Central Venous Catheterization before Versus after Computed Tomography in Hemodynamically Unstable Patients with Major Blunt Trauma: Clinical Characteristics and Factors for Decision Making

PURPOSE@#When hemodynamically unstable patients with blunt major trauma arrive at the emergency department (ED), the safety of performing early whole-body computed tomography (WBCT) is concerning. Some clinicians perform central venous catheterization (CVC) before WBCT (pre-computed tomography [CT] group) for hemodynamic stabilization. However, as no study has reported the factors affecting this decision, we compared clinical characteristics and outcomes of the pre- and post-CT groups and determined factors affecting this decision.@*METHODS@#This retrospective study included 70 hemodynamically unstable patients with chest or/and abdominal blunt injury who underwent WBCT and CVC between March 2013 and November 2017.@*RESULTS@#Univariate analysis revealed that the injury severity score, intubation, pulse pressure, focused assessment with sonography in trauma positivity score, and pH were different between the pre-CT (34 patients, 48.6%) and post-CT (all, p < 0.05) groups. Multivariate analysis revealed that injury severity score (ISS) and intubation were factors affecting the decision to perform CVC before CT (p=0.003 and p=0.043). Regarding clinical outcomes, the interval from ED arrival to CT (p=0.011) and definite bleeding control (p=0.038), and hospital and intensive care unit lengths of stay (p=0.018 and p=0.053) were longer in the pre-CT group than in the post-CT group. Although not significant, the pre-CT group had lower survival rates at 24 hours and 28 days than the post-CT group (p=0.168 and p=0.226).@*CONCLUSIONS@#Clinicians have a tendency to perform CVC before CT in patients with blunt major trauma and high ISS and intubation.

Measurement of Calf Circumference for Estimate the Adult Body Weight in the Emergency Department

PURPOSE: There is no reliable body index to use in estimating adult body weight. The purpose of the study was to develop a body index that can estimate adult body weight and to perform a regression equation of body weight versus the body index METHODS: We performed a prospective study. We measured body weight and various body indexes, including arm, wrist, calf, and ankle circumference, in the patients who visited our emergency department. A correlation analysis was performed between these body indexes and body weight, and a simple linear regression analysis was used to examine the relationship between the most correlative body index and body weight. RESULTS: Two hundred five patients were enrolled. The correlation coefficient between body weight and calf, arm, wrist, and ankle circumference were, respectively, 0.919, 0.792, 0.546, and 0.432 for males and 0.913, 0.781, 0.476, and 0.430 for females. The body index with the greatest correlation to body weight was calf circumference. The regression equations were: male body weight = 2.510 x calf circumference - 25.673, and female body weight = 2.375 x calf circumference - 22.560. CONCLUSION: The most reliable body index for estimating adult body weight is calf circumference.

Usefulness of D-dimer Test as Early Marker for Predicting Myocardial Infarction in Patients with Acute Coronary Syndrome and non-ST Elevation ECG

PURPOSE: To determine if D-dimer level is a supportive marker in the prediction of myocardial infarction in patients with acute coronary syndrome and non-ST elevation ECG, who arrive in the emergency room. METHODS: We conducted a prospective, observational study of patients with acute chest pain that had occurred within 24 hours and who had non-ST elevation on ECG. They were managed according to the 2005 ACLS guidelines; the following clinical tests were performed: D-dimer, cardiac markers, and CAG. Final diagnoses were divided into 3 groups: myocardial infarction (MI), unstable angina (UA), and others (non-specific or angina). RESULTS: Ninety-three (93) patients were included in this study. The mean D-dimer value was higher in patients diagnosed with MI (1.04+/-2.12 ug/dl) than in those patients diagnosed with UA (0.48+/-0.51 ug/dl) (p=0.026). At the 0.38 ug/dl diagnotic threshold estimated by ROC curve analysis, corresponding to the cutoff for diagnosis of myocardial infarction then in this value sensitivity and specificity of D-dimer were 70.6% and 62.7%. In cardiac enzymes, sensitivity and specificity of Tn-I were 47.1% and 98.3, respectively, and for CK-MB were 35.3% and 98.3%, respectively. CONCLUSION: D-dimer value may be at higher levels in AMI and the sensitivity of D-dimer was higher than that of TnI andCK-MB in patients with acute coronary syndrome and non- ST elevation ECG. However, because of relatively lower sensitivity and specificity of the D-dimer test, this test may useful as supporting marker for predicting myocardial infarction.