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.].

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.

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.

Value of plasma neutrophil gelatinase-associated lipocalin (NGAL) in distinguishing between acute kidney injury (AKI) and chronic kidney disease (CKD).

OBJECTIVE: In this study, we aimed to determine whether plasma NGAL levels could be used as a biomarker for distinguishing between AKI and CKD in emergency medicine. MATERIALS AND METHODS: This prospective study was conducted at the ED of a training and research hospital over a six-month period in 2015. Three groups were defined: an AKI group - defined as a new onset of at least a 1.5-fold or ≥0.3 mg increment increase of SCr values from the normal baseline, a stable CKD group - only included presence of stages 2 through 4 of CKD according to the National Kidney Foundation's KDIGO 2012, and a control group. After the initial evaluation of patients, venous blood samples were taken for routine biochemical, counter blood cell, and plasma NGAL measurement at admission. RESULTS: A total of 25 patients with AKI, 22 patients with stable CKD, and 22 control subjects were enrolled. Level of plasma NGAL in AKI group was higher than those of the stable CKD group (median: 794 ng/ml IQR: 317-1300 & 390 ng/ml IQR: 219-664, p < 0.001). AUC was measured as 0.68 (p = 0.02, 95% CIs: 0.54-0.84) to assess the utility of plasma NGAL levels at varying cut-off values for distinguishing between AKI and CKD. For plasma NGAL, the best cut-off level was found to be 457 ng/ml (sensitivity: 72.0%, specificity: 64%). CONCLUSION: This study has clearly demonstrated that plasma NGAL levels were higher in AKI patients than in CKD patients. However, in clinical practice, the use of plasma NGAL levels to distinguish between AKI and CKD is limited.

Copeptin levels in carbon monoxide poisoning.

BACKGROUND/AIM: The aim of this study is to identify the copeptin levels in patients presenting with carbon monoxide (CO) poisoning to the emergency department and to investigate its correlation with the neurological effects. MATERIALS AND METHODS: The study group consisted of patients presenting with CO poisoning and carboxyhemoglobin levels >10%. Blood samples for copeptin levels were obtained twice, first at presentation then at the fourth hour of observation. The data were analyzed using SPSS 16 for Windows. RESULTS: The median copeptin levels of the patient group were identified as 0.63 (0.39-1.06) ng/mL at hour 0 and 0.41 (0.31-0.49) at hour 4. The copeptin levels of the control group were 0.34 (0.25-0.42) ng/mL and were significantly lower than those of the patient group (P < 0.000). According to our results, 0.345 ng/mL for plasma copeptin level as the best cut-off level may be used with sensitivity of 94.0% and specificity of 60%. The copeptin levels at hour 0 were statistically significantly higher in the neurologically affected patients than those not affected (P < 0.001). CONCLUSION: In this study it was shown that blood copeptin levels increase in patients presenting to the emergency department with CO poisoning.