Investigation of firearm injury cases presented to training and research hospital's emergency service.

BACKGROUND: Firearm injuries are criminal events that may cause severe morbidity and mortality and concerned with Emergency Medicine and Forensic Medicine. The present study aims to evaluate the wound characteristics of the cases who presented to emergency services due to firearm injuries. METHODS: In this study, 213 patients who were 18 years of age or older who applied to the Saglik Bilimleri University Bozyaka Training and Research Hospital Emergency Service with gunshot injury were included. RESULTS: Of the 213 cases examined, 182 (85.4%) were male. The ages of the cases ranged from 18 to 78 years, and the mean age was found as 33.2±12.6. The most common months were April (n=28, 13.2%) and May (n=25, 11.6%). The findings showed that 194 (91.1%) of 213 patients were discharged after completing the treatment in the hospital, and 19 patients (8.9%) died despite all interventions. CONCLUSION: Our study presents an important cross-section of the gunshot injury patterns and their consequences in Turkey, but it contains regional data. In this regard, multicentre and multidisciplinary studies covering the country, in general, are considered to be a significant contribution to the literature.

The Impact of Treatment with Continuous Positive Airway Pressure on Acute Carbon Monoxide Poisoning.

INTRODUCTION: Approximately 50,000 patients per year present at emergency departments (EDs) because of carbon monoxide (CO) intoxication. The hypothesis of this study was that the half-life of CO and the regression period of complaints could be reduced more rapidly by applying oxygen with the Continuous Positive Airway Pressure (CPAP) modality using a non-invasive mechanical ventilator. METHODS: The patients were divided into Group 1 and Group 2 in terms of the treatment method applied. Patients in Group 1 received FiO2 1.0 15 l/minute oxygen at room temperature for at least 30 minutes with a non-rebreather mask. Patients in Group 2 received FiO2 1.0 oxygen at 12 cmH2O pressure with non-invasive mechanical ventilation for at least 30 minutes with an oronasal mask in the CPAP modality. RESULTS: The median values (interquartile range) of carboxyhemoglobin (COHb) levels at zero and 30 minutes of patients were 19% (8) and 14% (6) in Group 1 and 22% (8) and nine percent (3) in Group 2; a median difference of six percent (2) was detected in Group 1 and of 13% (4) in Group 2 in the first 30 minutes (P <.001). When the symptoms of the patients were examined, the median values of Group 1 and Group 2 at zero minutes were both eight units and at 30 minutes were five and three units, respectively. A decrease of five units was determined in the median of Group 2 in the first 30 minutes, and a decrease of two units in the median of Group 1 (P <.001). CONCLUSION: The use of CPAP was determined to more rapidly reduce COHb level as opposed to high-flow oxygen therapy. It is also thought that it may enable earlier discharge by reducing the duration of the emergency follow-up since it provides a faster improvement in the symptoms of the patients.

Estimation of Cardiac Systolic Function Based on Mitral Valve Movements: An Accurate Bedside Tool for Emergency Physicians in Dyspneic Patients.

OBJECTIVES: The purpose of this study was to determine the success of mitral valve movements in the estimation of left ventricular ejection fraction (LVEF). METHODS: Adult patients whose principal symptom was dyspnea were included in this prospective observational study. The distance from the anterior mitral valve (AMV) to the interventricular septum (IVS) during early diastole was measured first in B-mode in the parasternal long axis (PLAX) named parasternal long axis-anterior leaflet septal separation. Second, the AMV-IVS distance was measured in M-mode in the PLAX named E-point septal separation. Third, AMV-IVS distance was measured in B-mode in the apical 4-chamber view named apical 4-chamber view-anterior leaflet septal separation. Finally, maximum distance between the 2 mitral leaflets in the apical 4-chamber view was measured and named mitral valve leaflet separation. Comprehensive echocardiography was performed by an experienced cardiologist. Correlation was calculated between mitral valve measurements and LVEF. Cutoff values were determined using receiver operating characteristic curves and the chi-square test. RESULTS: A total of 118 patients were included in the study. Parasternal long axis-anterior leaflet septal separation, E-point septal separation, and apical 4-chamber view-anterior leaflet septal separation were highly correlated with LVEF (correlation coefficient, -0.848, -0.833, and-0.822 [P < .001]). Parasternal long axis-anterior leaflet septal separation values less than 2.30 mm, E-point septal separation values less than 2 mm, and mitral valve leaflet separation values greater than 25.15 mm exhibited a 100% negative predictive value in excluding reduced LVEF. Parasternal long axis-anterior leaflet septal separation values less than 4.95 mm, EPSS values less than 5.85 mm, apical 4-chamber view-anterior leaflet septal separation values less than 6.95 mm, and mitral valve leaflet separation values greater than 24.05 mm exhibited a 100% negative predictive value in excluding severe reduced LVEF. CONCLUSIONS: Mitral valve measurement methods may be useful in predicting LVEF or values thereof as a complementary method of diagnosing challenging patients on echocardiographic images.

Aorto-caval fistula resulting from an abdominal aortic aneurysm: A case report from the Emergency Department of Izmir Bozyaka Training and Research Hospital, Turkey.

The rupture of an abdominal aortic aneurysm into the inferior vena cava with fistula formation is a rare condition but is associated with high mortality. Classical symptoms and findings vary in a wide range, and early diagnosis and intervention can be life-saving. In this study, we present a case of abdominal aortic aneurysm associated with aorto-caval fistula formation accompanied by mortality.

The Effects of Lipid Emulsion, Magnesium Sulphate and Metoprolol in Amitriptyline-Induced Cardiovascular Toxicity in Rats.

The aim of this study was to evaluate the effects of metoprolol, lipid emulsion and MgSO4 which can be recommended for prevention of long QT that is one of the lethal consequences of amitriptyline intoxication. Thirty Sprague-Dawley male rats were included. Five groups respectively received the following: saline intraperitoneally (i.p.); amitriptyline (AMT) 100 mg/kg per os (p.o.) and saline i.p.; AMT 100 mg/kg p.o. and 5 mg/kg metoprolol i.p.; AMT 100 mg/kg p.o. and 20 ml/kg lipid emulsion i.p.; AMT 100 mg/kg p.o. and 75 mg/kg MgSO4 i.p. After 1 h, all groups were analysed by ECG recordings in DII lead; their blood was taken for biochemical examination and euthanasia was performed. For histological examination, cardiac tissues were removed and sections were prepared. QTc was significantly reduced in treatment groups compared to the AMT+saline group. When compared with the AMT+saline, lipid emulsion did not affect pro-BNP and troponin levels in biochemical analysis, but it significantly reduced Caspase 3 expression in histological examination. In the group treated with AMT and metoprolol, there was no significant effect on Caspase 3 expression. In MgSO4-treated group, there was a significant decrease in troponin, pro-BNP and urea levels biochemically and significant decrease in Caspase 3 expression histologically when compared with the control group. With further studies including clinical studies, MgSO4, lipid emulsion or metoprolol may be used to improve AMT-induced cardiotoxicity. They can possibly become alternative approaches in the future for suicidal or accidental intoxication of tricyclic antidepressant in emergency departments.

A comparison of carotid doppler ultrasonography and capnography in evaluating the efficacy of CPR.

INTRODUCTION AND PURPOSE: The end-tidal carbon dioxide (ETCO2) measurement is accepted as the gold standard method for assessing cardiopulmonary resuscitation (CPR) efficacy. In recent studies, the use of Carotid Doppler Ultrasonography has become widespread in showing CPR efficacy. In the present study, the carotid blood flow measurement was compared with ETCO2 measurement and an evaluation was made of whether this method could be used as an alternative method to capnography in the assessment of CPR efficacy. MATERIAL AND METHOD: This study was conducted on patients who presented at the Emergency Department (ED) with non-traumatic arrest or began to suffer from arrest during emergency service follow-up. The main carotid artery peak systolic velocity (PSV), end diastolic velocity (EDV) and time-dependent mean flow velocity (MNV), and ETCO2 values were measured and recorded after the 100th chest pressure of the CPR cycle and the results were statistically analyzed. RESULTS: The mean age of the patients was 54.5±12.3years and 65.6% of the patients were male. The mean values of patients measured from the carotid artery during the CPR were PSV 67.1±17.3, EDV 16.3±4.5, MNV 25.5±8.1 and ETCO2 22.2±8.1. A significant difference was found between in-hospital and out-of-hospital arrests in terms of patient outcome (return of spontaneous circulation (ROSC) and death) (p<0.05). The mean ETCO2 values of those who died were found to be lower than those of the ROSC group (p<0.05). Although there was a positive and low-level of correlation between the ETCO2 values and PSV values, and a positive and very low-level of correlation between the EDV and MNV values of all patients, these correlations were not statistically significant. (p>0.05). CONCLUSION: A low correlation was found between the PSV and ETCO2 values. With effective CPR, the results close to carotid blood flow in normal healthy individuals were obtained. However, the study showed that carotid blood flow measurement results during CPR were not as valuable as ETCO2 in demonstrating CPR efficacy.

The accuracy of bedside USG in the diagnosis of nasal fractures.

A comparison of the sensitivity and specificity of bedside ultrasonography with conventional radiography for the evaluation of nasal fractures. INTRODUCTION - PURPOSE: There is increasing use of ultrasonography in the Emergency Dept (ED) and other areas. The purpose of the present study was to evaluate the sensitivity and specificity of bedside ultrasonography with conventional radiographs in the evaluation of nasal fractures in the ED. METHOD: Patients admitted to ED with maxillofacial trauma were evaluated in this prospective study. Ultrasonography scans of the patients were taken by the emergency physician at the bedside. The images were obtained from both laterals and parallel to the nasal dorsum. The nasal radiography scans were evaluated by an experienced radiologist blinded to the study. The ultrasonography and radiography results were compared statistically. RESULTS: The study included 103 patients. In showing the presence of nasal fracture, the sensitivity of ultrasonography was determined to be 84.8% (95% CI 71.13%-93.66%), specificity was 93.0% (95% CI 83.00%-98.05%), positive predictive value (PPV) was 90.7% (95% CI 77.86%-97.41%), negative predictive value (NPV) was 88.3% (95% CI 77.43%-95.18%). CONCLUSION: Ultrasonography can be used in ED as an alternative method to conventional radiography with high rates of sensitivity and specificity in the evaluation of nasal fractures.

The role of inferior vena cava diameter in the differential diagnosis of dyspneic patients; best sonographic measurement method?

STUDY OBJECTIVE: We aimed to determine the role of inferior vena cava (IVC) diameter in making a differentiation between dyspnea of cardiac (acute heart failure [AHF]) and pulmonary origin. We also attempted to determine the best sonographic method for the measurement of IVC diameter. METHODS: This prospective observational study was conducted at the intensive care unit of the emergency department of a training and research hospital. This study enrolled patients with the main symptom of dyspnea who were categorized into 2 groups, cardiac dyspnea and pulmonary dyspnea groups, based on the final diagnosis. All patients underwent sonographic measurement of minimum and maximum diameters of IVC, and the caval index (CI) was calculated in both M-mode and B-mode. The sensitivity, specificity, and likelihood ratios (LR) of the IVC values for the differentiation of the 2 groups were calculated. RESULTS: This study included a total of 74 patients with a mean age of 72.8 years. Thirty-two patients had dyspnea of cardiac origin, and 42 patients had dyspnea of pulmonary origin. The IVC diameter measured with B-mode during inspiration (B-mode i) was the most successful method for differentiation of the 2 groups. B-mode i values greater than 9 mm predicted dyspnea of cardiac origin with a sensitivity of 84.4% and a specificity of 92.9% (+LR: 11.8, LR: 0.16). CONCLUSION: Sonographic assessment of the IVC diameter may be used as a rapid, readily, nonexpensive, complication-free, and reproducible technique for the differentiation of cardiac and pulmonary causes of dyspnea. B-mode i measurement may be more successful in the differentiation of dyspnea compared with other IVC diameters and calculations.

The role of inferior vena cava diameter in volume status monitoring; the best sonographic measurement method?

OBJECTIVES: This study aims to determine the site of and the best sonographic method for measurement of inferior vena cava (IVC) diameter in volume status monitoring. METHODS: This observational before-and-after study was performed at the intensive care unit of the emergency department. It included hypotensive adult patients with suspected sepsis who were recommended to receive at least 20 mg/kg fluid replacement by the emergency physician. The patients were fluid replaced at a rate of 1000 mL/h, and maximum and minimum IVC diameters were measured and the Caval index calculated sonographically via both B-mode and M-mode. Hence, IVC's volume response was assessed by a total of 6 parameters, 3 each in M-mode and B-mode. Freidman test was used to assess the change in IVC diameter with fluid replacement. Wilcoxon test with Bonferroni correction was used to determine which measurement method more sensitively measured IVC diameter change. RESULTS: Twenty-eight patients with a mean age of 71.3 were included in the final analysis.The IVC diameter change was significant with all 6 methods (P < .001). The IVC minimum diameter change measured on M-mode during inspiration (M-mode i) was the only measurement method that significantly showed diameter change with each 500-mL fluid replacements. The initial and the subsequent M-mode i values after each 500 mL of fluid were 5.65 ± 3.34; 8.05 ± 3.66; 10.16 ± 3.61, and 11.21 ± 2.94, respectively (P < .001, P < .002, and P < .003, respectively). CONCLUSION: Inferior vena cava diameter was changed by fluid administration. The M-mode i method that most sensitively measures that change may be the most successful method in volume status monitoring.

Multi-detector angio-CT and the use of D-dimer for the diagnosis of acute mesenteric ischemia in geriatric patients.

BACKGROUND: There is no specific laboratory method for the diagnosis of acute mesenteric ischemia (AMI). In this study, we aimed to determine the efficacy of the D-dimer test in selected cases prior to multi-detector angio-CT, which is expensive and has side effects. METHODS: Patients, over 65, with abdominal pain were included in this study. The D-dimer test was applied to 230 (34%) of 676 abdominal pain patients admitted to our emergency service. The D-dimer levels of the patients diagnosed with AMI by angio-CT were compared. RESULTS: In AMI patients sensitivity of the D-dimer test was 84.6% and the specificity was 47.9%. Elevated D-dimer levels and AF were observed in 90.9% of the patients diagnosed with AMI by CT. CONCLUSION: D-dimer levels were elevated in the AMI patients. Patients suspected of having AMI with unclear clinical results and patients with D-dimer levels above 1000 ng/ml and AF should undergo further evaluation.

Factors Affecting the Length of Stay of Patients in Emergency Department Observation Units at Teaching and Research Hospitals in Turkey.

OBJECTIVES: This study aimed to determine the reasons for long stays in monitoring units and to propose a solution. METHODS: The patients who were followed in monitoring units of emergency service and the factors affecting the length of their hospital stay were analyzed retrospectively. Demographic features, their initial complaint that lead to monitoring, diagnosis, their means of arrival to emergency service, their admittance date and hour, medical history, basic vital signs, length of stay in emergency service, invasive interventions, intubation, mortality rates, consultations, and clinical results were evaluated. RESULTS: The study included 603 patients. Average emergency service stay in monitoring unit was found to be 6.5 hours. In addition, 15 patients (2.5%) stayed 24 hours or longer, and 78 patients (12.9%) stayed 12 to 24 hours. Of the 15 patients who stayed in emergency service for 24 hours or more, 8 (53.3%) stayed because there wasn't enough space in intensive care units. The most prevalent complaint for admission to the emergency service was chest pain (25.5%), followed by dyspnea (21.9%) and tachycardia (11.6%). CONCLUSIONS: For real emergency conditions, monitoring units are necessary to follow patients closely and to perform immediate interventions. The fullness of the intensive care units primarily affects the emergency service and leads to long stays in emergency service as patients are waiting to be admitted to the intensive care unit. As the number of consultations increases, the monitoring period is prolonged.

The Value of Ultrasonography, Leukocyte Count and Clinical Results in Diagnosis of Acute Appendicitis and the Duration of Stay of the Patients in Emergency Department.

OBJECTIVES: In this study, we aimed to compare the clinical data of patients diagnosed with acute appendicitis in our center with the literature. METHODS: The patients who were diagnosed with acute appendicitis between 01.10.2010 and 01.10.2011 in Emergency Department of Izmir Bozyaka Training and Research Hospital were included in this study. Patient demographics, dates and times of emergency department application, dates and times of hospitalization in the general surgery ward, duration of stay in the emergency department, leukocyte count and its relationship with age, the perforation rate, the relationship of perforation with age and leukocyte count, and the final diagnosis and ultrasound findings were assessed in this study. RESULTS: A total of 482 patients who were diagnosed with acute appendicitis [300 (62.2%) male, mean age 30.7±12.03; 182 (37.8%) female, mean age 31.17±13.22)] were enrolled. The duration of stay in the emergency department was between 0-6 and 6-12 hours in 320 (66.4%) and 143 (29.7%) patients, respectively. The ultrasonography findings were consistent with acute appendicitis in 366 (75.9%) patients, and the mean leukocyte count of these patients was 13.141/mm(3). 46 (9.5%) of the patients were diagnosed with perforated appendicitis. The ultrasonography findings were not consistent with acute appendicitis in 36 (7.5%) patients and the leukocyte counts were less than 11.000/mm(3) in these patients. CONCLUSIONS: According to the present study results, acute appendicitis is commonly seen among the young adult male population. The coherence of ultrasonography findings with the diagnosis and its association with leukocytosis is significant and supportive. Additionally, the ultrasonography findings, leukocytosis, medical history and physical examination are important and essential factors for the diagnosis of acute appendicitis. A large number of patients with acute appendicitis were followed-up between 0-6 hours in the emergency department.

Effect of End-Tidal Carbon Dioxide Measurement on Resuscitation Efficiency and Termination of Resuscitation.

OBJECTIVES: In this study, the value of end-tidal carbon dioxide (ETCO2) levels measured by capnometry were evaluated as indicators of resuscitation effectiveness and survival in patients presenting to the emergency department with cardiopulmonary arrest. METHODS: ETCO2 was measured after 2 minutes of compression or 150 compressions. ETCO2 values were measured in patients that were intubated and in those who underwent chest compression. The following parameters were recorded for each patient: demographic data, chronic illness, respiration type, pre-hospital CPR, arrest rhythm, arterial blood gas measurements, ETCO2 values with an interval of 5 minutes between the measurement and the estimated time of arrest, time to return to spontaneous circulation. RESULTS: Cardiac arrest developed in 97 cases, including 56 who were out of the hospital and 41 who were in the hospital. Fifty of these patients returned to spontaneous circulation, and just one of these had an initial ETCO2 value below 10 mmHg. The mean of the final ETCO2 levels was 36.4±4.46 among Patients who Return to Spontaneous Circulation (RSCPs) and 11.74±7.01 among those that died. In all rhythms; Asystole, pulseless electrical activity (PEA) and VF/VT; Overall, RSCPs had higher ETCO2 levels than the cases who died. Among the PEA patients undergoing in-hospital arrests and those asystolic patients undergoing out of hospital arrest, the ETCO2 values of the RSCPs were significantly higher than those of the cases who died. CONCLUSIONS: ETCO2 levels predicted survival as well as the effectiveness of CPR for patients who received CPR and were monitored by capnometry in the emergency department. As a result, we believe that it would be suitable to use capnometry in all units where the CPR is performed.

Slow infusion metoclopramide does not affect the improvement rate of nausea while reducing akathisia and sedation incidence.

OBJECTIVE: To compare the effects of metoclopramide infusion in emergency department (ED) patients complaining of nausea to determine the changes in its therapeutic effect and prevention of side effects such as akathisia and sedation. METHODS: A prospective, randomised, double blind trial, from 1 March 2007 to 1 May 2008 in the ED of Pamukkale University Faculty of Medicine. Patients with moderate to severe nausea were randomised and divided into two groups: group 1 received 10 mg metoclopramide as a slow intravenous infusion over 15 min plus placebo (SIG); group 2 received 10 mg metoclopramide as an intravenous bolus infusion over 2 min plus placebo (BIG). The whole procedure was observed, and nausea scores, akathisia and vital changes were recorded. RESULTS: 140 patients suffering from moderate to severe nausea in the ED were included in the study. There was no significant difference between the groups in terms of mean nausea scores during follow-up (p=0.97). A significant difference in akathisia incidence was observed between the groups (18 (26.1%) in the BIG and 5 (7%) in the SIG) (p=0.002). There was also a significant difference in sedation incidence between the groups (19 (27.5%) in the BIG and 10 (14.5%) in the SIG) (p=0.05). CONCLUSION: Even though slowing the rate of infusion of metoclopramide does not affect the rate of improvement in nausea, it may be an effective strategy for reducing the incidence of akathisia and sedation in patients with nausea.

A trial of midazolam vs diphenhydramine in prophylaxis of metoclopramide-induced akathisia.

STUDY OBJECTIVE: The study aimed to evaluate the effects of midazolam and diphenhydramine for the prevention of metoclopramide-induced akathisia. METHODS: This randomized, double-blind, and controlled trial aimed to investigate coadministered midazolam vs diphenhydramine in the prophylaxis of metoclopramide-induced akathisia. Patients 18 to 65 years of age who presented to the emergency department with primary or secondary complaints of nausea and/or moderate to severe vascular-type headache were eligible for this study. Patients were randomized to one of the fallowing 3 groups: (1) metoclopramide 10 mg + midazolam 1.5 mg; (2) metoclopramide 10 mg + diphenhydramine 20 mg; (3) metoclopramide 10 mg + placebo. Metoclopramide was administered as a 2-minute bolus infusion. Midazolam, diphenhydramine, and normal saline solution were administered as a 15-minute slow infusion. The whole procedure was observed; and akathisia and sedation scores and vital changes were recorded. RESULTS: There were significant differences among groups with respect to akathisia (P = .016) and sedation (P < .001). The midazolam group showed the lowest mean akathisia score but the highest mean sedation score. Akathisia scores of the diphenhydramine group were not different from placebo. There were significant differences among groups in terms of changes in mean vital findings such as respiration rates, pulse rates, and systolic blood pressures (P < .05). There were no significant difference among groups in terms of changes in mean diastolic blood pressures (P = .09). CONCLUSION: Coadministered midazolam reduced the incidence of akathisia induced by metoclopramide compared to placebo but increased the rate of sedation. No difference was detected from diphenhydramine. Routine coadministered 20 mg diphenhydramine did not prevent metoclopramide-induced akathisia.

Effects of postgraduate emergency training among general practitioners working in emergency units in Denizli, Turkey.

INTRODUCTION: Emergency medicine is characterised by rapid decision-making to help patients in life-threatening situations. For this purpose, special qualifications are necessary. The aim of our study was to evaluate the emergency medicine knowledge obtained during an obligatory postgraduate emergency medicine training programme that has been recently applied among Turkish physicians. METHODS: The training targeted all general practitioners (GPs) working in emergency units in the city hospitals, city-wide primary healthcare centres, public health offices, emergency services and private hospitals. Over an 8-month period between September 2004 and April 2005, seven individual groups of approximately 45 physicians were formed. Each group undertook an identical 5-day training programme and every participant completed identical pre-and post-training tests. RESULTS: Two-hundred and ninety-eight physicians participated in the training programme. The majority of participants were male (n=224, 75.2%), aged between 35 and 39 years (n=127, 42.6%), had been in the medical professional for 11 to 15 years (n=121, 40.7%), and were employed in city hospitals (n=102, 34.2%). Surprisingly, the majority of GPs had never participated in a postgraduate training programme before (n=166, 55.7%). Mean post-test scores of the participants were significantly higher than the pre-test scores (89.70%+/-12.41% vs 43.15%+/-10.47%, respectively; P<0.001). Mean pretest scores were significantly higher in the emergency services subgroup (51%, P=0.001) and in the subgroup of participants that had previously undertaken two or more postgraduate training courses (47.9%, P=0.004) compared with the mean pre-test scores of the other subgroups. However post-test scores were not statistically different between the groups. CONCLUSIONS: This postgraduate emergency medicine training programme appears to be effective in improving physicians' knowledge regarding emergencies. Any developing emergency medicine system in Turkey should include continuous, up-to-date, standardised educational programmes for emergency professionals. These may include postgraduate workshops to improve the knowledge and skill levels of emergency professionals.

Evaluation of the outcome of out-of-hospital cardiac arrest resuscitation efforts in Denizli, Turkey.

The objective of this study was to evaluate the outcomes and associated factors for short-term success and long-term survival rates of resuscitated non-traumatic out-of-hospital cardiac arrest (OHCAs) in Denizli, Turkey. All non-traumatic OHCA patients from the Emergency Departments of the Pamukkale University and City Hospitals between the dates of January 1, 2004 and March 1, 2005 were included in this study. A successful outcome was defined as the return of spontaneous circulation or breathing, or evidence of a palpable pulse or a measurable blood pressure. Information on post-resuscitation long-term survival up to 9 months also was obtained by telephone. A total of 222 adults experiencing OHCAs were resuscitated. The number of successful outcomes was 85 (38.3%); 25 (11.2%) were discharged alive; and 21 (9.4%) were alive at the 9-month follow-up. The predicted mean arrest time was 11.7 min (95% confidence interval 10.27-13.2). Type of transportation to the Emergency Department (ambulance, 32.1% vs. private vehicle, 44.5%; p = 0.057), place of arrest (home, 32.6% vs. other, 44.0%; p = 0.08), first rhythm at the scene (asystole, 22.9% vs. ventricular fibrillation-pulseless ventricular tachycardia, 48.0%, vs. pulseless electrical activity, 12.5%; p = 0.056), and advanced cardiac life support starting time (the first 8 min, 46.8% vs. later than 8 min, 32.0%; p = 0.025) had an effect on outcome. Intensive public education for diagnosis and appropriate reporting of OHCA, the importance of bystander cardiopulmonary resuscitation, and the use of automated external defibrillators have an impact on the potential to increase the number of survivors.

A comparison of the prophylactic uses of topical mupirocin and nitrofurazone in murine crush contaminated wounds.

OBJECTIVES: This work was conducted to study the prophylactic efficacy of 2 topical antibiotic ointments (mupirocin and nitrofurazone) against wound infection in experimental contaminated crush wounds. METHODS: Male Wistar rats underwent two 2-cm incisions at the back side and randomized into 3 groups--placebo (n = 14), mupirocin (n = 14), and nitrofurazone (n = 14)--and infected with either Staphylococcus aureus or S. pyogenes. All wound edges were crushed for 5 seconds with hemostats to simulate crush injury before inoculation of the microorganisms. Half of the wounds were sutured and the other half left open. These wounds were treated 3 times daily for 6 days with topical mupirocin, nitrofurazone, or petrolatum (as placebo). At the end of 6 days, excisional biopsies were taken from wound edges and histopathologic assessments were made based on neutrophilic infiltration, edema formation, myofibroblastic proliferation, and granulation tissue formation. For the microbiologic assessments, quantitative tissue cultures were made. RESULTS: In S. aureus-inoculated wounds, mupirocin showed higher antibacterial activity against bacterial colonization and reduced infection rates compared to placebo groups. The same effect was observed for the infection rates in S. pyogenes-inoculated wounds. In S. pyogenes-inoculated open wounds, nitrofurazone showed higher antibacterial activity against infection, but this effect was not observed in closed wounds. In S. pyogenes- and S. aureus-infected wounds, mupirocin treatment significantly lowered infection rates compared to nitrofurazone treatment. Histopathologic examination showed higher myofibroblastic proliferation and higher volume of granulation tissue in the nitrofurazone groups compared to the mupirocin groups. CONCLUSION: Topical mupirocin application was effective against crush wound infections inoculated with S. pyogenes and S. aureus. Nitrofurazone provides better granulation tissue formation, but did not effectively prevent bacterial colonization and infection in crush contaminated wounds.