Lactate and base deficit combination score for predicting blood transfusion need in blunt multi-trauma patients.

BACKGROUND: Lactate and base deficit (BD) values are parameters evaluated as indicators of tissue perfusion and have been used as markers of severity of injury and mortality. OBJECTIVES: The aim of the study was to determine the relationship between combined score (CS) and blood transfusion need within 24 h and comparison of the variables between transfusion and non-transfusion group, correlation lactate with BD and with physiological, laboratory parameters, and determining the major risk factors of patients for the need for blood transfusion. METHODS: The study included a total of 359 patients (245 males, median age: 40, min-max: 18-95) with blunt multi-trauma. De-mographics data, laboratory parameters (hemoglobin [Hb], hematocrit [Htc], lactate, BD, pH), physiologic parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], respiratory rate [RR]), shock index (SI), and revised trauma score (RTS) were recorded. Logistic regression method was used to create the CS formula using lactate and BD values. According to this formula, the probability value of 0.092447509 was calculated for the need for blood transfusion within 24 h. If CS was higher than the probability value, the need for blood transfusion within 24 h was considered. Furthermore, univariate analysis was used to determine major risk for blood transfusion need in 24 h, and the receiver operating characteristic curves were performed to compare CS, lactate, BD, SI and RTS. RESULTS: The comparison between transfusion and non-transfusion group there was significance between SBP, DBP, HR, RR, SpO2, Glasgow coma scale, Hb, Htc, lactate, BD, pH, SI and RTS (for each p<0.05). Lactate value has a positive correlation with SI, HR and has a negative correlation with BD, RTS, SBP, and DBP. BD values has a positive correlation with RTS, SBP, DBP, Hb, and Htc and has a negative correlation with SI, HR, and RR. The main risks for blood transfusion need were SI, lactate, BD, SBP, and SpO2%. CS was 0.09 in 100 (27.85%) patients and 41 with high CS had blood transfusion within 24 h (p<0.001; OR21.803, sensitivity 83.7%, specificity 81%,positive predictive value 41%, and negative predictive value 96.9%). A ROC curve showed that CS (AUC: 86.) was more significant than SI and RTS for the need for blood transfusion. CONCLUSION: CS is effective for predicting blood necessity in 24 h for blunt multi-trauma patients.

Computed Tomographic Findings of Injuries After Mechanical and Manual Resuscitation: A Retrospective Study.

Introduction Cardiopulmonary resuscitation (CPR)-related injuries are complications of chest compressions during CPR. This study aimed to investigate the differences and complications between mechanical and manual CPR techniques by using computed tomography (CT). Methods Patients in whom return of spontaneous circulation was achieved after CPR and thorax CT imaging were performed for diagnostic purposes were included in the study. Results A total of 178 non-traumatic cardiac arrest patients were successfully resuscitated and had CT scans in the emergency department. The complications of CPR are sternum fracture, rib fracture, pleural effusion/hemothorax, and pneumothorax. There were no statistically significant differences in terms of age, first complaint, cardiac arrest rhythm, CPR duration, and complications between mechanical and manual CPR. The number of exitus in the emergency department was similar (p=0.638). The discharge from hospital rate was higher in the mechanical CPR group but there was no statistically significant difference (p=0.196). The duration of CPR was associated with the number of rib fractures and lung contusion, but it did not affect other CPR-related chest injuries. Conclusion There was no significant difference observed in terms of increased complications in patients who received mechanical compression as compared with those who received manual compression. According to our results, mechanical compression does not cause serious complications, and the discharge from hospital rate was higher than for manual CPR; therefore, its use should be encouraged.

Comparison of manual and mechanical chest compression techniques using cerebral oximetry in witnessed cardiac arrests at the emergency department: A prospective, randomized clinical study.

AIM: We aimed to compare regional cerebral oxygen saturation (rSO2) levels during cardiopulmonary resuscitation (CPR), performed either manually or using a mechanical chest compression device (MCCD), in witnessed cardiac arrest cases in the emergency department (ED), and to evaluate the effects of both the CPR methods and perfusion levels on patient survival and neurological outcomes. METHODS: This single-center, randomized study recruited patients aged ≥18 years who had witnessed a cardiopulmonary arrest in the ED. According to the relevant guidelines, CPR was performed either manually or using an MCCD. Simultaneously, rSO2 levels were continually measured with near-infrared spectroscopy. RESULTS: Seventy-five cases were randomly distributed between the MCCD (n = 40) and manual CPR (n = 35) groups. No significant difference in mean rSO2 levels was found between the MCCD and manual CPR groups (46.35 ± 14.04 and 46.60 ± 12.09, respectively; p = 0.541). However, a significant difference in rSO2 levels was found between patients without return of spontaneous circulation (ROSC) and those with ROSC (40.35 ± 10.05 and 50.50 ± 13.44, respectively; p < 0.001). In predicting ROSC, rSO2 levels ≥24% provided 100% sensitivity (95% confidence interval [CI] 92-100), and rSO2 levels ≥64% provided 100% specificity (95% CI 88-100). The area under the curve for ROSC prediction using rSO2 levels during CPR was 0.74 (95% CI 0.62-0.83). CONCLUSION: A relationship between ROSC and high rSO2 levels in witnessed cardiac arrests exists. Monitoring rSO2 levels during CPR would be useful in CPR management and ROSC prediction. During CPR, MCCD or manual chest compression has no distinct effect on oxygen delivery to the brain. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT03238287.

Evaluation of the Tp-e interval and Tp-e/QTc ratio in patients with benign paroxysmal positional vertigo in the emergency department compared with the normal population.

INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is a common diagnosis for dizziness patients admitting to emergency department and for initial diagnosis, cardiac causes of dizziness should be excluded at admittance. Electrocardiography (ECG) is a simple method to detect cardiac arrhythmias for these patients. Tp-e interval and Tp-e/QTc ratio are transmural repolarization parameters and shown to be strongly related to ventricular arrhythmias. With this study, we aim to investigate ventricular repolarization parameters like Tp-e interval and Tp-e/QTc ratio which can be easily evaluated by ECG in BPPV patients. MATERIALS AND METHODS: A total of 84 newly diagnosed BPPV patients and 59 age-sex matched control group without dizziness symptoms compatible with inclusion criteria were included for the study. Patients with previous vertigo, coronary artery disease, renal disease, heart failure, severe valvular disease, arrhythmia history, electrolyte disturbances and patients under 18 years of age were excluded. RESULTS: Mean age of the study population was 44.4 ±â€¯12.1 years, 36.4% were male. There was no significant difference among groups in terms of age, sex, diabetes mellitus, hypertension and hypothyroidism history. When ECG results were evaluated QRS interval, QT interval, Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio were statistically higher in BPPV patients compared to control group (p = 0.000, p = 0.047, p = 0.000, p = 0.000 and p = 0.001, respectively). DISCUSSION: As a result of our study, Tp-e and Tp-e/QTc ratio were significantly higher in BPPV patients compared to the control group. These findings suggest that ventricular arrhythmia risk may be higher in BPPV patients. Further evaluation of these patients in terms of ventricular arrhythmia would be beneficial.

A Rare Cause of Acute Abdominal Pain: Splenic Infarct (Case Series).

Splenic infarcts are rare cases. It may not be noticed in the emergency department because the clinical picture is likely to mimic various acute abdominal pains. The splenic infarct is often the result of systemic thromboembolism associated with cardiovascular disorders. The aim of this study is to present an evaluation of the patients that presented to the emergency department (ED) with abdominal pain and were diagnosed with splenic infarct.

An Evaluation of Complications in Ultrasound-Guided Central Venous Catheter Insertion in the Emergency Department.

OBJECTIVES: In emergency departments, emergency physicians frequently have to perform central venous access. In cases where peripheral venous access is not possible, central venous access is required for dialysis, fulfillment of urgent fluid need, or central venous pressure measurement. This study was carried out to evaluate the emergence of complications in the process of and in the 15 days following the insertion of central venous catheter under ultrasound guidance in the emergency department. METHODS: For this study, patients who presented to the emergency department over a period of eight months with an urgent need for central catheter were examined prospectively. Age, gender, and accompanying diseases of patients as well as the type, time, duration, and indication of the venous access were recorded. Furthermore, the amount of experience of the physician was taken into consideration. RESULTS: In the emergency department, physicians performed ultrasound-guided central venous catheter insertion for 74 patients (40 men and 34 women). For access, internal jugular vein was used in 65 (87.8%) patients, and femoral vein was used in 9 (12.2%) patients. The reason for access was urgent dialysis need in 55 (74.3%), CVP measurement in 3 (4.1%), fluid support due to severe hypovolemia in 6 (8.1%), and difficulty of peripheral venous access in 10 (13.5%) patients. None of the patients developed complications in the process of or after the insertion. Patients did not have infections related to the catheter in 15 days following the insertion. CONCLUSIONS: Central venous access is frequently required in emergency departments. The risk of complication is little if any in ultrasonographyguided access carried out under appropriate conditions.