Comparison of tricuspid and mitral annular plane systolic excursion in determination of acute blood loss in healthy volunteers.

Ultrasound is used more and more in determining acute blood loss. This study is to compare tricuspid annular plane systolic excursion (TAPSE) and mitral annular plane systolic excursion (MAPSE) measurement to determine volume loss pre and post blood donation in healthy volunteers. The systolic, diastolic and mean arterial blood pressures and pulses of the donors were measured in the standing and supine position by the attending physician, then, inferior vena cava (IVC), TAPSE and MAPSE measurements were made pre and post blood donation. Statistically significant differences were found in systolic blood pressure and pulse rate values that obtained in the standing position, and in the systolic blood pressure, diastolic blood pressure, mean arterial pressure and pulse values that obtained in the supine position (p < 0.05). The difference between IVC expiration (IVCexp) pre and post blood donation was 4.76 ± 2.94 mm, and the difference in IVC inspiration (IVCins) was 2.73 ± 2.91 mm. In addition, the MAPSE and TAPSE differences were 2.16 ± 1.4 mm and 2.98 ± 2.13 mm, respectively. Statistically significant differences were found between IVCins-exp, TAPSE and MAPSE values. TAPSE and MAPSE can be helpful in the early diagnosis of acute blood loss.

Effectiveness of pericapsular nerve group block with ultrasonography in patients diagnosed with hip fracture in the emergency department.

BACKGROUND: Hip fractures (HF) are among the most common fractures present in the emergency department and are very painful. Pericapsular nerve group block (PENG) is a new regional anesthesia technique developed for analgesia in total hip arthroplas-ties. We aimed to determine the effectiveness of PENG block used to reduce pain in patients with HF in the emergency department. METHODS: This single-center, randomized, and prospective study was carried out in the emergency department. The patients in-cluded in the study were selected according to the suitability of the personnel who will perform the procedure. The sealed envelope system was used for randomization. RESULTS: Statistical analysis was performed with 39 patients (18 patients in the PENG group, 21 patients in the control group). Thir-teen (33.3%) of the patients were female and 26 (66.7%) were male. The mean age was 75.3. At rest post-procedure, the mean Numeric Rating Scale (NRS) scores of the patients at the 30th min, 2nd, 6th, and 24th h were 1.78±1.83, 0.00±0.00, 0.00±0.00, and 1.28±1.41 in the PENG group. On the other hand, it was 3.38±1.86, 0.05±0.22, 2.86±2.37, and 4.95±1.47 in the control group, respectively. The mean NRS scores of the patients at 15° elevation of the leg at the 30th min, 2nd, 6th, and 24th h were 3.06±1.80, 0.06±0.24, 0.22±0.43, and 2.44±1.50 in the PENG group and it was 5.24±1.81, 1.05±0.92, 4.29±2.35, and 7.14±1.24 in the control group, respectively. CONCLUSION: PENG block can reduce pain and the need for systemic analgesics as a practical option in patients with HF.

Verification of Endotracheal Tube Position by Emergency Nurses Using Ultrasound: A Repeated Measures Cadaver Study.

INTRODUCTION: Endotracheal intubation is a lifesaving procedure frequently performed in emergency departments. It is associated with some potential risks. Rapid and reliable confirmation of endotracheal tube placement during intubation is critical. Nurses play an important role in the care of patients in various settings. Ultrasound can be performed and interpreted not only by physicians but also by nurses. The aim of this study was to evaluate how well nurses without previous ultrasound experience can determine both esophageal and tracheal localization of endotracheal tubes in cadavers after a short ultrasound training. METHODS: This was a repeated measures study with an educational intervention and no control/contemporaneous comparison group. The study was performed to evaluate the ability of emergency nurses to confirm correct endotracheal tube placement and identify esophageal intubations. A total of 7 emergency nurses were given theoretical education and hands-on training about ultrasound. They diagnosed tracheal or esophageal intubation using ultrasound. RESULTS: Four cadavers were used 8 times each for the study. A total of 32 intubation procedures were evaluated with ultrasound by each nurse. In the analysis based on 224 responses, sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and overall accuracy of ultrasound applied by nurses to detect tracheal intubation were 95.61% (90.06%-98.56%), 97.27% (92.24%-99.43%), 35.06 (11.48-107.10), 0.05 (0.02-0.11), and 96.43% (93.08%-98.45%), respectively. The mean time to evaluate the tube location by ultrasound was 6.57 seconds. DISCUSSION: The results support that ultrasound can be performed by nurses for the confirmation for esophageal and tracheal intubations quickly and accurately.

The role of tricuspite annular plane systolic excursion as a marker of hypovolemia in healthy blood donor volunteers.

AIM: The aim of this study is to compare the diameter of the inferior vena cava with tricuspid annular plane systolic excursion (TAPSE) measurement in order to determine the volume loss before and after blood donation in healthy volunteers. METHODS: This Institutional Review Board-approved single center, prospective, cross-sectional study included 60 healthy blood donors donating in a tertiary care hospital's blood bank. After obtaining written consent, systolic, diastolic, and mean arterial blood pressures along with pulse rate of the donors were measured in sitting and supine positions by the attending physician, then, inferior vena cava (IVC) and TAPSE measurements were made before and after blood donation. RESULTS: Statistically significant differences was found between standing systolic blood pressure and pulse rate, lying systolic blood pressure and pulse rate, IVC and TAPSE values before and after blood donation (p < 0.05). There was no difference between the other variables before and after blood donation. CONCLUSION: Our study revealed that, low IVC and TAPSE values correlated in determining blood loss after blood donation. TAPSE may be useful to predict blood loss in early stages of hypovolemic shock.

Simple Manual Pressure with Ultrasound-Guided Femoral Nerve Block: A randomized single blind study.

PURPOSE: The aim of this study was to investigate the effect of compression on the Visual Analog Scale (VAS) score following the application of 3-in-1 femoral nerve block (FNB), used for pain palliation in patients with hip fractures. METHODS: This was a randomized controlled trial study on application of pressure versus no pressure following FNB in patients with hip fractures. Their VAS scores were recorded and an ultrasound-guided 3-in-1 FNB was performed as a standardized procedure. After the procedure, patients were randomized into two groups and a weight with 2 kg pressure was applied to the treated area in one group. After 30 min, VAS scores were recorded again. VAS scores of all patients recorded before and after the procedure, and post-procedural VAS scores of pressure-applied and no pressure-applied groups were statistically compared. RESULTS: 34 patients were included in this study with 17 patients falling in the compression group (group C), and the remaining half in the non-compression group (group NC). The pre-procedural mean VAS scores were 9.35 (95% CI; 8.95-9.76)), while the post-procedural mean VAS scores dropped to 2.35 (95% CI; 1.65-3.06) in group C. The pre-procedural mean VAS score was 9.12 (95% CI; 8.64-9.59), while the post-procedural mean VAS score was 5.06 (95% CI; 4.09-6.03) in group NC. When the average reductions in VAS score following the procedure were compared, the mean difference between the two groups was calculated to be 2.94 (95% CI; 1.69-4.19) which favours group C. This difference was statistically significant (p < 0.001). CONCLUSION: Our study shows that, the application of simple compression after 3-in-1 FNB in patients with hip fractures provides a significant reduction in VAS scores.

Accuracy of Emergency Physicians for Detection of Regional Wall Motion Abnormalities in Patients With Chest Pain Without ST-Elevation Myocardial Infarction.

OBJECTIVES: Our aim was to evaluate the accuracy of emergency physicians (EPs) in the detection of regional wall motion abnormalities (RWMAs) using focused cardiac ultrasound (FOCUS) in patients suspected of non-having ST-elevation myocardial infarction. METHODS: We prospectively enrolled patients with chest pain. Three EPs underwent didactics and hands-on-training, of 3 hours each, by an experienced cardiologist, on detecting RWMAs using 2-dimensional echocardiography. They performed a FOCUS examination to evaluate for RWMAs and recorded the echo images. Our reference standard for the detection of RWMAs was accepted as a blinded cardiologist review of the prerecorded video clips. We calculated the corrected sample size and inter-rater agreement between the EPs (82 and 0.83, respectively). The analysis of the study was performed on 89 patients. RESULTS: Eighty-nine patients with chest pain were screened. Emergency physicians demonstrated the detection of RWMAs with good sensitivity and even excellent specificity: 76.9% (95% confidence interval [CI], 56.4%- 91.0%) and 92.1% (95% CI, 82.4%-97.4%), respectively. The accuracy of FOCUS was 87.6% (95% CI, 79.0%-93.7%). The area under the curve from a receiver operating characteristic curve analysis, which evaluated the EPs' rate of detecting the presence or absence of RWMAs, was 0.845 (95% CI, 0.753-0.913). CONCLUSIONS: Our study results suggest that EPs with training in bedside echocardiography can accurately rule in patients with RWMAs in suspected non-ST-elevation myocardial infarction cases.

Treating the elite athlete: anti-doping information for the health professional.

Physicians and health professionals are a vital component in preserving the integrity of competition and the core principles of true sport. When treating an athlete, health professionals need to be cognizant of the anti-doping rules of the relevant sport organization. This review aims to provide an overview of the World Anti-Doping Agency Prohibited List, Therapeutic Use Exemptions, roles and responsibilities of the health professional, as well as provide resources that will guide their work with athletes.