Diagnostic accuracy of venous system ultrasound for subtypes of acute kidney injury.

BACKGROUND: Management of acute kidney injury (AKI) in the ED can be difficult due to uncertainty regarding the aetiology. This study investigated the diagnostic value of venous system ultrasound for determining the aetiological subtypes of AKI in the ED. METHODS: This multidisciplinary prospective cohort study was conducted in a single academic ED over the course of a year. Adult patients with AKI were evaluated using the venous excess ultrasound (VExUS) score, which is a four-step ultrasound protocol. The protocol begins with the inferior vena cava (IVC) measurement and examines organ flow patterns, including portal, hepatic and renal veins in the presence of dilated IVC. The AKI subtypes (hypovolaemia, cardiorenal, systemic vasodilatation and renal) were adjudicated by nephrologists and emergency physicians, considering data that became available during the hospitalisation. We determined the diagnostic test characteristics of VExUS for identifying each of the four AKI aetiological subtypes. RESULTS: 150 patients with AKI were included in the study. Hypovolaemia was the most frequent finally adjudicated cause of AKI (66%), followed by cardiorenal (18%), systemic vasodilatation (8.7%) and renal (7.3%). In diagnosing the cardiorenal subtype, the area under the curve (AUC) for VExUS grade >0 was 0.819, with 77.8% sensitivity and 80.5% specificity, and the AUC for IVC maximum diameter >20.4 mm was 0.865, with 74.1% sensitivity and 86.2% specificity. For the hypovolaemia subtype, the AUC for VExUS grade ≤0 was 0.711, with 83.8% sensitivity and 56.9% specificity, and the AUC for IVC maximum diameter ≤16.8 mm was 0.736, with 73.7% sensitivity and 68.6% specificity. None of the parameters achieved adequate test characteristics for renal and systemic vasodilatation subtypes. CONCLUSION: The VExUS score has good diagnostic accuracy for cardiorenal AKI and fair accuracy for hypovolaemic AKI but cannot identify renal and systemic vasodilatation subtypes. It should not therefore be used in isolation to determine the cause of AKI in the ED. TRIAL REGISTRATION NUMBER: NCT04948710.

Diagnostic Accuracy of Early Systolic Notching in Pulmonary Embolism.

OBJECTIVE: Recently, a cardiac sonography finding, early systolic notching (ESN), was reported with high sensitivity and specificity for the diagnosis of pulmonary embolism (PE) in a limited population. The aim of this study was to determine the diagnostic accuracy of ESN finding for PE in emergency department (ED) patients. METHOD: This prospective multicenter study was conducted in 4 academic EDs. All patients who underwent computed tomography angiography for suspected PE were included in the study. After inclusion, cardiac ultrasound including the right ventricular outflow tract Doppler signal was performed. The diagnostic tests of ESN finding were used for PE and its subgroups. RESULTS: In the study, 183 of 201 patients met the study criteria. Of all patients, 52.5% had PE (n = 96), and 19.7% (n = 36) had ESN finding. In all ED patients, the sensitivity of ESN for PE was 34% (95% CI 25-45), and the specificity was 97% (95% CI 90-99). In the subgroup analysis, the sensitivity of ESN for PE with high or intermediate-high risk was 69% (95% CI 49-85), and the specificity was 90% (95% CI 84-94). Inter-rater reliability for ESN finding between the cardiologist and emergency physician was strong with a kappa statistic of 0.87. CONCLUSION: The pulmonary Doppler flow of ESN was moderate to high specific but low sensitive for PE in all ED patients. In the subgroup analysis, this finding was moderate specific and low sensitive.

Pandemic hospitals and reorganizing emergency departments

Emergency departments have always been the first point of contact for hospitals in many situations, including man-made and natural disasters. The first places where patients with symptoms of COVID-19 were met in health institutions were also emergency departments. Emergency departments play an important role in diagnosing the disease and isolating patients (by hospitalization if necessary). The process, which starts with the triage of outpatients admitted to the emergency department and brought by ambulance, continues as isolation of the patients in appropriate areas including physical evaluation, management of laboratory and scanning processes and, if necessary, providing cardiopulmonary resuscitation with airway support. Afterwards, patients can be treated as an outpatient, or hospitalized, or treated at the intensive care unit in line with their preliminary diagnosis and clinical conditions. Disruptions that may occur in one or more of these stages can lead to crowds and lengthy queues in the emergency department by prolonging the follow-up period of the patients. One of the strengths of Turkey at this point is that emergency departments are accustomed to the heavy patient load. The experiences gained from these conditions have facilitated the organization of pre-hospital emergency medical services, pandemic hospitals, and their emergency departments. In this organization, the main goal should be to provide uninterrupted and high-quality patient care through personnel training, personal protection measures, and the creation of physical conditions. Turkey's emergency departments are accustomed to managing the intensive patient flow, as they work at full capacity during normal times. Thanks to the experiences of emergency healthcare workers, health service was provided without any patient being turned away from the door of the emergency departments during the COVID-19 pandemic. In this review, we aimed to present the organization of pandemic hospitals and emergency departments during the COVID-19 pandemic. We made a schematic representation of the architectural areas through the emergency department of Ankara City Hospital, which has a bed capacity of 4200 with 256 beds in emergency department.

The factors predicting pneumonia in COVID-19 patients: preliminary results from a university hospital in Turkey

Background/aim: Pneumonia is the most serious clinical presentation of COVID-19. This study aimed to determine the demographic, clinical, and laboratory findings that can properly predict COVID-19 pneumonia. Materials and methods: This study was conducted in the Gazi University hospital. All hospitalized patients with confirmed and suspected SARS-CoV-2 infection between 16 March 2020 and 30 April 2020 were analyzed retrospectively. COVID-19 patients were separated into two groups, pneumonia and nonpneumonia, and then compared to determine predicting factors for COVID-19 pneumonia. Variables that had a P-value of less than 0.20 and were not correlated with each other were included in the logistic regression model. Results: Of the 247 patients included in the study 58% were female, and the median age was 40. COVID-19 was confirmed in 70.9% of these patients. Among the confirmed COVID-19 cases, 21.4% had pneumonia. In the multivariate analysis male sex (P = 0.028), hypertension (P = 0.022), and shortness of breath on hospital admission (P = 0.025) were significant factors predicting COVID-19 pneumonia. Conclusion: Shortness of breath, male sex, and hypertension were significant for predicting COVID-19 pneumonia on admission. Patients with these factors should be evaluated more carefully for diagnostic procedures, such as thorax CT.

BLUE protocol ultrasonography in Emergency Department patients presenting with acute dyspnea.

OBJECTIVE: Dyspnea is a common Emergency Department (ED) symptom requiring prompt diagnosis and treatment. The bedside lung ultrasonography in emergency (BLUE) protocol is defined as a bedside diagnostic tool in intensive care units. The aim of this study was to investigate the test performance characteristics of the BLUE-protocol ultrasonography in ED patients presenting with acute dyspnea. METHOD: This study was performed as a prospective observational study at the ED of a tertiary care university hospital over a 3-month period. The BLUE-protocol was applied to all consecutive dyspneic patients admitted to the ED by 5 emergency physicians who were certified for advanced ultrasonography. In addition to the BLUE-protocol, the patients were also evaluated for pleural and pericardial effusion. RESULTS: A total of 383 patients were included in this study (mean age, 65.5 ±â€¯15.5 years, 183 (47.8%) female and 200 (52.2%) male). According to the BLUE-protocol algorithm, the sensitivities and specificities of the BLUE-protocol are, respectively, 87.6% and 96.2% for pulmonary edema, 85.7% and 99.0% for pneumonia, 98.2% and 67.3% for asthma/COPD, 46.2% and 100% for pulmonary embolism, and 71.4% and 100% for pneumothorax. Although not included in the BLUE-protocol algorithm, pleural or pericardial effusion was detected in 82 (21.4%) of the patients. CONCLUSION: The BLUE-protocol can be used confidently in acute dyspneic ED patients. For better diagnostic utility of the BLUE-protocol in EDs, it is recommended that the BLUE-protocol be modified for the assessment of pleural and pericardial effusion. Further diagnostic evaluations are needed in asthma/COPD groups in terms of the BLUE-protocol.

Evaluation of the general characteristics of patients aged 85 years and above admitted to a university hospital emergency department

Background/aim: The number of elderly people (≥65 years old) is increasing both in Turkey and internationally due to improved living conditions and decreased mortality rates. Knowing the characteristics of elderly patients admitted to emergency departments can provide guidance for diagnosis and treatment approaches. In this study, we analyzed the characteristics of very old patients (4≥85 years old) admitted to the emergency department and put together data for use in forward planning in healthcare services.Materials and methods: This retrospective study included all patients aged ≥85 years admitted to the Adult Emergency Department of Gazi University Medical Faculty Hospital between 01.01.2014 and 31.12.2014. Data concerning the patients' age, sex, date of admission, weekday or weekend admission, reason for admission, length of stay, number of readmissions, admission from within or outside the province, and whether they were hospitalized or not were evaluated.Results: In this study, 1105 admissions of 780 patients aged ≥85 years to the emergency department were analyzed. The median age of the patients was 87 years and 59% were female. The most frequent admissions were in January (11.4%). Most patients (63.1%) were admitted only once to our emergency department within the study period. A total of 40.5% of patients were hospitalized in the clinics or intensive care units. The rate of mortality at first admission was 1.5% (12 patients). The most common complaints at admission were infection (13.3%) and soft tissue traumas (crashes, sprains, fractures, dislocations) related to the musculoskeletal system (11.8%). Readmissions were more frequent in males. It was seen that male patients were more frequently admitted due to deterioration of general health status and genitourinary system symptoms, despite pain being more common among women.Conclusion: Due to the changing population structure, emergency staff in Turkey as well as internationally encounter old and very old patients more frequently. It is now imperative that emergency departments acquire the necessary infrastructure, human resources, knowledge, and equipment needed to meet the needs of these patients.

Effects of fast-track in a university emergency department through the National Emergency Department Overcrowding Study.

OBJECTIVE: To determine the impact of a fast track area on emergency department crowding and its efficacy for non-urgent patients. METHODS: The prospective cross-sectional study was conducted in an adult emergency department of a university-affiliated hospital in Turkey from September 17 to 30, 2010. Non-urgent patients were defined as those with Canadian Triage Acuity Scale category 4/5. The fast track area was open in the emergency department for one whole week, followed by another week in which fast track area was closed. Demographic information of patients, their complaints on admission, waiting times, length of stay and revisits were recorded. Overcrowding evaluation was performed via the National Emergency Department Overcrowding Study scale. In both weeks, the results of the patients were compared and the effects of fast track on the results were analysed. Continuous variables were compared via student's t test or Mann Whitney U test. Demographic features of the groups were evaluated by chi-square test. RESULTS: A total of 249 patients were seen during the fast track week, and 239 during the non-fast track week at the emergency department. Satisfaction level was higher in the fast track group than the non-fast track group (p < 0.001). The waiting times shortened from 20 minutes to 10 minutes and length of stay shortened from 80 minutes to 42 minutes during the fast track week. Morbidity and mortality rates remained unchanged. CONCLUSION: Owing to fast track, overcrowding in the emergency department was lessened. It also improved effectiveness and quality measures.

Wells score and Pulmonary Embolism Rule Out Criteria in preventing over investigation of pulmonary embolism in emergency departments.

INTRODUCTION: Unnecessary diagnostic tests are usually ordered to most of the patients with dyspnea or pleuritic chest pain, because of the worse outcomes of missed diagnosis of pulmonary embolism (PE). To identify rates and causes of over investigation for PE and to search whether it was possible to reduce this over investigation by using Wells score and Pulmonary Embolism Rule Out Criteria (PERC). MATERIALS AND METHODS: A retrospective observational cohort study performed in an emergency department of a tertiary care university hospital. All patients who were ordered diagnostic with the suspicion of PE were included in the study. They were grouped into two as PE (+) and PE (-) and compared. RESULTS: Among 108 patients, 53 (49%) were diagnosed as PE (+) and overdiagnosis was present in 55 (51%) patients i.e., PE (-). The sensitivity of high Wells score was 43%, specificity 78%, positive predictive value 66% and negative predictive value 59%. PERC criteria found to be negative (when all of the eight criteria were fulfilled) in only five patients. The sensitivity of the test was 98%, specificity 7%, positive predictive value 50%, negative predictive value 80%. When individual parameters of PERC were evaluated solely for the exclusion of PE; "no leg swelling" and "no previous deep venous thrombosis or PE history" were found significantly negatively correlated with PE diagnosis (p= 0.001, r= -0.325 and p= 0.013, r= -0.214 respectively). CONCLUSION: Over investigation of PE in emergency departments still remains as an important problem. In order to prevent this, the clinical prediction rules must be developed further and their use in combination should be searched in future studies.

Endogenous carboxyhemoglobin concentrations in the assessment of severity in patients with community-acquired pneumonia.

INTRODUCTION: Previous studies have shown that carbon monoxide, which is endogenously produced, is increased in community-acquired pneumonia (CAP). However, it has not been studied enough whether severity of pneumonia is correlated with increased carboxyhemoglobin (COHb) concentrations in CAP. The aim of this study was to determine whether endogenous carbon monoxide levels in patients with CAP were higher compared with the control group and, if so, to determine whether COHb concentrations could predict severity in CAP. MATERIALS AND METHODS: Eighty-two patients with CAP were evaluated in this cross-sectional study during a 10-month period. Demographic data, pneumonia severity index and confusion, uremia, rate respiratory, pressure blood, age>65 (CURB-65) scores, hospital admission or discharge decisions, and 30-day hospital mortality rate were recorded. In addition, 83 control subjects were included to study. The COHb concentration was measured in arterial blood sample. RESULTS: The levels of COHb in patients with CAP were 1.70% (minimum-maximum, 0.8-3.2), whereas those in control subjects, 1.40% (minimum-maximum, 0.8-2.9). The higher COHb concentrations in patients with CAP were statistically significant (P < .05). Concentration of COHb correlated with pneumonia severity index (P = .04, r = 0.187); however, it did not correlate with CURB-65 (P = .218, r = 0.112). CONCLUSION: Although COHb concentrations show an increase in patients with pneumonia, it was concluded that this increase did not act as an indicator in diagnosis process or prediction of clinical severity for the physicians.

Mean platelet volume as a risk stratification tool in the emergency department for evaluating patients with ischaemic stroke and TIA.

OBJECTIVE: To investigate the variations of mean platelet volume in patients with ischaemic cerebrovascular complaints, and to find out its diagnostic utility in an acute setting to help risk stratification in patients with ischaemic stroke and transient ischaemic attacks. METHODS: The prospective cross-sectional study was conducted at the Gazi University Hospital, Ankara, Turkey, from November 2009 to June 2010. It comprised 143 consecutive patients of acute ischaemic stroke, 39 patients of transient ischaemic attacks and 60 healthy volunteers. SPSS 13 was used for statistical analysis, and so were t-test, one-way analysis of variance test and correlation analysis. Statistical significance was accepted at p < 0.05. RESULTS: Mean platelet volume results were significantly higher in patients with cortical infarction and transient ischaemic attack compared to the control group (p < 0.001 and p <0.002). A statistically significant increase was also noted in hospitalised patients when compared with discharged patients from the emergency department (p < 0.036). A weak positive correlation was identified between the National Institute of Health Stroke Scores and mean platelet volume levels (r = 0.207; p < 0.001). A significant relationship was identified between mean platelet volume levels and previous stroke (p < 0.005). CONCLUSION: The measurement of mean platelet volume levels may provide useful diagnostic and prognostic information to emergency physicians caring for patients with transient ischaemic attack and ischaemic stroke. In patients with suspected neurological ischaemic symptoms, high levels may be considered as an atherosclerotic risk factor.

Efficacy of triage by paramedics: a real-time comparison study.

OBJECTIVES: Triage has evolved as an effective method of separating patients who require immediate medical attention from patients with non-urgent problems. The aim of this study was to assess the agreement between paramedics and emergency residents about triage decisions using the 3-level triage (3L) system and the 5-level (5L) Australian triage scale in real time. METHODS: All patients who presented to a central triage area during a 1-week period were triaged by paramedics and emergency residents. The chance-adjusted measure of agreement kappa (κ) was calculated to evaluate the agreement between triage decisions made by paramedics and by emergency residents. RESULTS: A total of 731 patients were included in the final data analysis. Admitting time and waiting time were significantly consistent in the triage area. Agreement between the triage decisions made by paramedics and by emergency residents was 47% (κ = 0.47) when using the 3L triage scale and 45% (κ = 0.45) when using the 5L triage scale across all cases. A strong correlation existed among the general conditions of the patients, the 3L triage scale, and the 5L triage scale. DISCUSSION: Triaging is commonly performed by nurses in the American emergency system, and triage by paramedics is not common. Few studies are available about triage by paramedics, and more studies are necessary. A new triage scale may be necessary for untrained personnel so that all emergency departments can conduct simple triage.

The characteristics of assaulted victims presented to a university emergency department: Can head trauma in male patients be considered a clue for assaults?

BACKGROUND: Violence is a common issue without an exact number worldwide. The types are interpersonal, spousal, or domestic violence. We aim to reveal the demographic characteristics of cases involving violence, mechanisms of injury, and their relationship with head and face trauma. METHODS: The files of patients presented to our University Hospital Adult Emergency Department (ED) between January 2018 and December 2020 after an assault were reviewed retrospectively. The data were analyzed with SPSS 20.0. The demographic findings, injury mechanisms, and affected areas were reported. The Chi-square test tested the differences between the groups, and p<0.05 was considered significant. RESULTS: Among the 1280 patients presented after an assault, 71% were male with a median age of 32 (IQR 25-43). In 84% of the cases, the perpetrators were unknown, while their spouses were the perpetrators in 9% of the cases. The place was most noted as home (11%). The methods used were struggling (43%) and punching (42%). The most common affected area was the head (70%) and diagnosis for nasal fracture (4%); two patients had epidural bleeding, and one had a pneumothorax. Males were more common in the 20-40 age groups (χ2, p=0.003). Most of the female victims were battered by their spouses (χ2, p<0.001). Head injury was found in 83% of patients with high blood alcohol levels (χ2, p<0.001) and 75% of male patients had head injuries (χ2, p<0.001). CONCLUSION: Assault is a common problem predominantly among young males. The most commonly affected body part was the head, and nasal fractures were the diagnosis. Most of the patients with high blood levels were among the male victims. The perpetrator of the female victims was their spouses. In the ED, male patients who presented with head trauma were considered as assault victims.

Effectiveness of training in increasing awareness about managing pressure injuries in emergency departments.

INTRODUCTION: Emergency room conditions and the characteristics of the patients followed up pose a risk for pressure injury. AIM: This study was conducted as a pilot study to assess the effectiveness of a training program in increasing the awareness of healthcare professionals working in an emergency department about how to manage pressure injuries. METHODS: The study was a prospective, pre-test post-test intervention study without a control group. The study included 595 patients who were hospitalized in the emergency room for more than two hours and voluntarily agreed to participate, as well as 11 physicians and 17 nurses working in the emergency department between 15 April and 19 June 2019 2019. It was carried out in three stages. In the first stage, the 30-day pressure injury incidence rate in the emergency department was evaluated using the "Emergency Department Patients Information and Pressure Injury Assessment Form" and "The Braden Scale for Predicting Pressure Injury Risk". In the second stage, the healthcare professionals were given training about pressure injuries. The knowledge levels of healthcare professionals before and after the training were evaluated using "The Descriptive Characteristics Form for Emergency Department Personnel (doctors and nurses)" and "The Questionnaire for Identifying and Preventing Pressure Injury". In the third stage, the 30-day pressure injury incidence rate in the was re-evaluated after the training using the same two scales as before. The SPSS 25 package program was used to evaluate the data in terms of frequency, percentage, mean and standard deviation, and the Mann-Whitney U Test for independent groups, the t-test, the correlated sample t-test, the Wilcoxon Signed Rank test, Pearson Chi-square test, Yates Chi-square test and Fisher's Exact Chi-square test were also used. RESULTS: The mean knowledge test score of the healthcare professionals working in the emergency department was determined as X¯±SD = 53.71 ± 14.70 before the training and X¯±SD = 58.57 ± 11.83 after the training. The average score on the prevention dimension of the Questionnaire for Identifying and Preventing Pressure Injury was found to be statistically significantly higher than before the training (p < 0.05). The pressure injury incidence in the emergency department was 12.5% before the training and 8.8% afterwards. CONCLUSION: It was observed that the knowledge of healthcare professionals about pressure injury was insufficient and that training given on this topic both increased their knowledge and decreased the incidence of pressure injury. However, the difference was not statistically significant. Training about pressure injuries is important for preventing pressure injury, identifying the injury early, treating the injury appropriately and increasing the awareness of healthcare professionals.

The relationship between upper extremity functional performance and anthropometric features and the quality criteria of cardiopulmonary resuscitation.

Objectives: This study aims to examine the effect of upper extremity performance using the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) on cardiopulmonary resuscitation (CPR) quality criteria according to the European Resuscitation Council (ERC) Guidelines for Resuscitation 2015, including chest compression rate, depth, and recoil. Patients and methods: This simulation-based study included 105 paramedic students (43 males, 62 females; median age: 19 years; range, 18 to 20 years) attending a two-year paramedic program between February 2018 and April 2018. The CKCUEST was used to determine upper extremity performance scores, including the touch number, normalized, and power score of the paramedic students. A TrueCPR® feedback device was used to measure CPR quality criteria throughout the study. The characteristics of the providers, such as height, weight, body mass index (BMI), and fat-free mass were also analyzed. Results: Adequate compression depth had a positive correlation with body fat-free mass (r=0.397, p<0.001), power score (r=0.326, p=0.001), height (r=0.326, p=0.001), weight (r=0.314, p=0.001), and BMI (r=0.204, p=0.037). Full chest recoil had a negative correlation with the power score (r=-0.249, p=0.010) and height (r=-0.219, p=0.025). None of the variables were significantly different between the groups with and without the correct compression rate. In the receiver operating characteristic curve analysis for power score and correct compression depth as 100%, the area under the curve was 0.845 (p<0.001). Conclusion: The power score combination of upper extremity functionality and the rescuer's weight is the main factor affecting chest compression depth. However, this score is negatively correlated with full chest recoil.

Accuracy of Multi-organ Point-of-Care Ultrasound for Acute Kidney Injury Etiologies.

This study investigated the diagnostic performance of point-of-care ultrasound (POCUS) for acute kidney injury (AKI) etiological subgroups in emergency department (ED) patients. Multi-organ POCUS including kidney, bladder, inferior vena cava (IVC), lung and cardiac examinations were used to identify five AKI subgroups: hypovolemia, reduced cardiac output, systemic vasodilatation and renal vasomodulation, renal and post-renal. One hundred sixty-five AKI patients were included in the study. The most diagnostic parameter in the post-renal group was the presence of any hydronephrosis, with a sensitivity of 93.3% (95% confidence interval [CI]: 68.1-99.8) and specificity of 85.9% (95% CI: 79.3-91.1). For the reduced cardiac output group, the most diagnostic parameter was IVC maximum diameter >17 mm with a sensitivity of 100% (95% CI: 83.2-100) and specificity of 70.2% (95% CI: 61.6-77.7). For the hypovolemia group, the most diagnostic parameter was IVC maximum diameter ≤17.9 mm with a sensitivity of 81.2% (95% CI: 71.2-88.8) and specificity of 56.5% (95% CI: 44-68.4). For the systemic vasodilatation and renal vasomodulation group, the most diagnostic parameter was diffuse ascites with a sensitivity of 56.3% (95% CI: 29.9-80.2) and specificity of 89.9% (95% CI: 83.8-94.2). None of the parameters were significant for the renal group. We concluded that multi-organ POCUS is of diagnostic value for AKI subgroups.

Glass foreign body in soft tissue: possibility of high morbidity due to delayed migration.

BACKGROUND: Soft tissue foreign bodies (FBs) are a common occurrence in emergency departments (EDs). Some FBs cause complications, whereas others are asymptomatic and remain undetected for months or years. CASE REPORT: A 32-year-old man presented to the ED with complaints of back pain in the area of a subcutaneous lump that had migrated toward the midline, nearly 25 cm from its former location, over the previous 2 weeks. Twelve years previously, after falling onto a glass door that shattered, he had gone to a local ED and had his wound sutured, but no X-ray studies were taken. Within a few months, he noticed a lump near his scapula, but he did not relate it to the fall and it did not bother him much. Physical examination revealed a normal neurological examination and a palpable mass in the right paraspinal area at the level of the tenth thoracic vertebra. An X-ray study showed a 34-mm-long sharp density in the vicinity of the spinal canal near T10. Efforts lasting almost 2 h to identify and remove the foreign body were unsuccessful. The following day, a 4 × 6 × 34 mm sharp glass fragment was removed in the operating room under fluoroscopy. CONCLUSIONS: Retained soft-tissue foreign bodies may migrate very late and can cause high morbidity or mortality. It is important to be diligent in the search for foreign bodies, using ultrasound, computed tomography scan, or magnetic resonance imaging in cases in which initial plain radiographs are negative.

Effects of metronome use on cardiopulmonary resuscitation quality.

OBJECTIVE: Whether the use of metronome affects the quality of cardiopulmonary resuscitation (CPR) remains unclear. In this study, we investigated the effect of metronome use on CPR quality. METHODS: This was a prospective, simulation-based CPR manikin study. There were two phases: without and with metronome use. Chest compression was performed for 2 min, and three CPR quality criteria including chest compression depth, recoil, and rate were recorded with TrueCPR Feedback Device in both phases. RESULTS: In all, 102 resident physicians were included. The achievement of optimal chest compression depth and complete recoil was better with metronome use than without (83% and 77% vs. 78% and 39%, P ≤ 0.001, respectively). Optimal chest compression rate was also reached with metronome use because the range of the compression rate was closer to the normal limits than those without metronome use (110 [interquartile range (IQR) 109-113] vs. 120 [IQR 109-129], P ≤ 0.001). Of all the participants, 70.6% stated that metronome use had a positive effect on their performance during the CPR application and 66.7% stated that they wished to use the metronome in their daily practice. CONCLUSION: Using a metronome during simulation-based CPR improved the compression depth and recoil by fixing chest compression rate. We suggested that metronome should be used in CPR trainings of health-care professionals.

Cardiac tamponade via a fistula to the pericardium from a hydatid cyst: case report and review of the literature.

Although echinococcus is endemic in many sheep-raising areas of the world, cardiac involvement is rare. Cysts usually reach the heart by means of the coronary circulation, but other routes have been proposed. Pericardial tamponade due to a hydatid cyst has not yet been described in the literature. We present the case of a 46-year-old woman who presented to the Emergency Department with complaints of chest pain and mild dyspnea. Her medical history was positive for a liver hydatid cyst operation 26 years earlier. She was tachypneic, tachycardic, and hypotensive. Pleural and pericardial effusions were detected on transthoracic echocardiography. When she worsened clinically, pericardiocentesis was performed and she promptly improved. A fistula was detected between the liver and pericardium on computed tomography (CT) scan of the torso. Serologic test (agglutination) for Echinococcus granulosus was positive in a 1/32 dilution. A final diagnosis of mediastinal hydatic cyst was made, and a 4-week course of albendazol was given. Then the cyst was surgically excised, and the patient recovered without complications.

The real victims of the islamic feast of sacrifice: injuries related to the sacrifice.

BACKGROUND: During the Feast of Sacrifice in Muslim countries, thousands of animals are slaughtered every year. Many injuries occur during the sacrifice. Thus, the aim of this study was to determine the demographic characteristics of patients, their slaughtering experience, types of injury, and related hospital costs. METHODS: This prospective observational study was conducted in Emergency Departments (EDs) of Gazi University and Ankara Training and Research Hospital. One hundred and twenty adult patients were admitted to EDs with injuries related to the slaughter and processing of meat during two consecutive Feasts of Sacrifice. RESULTS: The average age of patients was 41.85 +/- 13.6, and 101 patients (84.2%) were male. One hundred sixteen patients (96.7%) were not professionals. Ninety-seven patients (80.8%) were admitted to EDs on the first day of the feasts. Ninety-nine injuries (82.5%) were related to cutting tools, and 21 patients (17.5%) were admitted with complaints of either falling or being harmed by animals. Fourteen patients (11.7%) with tendon lacerations, finger amputations, extremity fractures, and eye traumas were taken into surgery. Hospital costs were a median 104.76 [67.48-322.12] Turkish Liras (74.30 [47.86-228.45] USD). CONCLUSION: Proper conditions for slaughter should be provided and professionals should perform the slaughter and/or processing of the meat. EDs should be supplied both more equipment and physicians, especially on the first days of the feast.

[Ultrasonographic findings and evaluation of white blood cell counts in patients undergoing laparotomy with the diagnosis of acute appendicitis]. / Akut apandisit tanisiyla laparotomi uygulanan hastalarda ultrasonografi bulgulari ve lökosit sayisinin degerlendirilmesi.

BACKGROUND: Acute appendicitis (AA) is one of the most frequent pathologies among surgical illnesses. Diagnosis is easy in typical cases, but difficult in atypical cases. In this study, ultrasonographic (USG) findings and leukocyte counts of patients were examined to determine their values in the diagnosis of AA. METHODS: Data for 85 patients seen in the first six months of 2006 were examined retrospectively. Histopathological diagnosis together with leukocyte counts and USG findings were compared, and sensitivities in the diagnosis were determined. RESULTS: The average age of the patients was 33.5, and 44.7% were female. In 95.3% of the patients, leukocyte counts were 10000/mm3 and above. In 74.1% of the patients (63 patients), USG was performed, and 58.7% of the cases (37 patients) were compatible with AA. In four (4.7%) of the patients, AA was not found histopathologically (negative laparotomy). The sensitivity of leukocyte counts (> or =10000/mm(3)) was 98.8% and its selectivity was 75%. The sensitivity of USG was 61.0% and its selectivity was 75%. When the areas under the receiver operating characteristics (ROC) curve were compared, leukocyte counts were more sensitive in determining the diagnosis. CONCLUSION: In this study, the sensitivity of USG was lower than the high sensitivity ratios reported in the literature. However, the sensitivity of leukocyte counts was significantly higher than that of USG.