Cardiac monitoring in patients with electrocution injury.

BACKGROUND: The necessity of admitting patients exposed to electrocution injuries for monitoring and observation in the emergency department (ED) remains controversial. METHODS: We evaluated the medical records of 102 patients (86 male, 16 female; median age 29.5; range 18 to 68 years) admitted to the adult ED with electrocution injuries over the past 20 years. RESULTS: Only 9 deaths were reported: 3 as a result of contact with low-voltage electricity and 6 after contact with high-voltage electricity. With the exception of a case of sepsis, all deaths were related to early rhythm abnormalities immediately following the incident. The ECG findings of surviving patients in the study group were as follows: 70 normal, 8 sinus tachycardia, 3 sinus bradycardia, 4 ST-T wave changes, and 1 ventricular extrasystole. ECG recordings of 7 patients could not be found. 72 cases had been followed up with repeat ECG recordings. There were no observed ECG changes requiring any medical or electrical therapies in the surviving patients. CONCLUSION: Cardiac rhythm abnormalities related to electrocution injuries are usually observed at the time of the incident. If the patient's overall clinical condition is good and they have a normal ECG at the time of admission to the ED, the probability of observing any delayed serious dysrhythmia is unlikely.

10-year evaluation of train accidents.

BACKGROUND: Although less frequent than automobile accidents, train accidents have a major impact on victims' lives. METHODS: Records of patients older than 16 years of age admitted to the Adult Emergency Department of Hacettepe University Medical Center due to train accidents were retrospectively evaluated. RESULTS: 44 patients (30 males, 14 females) with a mean age of 31.8±11.4 years were included in the study. The majority of the accidents occurred during commuting hours. 37 patients were discharged, 22 of them from the emergency department. The mortality rate was 7/44 (16%). Overall mean Revised Trauma Score (RTS) was 10.5 (3 in deaths and 11.9 in survivors). In 5 patients, the cause of death was pelvic trauma leading to major vascular injury and lower limb amputation. In 1 patient, thorax and abdomen trauma and in 1 patient head injury were the causes of mortality. Primary risk factors for mortality were alcohol intoxication (100%), cardiopulmonary resuscitation on admittance (100%), recurrent suicide attempt (75%), presence of psychiatric illness (60%), and low RTS. CONCLUSION: In this study, most train accidents causing minor injuries were due to falling from the train prior to acceleration. Nevertheless, train accidents led to a mortality rate of 16% and morbidity rate of 37%. These findings draw attention to the importance of developing preventive strategies.

Effects of spinal immobilization devices on pulmonary function in healthy volunteer individuals.

BACKGROUND: We aimed to investigate the effects of spinal immobilization devices on pulmonary functions. METHODS: This study was a cross-over trial in healthy volunteer subjects; 60 volunteers were included. We performed a full spirometry in the supine position, and forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and FEV1/FVC were recorded in all subjects. Then, Philadelphia type cervical collar (Philly) and Kendrick extrication device (KED) were applied to all subjects. We measured FVC, FEV1, FEV1/FVC in all subjects in the supine position at the 5th and 30th minutes after application of cervical collar and KED. After a one-hour relaxation period, Philly and long spinal backboard with straps were applied to all subjects. FVC, FEV1, FEV1/FVC were measured again in all subjects at the 5th and 30th minutes after application of cervical collar and long spinal backboard. RESULTS: After application of KED, baseline levels were compared with levels at the 5th and 30th minutes. Statistically significant decreases were determined in FEV1 (p=0.000) and FVC levels (p=0.000) after application of KED, but there were no significant differences in FEV1/FVC levels. After application of the long spinal backboard, a comparison of baseline levels and levels at the 5th and 30th minutes demonstrated statistically significant decreases in FEV1 (p=0.000) and FVC levels (p=0.000), but no significant difference in FEV1/FVC levels. CONCLUSION: We determined that both KED and long spinal backboard cause a decrease in pulmonary functions.

Sensitivity and specificity of rapid antigen detection testing for diagnosing pharyngitis in the emergency department.

Acute pharyngitis in adults is primarily a viral infection; only about 10% of cases are of bacterial etiology. Most cases of bacterial pharyngitis are caused by group A beta-hemolytic streptococci (GABHS). One laboratory method for the diagnosis of GABHS is rapid antigen diagnostic testing (RADT), which can be processed during an emergency department visit and which has become a popular alternative to throat swab cultures. We conducted a study to define the sensitivity and specificity of RADT, using throat culture results as the gold standard, in 100 emergency department patients who presented with symptoms consistent with streptococcal pharyngitis. We found that RADT had a sensitivity of 68.2% (15 of 22), a specificity of 89.7% (70 of 78), a positive predictive value of 65.2% (15 of 23), and a negative predictive value of 90.9% (70 of 77). We conclude that RADT is useful in the emergency department when the clinical suspicion is GABHS, but results should be confirmed with a throat culture in patients whose RADT results are negative.

Acute mercury poisoning: a case report.

BACKGROUND: Mercury poisoning can occur as a result of occupational hazard or suicide attempt. This article presents a 36-year-old case admitted to emergency department (ED) due to exposure to metallic mercury. CASE PRESENTATION: A 36-year-old woman presented to the ED with a three-day history of abdominal pain, diarrhea and fever. One week ago her daughter had brought mercury in the liquid form from the school. She had put it on the heating stove. One day later, her 14-month old sister baby got fever and died before admission to the hospital. Her blood pressure was 134/87 mmHg; temperature, 40.2 degrees C; heart rate 105 bpm and regular; respiration, 18 bpm; O2 saturation, 96%. Nothing was remarkable on examination and routine laboratory tests. As serine or urinary mercury levels could not be tested in the city, symptomatic chelation treatment with N-acetyl cysteine (NAC) was instituted with regard to presumptive diagnosis and history. At the 7th day of admission she was discharged without any sequelae or complaint. At the discharge day blood was drawn and sent for mercury levels which turned out to be 30 microg/dL (normal range: 0-10 microg/dL). CONCLUSION: Public education on poisoning and the potential hazards of mercury are of vital importance for community health.

Patient population and factors determining length of stay in adult ED of a Turkish University Medical Center.

This study is designed to analyze retrospectively patients who present to adult emergency department (ED) from January 1, 2002, to February 28, 2002. Age, sex, presentation time to ED, length of stay in emergency service, consultations, the number of patients who need to be hospitalized and also the number of hospitalized patients, diagnosis categories, and discharge instructions are analyzed. It is found that patients in most admissions are at 21 to 25 years of age. At night, the number of visits is decreased. Hospitalizations could be done to only about half of patients who in fact should be hospitalized. There is a correlation between the length of stay of patients in emergency service and the number of consultations per patient. There is also a correlation between patient complexity and length of stay in emergency service. The ED overcrowding rises with increased visits and patients staying in ED who should be hospitalized.

Iatrogenic water intoxication after pelvic ultrasonography imaging.

Ultrasound (US) is a simple, easily accessible, and noninvasive method. Thus, it is commonly used. The bladder should be sufficiently filled to acquire pelvic images by US. This report describes water poisoning in 3 patients with no hepatic, cardiac, or renal disease. Both patients had a history of excessive fluid intake.

A rare clinic presentation of abdominal pain: rupture of splenic artery aneurysm: a case report.

BACKGROUND: Splenic artery aneurysms (SAA) are uncommon but the most common visceral artery aneurysm. Splenic artery aneurysms are important to recognize because up to 25% may be complicated by rupture and the mortality rate after rupture is between 25% and 70%. CASE REPORT: We present a patient who have abdominal pain. Previously healthy 22-year-old female admitted to emergency department with abdominal pain. Her physical examination reveals only left upper quadrant tenderness. Suddenly she developed hypovolemic shock. On emergent laparotomy massive blood collection within peritoneal cavity and retroperitoneal space at the left upper quadrant was detected. The source of bleeding was evident as rupture of splenic artery aneurysm. Splenectomy was performed following the ligation of splenic artery proximal to lesion. On the tenth day she was discharged from the hospital with complete recovery. CONCLUSION: It is important to remember rupture of splenic artery aneurysm in patients with abdominal pain and hypovolemic shock status.

An unusual cause of allergy: Case report of normal saline solution allergy.

Anaphylaxis and acute allergic reactions may sometimes be fatal. They occur within minutes in a sensitized individual. So quick diagnosis and management are necessary issues. In the literature, cases are widely reported against allergens found in drugs, foods and their additives, radiocontrast material, bee stings, and many other materials. Here, we present a 37-year-old woman who developed an anaphylactic reaction to normal saline infusion during evaluation for her acute abdominal pain. We found only one report about normal saline allergy in the literature (Litvin ME, Shemchuck AS, Lisetskii VA. Anaphylactic shock caused by intravenous injection of isotonic solution of sodium chloride. Klin Khir 1976;(7):59-61).

Acute aortic dissection with painless paraplegia: report of 2 cases.

Acute aortic dissection is often a life-threatening event that usually presents as a sudden, severe, exquisitely painful, ripping sensation in the chest or back. There are a few reports of atypical findings or no pain in the literature. We report 2 patients with painless acute aortic dissection who presented to the emergency department (ED) with sudden onset paraplegia.