Sepsis biomarkers for early diagnosis of bacteremia in emergency department.

INTRODUCTION: We compared the diagnostic values of individual and composite biomarkers used in the prediction of bacteremia in adult emergency department patients. METHODOLOGY: First-hour blood levels of C- reactive protein, procalcitonin, interleukin-6, lactate, lipopolysaccharide-binding protein and white blood cell count were collected from a 30-person control group and 47 adult patients. Patients included in this study were admitted to the emergency department on suspicion of sepsis. We categorized patients according to presence/absence of sepsis and bacteremia. Our control group was categorized as S-B -, septic patients with bacteremia were S+B+, and septic patients without bacteremia were S+B-. RESULTS: All biomarkers showed a statistically significant elevation when S+B- and S+B+ groups were compared with the S-B-. When S+B+ group was compared with the S+B- group only procalcitonin and lactate levels had statistically significant elevation (p < 0.005). Regression analysis demonstrated that lactate and procalcitonin were independently associated with having bacteremia in the state of sepsis and Hosmer-Lemeshow score was 0.772. The areas under the curve (AUC) values of biomarkers procalcitonin, lactate, C-reactive protein, combined 1 (procalcitonin+ lactate), and combined 2 (procalcitonin + lactate + C-reactive protein) were 0.773, 0.744, 0.523, 0.806, and 0.829 respectively. CONCLUSIONS: Combination of tests such as combined 1 or combined 2 were highly predictive of bacteremia in adult septic patients. Combined 2 demonstrated the best predictive performance and could be utilized as a tool to assist diagnosis of bacteremia before culture results are available.

Comparison of the efficacy of ShotBlocker and cold spray in reducing intramuscular injection-related pain in adults. A prospective, randomized, controlled trial.

OBJECTIVES: To compare the efficacy of ShotBlocker and cold spray in reducing intramuscular (IM) injection-related pain in adults. Methos: A prospective, randomized, controlled study carried out between January 2018 and March 2018 at the Department of Emergency Medicine, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey. Adult patients receiving IM injection of diclofenac sodium (75 mg/3 ml) were included. The patients were randomized into 3 groups: ShotBlocker, cold spray, and control. Each group comprised 40 patients. Patients were instructed to rate the intensity of IM injection-related pain using a 100-mm visual analog scale (VAS). Visual analog scale scores of the patients were statistically analyzed. Results: Visual analog scale scores were lower in the ShotBlocker (11 mm) and cold spray (10 mm) groups than in the control group (31 mm) (p=0.001). There were no significant differences in VAS scores between the ShotBlocker and cold spray groups. The operators' responses revealed that ShotBlocker was more difficult to administer than cold spray. Conclusion: ShotBlocker is an effective non-pharmacological method that reduces IM injection-related pain and is similar in efficacy, to cold spray.

Effects of different resuscitation fluids on tissue blood flow and oxidant injury in experimental rhabdomyolysis.

OBJECTIVE: This study was performed to evaluate the effects of 0.9% saline (SAL), 0.9% saline + sodium bicarbonate + mannitol (SAL/BIC/MAN), and hypertonic saline-dextran (HSD) on hemodynamic variables, tissue blood flow, and oxidant injuries in experimental traumatic rhabdomyolysis (TR) in rats subjected allogeneic muscle extract infusion. DESIGN: Prospective, randomized, experimental. SETTING: Physiology experiment laboratory. SUBJECTS: Male Sprague-Dawley rats, weighing 250-300 g. INTERVENTIONS: All groups (n = 8 each) underwent femoral artery and vein catheterization. The animals in the TR, SAL, SAL/BIC/MAN, and HSD groups received an infusion of 2 mL of autologous muscle extract for 60 mins. After autologous muscle extract infusion, the SAL and HSD groups received 30 mL/kg 0.9% saline for 30 mins or 4 mL/kg HSD for 5 mins, respectively. The SAL/BIC/MAN group received 30 mL/kg 0.9% saline for 30 mins plus a bolus of 1 g/kg mannitol and a bolus of 2 mEq/kg sodium bicarbonate diluted in 1 mL of saline. At 2 hrs of autologous muscle extract infusion, erythrocyte flows in liver and kidney were measured by using a laser Doppler flowmeter. Then, blood samples and kidney and liver biopsies were taken to measure levels of glutathione and malondialdehyde. MEASUREMENTS AND MAIN RESULTS: TR caused decreases in mean arterial pressure, tissue blood flow, and tissue glutathione and an increase in malondialdehyde. Rats in the HSD group had significant metabolic acidosis. SAL resuscitation did not correct tissue blood flow and prevent oxidant injury. HSD increased tissue blood flow, mean arterial pressure, and liver and kidney glutathione and decreased serum, liver, and kidney malondialdehyde. SAL/BIC/MAN resuscitation corrected all oxidant damage variables but did not increase tissue blood flow. SAL/BIC/MAN preserved serum malondialdehyde and liver glutathione better than the HSD did. CONCLUSIONS: HSD prevented oxidant injury and restored tissue blood flow but increased metabolic acidosis that followed autologous muscle extract infusion. SAL/BIC/MAN seems to be more effective than HSD in decreasing oxidant injury. Further research on the effects of the solute overload and metabolic acidosis due to HSD resuscitation on renal function in experimental rhabdomyolysis is warranted.

[The effects of lactated ringer's resuscitation on tissue blood flows and oxidant injury in experimental crush injury in rats]. / Deneysel Crush Yaralanmada Ringer Laktat Resusitasyonunun Doku Kan Ve Oksidan Hasara Etkisi.

BACKGROUND: In an experimental model of crush injury, tissue blood flow, the extend of oxidant injury and the effect of lactated ringer's resuscitation were investigated. MATERIAL AND METHOD: Rats were divided into sham (n: 8), crush injury (n: 8), and crush injury + lactated ringer's resuscitation (n: 8) groups. Arterial and venous catheterization were performed in all groups. Crush injury was done with intravenous infusion of allogenic muscle extract. In the crush injury + lactated ringer's resuscitation group 30 ml/kg lactated ringer's solution was infused in 30 minutes. Kidney and liver blood flow were measured by using a laser flowmeter. To assess the oxidant injury blood, liver, and kidney tissue samples were collected for malondialdehyde and glutathione measurements. RESULTS: In the crush injury, diminished liver and kidney blood flow rates were improved with lactated ringer's resuscitation. In addition, glutathione levels decreased whereas malondialdehyde levels and base deficit increased. Lactated ringer's resuscitation brought base deficit to the control levels. When compared with the crush injury, lactated ringer's infusion increased the glutathione levels but could not decrease the malondialdehyde ones. CONCLUSION: Lactated ringer's resuscitation improved the blood flow rates but could not prevent oxidant injury totally.

[Does the leukocyte count correlate with the severity of injury?]. / Kan lökosit degeri travmanin siddetini yansitir mi?

BACKGROUND: Injury severity score (ISS), Glasgow coma score (GCS), and revised trauma score (RTS) are the most frequently used methods to evaluate the severity of injury in blunt trauma patients. ISS is too complicated to assess easily and GCS and RTS are easy to assess but somewhat subjective. White blood cell count (WBC) is an easy, quick and objective test. This study was performed to evaluate the significance of the WBC count at presentation in the blunt trauma patients. METHODS: 713 blunt trauma patients, who were admitted to the Uludag University Medical Center Emergency Department between 01.04.2000-31.12.2000, were retrospectively evaluated in terms of ISS, GCS, RTS and white blood cell count at presentation. RESULTS: Statistical analysis revealed that WBC was correlated positively with ISS, but negatively with GCS and RTS. CONCLUSIONS: The leukocyte count at presentation can be used as an adjunct in the evaluation of the severity of injury in blunt trauma patients.

[Epidemiologic and clinical features of childhood falls]. / COCUKLUK CAGINDAKI DUSMELERIN EPIDEMIYOLOJIK VE KLINIK OZELLIKLERI.

BACKGROUND: Trauma is a leading cause of morbidity and mortality for childhood and young adults. Falls are the most common mechanism. for injury children. Aim of this study is to determine the epidemiology and clinical features of falls among children. METHODS: We retrospectively analysed children under 14 years of age sustained from falls admitted to the our emergency service between January 1997- June 2001. RESULTS: A total of 1039 children were admitted during the study period. Fa/ls comprised 38% these admissions, and 47% of falls were from balconies.252 patients were male and 141 patients were female. Mean age was 5.23. 62.3 % of children were under the 5 years old. Major injuries included head trauma (57%) extremity trauma ( 16%), and abdominal trauma (11%). Mean ISS score was 9.16 and 32% of children had an, 1SS score was 9,16. Overall mortality rate was 2.23 %. CONCLUSION: Although falls are the significant cause of childhood injury, these injuries are rarely fatal. Most, common type of injury is head trauma. ISS, age, and height are significantly associated with mortality. Key words: Children, trauma,fa/l, epidemiology, mortality.