: This prospective study was conducted on 217 patients who admitted to the emergency department (ED) with bonsai intake between December 20, 2014 and January 1, 2016, according to the patient history obtained from the patients. While 168 patients with negative urinary metabolites results were excluded from the study, 49 patients with positive urinary metabolites were included in the study. Patients were divided into two groups. The first group consisted of patients with only bonsai intake and the second group consisted of patients with bonsai and concomitant drug intake. The groups were compared in terms of symptoms, findings, blood gas values, duration of the symptoms, discharge time, hospitalization, and mortality rate. Data were analyzed using the Chi-square, the Fisher's exacttest, the Student t-test, and the Mann-Whitney U test. Data were evaluated at the 95% confidence interval. P<0.05 was considered statistically significant. RESULTS: The mean age of 49 patients included in the study was 26.7±8.9 years and 91.8% (n=45) of the patients were male. Concomittant drug intake was identified in 69.4% of patients. Concomitant drug use was as follows: cocaine (20.4%, n=10), amphetamines (14.3%, n=7), methamphetamines (8,2%, n=4,) tetrahydrocannabinol (32.7%, n=16), opiates (18.4%, n=9) and alcohol (30.6%, n=15). On admission, Glasgow Coma Score (GCS) of the bonsai with additional substance group was significantly higher (p=0,003). The most common symptom was palpitations (tachycardia) (75.5%, n=37). There were no patients hospitalized in Only Bonsai group (p=0,020). The median time to remission of symptoms and median follow-up time of the patients in the emergency room were 3 hours and 6 hours, respectively. Remission time of the symptoms and hospitalization rates were higher in patients with concomittant drug intake (p <0.05) Conclusion: While the bonsai intake alone is not considered mortal to the patients and most of them can be discharged from the ED after signs and symptoms disappear, concomitant drug use can increase the toxic effects of bonsai intake. That is why follow-up of patients taking concomitant drug and the treatment process should be carried out more carefully.

Comparison of ultrasonography and computed tomography in the determination of traumatic thoracic injuries.

OBJECTIVE: In this study, the accuracy of bedside thoracic ultrasonography (TUSG) performed by emergency physicians with patients in the supine position was compared with that of thoracic computed tomography (TCT) for the determination of thoracic injuries due to trauma. METHODS: Patients who suffered the multiple traumas, whose thoracic trauma was identified on physical examination or TCT imaging were included in the study. TUSG was performed following a physical examination by the emergency physician who managed the trauma patient. Subcutaneous emphysema, pneumothorax, pulmonary contusions (PCs), hemothorax, pericardial effusion and tamponade, sternal and clavicular fractures and rib fractures were identified by TUSG. TCT imaging was performed after the ultrasonography examination was completed. RESULTS: Eighty-one patients were included in the study. TCT scans showed subcutaneous emphysema in 16 (19.8%) patients, pneumothorax in 21 (25.9%), PCs in 27 (33.3%), hemothorax in 20 (24.7%), sternum and clavicular fractures in 6 (7.4%) and rib fractures in 21 (25.9%). The sensitivity and specificity of ultrasonography varied for detecting the following pathologies: subcutaneous emphysema (56% and 95%), pneumothorax (86% and 97%), hemothorax (45% and 98%), PCs (63% and 91%), sternal fractures (83% and 97%), clavicular fractures (83% and 100%) and rib fractures (67% and 98%), respectively. CONCLUSION: In conclusion, ultrasound was found to be highly specific but only moderately sensitive for the identification of thoracic injuries.

The comparison of point-of-care ultrasonography and radiography in the diagnosis of tibia and fibula fractures.

OBJECTIVE: We aimed to compare the efficacy of Point-of-care ultrasonography (POCUS) with radiography in the diagnosis of tibia fracture (TF) and fibula fracture (FF), and determation of fracture characteristics. METHODS: Patients aged 5-55 years who were admitted to ED due to low-energy, simple extremity trauma, who had a suspected TF and FF on physical examination were included in this prospective study. One physician performed POCUS examination. Other physician evaluated the radiography images. The obtained results were compared. RESULTS: A total of 62 patients were included in the study. TF was detected in 21 patients by radiography and in 24 patients by POCUS. FF was detected in 24 patients by radiography and in 25 patients by POCUS. Ten of the patients had both TF and FF. Compared with radiography, sensitivity, specificity, PPV and NPV of POCUS in the detection of TF were 100%, 93%, 88% and 100% (95% CI, 91-100%), respectively. Compared with direct X-ray imaging, sensitivity, specificity, PPV and NPV of POCUS in the detection of FF were 100%, 97%, 96% and 100% (95% CI, 96-100%), respectively. We determined that POCUS is also successful in detection of fracture features such as angulation, step-off, extension into the joint space that can determine the treatment decision. CONCLUSION: This study demonstrated that POCUS was found to be as successful as direct X-ray imaging in the diagnosis of TF and FF.

The comparison of radiography and point-of-care ultrasonography in the diagnosis and management of metatarsal fractures.

OBJECTIVE: It was aimed to compare the efficacy of point-of-care ultrasonography (POCUS) with radiography in the diagnosis and management of metatarsal fracture (MTF). METHODS: Patients aged 5-55 years admitted to emergency room due to low-energy, simple extremity trauma and had a suspected MTF, were included in this prospective study. Patients were evaluated by two different emergency physicians in the emergency room. The first physician performed POCUS examination. Second physician evaluated the radiography images. The obtained results were compared. RESULTS: Seventy-two patients were enrolled in the study. Fracture was detected in 39% by radiography and in 43% of patients by POCUS. Multiple MTFs were identified in 5% of patients. Compared with radiography, POCUS had a sensitivity of 93%, specificity of 89%, positive predictive value of 84% and a negative predictive value of 95% (95% CI, 83-98%) in the detection of fractures. While soft tissue edema was seen in 61% of patients by POCUS, soft tissue edema with hematoma was detected in 14%. Compared with radiography, the sensitivity and specificity of POCUS in the decision for surgery were 100% and 98% (95% CI, 97-100%), respectively, whereas its sensitivity and specificity were both 100% in the decision for reduction. CONCLUSION: In our study, we demonstrated that POCUS could be applied with success in the diagnosis and treatment of MTF in low-energy injuries. POCUS can be used as an alternative to radiography in the emergency rooms due to being easy to learn and practice and availability of soft tissue examination along with bone tissue examination.