A retrospective study of CT scan utilization in the emergency department for patients presenting with seizures.

BACKGROUND/AIM: The indications for neuroimaging in emergency department (ED) patients presenting with seizures have not been clearly defined. In this study, we aimed to investigate the findings that may influence the emergency management of patients with seizures undergoing brain computed tomography (CT) and the factors that influence these findings. MATERIAL AND METHODS: This is a retrospective, single-center study. Patients presenting to the ED with seizures-both patients with diagnosed epilepsy and patients with first-time seizures-who underwent brain CT were included. Demographic information and indications for CT scans were recorded. According to the CT findings, patients were classified as having or not having significant pathology, and comparisons were made. Intracranial mass, intraparenchymal, subdural, and subarachnoid hemorrhage, fracture, and cerebral edema were considered significant pathologies. RESULTS: This study included 404 patients. The most common reason for a CT scan was head trauma. A significant pathology was found on the CT scan in 5.4% of the patients. A regression analysis showed that hypertension, malignancy, and a prolonged postictal state were the predictive factors for significant pathology on CT. CONCLUSION: CT scanning of patients presenting to the ED with seizures has a limited impact on emergency patient management. Clinical decision-making guidelines for emergency CT scanning of patients with seizures need to be reviewed and improved to identify zero/near-zero risk patients for whom imaging can be deferred.

Value of integrated pulmonary index to predict exacerbation of chronic obstructive pulmonary Disease's severity.

PURPOSE: In this study, we aimed to examine the correlation between current prognostic scores and the integrated pulmonary index (IPI) in patients admitted to the emergency department (ED) with exacerbation of chronic obstructive pulmonary disease (COPD), and the diagnostic value of using the IPI in combination with other scores in determining patients who can be discharged safely. METHODS: This study was conducted as a multicenter and prospective observational study between August 2021 and June 2022. Patients diagnosed with COPD exacerbation (eCOPD) at the ED were included in the study and they were grouped according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. The CURB-65 (Confusion, Urea, Respiratory rate, Blood pressure, and age older than 65 years), BAP-65 (Blood urea nitrogen, Altered mental status, Pulse rate, and age older than 65 years), and DECAF (Dyspnea, Eosinopenia, Consolidation, Academia, and atrial Fibrillation) scores and IPI values of the patients were recorded. The correlation between the IPI and the other scores and its diagnostic value in detecting mild eCOPD were examined. The diagnostic value of CURB-IPI, a new score created by the combination of CURB-65 and IPI, in mild eCOPD was examined. RESULTS: The study was carried out with 110 patients (49 female and 61 male), mean age of 67 (min/max: 40/97). The IPI and CURB-65 had better predictive value in detecting mild exacerbations than DECAF and BAP-65 scores [Area under curves (AUC) were 0.893, 0.795, 0.735, 0.541 respectively]. The CURB-IPI score, on the other hand, had the best predictive value for detecting mild exacerbations (AUC 0.909). CONCLUSION: We found that the IPI has good predictive value in the detection of mild COPD exacerbations, and its predictive value increases when used in combination with CURB-65. We think that the CURB-IPI score can be a guide when deciding whether patients with exacerbation of COPD can be discharged.

Evaluation of postictal optic nerve sheath diameter at epileptic patients.

INTRODUCTION: During a seizure, metabolic rate and, consequently, cerebral blood flow increase to provide the required maintenance energy. It is thought that this causes an increase in intracranial pressure, but there is no comprehensive research on this subject. In this study, we aimed to measure and follow optic nerve sheath diameter (ONSD) in patients who applied to the emergency department (ED) after generalized tonic-clonic (GTC) seizures and to gain information about intracranial pressure changes in epilepsy patients in the postictal period. MATERIALS AND METHODS: This was a prospective observational study. Patients already diagnosed with epilepsy who applied to the ED within one hour after GTC seizures were included. The ONSD of the patients was measured by the same radiologist three times in both eyes using ultrasonography at the time of admission and the fourth hour of follow-up. The seizure characteristics and measurements of the patients were recorded, and the changes in ONSD over time and correlations between seizure characteristics and ONSD were examined. RESULTS: Sixty-six patients were included in the study. Thirty-four (51.5%) of the patients had seizures with auras. For both eyes, the first-hour ONSD values of the patients [right: 5.90 (5.73-6.16) mm, left: 5.86 (5.73-6.13) mm] were significantly higher than the fourth-hour ONSD values [right: 5.26 (5.19-5.40) mm, left: 5.28 (5.16-5.36) mm)] (p < 0.001 for both eyes). Additionally, the first- and fourth-hour ONSD values of patients with seizures with auras were significantly higher than those with seizures without auras (p < 0.001 for each condition). There was no correlation between other variables related to seizure type and ONSD. CONCLUSION: This study showed that after GTC seizures in epilepsy patients, ONSD increases in the first hour postictal and decreases over time. Another important result is that the increase in ONSD values in seizures with auras is significantly higher than in seizures without auras.

The effect of patient weight on the success of converting sinus rhythm in patients with PSVT treated with standard dose adenosine.

PURPOSE: The study aimed to investigate whether there is a difference in the amount of adenosine per kilogram (mg/kg) between the patient groups that can and cannot be converted to sinus rhythm (SR) with adenosine therapy in patients with supraventricular tachycardia (SVT). MATERIAL AND METHOD: This single-centered, retrospectively designed study was conducted in the ED of a training and research hospital between December 1, 2019 and December 1, 2022 on patients who were admitted to the ED with SVT diagnosis and treated with a 6-12-18 mg adenosine protocol. The main analyses were carried out in three stages. The first analysis was performed considering the first 6 mg dose of adenosine administered. The second analysis was performed by considering the 12 mg adenosine administered as the second dose because it did not respond to the first dose. Finally, the third analysis was performed by considering the 18 mg adenosine administered as the third dose because it did not respond to preciously dosages. The primary outcome variable was determined to be converting SR and created two groups according to this; the success SR group and the failure SR group. RESULTS: During the study period, 73 patients who were admitted to the ED with PSVT diagnosis and treated with intravenous adenosine were included. After the first 6 mg of adenosine treatment was administered to all 73 patients, SR was achieved in only 38% of patients. The mean adenosine dose (mg/kg) was significantly lower in the failure SR group, 0.07373 ± 0.014, compared with 0.08885 ± 0.017 mg/kg in the success SR group (mean difference with 95% CI: -0.01511 [-0.023 to -0.0071]; p < 0.001). In the second and third stage analyses, considering 12 and 18 mg adenosine doses, when the administrations with successful and failed SR were compared, no difference was found in terms of the applied adenosine doses per kilogram. CONCLUSION: This study suggest that the success of terminating SVT with the first 6 mg dose of adenosine appears to be dependent on patient weight. In patients given larger doses of adenosine, determinants of PSVT termination success may be factors other than patient weight.

Perfusion indices can predict early volume depletion in a blood donor model.

INTRODUCTION: Blood donation from healthy donors is used experimental model that surrogates for class 1 hemorrhage in humans. We examined changes in the perfusion index (PI) and plethysmographic variability index (PVI) in healthy blood donors after donating a unit of blood, and we evaluated the usability of these indices in detecting blood loss volumes of less than 750 mL (class 1 hemorrhagic shock trauma patients). MATERIALS AND METHODS: This study is a prospective, cross-sectional study. 180 healthy volunteers aged 18 and over, who donated blood at the local blood bank, were included in the study consecutively. The age, gender, and body mass index of the volunteers were recorded and, before and after the blood donation, the vital signs and perfusion indices were measured. RESULTS: Of the donors, 61.7% were men (n = 111), and the median age of all donors was 32 (IQR: 21-39). A statistically significant difference was found between the hemodynamic parameters and PIs before and after the blood donation (p < 0.01 for all parameters; median difference of PI [- 1.45, 95% CI: (- 0.9)-( - 2)], median difference of PVI [6, 95% CI: 7.77-4.23]. CONCLUSION: We evaluated the perfusion indices in the early diagnosis of blood volume loss in patients admitted to the emergency department due to trauma. After the participants donated one unit of blood, we found that their PI decreased and PVI increased compared to the measurements before the blood donation. Considering that major bleeding starts in the very early stage as minor bleeding, it is essential for emergency physicians to recognize class 1 hemorrhagic shock patients. Further, non-invasive and straightforward procedures, such as measuring PI and PVI, can be particularly useful in identifying blood loss volumes of less than 750 mL.

The Role of Brain CT in Patients with Out-of-Hospital Cardiac Arrest with Return of Spontaneous Circulation.

BACKGROUND AND AIM: The diagnosis and treatment process after resuscitation of patients with spontaneous return of circulation (ROSC) after cardiac arrest is important. There is no clear recommendation on utilization of computerized tomography (CT) of the brain in patients with ROSC. In this study, it was aimed to diagnosis the pathology detection rates in the brain tomography of out-of-hospital cardiac arrest (OHCA) patients with ROSC after resuscitation in the emergency department and the effect of these pathologies on treatment management. MATERIALS AND METHODS: 131 patients who were admitted to the Emergency Medicine Clinic with cardiac arrest between 08.05.2019 and 07.12.2020, had ROSC after resuscitation and underwent brain CT in the first 24 h were included in the study. The patients were divided into two groups; those with clinically significant pathology in brain CT who underwent treatment changes and those without clinically significant pathology. All data recorded in the study form were analyzed using IBM SPSS 20.0 (Chicago, IL, USA) statistics program. P < 0.005 value was considered statistically significant. RESULTS: 51.1% (67) of the patients were women. The age median value was 73 (IQR25-IQR75;63-83). The most common comorbidity in patients was hypertension with 42% (55). Patients with clinically significant pathology observed in brain tomography studied after ROSC were 12.2% (16) of all patients. The most common management changes were requesting a consultation from the neurology department (n = 9) and adding a new drug to the treatment (n= 5) The 30-day and 1-year mortality rates showed no significant difference between the two groups (p > 0.05). CONCLUSION: We have seen that the data obtained from the CT studied in the early period after the ROSC was achieved, did not change the management of our patients x in the early and late periods after resuscitation. We conclude that it is not necessary to have a brain CT scan in the emergency department in the early period.

Impact of COVID-19 pandemic on visits of an urban emergency department.

OBJECTIVE: The aim of this study was to reveal how the pandemic process affected the number of ED visits and the reasons for application. METHODS: The daily number of ED visits during the pandemic were analyzed in 3 different periods; prepandemic period (February 1st to March 11th, declaration of the first COVID-19 case in Turkey), early pandemic period (March 12th to May 31th, period of strict measures), and late pandemic period (June 1st to July 31st, period of new norms). The pandemic periods were compared with the same timeframes in 2019 (comparison periods). Demographic variables and complaints of the patients on admission were investigated. RESULTS: The total number of ED visits in the study period in 2020 was 78,907, which was only the half of the applications in the same period in 2019 (n: 149,387). Data showed a sharp decrease at the number of daily visits to green and yellow zones after the announcement of the first case however red zone applications were more than twice that of the previous year. During pandemic nonspecific complaints was decreased and there was an increase at the percentages of respiratory, cardiac, and neurological complaints. CONCLUSION: Number of ED visits during the pandemic were decreased by half when compared to the previous year. It was an advantage of the pandemic to decrease ED visits due to "nonemergent" complaints, and thus, unnecessary patient burden. However, on the other hand, patients avoided seeking medical attention, even for life-threatening conditions which led to increased mortality and morbidity.

Effectiveness of the CRISP Method on the Primary Cardiac Arrhythmia Interpretation Accuracy of Nurses.

BACKGROUND: Accurate electrocardiogram (ECG) interpretation is key to quickly providing attention to patients, and the first health staff who evaluate ECGs are nurses. METHOD: This was a prospective study with a pre-posttest design. The study test included 15 ECGs related to primary cardiac arrhythmias. After pretest nurses were instructed on arrhythmia interpretation using the Cardiac Rhythm Identification for Simple People (CRISP) method, posttests were completed. RESULTS: There was a significant difference between the pretest scores of nurses who had postgraduate education on ECG interpretation and who did not (p = .002). Median test score increased from 3 (interquartile range [IQR] = 2-5) to 7 (IQR = 5-9) (p < .001). Participants mostly missed questions about heart blocks and were most successful with questions about fatal arrhythmias after education. CONCLUSION: The CRISP method is an effective, simple, and easy method for accurate ECG interpretation by nurses. The posttest scores of the participants, especially accurate interpretation of fatal arrhythmias, increased significantly after training. [J Contin Educ Nurs. 2020;51(12):574-580.].

Assessment of factors affecting mortality in geriatric patients with warfarin overdose.

OBJECTIVES: The aim of the present study was to perform a demographic analysis of complications and to determine the factors affecting in-hospital mortality in geriatric patients with warfarin overdose. MATERIALS AND METHODS: All patients aged 65 years or older using warfarin with an international normalized ratio (INR) level above 3.5 IU between 01.01.2014 and 01.01.2018 were included in the study. Characteristics of patients with in-hospital mortality and surviving patients were compared. Multivariate regression analysis was used to assess the predictors for in-hospital mortality. RESULTS: A total of 302 geriatric patients included in the study for statistical analyses. Bleeding rate was 14.2%. A comparison of patient characteristics for in-hospital mortality (survivor vs. nonsurvivor) revealed significant differences for age, gender, chronic renal failure history, creatinine, aspartate aminotransferase (AST), and alanine aminotransferase levels (P < 0.05). A multivariate logistic regression analysis was performed. It was found that elevated AST (P = 0.029, odds ratio [OR]: 1.004, 95% confidence intervals [CIs]; 1.001-1.007) and creatinine (P = 0.045, OR: 2.36, 95% CIs; 1.02-5.48) levels as well as advanced age (P = 0.031, OR: 1.11, 95% CIs; 1.01-1.22) and male gender (P = 0.017, OR: 5.48, 95% CIs; 1.35-22.1) had a negative impact on survival. CONCLUSION: Our study results revealed that male gender, advanced age, and hepatic and renal dysfunctions were the predictors of in-hospital mortality in the elderly with warfarin overdose. In order to avoid serious warfarin-related complications in the older age groups, particularly when there is renal or hepatic dysfunction, patients should be informed about minor warning side effects of warfarin, INR levels should be more frequently checked, and patients should have more strict follow-up schedules.

Assessment of the carotid artery Doppler flow time in patients with acute upper gastrointestinal bleeding.

INTRODUCTION: Because of the subjectivity and ambiguity of the noninvasive measurements and limited use of invasive ones, there is an impending need for a real-time, fast, inexpensive, and reproducible noninvasive measurement method in acute upper gastrointestinal (GI) bleeding with active bleeding in emergency services. AIMS: In this study, we aimed to evaluate the effect of bedside carotid artery flow time (CFT) measurement before and after the passive leg raising (PLR) maneuver on the determination of active bleeding in patients admitted to the emergency department (ED) with upper GI bleeding. MATERIALS AND METHODS: This prospective case-control study was conducted in the ED of a training and research hospital with upper GI bleeding. Patients were placed in the supine position to perform bedside carotid Doppler ultrasonography before starting treatment. CFT, corrected CFT (CFTc), and carotid artery Doppler flow velocity were measured. After then performed PLR, the same parameters were measured again. RESULTS: A total of 94 patients, including 50 patients with GI bleeding and 44 healthy volunteers as control group were included in the study. CFT and CFTc were shorter in the patient group than the control group (P < 0.001, P = 0.004, respectively). After PLR, there were statistically significant differences in change in the CFT (ΔCFT) and change in the corrected CFT (ΔCFTc) between the groups (P = 0.001, P < 0.001). There were also statistically significant differences in ΔCFT and ΔCFT between the patients with active bleeding and the nonbleeding ones (P = 0.01, P = 0.005, respectively). Area under curve to detect active bleeding for ΔCFT and ΔCFTc were calculated as 0.801 (95% confidence interval [CI]: 0.65-0.95) and 0.778 (95% CI: 0.63-0.91), respectively. CONCLUSION: The corrected carotid Doppler flow time measurements in patients with GI bleeding at the time of presenting to the emergency department can be helpful to interpret the active bleeding.

Effects of spinal immobilization at 20° on end-tidal carbon dioxide.

OBJECTIVE: The aim was to determine the effect on end-tidal carbon dioxide (ETCO2) of spinal immobilization (SI) at a conventional 0° angle and to investigate the usefulness of immobilization at a 20° angle for preventing possible hypoventilation. METHODS: The study included 80 healthy volunteers, randomly divided into two groups. Spinal backboards and cervical collars were applied in Group 1 using a 0° angle and in Group 2 using a 20° angle, with the head up. SI was continued for 1 h, and ETCO2 values were measured at the 0th, 30th and 60th minute. RESULTS: There were no significant differences between the groups in 0th and 30th minute ETCO2. However, after 60th minute, results showed a statistically significant increase in ETCO2 in Group 1 (35.5 mmHg [IQR 25-75:35-38]) compared to Group 2 (34 mmHg [IQR 25-75:33-36]) (p < 0.001). During SI, there was a statistically significant increase in ETCO2 in Group 1 (35 mmHg [IQR 25-75:34-36], 35.5 mmHg [IQR 25-75:34-37] and 36 mmHg [IQR 25-75:35-38] respectively at the 0th, 30th and 60th minute after SI) (p < 0.001) and no change in Group 2. Also, we found statistically significant differences between ΔETCO2 levels in Groups 1 and 2 at all 3 time intervals. CONCLUSION: Conventional SI with an angle of 0° led to an increase in ETCO2 while subjects immobilization at a 20° angle maintained their initial ETCO2 values. Immobilization at 20° may prevent decompensation in patients who have thoracic trauma or lung diseases or those who are elderly, pregnant, or obese.

Evaluation of electrocardiographic parameters in patients with epileptic seizure.

The aim of the study is to evaluate the changes in electrocardiographic parameters, including QTc dispersion (QTcd), Tpeak-Tend (Tp-e)/QTc ratio and P-wave dispersion (Pd), during the period without seizure activation in patients, presented to the emergency department (ED) with epileptic seizures. This prospective case-control study was conducted between January 2017 and January 2018. Patients, over 18 years old and presented to the ED with epileptic seizure, were consecutively included in the study. Interictal period ECGs of patients were obtained at least 2 hours after the end of the postictal period. ST-segment changes, QT interval, corrected QT interval (QTc), QTd, Pd, Tp-e, Tp-e dispersion (Tp-ed), Tp-e/QTc ratio and arrhythmias were evaluated in interictal ECGs. A total of 103 epileptic patients and 31 control cases were included in the study. Heart rate, QTc, QTcd, Pd, Tp-ed and Tp-e/QTc ratio were significantly higher in the epilepsy group than in the control group (p < 0.05 for all values). No statistically significant difference in those parameters was observed between the patients with known epilepsy and the patients who had seizure for the first time. There was also no statistically significant difference between patients who had recurrent seizures during the observation period and who did not. The patients with epileptic seizures had increased Pd, QTd, QTcd, Tp-ed and Tpe/QTc ratio during interictal period compared to healthy subjects. These electrocardiographic changes might be associated with an increased risk of dysrhythmia. However, prospective large cohorts with short- and long-term follow-up are needed for clinical reflections.

Effects of 20-degree spinal immobilization on respiratory functions in otherwise healthy volunteers with android-type obesity.

AIM: The aim of the study was to assess whether spinal immobilization with long back board (LBB) and semi-rigid cervical collar (CC) at 20° instead of 0° conserves pulmonary functions in obese volunteers, including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio. METHODS: The study included adult volunteer subjects with android-type obesity who were otherwise healthy. First, pulmonary functions were tested in a seated position to obtain baseline levels, than volunteers were immobilized with LBB and CC at 0-degree and measurements repeated at 0th and 30th minute of immobilization. Next day, same procedures were repeated with the trauma board at 20-degree. Changes over time in FEV1, FVC values and FEV1/FVC ratios during spinal immobilization at 0° and 20° were compared to baseline levels. RESULTS: Study included 30 volunteers. Results showed a significant decline in all values for both situations following spinal immobilization (p < .001). We also compared the decrease over time in those values (ΔFEV1, ΔFVC, and ΔFEV1/FVC ratio) during spinal immobilization at 0° and 20°. The decrease in pulmonary functions was similar in both groups (p > .05). CONCLUSION: The present findings confirm that spinal immobilization reduces pulmonary functions in obese volunteers, and that 20-degree immobilization has no conservative effect on these values when compared to the traditional 0-degree immobilization. It may be that 20° is insufficient to decrease the negative effect of abdominal obesity on pulmonary functions.

Evaluation of relationship between inflammatory markers and hyperemesis gravidarum in patients admitted to emergency department.

BACKGROUND: Hyperemesis gravidarum (HG) is defined as severe nausea and vomiting in pregnancy and considered as one of the most frequent causes to emergency department (ED) admissions. Previous research has shown that HG is associated with systemic inflammation, but there have been no prospective studies to explore this link. The objective of this study was to assess the impact of inflammation in HG pathophysiology and to investigate the association between severity of HG and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and CRP in patients who were admitted to ED with nausea and vomiting. METHODS: This prospective study has been conducted in a tertiary clinic between 2015 and 2016. A total of 162 patients with <16 weeks gestation with singleton pregnancies and without any chronic diseases enrolled in the study. The study group consisted of 113 patients with HG and the control group included 49 healthy subjects. PUQE Index and VAS were used to evaluate the severity of symptoms. RESULTS: Demographical data were similar between both groups. The study group demonstrated significantly higher NLR, PLR and CRP levels (NLR 3.39 vs 2.5, p = 0.001; PLR 134.3 vs 111.2, p = 0.005; CRP 0.85 mg/dL vs 0.19 mg/dL, p = 0.001). While NLR and PLR levels were not correlated with severity of HG, CRP levels were associated with severity of disease (p = 0.001) regarding to PUQE index. CONCLUSION: NLR and PLR are easily obtained and routinely used diagnostic tools for various inflammatory diseases. Measurement of this markers might provide useful information in HG pathogenesis and diagnosis.

Predictive value of capnography for severity of acute gastroenteritis in the emergency department.

OBJECTIVE: This study first aims to assess the utility of ETCO2 levels in evaluating the severity of dehydration in adult patients that present to the ED with acute gastroenteritis. AGE. Second, it intends to evaluate the correlation between ETCO2 and several metabolic parameters: creatinine, pH, bicarbonate (HCO3), and bases excessive (BE). METHOD: This prospective study was conducted with AGE patients in the ED of a training and research hospital between June 2018 and April 2019 after approval of the local ethical-committee. The two groups were defined according to the severity of AGE: mild and non-mild groups. For both groups, ETCO2 levels were measured and recorded on admission of the patients. RESULTS: 87 patients were included in the analyses. The median of ETCO2 values was found as lower in non-mild group than mild group; 30 (25-35) & 39 (33-34), respectively (p < 0.001). In ROC analysis for distinguishing between the both groups, the AUC value was found to be 0.988 and the best cut-off level was found as 33.5 with 95% sensitivity and 93% specificity. In addition, strong negative correlation between ETCO2 and creatinine (p < 0.001, r: -0.771) were found. CONCLUSION: ETCO2 levels decreased in the non-mild group of AGE patients; it could be useful to distinguish the mild group from the non-mild group. ETCO2 could be a reliable marker in predicting AKI in the management of AGE patients.

Association of trans-myocardial repolarisation parameters with size of the diffusion limitation area in acute ischaemic stroke.

OBJECTIVES: This study aimed to evaluate the relationship between transmyocardial repolarisation parameters and the size of the diffusion limitation area measured using diffusion weighted magnetic resonance imaging (DWMRI) in patients diagnosed with ischaemic stroke without known cardiac diseases. MATERIAL AND METHODS: The study was a prospective, observational clinical study. Patients without cardiac disease with acute ischaemic stroke were included in the study. Electrocardiography (ECG) was received from the patients. P, QT, QTc and Tp-e dispersions were calculated. All the patients had computerised brain tomography (CT) and then DWMRI carried out so as to calculate infarct areas. RESULTS: Seventy ischaemic stroke patients and 30 control patients were included in the study. All parameters except for QTc dispersion (p = 0.88) were higher in the stroke group than in the control group (p < 0.05 for all values). The infarct area calculated with DWMRI was divided into four groups according to quartiles, and QT, QTc, P, and Tp-e dispersions of patients were evaluated. Patients were found to have a prolonged dispersion as the infarct area expanded, and this difference was statistically significant (p < 0.05 for all values). CONCLUSIONS: When we compared the patients with ischaemic stroke who had no known cardiac disease to those in the control group we found an increase in transmyocardial repolarisation parameters. As diffusion limitation areas grew larger, QT, QTc, P, and Tp-e dispersions increased. Physicians should be aware of dysrhythmias and sudden cardiac death in acute stroke and should observe these patients, especially those with larger stroke lesions.

Comparison of social supports for geriatric patients admitted to emergency department for trauma and medical reasons.

OBJECTIVES: Developments in medical technology have increased life expectancy around the world thereby, the population of elderly patients increases. While diagnosing the elderly patients, besides factors like physiological changes, comorbidities, multiple medications and admittance to the Emergency Department (ED) for serious causes, a lack of information and experience complicate the work of emergency physicians. Elderly people are admitted to ED with medical or traumatic complaints; nevertheless, independent of the reason for admittance to the ED their presenting condition should be simultaneously assessed for comorbidities. In this study, we aimed to compare social support and stress levels in geriatric patients admitted to the ED for trauma and medical reasons. METHODS: This was a single-center, prospective, descriptive, epidemiologic trial conducted in the ED of a training and research hospital between October 1st, 2015, and April 1st, 2016. Participants consisted 197 patients who were older than 65 years and presented to ED with medical reasons or trauma whose Emergency Severity Index (ESI) was ≥3. A socio-demographic and clinical data form, and the DUKE Social Support and Stress Scale (DUSOCS) were completed for each patient. RESULTS: Patients presenting with medical problems had higher family support levels than patients presenting with traumatic incidents, and this difference was statistically significant (p = 0.028). Concurrently, when both groups' family stress and social stress levels are viewed, patients presenting with trauma had higher levels of stress, and this difference was also statistically significant (p < 0.001). CONCLUSION: This study revealed that the patients admitted to the ED for trauma have lower social support levels than patients admitted for medical reasons. Moreover, social stress levels were also higher in these patients.

Evaluating Effectiveness of Nasal Compression With Tranexamic Acid Compared With Simple Nasal Compression and Merocel Packing: A Randomized Controlled Trial.

STUDY OBJECTIVE: The primary objective of this study is to compare the effectiveness of 3 treatment protocols to stop anterior epistaxis: classic compression, nasal packing, and local application of tranexamic acid. It also aims to determine the frequency of rebleeding after each of these protocols. METHODS: This single-center, prospective, randomized controlled study was conducted with patients who had spontaneous anterior epistaxis. The study compared the effect of 3 treatment options, tranexamic acid with compression but without nasal packing, nasal packing (Merocel), and simple nasal external compression, on the primary outcome of stopping anterior epistaxis bleeding within 15 minutes. RESULTS: Among the 135 patients enrolled, the median age was 60 years (interquartile range 25% to 75%: 48 to 72 years) and 70 patients (51.9%) were women. The success rate in the compression with tranexamic acid group was 91.1% (41 of 45 patients); in the nasal packing group, 93.3% (42 of 45 patients); and in the compression with saline solution group, 71.1% (32 of 45 patients). There was an overall statistically significant difference among the 3 treatment groups but no significant difference in pairwise comparison between the compression with tranexamic acid and nasal packing groups. In regard to no rebleeding within 24 hours, the study found rates of 86.7% in the tranexamic acid group, 74% in the nasal packing group, and 60% in the compression with saline solution group. CONCLUSION: Applying external compression after administering tranexamic acid through the nostrils by atomizer stops bleeding as effectively as anterior nasal packing using Merocel. In addition, the tranexamic acid approach is superior to Merocel in terms of decreasing rebleeding rates.

The effects of spinal immobilization at 20° on intracranial pressure.

OBJECTIVE: In this study, it was aimed to evaluate whether spinal immobilization at 20°, instead of the traditional 0°, affects intracranial pressure (ICP) via the ultrasonographic (USG) measurement of optic nerve sheath diameter (ONSD). METHODS: 140 healthy, adult, non-smoking volunteers who had no acute or chronic diseases were included this study. Volunteers were randomly divided into two groups; performed spinal immobilization at 0° (Group 1) and at 20° (Group 2). After spinal immobilization (at 0 or 20°), measurements of ONSD were performed at 0, 30, and 60 min in an immobilized position. RESULTS: When evaluating the change in ONSD over time (at 30 and 60 min) as compared to basal measurements at 0 min, it was found that the ONSD values of both sides (the right and left eyes) were significantly increased in Group 1 and Group 2. For Groups 1 and 2, these differences existed both between 0 and 30 min and between 30 and 60 min. In addition, in this study, the amounts of increase in the ONSD measurements from 0 to 30 min and from 30 to 60 min (ΔONSD0-30 min and ΔONSD30-60 min) in both groups were compared. The results showed that there was no significant difference between Group 1 and Group 2 in terms of ΔONSD measurements. CONCLUSIONS: Spinal immobilization at 0° as a part of routine trauma management increased ONSD and thus ICP. Secondly, we found that similar to immobilization at 0°, spinal immobilization at 20° increased ONSD.