Homemade phantoms improve ultrasound-guided vein cannulation confidence and procedural performance on patients.

BACKGROUND: Ultrasound-guided vein cannulation is an essential skill in emergency medicine. Prohibitive costs of commercial ultrasound phantoms limit the ability to adequately train residents. We assess the clinical utility of homemade phantoms for medical education. METHODS: Eighteen emergency medicine residents each performed 10 ultrasound-guided IV attempts on patients, half of the attempts before and half after a training course using two homemade ultrasound phantoms with 14 total Penrose drains. We conducted a prospective feasibility study using pre- and post-training surveys comparing confidence and success rates of IV cannulation attempts on patients. RESULTS: Residents demonstrated an improvement in successful ultrasound-guided peripheral vein cannulations from an average of 47.8% during the first five attempts to 71.1% in the last five attempts. No benefit was noted from the first to the fifth attempts, nor from the six to the tenth attempts, suggesting minimal benefit from experience early on. Residents reported increased confidence in performing ultrasound-guided venous cannulation on patients, identifying the correct probe, adjusting gain and depth, visualizing veins in short and long axis, differentiating arteries from veins, and vein cannulation on a phantom model. CONCLUSION: Homemade ultrasound phantoms are cost effective, increase confidence, and improve emergency medicine residents' ability to perform ultrasound-guided vein cannulation.

The effects of desert dust storms, air pollution, and temperature on morbidity due to spontaneous abortions and toxemia of pregnancy: 5-year analysis.

Epidemiological studies have suggested an association between particulate air pollution, increased temperatures, and morbidity related to pregnancy outcomes. However, the roles of desert dust storms and climatological factors have not been fully addressed. The objectives of the present study were to investigate the association between desert dust storms, particulate matter with a diameter ≤10 µm (PM10), daily temperatures, and toxemia of pregnancy and spontaneous abortion in Gaziantep, South East Turkey. The study was conducted retrospectively at emergency department of two hospitals in Gaziantep city. Data from January 1, 2009, to March 31, 2014, were collected. Patients, who were diagnosed with toxemia of pregnancy and spontaneous abortion by radiological imaging modalities, were included in the study. Daily temperature ranges, mean temperature values, humidity, pressure, wind speed, daily PM10 levels, and records of dust storms were collected. A generalized additive regression model was designed to assess variable effects on toxemia of pregnancy and spontaneous abortion, while adjusting for possible confounding factors. Our findings demonstrated that presence of dust storms was positively associated with the toxemia of pregnancy both in outpatient admissions (OR=1.543 95% CI=1.186-2.009) and inpatient hospitalizations (OR=1.534; 95% CI=1.162-2.027). However, neither PM10 nor maximum temperature showed a marked association with spontaneous abortion or toxemia of pregnancy in our study population. Our findings suggest that desert dust storms may have an impact on the risk for adverse pregnancy outcomes such as toxemia of pregnancy. Health authorities should take necessary measures to protect pregnant women against detrimental effects of these storms.

Comparison of manual pulse palpation, cardiac ultrasonography and Doppler ultrasonography to check the pulse in cardiopulmonary arrest patients.

OBJECTIVE: For health professionals, the absence of pulse checked by manual palpation is a primary indicator for initiating chest compressions in patients considered to have cardiopulmonary arrest (CA). However, using a pulse check to evaluate perfusion during CA may be associated with some risks of its own. Our objective was to compare the efficiency of cardiac ultrasonography (CUSG), Doppler ultrasonography (DUSG), and manual pulse palpation methods to check the pulse in CA patients. MATERIAL AND METHODS: This study was prospectively performed in 137 patients older than 16 years of age who underwent cardiopulmonary resuscitation (CPR). CUSG, DUSG, and manual pulse palpation were practiced simultaneously as suggested in the relevant guidelines. Findings of the patients were recorded at the first min, at min 15 and at the end of CPR. SPSS 18.0 was used for statistical analysis. FINDINGS: A total of 72.3% (n = 99) of the cardiopulmonary arrest incidents occurred out-of-hospital. CUSG (4.76 ± 2.19, 4.33 ± 2.17, and 3.68 ± 2.14 s), DUSG (9.59 ± 2.37, 8.22 ± 2.86, and 7.60 ± 2.83 s), and manual pulse palpation (10.76 ± 1.03, 9.72 ± 3.01, and 9.29 ± 3.36 s) measurements of the first, second, and last inspections were detected, respectively. The false negative rates (100%, 28%, and 0%) and false positive rates (5.3%, 3.5%, and 0%) of manual pulse palpation the first, second, and last inspections were calculated, respectively, as well. CONCLUSION: The use of real-time CUSG during resuscitation provides a substantial contribution to the resuscitation team. CUSG will allow earlier and more accurate detection of pulse than manual pulse palpation and DUSG.

Effects of Dust Storms and Climatological Factors on Mortality and Morbidity of Cardiovascular Diseases Admitted to ED.

OBJECTIVE: This study was designed to investigate the effects of Desert Dust Storms and Climatological Factors on Mortality and Morbidity of Cardiovascular Diseases admitted to emergency department in Gaziantep. METHOD: Hospital records, obtained between September 01, 2009 and January 31, 2014, from four state hospitals in Gaziantep, Turkey, were compared to meteorological and climatological data. Statistical analysis was performed by Statistical Package for the Social Science (SPSS) for windows version 24.0. RESULTS: 168,467 patients were included in this study. 83% of the patients had chest pain and 17% of patients had cardiac failure (CF). An increase in inpatient hospitalization due to CF was observed and corresponded to the duration of dust storms measured by number of days. However, there was no significant increase in emergency department (ED) presentations. There was no significant association of cardiac related mortality and coinciding presence of a dust storm or higher recorded temperature. The association of increases in temperature levels and the presence of dust storms with "acute coronary syndrome- (ACS-) related emergency service presentations, inpatient hospitalization, and mortality" were statistically significant. The relationship between the increase in PM10 levels due to causes unrelated to dust storms and the outpatient application, admission, and mortality due to heart failure was not significant. The increase in particle matter 10 (PM) levels due to causes outside the dust storm caused a significant increase in outpatient application, hospitalization, and mortality originated from ACS. CONCLUSION: Increased number of dust storms resulted in a higher prevalence of mortality due to ACS while mortality due to heart failure remained unchanged. Admission, hospitalization, and mortality due to chest pain both dependent and independent of ACS were increased by the presence of dust storms, PM10 elevation, and maximum temperature.

Comparison of IV dexketoprofen trometamol, fentanyl, and paracetamol in the treatment of renal colic in the ED: A randomized controlled trial.

OBJECTIVE: In this study, we aimed to compare the analgesic efficacy of intravenous dexketoprofen trometamol, fentanyl, and paracetamol in patients presenting to the emergency department with renal colic. MATERIALS AND METHOD: Data obtained from the emergency departments of Gaziantep University's Hospital for Research and Practice along with two other state hospitals in Gaziantep, Turkey between January 2016 and January 2017 was used for this study. A total of three hundred patients (n=300), who presented to the ER with complaints most common to renal colic whose diagnoses were subsequently confirmed with Computerized Tomography were included in the study. Patients' pain scores were recorded using the Visual Analogue Scale, at admission (immediately before drug administration), then at the 15th, and 30th minutes. SPSS 22.0 software package was used for analysis. p<0.05 was considered significant. RESULTS: At the 15th minute comparison, the efficacies of the three groups of drugs were not superior to one other, but at the 30th minute, dexketoprofen trometamol was statistically more effective than paracetamol and fentanyl. There was no statistically significant difference between fentanyl and paracetamol. The need for additional analgesia in the group receiving dexketoprofen trometamol was found to be lower. Dexketoprofen trometamol was statistically superior to the other two agents in achieving full analgesia at the end of the thirty-minute period. Fentanyl was found to be statistically significant in achieving moderate analgesia. CONCLUSION: As a Non-steroidal antiinflammatory drug dexketoprofen trometamol is superior to paracetamol and fentanyl in achieving analgesia and reducing the need for additional drugs for the treatment of renal colic.

Clinical severity in forecasting platelet to lymphocyte ratio in Crimean-Congo hemorrhagic fever patients.

Crimean-Congo hemorrhagic fever (CCHF) is a life-threatening disease that develops as a result of infection by a member of the Nairovirus genus of the Bunyaviridae family, and its initial symptoms are not specific. In patients with severe clinical progression, in particular, the neutrophil rate is high, whereas lymphocyte and monocyte levels are low. A total of 149 patients, in whom the diagnosis was confirmed with reverse transcriptase PCR, were included in the study. In order to compare patient clinical progression severity, we divided the patients into two groups. For group 1, Çevik's severity score was used. The patients who had a platelet/lymphocyte ratio (PLR) <41 constituted group 2. Of 149 patients, 20 (13.4 %) were determined as group 1 (Çevik's classification) and 38 (25.5 %) were determined as group 2 (PLR <41). Of 11 deaths, 4 (36.4 %) patients were from group 1 and 7 (63.6 %) were from group 2. This is the first study to our knowledge to analyse the relationship between severity and PLR in patients with CCHF. PLR is a simple laboratory test that can aid in determining the prognosis of individuals with this disease.

Benefits of cardiac sonography performed by a non-expert sonographer in patients with non-traumatic cardiopulmonary arrest.

UNLABELLED: The purpose of this study was to evaluate a rapid cardiac ultrasound assessment performed by trained non-expert sonographers integrated into the advanced cardiac life support (ACLS). MATERIAL AND METHODS: This study was prospectively performed in 179 patients (104 males and 75 females) who underwent cardiopulmonary resuscitation (CPR) in an emergency department (ED) during two calendar years (2013 and 2014). Two senior doctors, who had received emergency cardiac ultrasonography training, performed cardiac ultrasound through the apical, subxiphoid, or parasternal windows. Ultrasound evaluation and pulse controls were performed simultaneously. SPSS 18.0 was used for statistical analysis. RESULTS: A total of 63.7% (114) of the cardiopulmonary arrest incidents occurred out of the hospital. Only 13 patients had a femoral pulse during the initial evaluation, while 166 showed no femoral pulse. Initial monitoring showed a regular rhythm in 53 patients, ventricular fibrillation in 18 patients, and no rhythms in 108 patients. The first evaluation with ultrasound detected an effective heart rate in 26 patients and ventricular fibrillation in 14 patients, while no effective heart rate was observed in 139 patients. In addition, ultrasound revealed pericardial tamponade in seven patients and right ventricular enlargement in four cases. Global hypokinesia was detected in four patients and hypovolemia was observed in another four patients. CONCLUSION: The use of real-time ultrasonography during resuscitation with real-time femoral pulse check can help facilitate the distinguishing of pea-type arrest, ascertain the cause of the arrest, infer a suitable treatment, and optimize medical management decisions regarding CPR termination.

Effect of music on pain, anxiety, and patient satisfaction in patients who present to the emergency department in Turkey.

AIM: The objective of this study is to evaluate the effect of music therapy on pain, anxiety, and patient satisfaction in patients who present to the emergency department in Turkey. METHODS: This controlled and experimental study was conducted in the emergency department of a hospital in Turkey between July and October 2012. The study sample consisted of 200 patients in total, 100 forming the intervention group and 100 being the control group, who fell under color code green in the triage system and came with complaints of pain due to nausea/vomiting and diarrhea, abdominal pain, headaches, and joint pain. A questionnaire, the State Anxiety Scale, and the Visual Analog Scale to measure the patients' level of pain were used in the study. The questionnaires of the intervention group were administered after playing the music. RESULTS: When the intervention and control groups were compared, it was observed that there was a significant decrease in the VASP and STAI-S scores in favor of the intervention group. It was observed that 21.0% of the patients in the intervention group were very pleased to hear music in the emergency department, 58% of them were moderately or at least a little pleased, and 21.0% were not pleased at all. CONCLUSION: The results showed that music therapy had a positive effect in terms of reducing the severity of pain and the level of anxiety in patients, that only a very small portion of the patients were not pleased to listen to music in the emergency department.

An assessment of antioxidant status in patients with carbon monoxide poisoning.

BACKGROUND: Carbon monoxide poisoning (COP) is an important cause of mortality and morbidity worldwide. This study was to investigate the levels of serum paraoxonase (PON), arylesterase (ARYL), ceruloplasmin (Cp), and sulfhydryl (-SH) in the treatment of COP, and to further understand the pathophysiology of COP. METHODS: This prospective study comprised 107 individuals with COP (group 1) and 50 healthy volunteers (group 2). Serum, plasma, and erythrocyte samples were taken on admission from all participants with COP. This process was repeated in the 90(th) and 180(th) minutes of treatment. Samples were taken from the control group only once. The levels of plasma PON, ARYL, Cp activity and -SH were measured in both groups. RESULTS: Age, gender, and carboxyhemoglobin level were not correlated with PON, ARYL, Cp, and -SH levels. PON, ARYL, and -SH levels were significantly decreased in group 1 compared with group 2. Conversely, Cp was significantly elevated in group 1 in contrast to group 2. Although ARYL was lower on admission in patients with COP than that was observed in the 90(th) and 180(th) minutes (P<0.001), Cp was higher on admission than at the other time points (P<0.001). CONCLUSIONS: Participants with COP had decreased levels of antioxidants (PON, ARLY, and -SH). COP represses the antioxidant system.

Impact of scorpion stings on electrocardiographic changes and relationship with body oxidant and antioxidant status.

OBJECTIVE: To investigate electrocardiogram changes due to scorpion stings and association between oxidative stress index, body oxidant/antioxidant system and the electrocardiogram changes. METHODS: The study was conducted at the Faculty of Medicine, Gaziantep University, Turkey, between May 2009 and October 2010. It comprised 44 patients admitted to the emergency department for scorpion sting, and a control group of matched age and gender of 20 persons. Electrocardiograms were taken promptly in the most painful phases of the patients. Cardiac parametres were measured. Erythrocyte packages were prepared to detect toxin/antioxidant levels. SPSS 18 was used for statistical analysis. RESULTS: Of the 44 patients, 22 (50%) were male. Overall average age of the patients was 45.22 +/- 17.99 years. None of the patients required intensive care and none of them had limb losses. Cardiac parametres of the patients in electrocardiogram were higher (p < 0.05). Difference between those with changed electrocardiogram and unchanged electrocardiogram in terms of the values of total antioxidant status, total oxidant status, and oxidative stress index, were not statistically significant (p > 0.05). CONCLUSION: Scorpion stings associated with electrocardiogram changes. The mechanism of this relationship is not related with the status of body oxidative stress index and body oxidant and antioxidant capacity. Some parametres warrant further study in terms of potential serious arrhythmias in scorpionism.

Analysis of complaints lodged by patients attending a university hospital: a 4-year analysis.

OBJECTIVE: Health practitioners often regard complaints concerning the quality of patient care in a negative light. However, complaints by patients and their relatives are an important source of information when considering ways in which to improve care. In the present study, we evaluated the complaints of patients and their relatives with regard to our hospital, such that we could take adequate remedial measures. METHOD: Records of all patient complaints made between June 2008 and June 2012 were retrieved from the archives of the Quality Improvement Unit. The socio-demographic profiles of complainants, and their reasons for complaining, were analyzed using the SPSS statistical package. RESULTS: The results revealed that 453 complaints, relating to medical care, the attitude of staff, waiting times, and financial issues, were made against our hospital over 4 years. Of the complainants, 68.9% (n = 312) were male, and 31.1% (n = 141) were female. The majority (16.3% and 20.4%, respectively) of the complaints were due to medical care and staff attitude problems. The unit about which most patients complained was hospital administration (22.1%), and one hundred fifty-three (33.8%) complaints were about physicians. Complaint frequency was 0.22 per 1.000 visits. CONCLUSION: Complaints may be potentially useful quality assurance tools, and can identify system flaws. The primary causes of complaints were medical care, attitude of the staff, and waiting time, and many of these issues may be remedied.

Efficiency of Ankaferd Blood Stopper used in bleeding control on intraabdominal adhesions formed postoperatively.

PURPOSE: The purpose of this study is to investigate the hispathological, biochemical, and clinical efficiency of Ankaferd Blood Stopper (ABS) in preventing postoperative intraabdominal adhesions. METHOD: A total of 40 Wistar albino species female rats were randomly separated into 4 groups. For the control group, 1 mL normal saline was administered; and for the second, third, and fourth groups 0.5, 1, and 2 mL, respectively, ABS was administered. Statistical analyses were evaluated with Tukey and analysis of variance test. FINDINGS: Significant increase was observed in fibroblast and vascularization microscopically with increasing amount of ABS used. Degree of adhesion in the group administered with normal saline was lower compared to the other groups. Adhesion thickness and prevalence macroscopically increased with the increasing amount of ABS used in groups. CONCLUSION: It was determined in our study that ABS is not efficient in preventing intraabdominal adhesions; on the contrary, adhesions were increased with the increased amount of ABS used.

An assessment of oxidant/antioxidant status in patients with snake envenomation.

OBJECTIVE: The aim of this study is to investigate the antioxidant status (TAS), oxidant status (TOS) and oxidative stress index (OSI) in patients with snake envenomation and to learn more about the pathophysiology of snake envenomation. METHOD: Between May 2009 and October 2010, 47 patients were admitted to our emergency department with snake bites, and as a control group 20 healthy volunteers were enrolled in this study. Serum, plasma, and erythrocyte components were prepared for all patients on admission and at the control after 1 month. Serum TOS/TAS levels were measured. RESULTS: No correlation was observed among age, gender and the levels of TAS, TOS and OSI. TAS, TOS and OSI levels were higher in snake envenomation patients upon arrival at the emergency department than in the healthy control group. Upon admission, all levels of patients with snake envenomation were higher than the control levels taken after 1 month. CONCLUSIONS: Serum TAS, TOS and OSI levels increase in snake envenomation patients. The results obtained in this study indicate that the snake bite was associated with a shift to an oxidative state, and oxidative stress plays an important role in the pathophysiology of snake envenomation.

An assessment of antioxidant status in patients with carbon monoxide poisoning / 世界急诊医学杂志（英文）

BACKGROUND:Carbon monoxide poisoning (COP) is an important cause of mortality and morbidity worldwide. This study was to investigate the levels of serum paraoxonase (PON), arylesterase (ARYL), ceruloplasmin (Cp), and sulfhydryl (-SH) in the treatment of COP, and to further understand the pathophysiology of COP. METHODS:This prospective study comprised 107 individuals with COP (group 1) and 50 healthy volunteers (group 2). Serum, plasma, and erythrocyte samples were taken on admission from allparticipants with COP. This process was repeated in the 90th and 180th minutes of treatment. Samples were taken from the control group only once. The levels of plasma PON, ARYL, Cp activity and -SH were measured in both groups. RESULTS:Age, gender, and carboxyhemoglobin level were not correlated with PON, ARYL, Cp, and -SH levels. PON, ARYL, and -SH levels were significantly decreased in group 1 compared with group 2. Conversely, Cp was significantly elevated in group 1 in contrast to group 2. Although ARYL was lower on admission in patients with COP than that was observed in the 90th and 180th minutes (P<0.001), Cp was higher on admission than at the other time points (P<0.001). CONCLUSIONS:Participants with COP had decreased levels of antioxidants (PON, ARLY, and -SH). COP represses the antioxidant system.

Effects of music therapy on pain and anxiety in patients undergoing port catheter placement procedure.

BACKGROUND: Patients scheduled to invasive medical procedures experience high levels of anxiety, which may lead to increased perceptions of pain and vital sign instability throughout. AIMS: To examine the effect of a music intervention (MI) on stress hormones, physiologic parameters, pain, and anxiety state before and during port catheter placement procedures (PCPPs). METHODS: We conducted a prospective, randomized, controlled study in 100 oncology patients, who were randomly assigned to an MI group (n=50) or a control group (n=50). The effects of music were assessed by determination of serum cortisol and adrenocorticotropic hormone (ACTH) levels, heart and respiratory rate (HR, RR) and systolic and diastolic blood pressure (SBP, DBP), on arrival in the surgical intervention room, as well as immediately prior to and immediately after the PCPP, in both groups. Furthermore, pain and anxiety levels were identified using visual analogue scale and state-trait anxiety inventory scales. RESULTS: On arrival, there were no differences between the patients in terms of serum cortisol and ACTH levels, HR, RR, SBP, DBP and anxiety levels. There were significant reductions in hormone levels (p<0.05 for all), HR (p<0.001), RR (p<0.001), SBP (p<0.05) and DBP (p<0.05), immediately prior to and immediately after the PCPP in participants in the MI group compared to those in the control group. Furthermore, music led to a significant reduction in pain (p<0.05) and anxiety scores (p<0.05) in the MI group compared to control group. CONCLUSION: During invasive medical procedures, MI significantly decreases stress hormone levels, physiological parameters, acute procedural pain and anxiety.

Therapeutic red cell exchange for severe carbon monoxide poisoning.

BACKGROUND AND OBJECTIVE: Carbon monoxide (CO) is the most common cause of fatal poisoning worldwide. Therapeutic red cell exchange (TREX) has been used in the treatment of many different diseases. Therefore, we aimed to evaluate the efficacy of TREX on the clinical status, outcome, and discharge of patients with severe CO poisoning. METHODS: Demographic data, clinical status, and outcomes of 12 patients that were treated with TREX for severe CO poisoning after referral to the Emergency and Hematology Departments of Gaziantep University between November 2011 and April 2012 were evaluated. RESULTS: Mean carboxyhemoglobin level decreased from (59.7 ± 12.7)% (38-79%) to (17 ± 9.4)% (8-43%), and mean Glasgow Coma Scale score increased from 4 ± 1.6 (3-8) to 9.4 ± 3.5 (3-14) after TREX therapy. Five patients were admitted to the intensive care unit. Rhabdomyolysis developed in one case. Of the 12 patients, 11 were discharged alive, and one patient died. CONCLUSION: TREX may be an alternative treatment method for reducing mortality and morbidity in cases of severe CO poisoning.

Role of inferior vena cava and right ventricular diameter in assessment of volume status: a comparative study: ultrasound and hypovolemia.

OBJECTIVE: Ultrasonography has been suggested as a useful noninvasive tool for the detection and follow-up for hypovolemia. Two possible sonographic markers as a surrogate for hypovolemia are the diameters of the inferior vena cava (dIVC) and the right ventricle (dRV). The goal of this study was to evaluate IVC and RV diameters and diameter changes in patients treated for hypovolemia and compare these findings with healthy volunteers. METHODS: Fifty healthy volunteers and 50 consecutive hypovolemic patients were enrolled in the study. The dIVC, both during inspiration (IVCi) and expiration (IVCe), was measured in hypovolemic patients both before and after fluid resuscitation, and they were also measured in healthy volunteers during the time they participated in the study. The dIVC, in hypovolemic patients both before and after fluid resuscitation, was measured ultrasonographically by M-mode in the subxiphoid area. The dRV was measured ultrasonographically by B-mode in the third and fourth intercostals spaces. RESULTS: The average diameters of the IVCe, IVCi, and dRV in hypovolemic patients upon arrival were significantly lower compared with healthy volunteers (P = .001). After fluid resuscitation, there was a significant increase in the mean diameters of the IVCe, IVCi, and RV in hypovolemic patients (P = .001). CONCLUSIONS: The results indicate that the dIVC and dRV are consistently low in hypovolemic subjects when compared with euvolemic subjects. Bedside serial measurements of dIVC and dRV could be a useful noninvasive tool for the detection and follow-up of patients with hypovolemia and evaluation of the response to the treatment.

Oxidant/antioxidant status in cases of snake bite.

BACKGROUND: Snake bites are an important cause of mortality and morbidity worldwide, especially in rural areas. OBJECTIVE: The aim of this study was to investigate serum paraoxonase (PON), arylesterase (ARLY), ceruloplasmin (Cp), and myeloperoxidase (MPO) activity and lipid hydroperoxide (LOOH) and total sulfhydryl group (-SH) levels in patients with snake venom poisoning. METHODS: The study included 49 patients with snake bite envenomation (Group 1) and 39 healthy volunteers as the control group (Group 2). Plasma PON, ARLY, Cp, and MPO activity and LOOH and -SH levels were measured. Laboratory measurements of 20 patients with snake bite envenomation (Group 3) were performed again after treatment. RESULTS: PON and ARLY activity and -SH levels were significantly decreased in Group 1 compared with those in Group 2. Cp and MPO activity and LOOH levels were significantly elevated in Group 1 compared with those in Group 2. PON and ARLY activity were significantly elevated in Group 3 compared with those in Group 1. Cp and MPO activity and LOOH levels were significantly decreased in Group 3 compared with those in Group 1. CONCLUSIONS: Patients with snake bite envenomation had increased oxidants (MPO and LOOH) and decreased antioxidants (PON, ARLY, and -SH). Results obtained in this study demonstrate that snake bites are associated with a shift to oxidative status. Therapy with antioxidants can lead to an increase in the antioxidant defense system, and thus improvements in clinical symptoms.

Plasma exchange as a complementary approach to snake bite treatment: an academic emergency department's experiences.

Snake bites are leading causes of morbidity and mortality worldwide, especially in rural areas. Therapeutic plasma exchange has been used in the treatment of many different conditions such as immunologic diseases, toxicologic disorders, and snake envenomation. The aim of this study is to evaluate the efficacy of plasma exchange treatment on clinical status, outcomes, and discharge of patients who were bitten by venomous snakes. The study was conducted retrospectively in the Emergency Department of Gaziantep University from January 2002 to December 2011. Thirty-seven patients were included in the present study. Routine biochemical and hematologic laboratory parameters were studied before and after plasma exchange. Demographic data, clinical status, and outcomes of patients were recorded. Plasma exchange was performed by using centrifugation technology via an intravenous antecubital or subclavian vein catheter access. Human albumin/fresh frozen plasma was used as replacement fluids. A significant correlation was seen between therapeutic plasma exchange and improvement of laboratory results. None of the study patients lost their limbs. Eight patients were sent to the intensive care unit. The mean length of the hospital stay was 12.2 days (4-28). All patients were discharged with good recovery. No complications were seen during the 3 months following discharge. Plasma exchange appears to be an effective treatment intervention for snake bite envenomations, especially in the management of hematologic problems and in limb preservation/salvage strategies. In addition to traditional treatment methods, plasma exchange should be considered by emergency physicians in cases of snake bite envenomation as a therapeutic approach to facilitate rapid improvement.

Pneumomediastinum after retching.

A 25-year-old woman with hirsutism presented to the Emergency Department of the medicine faculty in Gaziantep University with a 4-h History of dyspnoea, dysphagia, coughing, continuous and progressive chest pain radiating to the back and palpation of her neck. The physical examination was significant for diffuse neck and chest subcutaneous emphysema. The x-ray study and CT scan of the chest revealed pneumomediastinum. The patient reported that 6 h before presentation she took spironolactone due to hirsutism and she retched. Retching caused the symptoms. The patient was followed conservatively and fully recovered over the next 7 days. Spontaneous pneumomediastinum developed in this patient with no underlying lung disease, presumably from air leakage secondary to the excessive elevation of intrathoracic pressure due to retching. Pneumomediastinum is an uncommon disease arising most frequently and remains largely underdiagnosed clinically, especially in young, healthy patients.