Less Exposure for Health Care Workers, More Comfort for Patients During COVID-19 Swab Testing.

BACKGROUND: Nasopharyngeal (NP) and oropharyngeal (OP) swab sampling for coronavirus disease 2019 (COVID-19) diagnosis may lead to release of particles of varying sizes and increase the exposure risk for health care workers (HCWs). However, there is limited evidence for effective methods to reduce occupational exposure from NP and OP swab sampling. This study aimed to reduce droplet-forming responses (DFRs) and the related exposure risk of NP and OP swab sampling by administering 10% lidocaine spray (LS) to the NP and OP areas prior to conducting swab tests. METHODS: This quasi-experimental study was conducted with 100 patients who presented to our tertiary care hospital with symptoms of COVID-19 between December 1 and 15, 2020. First, NP and OP swabbings were performed on each patient. Thereafter, LS was applied to the OP and NP regions, and the swab samples were taken once again. Frequency of DFRs and real-time polymerase chain reaction (RT-PCR) test results before and after LS application were recorded for comparison. In addition, the cycle threshold (Ct) was used as a proxy indicator for SARS-CoV-2 viral load in COVID-19 positive cases. FINDINGS: Significant differences in OP DFR frequencies before and after LS intervention were found (37% and 9%, respectively), as well as before and after NP DFR (31% and 18%, respectively). The mean Ct values for the positive samples did not differ before and after applying LS. CONCLUSION: Our results suggest that applying LS to the OP and NP area prior to swab testing reduces DFR frequencies without affecting (RT-PCR) test results for SARS-CoV-2 and may increase patient and practitioner comfort.

Evaluation of vapocoolant spray effect on pain reduction during digital nerve block: A randomized clinical trial.

INTRODUCTION: The digital nerve block is an effective method of anesthesia before minor surgical interventions on the fingers. However, patients may experience a lot of pain and anxiety during this procedure. The efficacy of topical vapocoolant spray during minor procedures has been demonstrated in previous studies. we aimed to evaluate the effectiveness of topical vapocoolant spray in reducing pain during digital nerve block. METHODS: This prospective, randomized clinical study was conducted to evaluate the effectiveness of vapocoolant spray application in reducing pain during digital block. The patients were categorized into 2 groups as spray-treated and control group. A routine digital block process was applied to the control group. Spray application was performed in two groups of 50 each, in a manner of bilateral and unilateral to the finger. Demographic data of the patients, such as gender, age, dominant hand, injury patterns, injection site and injury sites, were recorded. After the application, the patients' visual analog scale (VAS) was evaluated. RESULTS: Of the participants, 100 were randomly assigned to the vapocoolant spray-treated group, and 50 were included in the control group. The VAS pain score during penetration in both spray groups was significantly lower than the control group (p < 0.001). Pain change during penetration was found to be significantly lower in the bilateral spray-treated group compared to the control group (p < 0.001). Pain change during infiltration was significantly lower in both spray groups compared to the control group (p < 0.001). CONCLUSIONS: Spray application prior to digital nerve blocking can be used to reduce needle penetration pain associated with this procedure and pain associated with local anesthetic infiltration.

Concomitant Substance Use Increases the Toxic Effect of synthetic cannabinoid (Bonsai): A Prospective Study.

OBJECTIVE: In this study, we aimed to contribute to the literature by evaluating bonsai and additional drugs. MATERIALS AND METHODS: This prospective study was conducted on 217 patients who admitted to the emergency department (ED) with bonsai intake between December 20, 2014 and January 1, 2016, according to the patient history obtained from the patients. While 168 patients with negative urinary metabolites results were excluded from the study, 49 patients with positive urinary metabolites were included in the study. Patients were divided into two groups. The first group consisted of patients with only bonsai intake and the second group consisted of patients with bonsai and concomitant drug intake. The groups were compared in terms of symptoms, findings, blood gas values, duration of the symptoms, discharge time, hospitalization, and mortality rate. Data were analyzed using the Chi-square, the Fisher's exacttest, the Student t-test, and the Mann-Whitney U test. Data were evaluated at the 95% confidence interval. P<0.05 was considered statistically significant. RESULTS: The mean age of 49 patients included in the study was 26.7±8.9 years and 91.8% (n=45) of the patients were male. Concomittant drug intake was identified in 69.4% of patients. Concomitant drug use was as follows: cocaine (20.4%, n=10), amphetamines (14.3%, n=7), methamphetamines (8,2%, n=4,) tetrahydrocannabinol (32.7%, n=16), opiates (18.4%, n=9) and alcohol (30.6%, n=15). On admission, Glasgow Coma Score (GCS) of the bonsai with additional substance group was significantly higher (p=0,003). The most common symptom was palpitations (tachycardia) (75.5%, n=37). There were no patients hospitalized in Only Bonsai group (p=0,020). The median time to remission of symptoms and median follow-up time of the patients in the emergency room were 3 hours and 6 hours, respectively. Remission time of the symptoms and hospitalization rates were higher in patients with concomittant drug intake (p <0.05) Conclusion: While the bonsai intake alone is not considered mortal to the patients and most of them can be discharged from the ED after signs and symptoms disappear, concomitant drug use can increase the toxic effects of bonsai intake. That is why follow-up of patients taking concomitant drug and the treatment process should be carried out more carefully.

Comparison between new modified external rotation method and external rotation method for reduction of ASD.

INTRODUCTION: Dislocation of the shoulder joint is common and is mainly anterior. Several reduction methods have been described and the external reduction method (ERM) is one of the newest. We modified the ERM by making some additions in hopes to develop a less painful, quick and simple method. The aim of this study was to compare the new modified external rotation reduction method (MERM) with ERM in acute anterior shoulder dislocations (ASD). METHODS: A total of 62 patients with ASD were classified randomly into 2 groups. The reduction was performed with MERM in one group and with ERM in the other group and the results were compared. Patients' pain scores, reduction time, success rate of the reduction methods, age, sex, dislocation side, dislocation time, previous dislocations history, injury mechanism, any complications, reduction time and neurovascular examination were collected. Parametric and nonparametric analyses were used to compare MERM and ERM. RESULTS: The study cohort consisted of 62 patients (52 males, 10 females; mean age, 35 years; age range, 18-73 years) who were randomly assigned to treatment with the MERM (n = 32) or the ERM (n = 30). There was a statistically significant difference between the two methods in terms of time, and the MERM can be applied much faster than ERM (1.34 ±â€¯1.41 min vs 3.05 ±â€¯1.93 min; p < 0.001). The intra-reduction VAS pain score was not significantly in patients who were treated with MERM (85.31 ±â€¯10.39 vs. 78.33 ±â€¯16.54; p = 0.122). CONCLUSION: MERM can be an alternate method compared to the ERM for the reduction of ASD.

Diagnostic Value and Effect of Bedside Ultrasound in Acute Appendicitis in the Emergency Department.

OBJECTIVE: Early and accurate diagnosis of acute appendicitis (AA) with ultrasound (US) can minimize the morbidity and mortality of the patients. In this regard, US can help emergency physicians (EPs) in the diagnosing process and clinical decision making for AA. Therefore, we primarily aimed to evaluate the effectiveness of point-of-care US (POCUS) in clinical decision making of EPs for the diagnostic evaluation for AA in the emergency department (ED). METHODS: The study sample consisted of patients aged > 18 years who presented to the ED with abdominal pain and underwent diagnostic evaluation for AA. All patients were examined initially with POCUS by EPs and then with radiology-performed US (RADUS) by radiologists. Pre- and post-POCUS median diagnostic certainty values (MDCVs) for AA were determined with visual analog scale (VAS) scores (0 = not present, 100 = certainly present) by POCUS performers. Definitive diagnoses were determined by surgery, pathologic evaluation of appendectomy specimens, or clinical follow-up results. The sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) for POCUS and RADUS together with pre- and post-POCUS VAS scores for MDCVs were compared. RESULTS: A total of 264 patients were included into the final analysis and 169 (64%) had a diagnosis of AA. The sensitivity, specificity, PLR, and NLR of US examinations were 92.3% (95% confidence interval [CI] = 87.2%-95.8%), 95.8% (89.5%-98.8%), 21.9 (8.4-57.2), and 0.08 (0.05-0.1) for POCUS and 76.9% (69.8-83%), 97.8% (84.9-99.7%), 36.4 (9.25-144.3), and 0.24 (0.18-0.31) for RADUS, respectively. Pre-POCUS and post-POCUS VAS scores for MDCVs were 60 (interquartile range [IQR] = 50-65) and 95 (IQR = 20-98), respectively (p = 0.000). CONCLUSION: Point-of-care ultrasonography, when performed in ED for the diagnosis of AA, has high sensitivity and specificity and had a positive impact on the clinical decision making of EPs.

CT interpretations in multiply injured patients: comparison of emergency physicians and on-call radiologists.

OBJECTIVE: In this study, emergency physicians and on-call radiologists were compared regarding identification of fatal injuries on computed tomographic (CT) scans in patients with trauma. MATERIALS AND METHODS: Multiply injured patients who were older than 18 years and underwent CT scanning were included in the study. The CT scans were interpreted by the responsible emergency physician. At the same time, these images were also evaluated by the on-call radiologist. Final evaluation was done 1 week later by a radiology instructor who knew the clinical follow-up of the patient. RESULTS: The study included 156 patients. The mean age of the patients included in the study was found to be 41.6 years. Less than half (33.5%) of the patients were female and 86.5% were male. A total of 482 CT scans were performed in the patients. Regarding brain CTs, the concordance rate for emergency physicians was 98%, whereas it was 94% for on-call radiologists. Regarding thoracic CTs, the concordance rate for emergency physicians was 91%, whereas was 93% for on-call radiologists. There was a perfect concordance (κ value > 0.75) for on-call radiologists and emergency physicians in terms of brain and thoracic CTs. Regarding abdominal-pelvic CTs, the concordance rate for emergency physicians was 97%, whereas it was 98% for on-call radiologists. Moderate concordance (κ range = 0.40-0.75) was detected for emergency physicians in terms of identification of liver, spleen, kidney, and intra-abdominal/retroperitoneal hemorrhages. There was a perfect concordance (κ value > 0.75) for pelvic fractures. CONCLUSION: In this study, it was shown that emergency physicians were successful in identifying fatal injuries on trauma CT images after a short-term training on interpretation of trauma CTs.

The value of point-of-care ultrasound for detecting nail bed injury in ED.

OBJECTIVE: The aim of this study is to detect the value of point-of-care ultrasound (POCUS) for diagnosing a nail bed injury and fracture of distal phalanx in patients presenting with distal finger trauma to the emergency department (ED). METHODS: Patients, 18 to 65 years old, presenting with a blunt trauma of distal finger and diagnosed with subungual hematoma were eligible for the study. Subungual hematoma extending over more than 50%, fracture of distal phalanx, and disruption of periungual tissue or nail integrity were accepted as the indications for nail bed inspection. All the study patients underwent POCUS to detect the existence of a distal phalanx fracture or nail bed injury. X-ray was also obtained from all the patients. RESULTS: Nail bed was visualized in 45 patients. Squeezing and crush injury were the most reported trauma mechanism in study patients (66.7%). The sensitivity and specificity of POCUS in detecting nail bed injury were 93.4% (95% CI, 80%-99%) and 100% (95% CI, 74%-100%), respectively. The sensitivity was 100% (95% CI, 79%-100%), and specificity was 98.4% (95% CI, 91%-100%) for distal phalanx fracture. CONCLUSION: Point-of-care ultrasound is a promising tool in detecting the nail bed injury and distal phalanx fractures in patients presented with distal finger trauma. Further studies with bigger sample size are needed to reveal the diagnostic ability of POCUS before using it regularly in the ED.

The effectiveness of bedside point-of-care ultrasonography in the diagnosis and management of metacarpal fractures.

OBJECTIVE: We aimed to compare the effectiveness of point-of-care ultrasonography (POCUS) with direct radiography (DR) in the diagnosis and management of the patients with metacarpal fractures (MFs). METHODS: Patients between ages 5 and 55 years admitted to the emergency department with suspected MFs were included to the study. Emergency physicians (EPs) participating in the study were divided into 2 groups (POCUS, DR). Patients were evaluated by one of the EPs from each group. The EP performing the POCUS examination was blinded to the radiograph results. RESULTS: A total of 66 patients with MFs were included to the study. Fracture was determined in 36 (55%) patients with DR and in 37 (56%) patients with POCUS. When compared with radiography, the sensitivity of fracture detection with POCUS was 92%; specificity, 87%; positive predictive value, 89%; and negative predictive value, 90% (95% confidence interval, 80%-98%). Sensitivity of detecting localization of the fracture with POCUS was 92%; specificity, 87%; positive predictive value, 89%; and negative predictive value, 89% (95% confidence interval, 80%-98%). Of the patients with fracture, 69% have angulation and 24% have step-off determined with POCUS. Specificity of POCUS in the decision for treatment choice was 100%, and sensitivity was 99%. CONCLUSION: We found that POCUS could be applied easily with success by EPs in diagnosing MFs, determining the type of the fracture and required treatment methods correctly. Point-of-care US can be used to rule out a suspected MF, thereby avoiding the time and expense of radiography.

Evaluation of the effectiveness of bedside point-of-care ultrasound in the diagnosis and management of distal radius fractures.

OBJECTIVE: The aim of the study was to compare the effectiveness of point-of-care ultrasound (POCUS) with direct radiography in diagnosis and management of the patients with distal radius fractures (DRFs). METHODS: In this study, patients between ages 5 and 55 years admitted to the emergency department with low energy upper extremity trauma with suspected DRF were evaluated with POCUS and direct radiography by emergency physicians (EPs) trained in either musculoskeletal (MSK) imaging or x-ray interpretation of DRF. The EP performing the POCUS examination was blinded to the x-ray results. RESULTS: A total of 83 patients with DRF were included in the study. There were 18 (22%) females, and 65 (78%) males enrolled in the study. Mean age was 13 ± 14 years for males, and 15 ± 13 years for females. Compared with direct radiography, POCUS yielded 98% sensitivity, 96% specificity, 98% positive predictive value, 96% negative predictive value, and 98% accuracy of the test in detecting fractures. POCUS yielded 96% sensitivity, 93% specificity value in detecting linear fractures; 78% sensitivity, 98% specificity in detecting torus-type fractures, and 100% specificity and sensitivity for detecting fissure fractures. Specificity of POCUS in the decision for reduction was 100% and sensitivity was 98%; specificity was 100% for splint application. CONCLUSION: In our study, it was shown that POCUS could be applied easily by EPs trained in MSK POCUS imaging with success in diagnosing DRF and determining the correct fracture type and required treatment methods.

How stylet use can effect confirmation of endotracheal tube position using ultrasound.

INTRODUCTION: None of the techniques used for confirmation of endotracheal tube (ET) placement are proven reliable 100% of the time. The purpose of our study is to determine whether ultrasound can accurately detect the passage of ET through the trachea and esophagus and to see whether this visualization is augmented with the use of a metal stylet. METHODS: A total of 7 physicians made assessments of ET positions using an ultrasound during their passage through the trachea or esophagus. A total of 40 esophageal and 40 tracheal intubations were performed randomly in a blinded fashion on a fresh, unfrozen human cadaver. Half were performed with a metal stylet and the other half without a stylet. RESULTS: During transtracheal assessment regardless of stylet use, correct identification of ET position was achieved in 275 of 280 esophageal intubations and 268 of 280 tracheal intubations. The overall sensitivity was 95.7%, and specificity was 98.2%. The presence and the absence of stylet was identified in 109 of 280 and in 155 of 280 attempts, respectively. Correct identification of stylet presence yielded a sensitivity of 38.9% and a specificity of 55.4%. Ultrasound can be used by emergency physicians to accurately detect the passage of ET through the trachea and esophagus; however, stylet use did not augment ET visualization.

Determination of difficult intubation in the ED.

OBJECTIVE: The aim of this study is to determine the predictors of difficult intubation in the emergency setting. METHODS: This prospective observational clinical study was conducted in the emergency department (ED) of a University Hospital with an annually census of 50 000 visits from May 2005 to May 2007. All patients requiring intubation in the ED were included into the study. During the study period, same airway management protocol was used all intubations. The study form included patient's demographic and variables according to intubation such as the Cormack-Lehane grade, modified LEMON score, Glasgow Coma Scale score, success rate, and associated complications. RESULTS: A total of 366 patients were included in the study. The mean age of the study patients was 46.8 +/- 22.8, and 68.6% (n = 251) of them were male. A total of 86 (23.5%) patients were classified in the difficult intubation group and 280 (76.5%) patients in easy intubation group. Logistic regression analysis performed by the variables found to be significant in the univariate analysis revealed thyroid-to-hyoid distance less than 2 fingers (odds ratio, 3.34; 95% confidence interval, 1.35-8.27; P = .009) as an independent factor complicating the intubation. Cormack and Lehane classification was strongly related to difficult intubation. Intubation was more difficult from grade 1 to 4 (11% vs 25.2% vs 34% vs 81.8%, respectively; P = .000). CONCLUSIONS: The thyroid-to-hyoid distance less than 2 fingers is the only independent variable in predicting difficult intubation. Mallampati classification is not a useful tool in classifying the difficult intubation in the ED that the "LEMON" acrostic can be modified to "LEON".

Water park injuries.

BACKGROUND: The purpose of this study was to identify water park injuries, particularly injuries related to waterslides. METHODS: This prospective observational study was carried out between May 2005 and September 2006 in a university hospital emergency clinic, which has 50,000 annual visits. The study form, including patient demographics, types and mechanisms of injuries and the final diagnoses, was completed for all patients. A total of 73 patients were enrolled into the study. The mean age of the patients was 23.92+/-15.05 and 48 patients (65.8%) were male. RESULTS: The mechanisms of injury were as follows: 23 patients (31.5%) were injured on waterslides, 16 (21.9%) were injured in pools and 34 (46.6%) were injured by slipping and falling on the wet surfaces. After the emergency department evaluations, 15 patients (20.5%) were diagnosed to have spinal trauma, 16 (21.9%) head trauma, 15 (20.5%) maxillofacial trauma, and 30 (41%) other injuries. CONCLUSION: In water park injuries, while children have especially head and maxillofacial trauma, extremity and spinal injuries are more frequent in the adult group. Unless sufficient and required safety precautions are maintained during water park activities, fatal injuries may occur.

[Analysis of motorcycle accident victims presenting to the emergency department]. / Acil servise basvuran motosiklet kazasi olgularinin özellikleri.

BACKGROUND: Motorcycle accidents are one of the major causes of traumatic injuries and deaths. The purpose of this study was to analyze the features of the victims presenting with motorcycle-related injuries. METHODS: This study was conducted prospectively from July 1 to September 30, 2005 at the Emergency Department (ED) of Akdeniz University Hospital. RESULTS: During the study period, 142 patients presented to the ED with motorcycle-related injuries. Sixteen patients were excluded from the analysis because their forms were incomplete and four were still under treatment in the hospital. Of the 122 injured, 72 (59.0%) were discharged and 40 (32.8%) were admitted. Only 11 patients declared use of a helmet. Median length of stay in the hospital was five days. CONCLUSION: Motorcycle accidents result in more serious injuries than motor vehicle accidents due to the limited safety precautions and the difference in injury mechanism. The frequency of accidents, higher admission rates, longer periods of admissions, and higher total hospital costs highlight motorcycle accidents as a major public health issue and an economical burden. To prevent accidents, compliance with the legal requirements should be regularly audited. Studies should be done to increase motorcycle safety precautions, and education programs should be organized for motorcyclists. The effects of these interventions should be analyzed.