The Effect of Urea/Albumin Ratio on Mortality in the Geriatric Patients Admitted in the Intensive Care Unit.

OBJECTIVE: To analyse the effect of urea albumin ratio on mortality in intensive care patients aged over 65 years. STUDY DESIGN: An observational study. Place and Duration of the Study: Health Sciences University, Ankara Training and Research Hospital, Emergency Critical Intensive Care Unit, from October 2021 to March 2022. METHODOLOGY: Patients over 65 years of age admitted in the intensive care unit were included in this study, and the laboratory and clinical data were recorded within the first 24 hours after the admission of the patient. The urea : albumin ratio was calculated using serum urea and albumin concentrations. All the patients were monitored during intensive care admission and mortality rates were recorded; additionally 1-month mortalities of the patients were also recorded. The data of the survivors and non-survivors were compared. RESULTS: There were 362 patients with mean age of 79.00±8.40 years; 53.9% were females. The median urea : albumin ratio was found to be 22.8 mg/gr. The area under curve, sensitivity and specificity values were found to be 0.631, 68%, and 56% at a cut-off value of 22.1 mg/gr for urea : albumin ratio, respectively. In addition, urea : albumin ratio >22.1mg/gr was found to be significant in univariate regression analysis (p<0.001) and multivariate regression analysis (p<0.002) for the predictive value of 1-month mortality. CONCLUSION: Urea : albumin ratio is a simple and potentially useful prognostic factor in the geriatric patient population admitted in the intensive care unit. KEY WORDS: Geriatrics intensive care unit, Urea:albumin ratio, Mortality (MeSH database).

Significance of Intra-abdominal Free Fluid Detected in Ultrasonography in the Clinical Assessment and Outcomes of Adult Patients Presenting to the Emergency Department Due to Abdominal Pain.

Objective The aim of the study was to evaluate the diagnostic process and clinical course in adult patients who presented to the emergency department (ED) with acute abdominal pain (AAP) and were found to have intra-abdominal free fluid (FF) on ultrasonography (USG). Methods This prospective observational study was conducted in a training and research hospital adult emergency department between March 15, 2013, and April 15, 2013. The study included 252 patients aged above 18 years, who were admitted to the emergency room complaining of non-traumatic acute abdominal pain and provided consent for the study. Results The most common diagnoses were acute, nonspecific abdominal pain (37.3%), acute appendicitis (19%), and urinary tract pathology (15.9%). Intra-abdominal free fluid was detected with ultrasonography in 42.5% of patients. Patients with intra-abdominal free fluid were younger than the other patients. The emergency department length of stay was longer in patients with intra-abdominal free fluid (p=0.011). Of the 252 patients enrolled in the study, 32.9% were admitted to the hospital, 21.4% of whom underwent surgery and 11.5% received medical therapy. Most of the patients (64.5%) who were discharged home had no intra-abdominal free fluid in the ultrasonography (p<0.001). Conclusion The presence of intra-abdominal free fluid alone did not guide the clinical decision regarding the diagnostic evaluation of adult patients that presented to the emergency department complaining of non-traumatic acute abdominal pain.

Anaphylaxis after intravenous infusion of dexketoprofen trometamol.

Dexketoprofen trometamol (DT), a nonsteroidal anti-inflammatory drug, is a highly water-soluble salt and active enantiomer of rac-ketoprofen. Its parenteral form is commonly used for acute pain management in emergency departments of our country. Side effects such as diarrhea, indigestion, nausea, stomach pain, and vomiting may be seen after the use of DT. Anaphylactic shock (AS) secondary to infusion of DT is very rare and, to our knowledge, it is the first case report describing this side effect. This case report was presented to emphasize that AS may be seen after the use of DT.

Complete guidewire retention after femoral vein catheterization.

Central venous catheters (CVCs) are often used for various purposes in the emergency departments (ED). The main uses of CVCs in the EDs are emergent hemodialysis, in situations where peripheral vein catheterization cannot be achieved, and continuous invasive hemodynamic monitoring. The complications related to CVC insertion are usually mechanical and observed in the near term after the procedure. Retained CVC guidewire after catheterization is a rare complication in the published reports and usually related with intra- or postoperative settings and jugular or subclavian vein. The present study reported a young female patient who underwent left femoral vein catheterization 6 months earlier in an intensive care unit of another hospital and was diagnosed with complete guidewire retention in the ED. To the best of the authors' knowledge, this is the first case in published reports with a diagnosis of retained CVC guidewire with retrograde migration into the femoral vein. Surprisingly, the patient developed no thrombotic or embolic complication during this 6-month period.

Comparison of end-tidal carbon dioxide levels with cardiopulmonary resuscitation success presented to emergency department with cardiopulmonary arrest.

OBJECTIVE: To measure end-tidal carbon dioxide pressure (PetCO2) in preset interval in order to evaluate the efficiency of cardiopulmonary resuscitation (CPR) performed on patients in cardiopulmonary arrest, evaluate the validity of PetCO2 in predicting the mortality and finally assess the PetCO2 levels of the patients in cardiopulmonary arrest based on the initial presenting rhythm. METHODS: This prospective study was conducted at the Ankara Training and Research Hospital on patients who presented with cardiopulmonary arrest. Standard ACLS (Advanced Cardiac Life Support) protocols were performed. Patients were categorized in two groups based on their rhythms as Ventricular Fibrillation and Asystole. Patients' PetCO2 values were recorded. RESULTS: PetCO2 levels of the Return of Spontaneous Circulation (ROSC) group in the 5th, 10th, 15th and 20th minutes were significantly higher compared to the exitus group (p<0.001). In distinguishing ROSC and exitus, PetCO2 measurements within 5-20 minute intervals showed highest performance on the 20th and lowest on the 5th minutes. CONCLUSION: PetCO2 values are higher in the ROSC group. During the CPR, the most reliable time for ROSC estimation according to PetCO2 values is 20th minute. None of the patients who had PetCO2 levels less than 14 mmHg survived.

Mechanical and infectious complications developing due to central venous catheterizations in the Emergency Department.

AIM: To investigate the rate of catheter-related bloodstream infections (CRBSI) and mechanical complications due to central venous catheter (CVC) insertion in the emergency department (ED) and the contributing factors. METHODS: A total of 236 patients who were admitted to our ED and underwent CVC insertion between July 2008 and July 2009 were included in this prospective study. The CVC indications, the urgency of the insertion (emergency or elective), catheter complications (mechanical or CRBSI) and the compliance of the emergency physician placing the catheter with infection control and prevention measures were investigated. RESULTS: The CVC had been inserted urgently in 103 (44%) of the cases and mechanical complication rates in these patients were higher than those receiving it electively (p less 0.05). Our total mechanical complication rate was 27 (11.4%) with the highest rate for femoral catheter (FC). The CRBSI rate was 5/1000 catheter days. None of the physicians inserting a catheter ensured hand hygiene before the procedure. CONCLUSION: The FC is used as the most common access route for a CVC in our ED but CRBSI rate and mechanical complication rate were lower than in the literature. We believe that increasing compliance with infection control and prevention measures, especially hand hygiene, can further decrease the CRBSI rate in the ED.