Low peripheral perfusion index values may indicate the need for antivenom in the early phase of scorpion envenomation.

BACKGROUND: Scorpion envenomation may cause local symptoms as well as life-threatening situations including shock, and death. Antivenom administration is the cornerstone of therapy, meticulous patient selection is needed because of the possible side effects of the antivenom including anaphylaxis. Peripheral perfusion index (PPI) is a simple, non-invasive test that is widely used for the detection of peripheral hypoperfusion. We aimed to investigate the value of using PPI to predict the need for antivenom administration for scorpion envenomation. METHODS: This prospective observational study was conducted in the ED of a tertiary care center. We consecutively enrolled patients with scorpion envenomation on the extremities who are over 18 years old without pregnancy and a peripheral arterial disease between March 1, 2021, to October 31, 2021. Demographics included age, sex, sting zone, the time between sting and the ED admission, and vital parameters, we blindly measured PPI both on affected and contralateral extremities before any therapeutic intervention. We compared PPI levels, vital parameters, and the outcome including discharge from the ED, admission to ward or ICU, and death between patients who received antivenom and those who did not. RESULTS: Twenty-nine male (58.0%) and 21 (42.0%) female patients with scorpion envenomation were enrolled in the study. The median age was 46.5 [IQR 33.3]. Thirty-eight (76.0%) patients had Class I, 12 (24.0%) patients had Class II and III envenomation. The median duration of the ED admission after the sting was 90 [IQR 120] minutes. Antivenom was administered in 13 (26.0%) patients. PPI was significantly lower both on the affected and the contralateral extremities (p = 0.043 and p = 0.045, respectively) in patients who required antivenom. With a cut-off value of 2.4, PPI can predict the need for antivenom with a sensitivity of 61.54%, a specificity of 86.5%, a positive likelihood ratio of 4.55, a negative likelihood ratio of 0.44, a positive predictive value of 61.54%, a negative predictive value of 86.49%, and an accuracy of 80% (AUC 0.691, p < 0.05). CONCLUSION: PPI can better reflect the ongoing systemic inflammation and the need for antivenom compared to other vital parameters. Therefore, we suggest this noninvasive and objective test may have a significant role in detecting patients who need antivenom in the early phase of scorpion envenomation. However, more studies are needed to elucidate the role of PPI in scorpion envenomation.

The Demographic Analysis of the Probable COVID-19 Cases in Terms of RT-PCR Results and Age.

BACKGROUND: Despite global prevention and quarantine efforts, the incidence of COVID-19 disease continues to increase. As a possible cause, our aim was to investigate which parameters increase the sensitivity or protection against COVID-19 between RT-PCR positive and RT-PCR negative cases in patients admitted to the emergency department. METHODS: In the pandemic process, patients admitted to the hospital with suspicion of COVID-19 were evaluated retrospectively. RT-PCR test was divided into + (for Group 1) and - (Group 2). The gender, age, clinical information, application symptoms, and comorbidity data of the patients were evaluated. RESULTS: One hundred and sixty-seven cases were evaluated in the study. Group 1: 88 cases, M/F ratio: 46/42 and average age 48 ± 17.3 years, Group 2: 79 cases, M/F ratio was approximately 3/2, and the average age was 48.3 ± 19.4 years. When the groups were compared in terms of symptoms, fever, cough, weakness, and headache were prominent in Group 1, whereas the contact was significantly higher in Group 2 (p < 0.05). Among the comorbid diseases, only COPD showed a significant difference between the groups, and it was found significantly higher in Group 2 (p < 0.05). CONCLUSIONS: Cough, headache, and fever were found valuable in the detection of cases. Attention should be paid to contact isolation to circumvent the pandemic process with less damage. Having chronic diseases, especially COPD, increases the risk of infection with SARS-CoV-2. Close monitoring and control of chronic diseases can positively change the course of COVID-19.

Clinical use of copeptin in migraine patients admitted to the emergency department.

PURPOSE: The purpose of this study was to investigate the clinical use of copeptin to evaluate migraine attacks in the Emergency Department. An additional aim was to detect changes in serum copeptin levels in migraine patients during attack and attack-free periods. METHODS: This prospective case-control study included 52 migraine patients and 51 healthy individuals with similar demographic characteristics. Blood samples were collected from migraine patients both in attack and attack-free periods. RESULTS: The mean copeptin levels in the patients group in the attack and attack-free periods were 689.28 and 576.68 pg/ml, respectively, whereas they were 608.68 pg/ml in the control group. There was a significant difference in the mean copeptin level in the attack period and attack-free periods (p = 0.026). The sensitivity and specificity of copeptin in detecting headache episodes in migraine patients were 58.8% and 60.7%, respectively, at a cut-off value of 388.67 pg/ml. CONCLUSION: This is the first study to investigate the diagnostic efficacy of serum copeptin levels in migraine patients. Although the diagnostic efficacy of serum copeptin levels for migraines was unsatisfactory, it could be helpful at management of migraine patients in ED.

A New Promising Treatment Strategy for Carbon Monoxide Poisoning: High Flow Nasal Cannula Oxygen Therapy.

BACKGROUND High-flow nasal cannula (HFNC) is an alternative to conventional normobaric oxygen therapy (NBO) for hypoxemic patients. Since nothing is known about its effect on carbon monoxide (CO) poisoning, we hypothesized that HFNC might be a useful device in the treatment of CO poisoning victims. MATERIAL AND METHODS We retrospectively reviewed the medical records of patients who were admitted consecutively to the emergency department with CO intoxication. Patients were divided into 2 groups: patients treated with HFNC and patients treated with conventional face mask (CFM). Demographic data, pretreatment, and control (after 1 hour) arterial blood gas analyses values of the patients were evaluated. RESULTS Sixty-eight patients (mean age 35.8±18.7 years) were included in this study. NBO was given via HFNC to 38 patients (55.9%), and via CFM to 30 patients (44.1%). The demographic characteristics and pretreatment values of carboxy-hemoglobin (COHb) were similar in the 2 groups. The mean COHb value of the HFNC group at the first hour was found significantly lower than the CFM group: 9.5±4.7 and 12.0±5.1, respectively (P=0.041). Improvement of COHb level was significantly higher in the HFNC group compared to the CFM group: 12.5±4.5 versus 6.7±3.7, respectively (P=0.001). CONCLUSIONS HFNC was superior than CFM in alleviating COHb levels in the victims of CO poisoning. We believe that using HFNC will increase patient comfort by shortening the duration of treatment in emergency department settings, especially in patients who have mild clinical findings of CO poisoning.

Which is the best in carbamazepine overdose?

Intravenous lipid emulsion treatment is safer, faster, and easier to apply and could be a powerful alternative to extracorporeal treatment methods in carbamazepine intoxication.

Prognostic value of neglected biomarker in sepsis patients with the old and new criteria: predictive role of lactate dehydrogenase.

OBJECTIVES: This study examined the pH, lactate dehydrogenase (LDH), and heart rate values on the first day of hospitalization in patients with a prediagnosis of sepsis and biomarkers that may predict mortality. METHODS: Patients hospitalized in an emergency intensive care unit with a diagnosis of systemic inflammatory response syndrome were classified as having sepsis (n = 28), septic shock (n = 8), or severe sepsis (n = 8) according to International Sepsis Guidelines (old criteria). Forty-four patients were classified as having sepsis (n = 4), septic shock (n = 30), or infection (n = 10) according to The Third International Consensus Definitions for Sepsis and Septic Shock (new criteria). The effects of these patients' laboratory values on survival between groups were compared. Significant values were evaluated by χ2 automatic interaction detection analysis. RESULTS: When the patients were categorized according to the new classification criteria, there was an increase in the number of septic shock patients and a decrease in the number of sepsis patients. In addition, 10 patients were removed from the sepsis category. There was a significant difference between ex and discharged patients in terms of heart rate, pH, sodium bicarbonate, lactate, and LDH (P= .007, P= .002, P= .034, P= .009, and P= .002, respectively). Based on a χ2 automatic interaction detection analysis of the significant values, pH, LDH, and heart rate were prominent predictors of prognosis. CONCLUSIONS: Systemic pH, LDH, and heart rate values may be used to determine the best time to discharge patients from intensive care to other, more affordable hospital units.

Comparision of ultrasound-based methods of jugular vein and inferior vena cava for estimating central venous pressure.

OBJECTIVE: The aim in this study was to compare the ultrasound estimation of the jugular vein diameter (IJVmax, IJVmin) and area (IJVarea), the height of the right internal jugular vein (CVPusg), the vena cava diameter (IVCmax, IVCmin), and the vena cava index (IVCindex) with direct estimation of central venous pressure (CVPinv). METHODS: Ultrasonography was performed on 37 nonventilated and 36 ventilated patients while monitoring central venous pressure. The IJV and IVC were measured during the respiratory cycle and the IJVarea and IVCindex were calculated. Tapering portion of the right IJV defined and height from this point to the sternal angle was used to estimate CVPusg. RESULTS: A CVP of 10 mmHg was chosen as a clinically significant cutoff for high CVP, and 6 mmHg was chosen for low CVP estimation. The CVPusg, IJVmax and IJVmin correlated moderately with CVPinv (R² = 0.66, 0.53, and 0.54, respectively) whereas the IVCmax, IVCmin and IVCindex showed poor correlation (R² = 0.29, 0.32 and 0.27, respectively). The CVPusg cutoff value of 7 predicted CVPinv > 10 mmHg with sensitivity of 90%, specific-ity of 67.3% and predicted CVPinv < 6 mmHg with sensitivity of 77%, specificity of 68%. IJVmax, IJVmin, IJVarea and IVCmax showed high sensitivity (90.32%, 83.87%, 90.32%, and 93.10%, respectively) for low CVP levels. The IVCindex has high sensitivity (95.2%) and poor specificity (42.9%) for high CVP levels. CONCLUSION: IVCindex and CVPusg has better diagnostic performance for estimating high CVP. IJVmax, IJV area, and IVCmax showed high sensitivity and NPV for low CVP levels.