Benefits of cardiac sonography performed by a non-expert sonographer in patients with non-traumatic cardiopulmonary arrest.

UNLABELLED: The purpose of this study was to evaluate a rapid cardiac ultrasound assessment performed by trained non-expert sonographers integrated into the advanced cardiac life support (ACLS). MATERIAL AND METHODS: This study was prospectively performed in 179 patients (104 males and 75 females) who underwent cardiopulmonary resuscitation (CPR) in an emergency department (ED) during two calendar years (2013 and 2014). Two senior doctors, who had received emergency cardiac ultrasonography training, performed cardiac ultrasound through the apical, subxiphoid, or parasternal windows. Ultrasound evaluation and pulse controls were performed simultaneously. SPSS 18.0 was used for statistical analysis. RESULTS: A total of 63.7% (114) of the cardiopulmonary arrest incidents occurred out of the hospital. Only 13 patients had a femoral pulse during the initial evaluation, while 166 showed no femoral pulse. Initial monitoring showed a regular rhythm in 53 patients, ventricular fibrillation in 18 patients, and no rhythms in 108 patients. The first evaluation with ultrasound detected an effective heart rate in 26 patients and ventricular fibrillation in 14 patients, while no effective heart rate was observed in 139 patients. In addition, ultrasound revealed pericardial tamponade in seven patients and right ventricular enlargement in four cases. Global hypokinesia was detected in four patients and hypovolemia was observed in another four patients. CONCLUSION: The use of real-time ultrasonography during resuscitation with real-time femoral pulse check can help facilitate the distinguishing of pea-type arrest, ascertain the cause of the arrest, infer a suitable treatment, and optimize medical management decisions regarding CPR termination.

An assessment of antioxidant status in patients with carbon monoxide poisoning.

BACKGROUND: Carbon monoxide poisoning (COP) is an important cause of mortality and morbidity worldwide. This study was to investigate the levels of serum paraoxonase (PON), arylesterase (ARYL), ceruloplasmin (Cp), and sulfhydryl (-SH) in the treatment of COP, and to further understand the pathophysiology of COP. METHODS: This prospective study comprised 107 individuals with COP (group 1) and 50 healthy volunteers (group 2). Serum, plasma, and erythrocyte samples were taken on admission from all participants with COP. This process was repeated in the 90(th) and 180(th) minutes of treatment. Samples were taken from the control group only once. The levels of plasma PON, ARYL, Cp activity and -SH were measured in both groups. RESULTS: Age, gender, and carboxyhemoglobin level were not correlated with PON, ARYL, Cp, and -SH levels. PON, ARYL, and -SH levels were significantly decreased in group 1 compared with group 2. Conversely, Cp was significantly elevated in group 1 in contrast to group 2. Although ARYL was lower on admission in patients with COP than that was observed in the 90(th) and 180(th) minutes (P<0.001), Cp was higher on admission than at the other time points (P<0.001). CONCLUSIONS: Participants with COP had decreased levels of antioxidants (PON, ARLY, and -SH). COP represses the antioxidant system.

Impact of scorpion stings on electrocardiographic changes and relationship with body oxidant and antioxidant status.

OBJECTIVE: To investigate electrocardiogram changes due to scorpion stings and association between oxidative stress index, body oxidant/antioxidant system and the electrocardiogram changes. METHODS: The study was conducted at the Faculty of Medicine, Gaziantep University, Turkey, between May 2009 and October 2010. It comprised 44 patients admitted to the emergency department for scorpion sting, and a control group of matched age and gender of 20 persons. Electrocardiograms were taken promptly in the most painful phases of the patients. Cardiac parametres were measured. Erythrocyte packages were prepared to detect toxin/antioxidant levels. SPSS 18 was used for statistical analysis. RESULTS: Of the 44 patients, 22 (50%) were male. Overall average age of the patients was 45.22 +/- 17.99 years. None of the patients required intensive care and none of them had limb losses. Cardiac parametres of the patients in electrocardiogram were higher (p < 0.05). Difference between those with changed electrocardiogram and unchanged electrocardiogram in terms of the values of total antioxidant status, total oxidant status, and oxidative stress index, were not statistically significant (p > 0.05). CONCLUSION: Scorpion stings associated with electrocardiogram changes. The mechanism of this relationship is not related with the status of body oxidative stress index and body oxidant and antioxidant capacity. Some parametres warrant further study in terms of potential serious arrhythmias in scorpionism.

Analysis of complaints lodged by patients attending a university hospital: a 4-year analysis.

OBJECTIVE: Health practitioners often regard complaints concerning the quality of patient care in a negative light. However, complaints by patients and their relatives are an important source of information when considering ways in which to improve care. In the present study, we evaluated the complaints of patients and their relatives with regard to our hospital, such that we could take adequate remedial measures. METHOD: Records of all patient complaints made between June 2008 and June 2012 were retrieved from the archives of the Quality Improvement Unit. The socio-demographic profiles of complainants, and their reasons for complaining, were analyzed using the SPSS statistical package. RESULTS: The results revealed that 453 complaints, relating to medical care, the attitude of staff, waiting times, and financial issues, were made against our hospital over 4 years. Of the complainants, 68.9% (n = 312) were male, and 31.1% (n = 141) were female. The majority (16.3% and 20.4%, respectively) of the complaints were due to medical care and staff attitude problems. The unit about which most patients complained was hospital administration (22.1%), and one hundred fifty-three (33.8%) complaints were about physicians. Complaint frequency was 0.22 per 1.000 visits. CONCLUSION: Complaints may be potentially useful quality assurance tools, and can identify system flaws. The primary causes of complaints were medical care, attitude of the staff, and waiting time, and many of these issues may be remedied.

An assessment of oxidant/antioxidant status in patients with snake envenomation.

OBJECTIVE: The aim of this study is to investigate the antioxidant status (TAS), oxidant status (TOS) and oxidative stress index (OSI) in patients with snake envenomation and to learn more about the pathophysiology of snake envenomation. METHOD: Between May 2009 and October 2010, 47 patients were admitted to our emergency department with snake bites, and as a control group 20 healthy volunteers were enrolled in this study. Serum, plasma, and erythrocyte components were prepared for all patients on admission and at the control after 1 month. Serum TOS/TAS levels were measured. RESULTS: No correlation was observed among age, gender and the levels of TAS, TOS and OSI. TAS, TOS and OSI levels were higher in snake envenomation patients upon arrival at the emergency department than in the healthy control group. Upon admission, all levels of patients with snake envenomation were higher than the control levels taken after 1 month. CONCLUSIONS: Serum TAS, TOS and OSI levels increase in snake envenomation patients. The results obtained in this study indicate that the snake bite was associated with a shift to an oxidative state, and oxidative stress plays an important role in the pathophysiology of snake envenomation.

Efficiency of Ankaferd Blood Stopper used in bleeding control on intraabdominal adhesions formed postoperatively.

PURPOSE: The purpose of this study is to investigate the hispathological, biochemical, and clinical efficiency of Ankaferd Blood Stopper (ABS) in preventing postoperative intraabdominal adhesions. METHOD: A total of 40 Wistar albino species female rats were randomly separated into 4 groups. For the control group, 1 mL normal saline was administered; and for the second, third, and fourth groups 0.5, 1, and 2 mL, respectively, ABS was administered. Statistical analyses were evaluated with Tukey and analysis of variance test. FINDINGS: Significant increase was observed in fibroblast and vascularization microscopically with increasing amount of ABS used. Degree of adhesion in the group administered with normal saline was lower compared to the other groups. Adhesion thickness and prevalence macroscopically increased with the increasing amount of ABS used in groups. CONCLUSION: It was determined in our study that ABS is not efficient in preventing intraabdominal adhesions; on the contrary, adhesions were increased with the increased amount of ABS used.

An assessment of antioxidant status in patients with carbon monoxide poisoning / 世界急诊医学杂志（英文）

BACKGROUND:Carbon monoxide poisoning (COP) is an important cause of mortality and morbidity worldwide. This study was to investigate the levels of serum paraoxonase (PON), arylesterase (ARYL), ceruloplasmin (Cp), and sulfhydryl (-SH) in the treatment of COP, and to further understand the pathophysiology of COP. METHODS:This prospective study comprised 107 individuals with COP (group 1) and 50 healthy volunteers (group 2). Serum, plasma, and erythrocyte samples were taken on admission from allparticipants with COP. This process was repeated in the 90th and 180th minutes of treatment. Samples were taken from the control group only once. The levels of plasma PON, ARYL, Cp activity and -SH were measured in both groups. RESULTS:Age, gender, and carboxyhemoglobin level were not correlated with PON, ARYL, Cp, and -SH levels. PON, ARYL, and -SH levels were significantly decreased in group 1 compared with group 2. Conversely, Cp was significantly elevated in group 1 in contrast to group 2. Although ARYL was lower on admission in patients with COP than that was observed in the 90th and 180th minutes (P<0.001), Cp was higher on admission than at the other time points (P<0.001). CONCLUSIONS:Participants with COP had decreased levels of antioxidants (PON, ARLY, and -SH). COP represses the antioxidant system.

Effects of music therapy on pain and anxiety in patients undergoing port catheter placement procedure.

BACKGROUND: Patients scheduled to invasive medical procedures experience high levels of anxiety, which may lead to increased perceptions of pain and vital sign instability throughout. AIMS: To examine the effect of a music intervention (MI) on stress hormones, physiologic parameters, pain, and anxiety state before and during port catheter placement procedures (PCPPs). METHODS: We conducted a prospective, randomized, controlled study in 100 oncology patients, who were randomly assigned to an MI group (n=50) or a control group (n=50). The effects of music were assessed by determination of serum cortisol and adrenocorticotropic hormone (ACTH) levels, heart and respiratory rate (HR, RR) and systolic and diastolic blood pressure (SBP, DBP), on arrival in the surgical intervention room, as well as immediately prior to and immediately after the PCPP, in both groups. Furthermore, pain and anxiety levels were identified using visual analogue scale and state-trait anxiety inventory scales. RESULTS: On arrival, there were no differences between the patients in terms of serum cortisol and ACTH levels, HR, RR, SBP, DBP and anxiety levels. There were significant reductions in hormone levels (p<0.05 for all), HR (p<0.001), RR (p<0.001), SBP (p<0.05) and DBP (p<0.05), immediately prior to and immediately after the PCPP in participants in the MI group compared to those in the control group. Furthermore, music led to a significant reduction in pain (p<0.05) and anxiety scores (p<0.05) in the MI group compared to control group. CONCLUSION: During invasive medical procedures, MI significantly decreases stress hormone levels, physiological parameters, acute procedural pain and anxiety.

Therapeutic red cell exchange for severe carbon monoxide poisoning.

BACKGROUND AND OBJECTIVE: Carbon monoxide (CO) is the most common cause of fatal poisoning worldwide. Therapeutic red cell exchange (TREX) has been used in the treatment of many different diseases. Therefore, we aimed to evaluate the efficacy of TREX on the clinical status, outcome, and discharge of patients with severe CO poisoning. METHODS: Demographic data, clinical status, and outcomes of 12 patients that were treated with TREX for severe CO poisoning after referral to the Emergency and Hematology Departments of Gaziantep University between November 2011 and April 2012 were evaluated. RESULTS: Mean carboxyhemoglobin level decreased from (59.7 ± 12.7)% (38-79%) to (17 ± 9.4)% (8-43%), and mean Glasgow Coma Scale score increased from 4 ± 1.6 (3-8) to 9.4 ± 3.5 (3-14) after TREX therapy. Five patients were admitted to the intensive care unit. Rhabdomyolysis developed in one case. Of the 12 patients, 11 were discharged alive, and one patient died. CONCLUSION: TREX may be an alternative treatment method for reducing mortality and morbidity in cases of severe CO poisoning.

Role of inferior vena cava and right ventricular diameter in assessment of volume status: a comparative study: ultrasound and hypovolemia.

OBJECTIVE: Ultrasonography has been suggested as a useful noninvasive tool for the detection and follow-up for hypovolemia. Two possible sonographic markers as a surrogate for hypovolemia are the diameters of the inferior vena cava (dIVC) and the right ventricle (dRV). The goal of this study was to evaluate IVC and RV diameters and diameter changes in patients treated for hypovolemia and compare these findings with healthy volunteers. METHODS: Fifty healthy volunteers and 50 consecutive hypovolemic patients were enrolled in the study. The dIVC, both during inspiration (IVCi) and expiration (IVCe), was measured in hypovolemic patients both before and after fluid resuscitation, and they were also measured in healthy volunteers during the time they participated in the study. The dIVC, in hypovolemic patients both before and after fluid resuscitation, was measured ultrasonographically by M-mode in the subxiphoid area. The dRV was measured ultrasonographically by B-mode in the third and fourth intercostals spaces. RESULTS: The average diameters of the IVCe, IVCi, and dRV in hypovolemic patients upon arrival were significantly lower compared with healthy volunteers (P = .001). After fluid resuscitation, there was a significant increase in the mean diameters of the IVCe, IVCi, and RV in hypovolemic patients (P = .001). CONCLUSIONS: The results indicate that the dIVC and dRV are consistently low in hypovolemic subjects when compared with euvolemic subjects. Bedside serial measurements of dIVC and dRV could be a useful noninvasive tool for the detection and follow-up of patients with hypovolemia and evaluation of the response to the treatment.

Oxidant/antioxidant status in cases of snake bite.

BACKGROUND: Snake bites are an important cause of mortality and morbidity worldwide, especially in rural areas. OBJECTIVE: The aim of this study was to investigate serum paraoxonase (PON), arylesterase (ARLY), ceruloplasmin (Cp), and myeloperoxidase (MPO) activity and lipid hydroperoxide (LOOH) and total sulfhydryl group (-SH) levels in patients with snake venom poisoning. METHODS: The study included 49 patients with snake bite envenomation (Group 1) and 39 healthy volunteers as the control group (Group 2). Plasma PON, ARLY, Cp, and MPO activity and LOOH and -SH levels were measured. Laboratory measurements of 20 patients with snake bite envenomation (Group 3) were performed again after treatment. RESULTS: PON and ARLY activity and -SH levels were significantly decreased in Group 1 compared with those in Group 2. Cp and MPO activity and LOOH levels were significantly elevated in Group 1 compared with those in Group 2. PON and ARLY activity were significantly elevated in Group 3 compared with those in Group 1. Cp and MPO activity and LOOH levels were significantly decreased in Group 3 compared with those in Group 1. CONCLUSIONS: Patients with snake bite envenomation had increased oxidants (MPO and LOOH) and decreased antioxidants (PON, ARLY, and -SH). Results obtained in this study demonstrate that snake bites are associated with a shift to oxidative status. Therapy with antioxidants can lead to an increase in the antioxidant defense system, and thus improvements in clinical symptoms.

Plasma exchange as a complementary approach to snake bite treatment: an academic emergency department's experiences.

Snake bites are leading causes of morbidity and mortality worldwide, especially in rural areas. Therapeutic plasma exchange has been used in the treatment of many different conditions such as immunologic diseases, toxicologic disorders, and snake envenomation. The aim of this study is to evaluate the efficacy of plasma exchange treatment on clinical status, outcomes, and discharge of patients who were bitten by venomous snakes. The study was conducted retrospectively in the Emergency Department of Gaziantep University from January 2002 to December 2011. Thirty-seven patients were included in the present study. Routine biochemical and hematologic laboratory parameters were studied before and after plasma exchange. Demographic data, clinical status, and outcomes of patients were recorded. Plasma exchange was performed by using centrifugation technology via an intravenous antecubital or subclavian vein catheter access. Human albumin/fresh frozen plasma was used as replacement fluids. A significant correlation was seen between therapeutic plasma exchange and improvement of laboratory results. None of the study patients lost their limbs. Eight patients were sent to the intensive care unit. The mean length of the hospital stay was 12.2 days (4-28). All patients were discharged with good recovery. No complications were seen during the 3 months following discharge. Plasma exchange appears to be an effective treatment intervention for snake bite envenomations, especially in the management of hematologic problems and in limb preservation/salvage strategies. In addition to traditional treatment methods, plasma exchange should be considered by emergency physicians in cases of snake bite envenomation as a therapeutic approach to facilitate rapid improvement.

Pneumomediastinum after retching.

A 25-year-old woman with hirsutism presented to the Emergency Department of the medicine faculty in Gaziantep University with a 4-h History of dyspnoea, dysphagia, coughing, continuous and progressive chest pain radiating to the back and palpation of her neck. The physical examination was significant for diffuse neck and chest subcutaneous emphysema. The x-ray study and CT scan of the chest revealed pneumomediastinum. The patient reported that 6 h before presentation she took spironolactone due to hirsutism and she retched. Retching caused the symptoms. The patient was followed conservatively and fully recovered over the next 7 days. Spontaneous pneumomediastinum developed in this patient with no underlying lung disease, presumably from air leakage secondary to the excessive elevation of intrathoracic pressure due to retching. Pneumomediastinum is an uncommon disease arising most frequently and remains largely underdiagnosed clinically, especially in young, healthy patients.

Rupturing of renal angiomyolipoma due to physical examination.

Renal angiomyolipoma (AML) is relatively a rare benign tumour including vascular smooth muscle, and fatty elements; and the majority of renal AML run an asymptomatic, benign course. Potentially life-threatening complication of renal AML is tumour rupturing that can be seen after a low-velocity trauma. Flank pain and haematuria may be considered not important in emergency department if underlying cause is not kept in mind. In present study, the authors aimed to discuss a patient who developed ruptured AML during physical examination.

Prognostic value of pleural effusion, CA-125 and NT-proBNP in patients with acute decompensated heart failure.

BACKGROUND: Acute decompensated heart failure (HF) is a serious complication associated with significant morbidity and mortality. The CA-125 and NT-proBNP levels have been shown in some studies to predict the outcome, however, the prognostic value of other simple clinical parameters such as pleural effusion has not been established yet. AIM: To assess the prognostic value of pleural effusion regarding in-hospital and 6-month follow-up outcome in patients with acute decompensated HF and the relationship between pleural effusion and CA-125 and NT-proBNP levels. METHODS AND RESULTS: The CA-125 and NT-proBNP levels were measured at baseline and the presence of pleural effusion was examined on chest radiograms. One hundred patients were prospectively followed until the occurrence of cardiac death, defined as death from worsening HF or sudden cardiac death, or completion of follow-up period. There were 27 deaths over the course of 6 months of follow-up. An insignificant trend towards higher values of CA-125 was found in patients with pleural effusion. Univariate Cox regression analysis showed that there was no relationship between pleural effusion and in-hospital outcome as well as mortality during 6-month follow-up. The CA-125 and NT-proBNP levels predicted mortality. Multivariate Cox regression analysis showed that only CA-125 was an independent predictor of the 6-month outcome (RR: 1.2; 1.04-1.4; p = 0.001). CONCLUSIONS: In patients with acute decompensated HF, accompanying pleural effusion did not predict mortality or rehospitalisation during the 6-month follow-up. The increased CA-125 level was found to be an independent predictor of poor outcome, irrespective of pleural effusion.

A case of non-fatal oleander poisoning.

We present a case of non-fatal poisoning with oleander blooms in a 42-year-old woman. After repeated vomiting and gastrointestinal distress, the patient was admitted to the hospital with cardiac symptoms 4 h after the ingestion. Urine and blood samples were assayed for drugs of abuse and for general toxicological screen. Blood was analysed for alcohol and volatiles. Oleandrin was detected in the blood sample at a concentration of 14.7 ng/ml. Following a review of the literature, this is the first case of oleander poisoning in which the patient recovered with only conservative treatment. Oleander poisonings occur rarely, and generally result in death.

[Mortality factors in flame and scalds burns: our experience in 816 patients]. / Alev ve haslanma yaniklarinda mortalitede etkili faktörler: 816 hastada deneyimlerimiz.

BACKGROUND: Our aim was to evaluate the effective factors on mortality in flame and scald burns in the Diyarbakir region. METHODS: The data of 816 patients who applied to the Dicle University Emergency Department between January 2001 and May 2005 with flame and scald burns were investigated retrospectively. The patients were separated into two groups as alive or deceased. Gender, age, burns shapes, burn degrees and rates, burn regions, admission periods, hospitalization times, complications, and the treatments were analyzed. RESULTS: 43.5% of the patients were female and 57.5% were male. Six hundred fifty-eight patients were under 6 years old. 70.5% of burns occurred as a result of negligence; 76.5% occurred due to scald and 23.5% due to flame. In cases of death, 39 patients were under 10 years old. The mean age was 9.32 years. The average hospitalization period was 10.37 days. The most common complication was wound infection. The mortality rate was 6.1%. CONCLUSION: The mortality rate was higher among patients who were hospitalized longer than 15 days (p = 0.030); whose burns were due to suicide attempt (p = 0.002); who used shoe paint on the burn wounds instead of treatment (p = 0.000); who had more than 40% second-degree burns (p = 0.000) or more than 20% third-degree burns (p = 0.000); and among those with acute respiratory failure, compartment syndrome, hypoalbuminemia, and sepsis (p = 0.000).

Effectiveness of Ankaferd blood stopper in the topical control of active bleeding due to cutaneous-subcutaneous incisions.

OBJECTIVE: To assess the effectiveness of Ankaferd blood stopper (ABS) in the topical control of bleeding due to cutaneous/subcutaneous incisions. METHODS: We included in this study, 69 patients with cancer that were admitted for port insertion to the Emergency Department of Gaziantep University Hospital, Gaziantep, Turkey, between May and July 2008. We used the wet compress form of ABS in 37 patients (group I), and regular dry sterile sponges in 32 patients (group II), to stop the bleeding that occurs during the clinically indicated vascular port insertion in patients with cancer. The success rate in terms of bleeding control, time needed to stop the bleeding, recurrence of bleeding, and complications were recorded. RESULTS: A total of 69 patients were included in this study. The average time needed to stop the bleeding was 32.97 +/- 29.9 seconds for group I, and 123.75 +/- 47.5 seconds for group II. Bleeding restarted in 24% in group I, and in 50% in group II. Among the patients in group I, 13.5% developed localized redness, and 8.1% minor swelling, while 8.1% reported local pain at the wound site; in 5.4% of the patients, the sutures at the wound site opened. The same parameters were recorded for group II; 9.4% for localized redness, 0.0% for minor swelling, 6.2% reported local pain, and the sutures at the wound site opened in 3.2% (p=0.592). CONCLUSION: The Ankaferd blood stopper was proven to stop local bleeding in a shorter time, with a lower recurrence rate in comparison with the sterile sponge.

Chronic carbon monoxide exposure is associated with the increases in carotid intima-media thickness and C-reactive protein level.

Being the most common cause of death from poisoning worldwide, cardiovascular manifestations of acute carbon monoxide (CO) poisoning have been subject of various studies but current evidence about effects of chronic CO exposure on atherosclerosis is limited which is very common. We aimed to investigate association of chronic CO exposure with atherosclerosis by measuring carotid intima-media thickness (CIMT) and high-sensitivity C-reactive protein (hs-CRP). Forty healthy male non-smoker indoor barbecue workers (mean age; 33.0 +/- 9.0 years) working in different restaurants for at least three years and 48 age-matched healthy men (mean age; 34.3 +/- 6.6 years) enrolled in the study. Clinical characteristics of indoor barbecue workers and control group were comparable in terms of body mass index, blood pressure, and lipid profile. However, carboxyhemoglobin (COHb) (6.4 +/- 1.5% vs. 2.0 +/- 1.1%), hs-CRP (2.7 +/- 2.0 mg/L vs. 1.1 +/- 0.8 mg/L) and CIMT (1.1 +/- 0.3 mm vs. 0.9 +/- 0.1 mm) were higher in indoor barbecue workers (p < 0.001 for each). In Pearson correlation analysis, CIMT was correlated with COHb concentration (r = 0.635, p < 0.001) and hs-CRP level (r = 0.466, p < 0.001). Among indoor barbecue workers, the years worked (years exposed to CO) are correlated with COHb, hs-CRP and CIMT. In multivariate analysis, COHb concentration is the only independent predictor of CIMT (beta = 0.571, p < 0.001). The increased CIMT and hs-CRP in indoor barbecue workers suggest that chronic CO exposure may increase the risk of atherosclerotic cardiovascular events.