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1.
Med Klin Intensivmed Notfmed ; 117(1): 34-40, 2022 Feb.
Article in English | MEDLINE | ID: mdl-33103218

ABSTRACT

BACKGROUND: The benefit of end-tidal carbon dioxide (ETCO2) and inferior vena cava collapsibility index (IVCCI) in predicting fluid responsiveness in mechanically ventilated patients has been demonstrated. However, the data on spontaneously breathing patients is controversial. This study aims to investigate the accuracy of variations in the ETCO2 (∆ETCO2) and IVCCI (∆IVCCI) gradient in predicting volume responsiveness in spontaneously breathing patients with hypovolemia. METHODS: This was a prospective observational study conducted in an academic emergency department (ED). Spontaneously breathing patients who required fluid resuscitation due to hypovolemia were included in the study. Cardiac output (CO), IVCCI and ETCO2 were measured before and after the passive leg raise (PRL). A change in the CO of ≥15% after the PLR were considered volume responsive. The difference in the ∆ETCO2 and ∆IVCCI were compared between the volume responsive and nonresponsive groups. RESULTS: A total of 31 patients were included in the study, of whom 15 patients were volume responsive. The difference in the ∆ETCO2 was 4 mm Hg in the volume responsive and 2 mm Hg in the nonresponsive group (p = 0.02). There was no significant difference in ∆IVCCI between the groups. A moderate correlation was detected between the difference in ∆ETCO2 and CO (0.585; p = 0.001). CONCLUSION: ∆ETCO2 can be an alternative method in predicting volume responsiveness in spontaneously breathing patients with hypovolemia.


Subject(s)
Carbon Dioxide , Fluid Therapy , Cardiac Output , Humans , Prospective Studies , Vena Cava, Inferior/diagnostic imaging
2.
Urol Res ; 40(1): 61-5, 2012 Feb.
Article in English | MEDLINE | ID: mdl-21792674

ABSTRACT

Urinary stone disease (USD) alone can cause much morbidity, but when present in conjunction with urinary tract infection, complications and morbidity increase even more. This study investigated the clinical and laboratory findings in patients who had USD with and without infection and evaluated the most suitable diagnostic value for urinary tract infection parameters before urine culture results were available. In a prospective fashion, patients who presented to the emergency department with a complaint of colicky flank pain (with or without hematuria) and who were diagnosed as having urolithiasis with ultrasound were evaluated for 1 year. The gold standard for the diagnosis of urinary tract infection was urine culture. The most suitable diagnostic value for urinary tract infection parameters was determined by receiver operating characteristic (ROC) curves. Logistic regression was used to identify independent variables that predicted a positive urine culture. Of the 192 eligible patients, 177 agreed to participate in the study. Of the clinical and laboratory characteristics analyzed, urine WBC, blood WBC, and fever were significantly different between culture positive and negative patients (p < 0.001, p = 0.04 p = 0.012, respectively). Using ROC curve analysis, pyuria (over 10 WBCs per HPF), fever over 37.9°C, and leucocytosis over 11,300 were the best predictors of a positive culture result. The logistic regression model for leukocytosis >11,300 (OR 2.1), pyuria (OR 2.8), and temperature >37.9°C (OR 3.1) showed a significantly increased risk of having a positive urine culture (correct class 87.9%). While a single physical examination or laboratory finding cannot predict urinary tract infection in USD patients with complete reliability, the presence of pyruria, fever, and leukocytosis significantly increases the odds of a positive urine culture.


Subject(s)
Urinary Tract Infections/diagnosis , Urolithiasis/complications , Adolescent , Adult , Aged , Case-Control Studies , Female , Humans , Hydronephrosis/complications , Logistic Models , Male , Middle Aged , Prospective Studies , ROC Curve
3.
Emerg Med J ; 22(10): 753-4, 2005 Oct.
Article in English | MEDLINE | ID: mdl-16189050

ABSTRACT

Apraclonidine eye drop is an alpha adrenergic agonist derived topical clonidine, used for the treatment of intraocular pressure elevation. We report what is to our knowledge the first case of systemic toxicity of apraclonidine resulted from repeated local administration. Clinical manifestation of toxicity was similar to oral clonidine overdose. Toxicities of ocular drugs should always be considered when a patient presents with new systemic problems.


Subject(s)
Adrenergic alpha-Agonists/adverse effects , Antihypertensive Agents/adverse effects , Clonidine/analogs & derivatives , Consciousness Disorders/chemically induced , Adrenergic alpha-Agonists/administration & dosage , Antihypertensive Agents/administration & dosage , Clonidine/administration & dosage , Clonidine/adverse effects , Female , Humans , Hypotension/chemically induced , Middle Aged , Ophthalmic Solutions
4.
Ulus Travma Derg ; 7(3): 189-94, 2001 Jul.
Article in Turkish | MEDLINE | ID: mdl-11705223

ABSTRACT

Head trauma is a major health problem which affects young people, especially young males and also causes serious economic losses. Although major head injuries are cause greater morbidity and mortality, minor head injuries are more common presentations to emergency departments. In this study our goal is to determine the prevalence of CT usage in minor, adult head injury patients and determine clinical variables for the use of head CT scans. In our study we retrospectively examined 230 adult head injury patients who were presented to the Dokuz Eylül University Medical School Hospital Emergency Department. We recorded age, gender, symptoms of nausea, vomiting, headache, alcohol use, physical examination findings, history of loss of consciousness prior to presentation, concurrent injuries, and Glasgow Coma Scale (GCS) scores. Head CT ordering and abnormal findings were correlated with the above clinical variables. We ascertained that all variables affected the ordering of CT scans except age, gender and alcohol use. The prevalence of abnormal head CT in all patients were 21.7%. We found that GCS is only one clinical variability of which statistically significant relationship to acquaint abnormal CT findings.


Subject(s)
Craniocerebral Trauma/diagnostic imaging , Craniocerebral Trauma/epidemiology , Tomography, X-Ray Computed/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Emergency Treatment/statistics & numerical data , Female , Glasgow Coma Scale , Humans , Male , Middle Aged , Prevalence , Retrospective Studies , Turkey/epidemiology
5.
Int Urol Nephrol ; 33(2): 315-9, 2001.
Article in English | MEDLINE | ID: mdl-12092646

ABSTRACT

The aim of this study is to compare the effectiveness of the 5-HT3 antagonist, ondansetron and a non-steroidal anti-inflammatory agent, diclofenac sodium, as a pain reliever in the treatment of acute ureteral colic. Sixty four patients with severe or moderate pain who were clinically diagnosed as having ureteral colic associated with microscopic or gross hematuria were included in the study. Thirty three patients were administered ondansetron and 31 patients were administered diclofenac sodium. Exclusion critera were known kidney or liver disease causing dysfunction, known hypersensitivity to ondansetron or diclofenac sodium, pregnancy, lactation, duodenal ulcer or bleeding. After pain assessment with a verbal scale and a visual analog scale (VAS), we randomized patients and administered 8 mg ondansetron intravenously to 33 patients and 75 mg diclofenac sodium intramuscularly to 31 patients and pain scores were recorded every 15 minutes. If significant pain relief was not achieved within 60 minutes, i.v. meperidine was given as rescue pain medication. Ondansetron was effective as a primary pain reliever in 14 (42.4%) patients, whereas 19 patients required additional medication. Diclofenac sodium was effective as a primary pain reliever in 24 (77.4%) patients, whereas 7 patients required additional medication. Ondansetron was not superior to diclofenac sodium in relieving pain in patients with acute ureteral colic.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Colic/drug therapy , Diclofenac , Ondansetron/therapeutic use , Ureteral Diseases/drug therapy , Acute Disease , Adult , Aged , Aged, 80 and over , Double-Blind Method , Female , Humans , Male , Middle Aged , Pain Measurement
6.
Ulus Travma Derg ; 6(4): 250-4, 2000 Oct.
Article in Turkish | MEDLINE | ID: mdl-11813481

ABSTRACT

We have evaluated retrospectively adult trauma patients admitted to the Dokuz Eylul University Hospital Emergency Department (ED) between 1.1.1997-30.6.1997 by the aim of contributing epidemiological data about trauma related injuries of Turkey. Among the 1063 study patients, 626 patients were male, 437 patients were female and mean age of the patients was 40.6 +/- 18. The most common causes of injury was fall. The revised trauma score lesser than 12 was 75 patients. It has been determined that 90.8% of the patients were brought to ED by the vehicles other than the ambulance. Among all patients, 872 patients (82%) were discharged from ED, 118 patients (11.1%) were admitted, 73 patients (6.9%) were referred to another hospitals and 13 patients (1.2%) were died. We have determined the significantly increased hospital admission rate in the subgroups of the penetrating trauma patients, patients older than 65 years old (p = 0.001 and 0.003, respectively) and the significantly increased operative intervention and death in penetrating trauma patients (p = 0.000 and 0.009, respectively).


Subject(s)
Accidental Falls/statistics & numerical data , Emergency Treatment/statistics & numerical data , Wounds and Injuries/epidemiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Patient Admission/statistics & numerical data , Retrospective Studies , Risk Factors , Transportation of Patients/statistics & numerical data , Trauma Severity Indices , Turkey/epidemiology , Wounds and Injuries/etiology , Wounds and Injuries/pathology , Wounds and Injuries/therapy
7.
Eur J Emerg Med ; 7(4): 287-90, 2000 Dec.
Article in English | MEDLINE | ID: mdl-11764137

ABSTRACT

We assessed the effect of magnesium sulphate (MgSO4) on lowering the rate in ventricular atrial fibrillation (AF), and evaluated the effect of this therapy in magnesium (Mg) deficient and nondeficient patients. This experimental clinical study was performed on 34 patients with rapid AF (ventricular rate [VR] > 120/minute) presenting to the emergency department of a tertiary care university hospital. Patients with systolic blood pressure < or = 100 mmHg, Hb level < or = 11.8, saO2 of < or = 96%, BUN > or = 40 or creatine > or = 1.8 were excluded (n = 15). Nineteen patients were given an initial 2 g MgSO4 bolus i.v. and a 1 g/hour continuous infusion over 6 hours. To evaluate the presence of Mg deficiency, urine was collected from the onset of treatment and continued for the next 24 hours, and the excretion rate of administered Mg was calculated. Ventricular rates were obtained at baseline, after MgSO4 bolus, and every 15 minutes for the first hour. The decrease in the VR was statistically significant at 15, 30 and 60 minutes after Mg therapy (p = 0.0025, p < 0.001, p > 0.001). There was no difference in the response to Mg therapy between Mg deficient and nondeficient patients at 15, 30 or 60 minutes after therapy (p = 0.41, p = 0.28, p = 0.08). It is concluded that i.v. MgSO4 has a statistically significant but clinically limited effect on VR and this effect did not differ between patients with and without Mg deficiency.


Subject(s)
Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/drug therapy , Magnesium Deficiency/drug therapy , Magnesium Sulfate/therapeutic use , Magnesium/blood , Tachycardia, Ventricular/drug therapy , Adult , Aged , Aged, 80 and over , Atrial Fibrillation/blood , Atrial Fibrillation/complications , Female , Humans , Magnesium/urine , Magnesium Deficiency/blood , Magnesium Deficiency/complications , Male , Middle Aged , Tachycardia, Ventricular/blood , Tachycardia, Ventricular/etiology , Time Factors , Treatment Outcome
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