Emergency service results of central venous catheters: Single center, 1042 patients, 10-year experience.

BACKGROUND: Central venous catheterization is currently an important procedure in critical care. Central catheterization has important advantages in many clinical situations. It can also lead to different complications such as infection, hemorrhage, and thrombosis. It is important to investigate critically ill patients undergoing catheterization. AIM: To evaluate the characteristics, such as hospitalization, demographic characteristics, post-catheterization complications, and mortality relationships, of patients in whom a central venous catheter was placed in the emergency room. METHODS: A total of 1042 patients over the age of 18 who presented to the emergency department between January 2005 and December 2015 were analyzed retrospectively. The patients were divided into three groups, jugular, subclavian, and femoral, according to the area where the catheter was inserted. Complications related to catheterization were determined as pneumothorax, guidewire problems, bleeding, catheter site infection, arterial intervention, and sepsis. Considering the treatment follow-up of the patients, three groups were formed as outpatient treatment, hospitalization, and death. RESULTS: The mean age of the patients was 60.99 ± 19.85 years; 423 (40.6%) of them were women. Hospitalization time was 11.89 ± 16.38 d. There was a significant correlation between the inserted catheters with gender (P = 0.009) and hospitalization time (P = 0.040). Also, blood glucose, blood urea nitrogen, creatinine, and serum potassium values among the biochemical values of the patients who were catheterized were significant. A significant association was observed in the analysis of patients with complications that develop according to the catheter region (P = 0.001) and the outcome stage (P = 0.001). In receiver operating characteristic curve analysis of hospitalization time and mortality area under curve was 0.575, the 95% confidence interval was 0.496-0.653, the sensitivity was 71%, and the specificity was 89% (P = 0.040). CONCLUSION: Catheter location and length of stay are important risk factors for catheter-borne infections. Because the risk of infection was lower than other catheters, jugular catheters should be preferred at entry points, and preventive measures should be taken by monitoring patients closely to reduce hospitalization infections.

Evaluation of the diagnostic value of platelet indices in pediatric acute appendicitis.

OBJECTIVE: Abdominal examination findings in pediatric acute appendicitis (AA) significantly vary by age. Therefore, grading systems have been developed for diagnosing pediatric appendicitis, and laboratory and radiological findings have an important role in this diagnosis. However, there is a need to develop new parameters for diagnosing AA. This study aimed to investigate the diagnostic value of platelet indices in AA. METHODS: This retrospective, observational study included 207 pediatric patients who were admitted to the Emergency Department and operated on for AA. The patients were divided into three groups on the basis of their surgical and histopathological findings (non-AA, uncomplicated AA, and complicated AA). RESULTS: There was no significant difference in the mean platelet volume/platelet count (MPV/PC) ratio among the groups. The white blood cell (WBC) count and the MPV/PC ratio showed a significant negative relationship (r = -0.239). The specificity for MPV was 61.8% and the sensitivity was 68.8%. Receiver operating curve analysis of WBC and MPV showed significance for diagnosing AA. CONCLUSION: There is a negative, but weak, relationship between the WBC count and the MPV/PC ratio. However, the MPV/PC ratio could be a useful parameter for diagnosing pediatric AA according to receiver operating curve analysis.

R/S ratio in lead II, and the prognostic significance of red cell distribution width in acute coronary syndrome.

BACKGROUND: In spite of developing medical technologies to discover the etiopathogenesis of diseases and developments in the treatment of coronary artery disease, acute coronary syndromes (ACS) continue to be the main cause of mortality and morbidity worldwide. New cardiac biomarkers and techniques are needed to help provide rapid diagnosis in order to evaluate risk in coronary artery patients. AIM: To evaluate the effects of R to S ratio (RSR) in the electrocardiograph of patients with ACS, from the point of the arising complication after myocardial infarction (MI), to three-vessel disease (TVD) and mortality. METHODS: The data of 1,296 patients with ACS, who presented to the emergency department of our hospital with chest pain between January 2014 and December 2018 and were admitted to the cardiology clinic, were retrospectively included in this cross-sectional cohort study. Patients with an RSR value less than I were assigned to group I, while those with an RSR value greater than I were assigned to group II. RESULTS: In our study, 466 (35.9%) of the 1,296 patients, 357 (38.3%) in group 1 and 109 (29.9%) in group 2, were female, with a mean age of 61.56 ± 9.42. ST-elevation MI 573 (44.2%), unstable angina (UA) 502 (38.7%) and non ST-elevation MI 220 (17%) were more prevalent in group I. Acute anterior MI 263 (20.3) in group I, and acute inferior MI 184 (14.2) in group II was higher. Ischemic heart failure was the most common complication. In group II, the red cell distribution width (RDW) was 15.42 ± 1.82, the gensini score was 48.39 ± 36.44, the left ventricular ejection fraction was 41.17 ± 10.41, the TVD was 111 (8.5), and the mortality rate was 72 (5.6), which was significantly higher than group I RDW; in MI with ST and non-ST-elevation, in TVD, mortality and complications were high and low in UA. In single and multivariate regression analyses, the variables were associated with ACS risk. CONCLUSION: RSR levels may be an auxiliary predictive value in ACS in terms of complications developing after MI, TVD, and mortality.

Predicting of neuropsychosis in carbon monoxide poisoning according to the plasma troponin, COHb, RDW and MPV levels: Neuropsychoses in carbon monoxide poisoning.

OBJECTIVE: Carbon monoxide (CO) poisoning is very common worldwide. In this study, we aimed to evaluate the predictivity of neuro psychosis in carbon monoxide poisoning by the admission levels of red cell distribution (RDW), mean platelet volume (MPV) and troponin I levels which can be measured quickly and easily in the emergency department (ED). PATIENTS AND METHODS: This single center observational study included a total of 216 consecutive patients who presented to the ED due to CO poisoning between January 2009 and December 2013. The diagnosis of CO poisoning was made according to the medical history and carboxyhemoglobin (COHb) level of >5%. According to the carboxyhemoglobin levels, the patients were classified as mildly (COHb < 20%) and severely poisoned (COHb > 20%). In addition, patients were divided into 2 groups, i.e., those with positive (>0.05 ng/mL for our laboratory) and negative (<0.05 ng/mL for our laboratory) troponin levels. RESULTS: Patients mean age was 52.58 ±â€¯10.58. 57.9% of the patients had high troponin levels and 51.9% were poisoned severely according to COHb levels. Patients with positive troponin and COHb had longer CO exposure time and higher neutrophil, lymphocyte, mean platelet volume (MPV), COHb and red cell distribution width (RDW) levels at the index admission following CO poisoning than patients with negative troponin (p < 0.05). Age, COHb level, CO exposure time, MPV and RDW (p = 0.001, p < 0.05) remained associated with an increased risk of troponin positivity following adjustment for the variables that were statistically significant. CONCLUSIONS: In patients presenting to the ED with CO poisoning, RDW and MPV can be helpful for risk stratification of neuropsychosis.

Comparison of manual pulse palpation, cardiac ultrasonography and Doppler ultrasonography to check the pulse in cardiopulmonary arrest patients.

OBJECTIVE: For health professionals, the absence of pulse checked by manual palpation is a primary indicator for initiating chest compressions in patients considered to have cardiopulmonary arrest (CA). However, using a pulse check to evaluate perfusion during CA may be associated with some risks of its own. Our objective was to compare the efficiency of cardiac ultrasonography (CUSG), Doppler ultrasonography (DUSG), and manual pulse palpation methods to check the pulse in CA patients. MATERIAL AND METHODS: This study was prospectively performed in 137 patients older than 16 years of age who underwent cardiopulmonary resuscitation (CPR). CUSG, DUSG, and manual pulse palpation were practiced simultaneously as suggested in the relevant guidelines. Findings of the patients were recorded at the first min, at min 15 and at the end of CPR. SPSS 18.0 was used for statistical analysis. FINDINGS: A total of 72.3% (n = 99) of the cardiopulmonary arrest incidents occurred out-of-hospital. CUSG (4.76 ± 2.19, 4.33 ± 2.17, and 3.68 ± 2.14 s), DUSG (9.59 ± 2.37, 8.22 ± 2.86, and 7.60 ± 2.83 s), and manual pulse palpation (10.76 ± 1.03, 9.72 ± 3.01, and 9.29 ± 3.36 s) measurements of the first, second, and last inspections were detected, respectively. The false negative rates (100%, 28%, and 0%) and false positive rates (5.3%, 3.5%, and 0%) of manual pulse palpation the first, second, and last inspections were calculated, respectively, as well. CONCLUSION: The use of real-time CUSG during resuscitation provides a substantial contribution to the resuscitation team. CUSG will allow earlier and more accurate detection of pulse than manual pulse palpation and DUSG.

Serum Paraoxonase, Arylesterase, and Glutathione-S-Transferase Activities and Oxidative Stress Levels in Patients with Mushroom Poisoning.

OBJECTIVES: Consumption of toxic species of mushrooms may have detrimental effects and increase oxidative stress. Paraoxonase, arylesterase and glutathione-S-transferase are antioxidants that resist oxidative stress. In this study, we analyzed the changes in these enzymes during intoxication due to mushrooms. METHODS: The study enrolled 49 adult patients with a diagnosis of mushroom poisoning according to clinical findings and 49 healthy volunteers as the control group. The patients with mild clinical findings were hospitalized due to the possibility that the patient had also eaten the mushrooms and due to clinical findings in the late period, which could be fatal. Paraoxonase, arylesterase, and glutathione-S-transferase concentrations, as well as total antioxidant and oxidant status, were determined in the 49 patients and 49 healthy volunteers by taking blood samples in the emergency department. RESULTS: While paraoxonase, arylesterase, and total antioxidant status were significantly decreased in the patient group (p<0.05), glutathione-S-transferase, total oxidant status and the oxidative stress index were significantly higher (p<0.05). There was a positive correlation between the hospitalization time and the oxidative stress index (r=0.752, p<0.001), whereas a negative correlation was found with glutathione-S-transferase (r=-0.420, p=0.003). CONCLUSION: We observed a significant decrease in paraoxonase and arylesterase and an increase in glutathione-S-transferase and oxidative stress indexes in patients with mushroom poisoning, indicating that these patients had an oxidative status. In particular, a low total antioxidant status and high oxidative stress index may gain importance in terms of the assessment of hospitalization duration.

Comparison of IV dexketoprofen trometamol, fentanyl, and paracetamol in the treatment of renal colic in the ED: A randomized controlled trial.

OBJECTIVE: In this study, we aimed to compare the analgesic efficacy of intravenous dexketoprofen trometamol, fentanyl, and paracetamol in patients presenting to the emergency department with renal colic. MATERIALS AND METHOD: Data obtained from the emergency departments of Gaziantep University's Hospital for Research and Practice along with two other state hospitals in Gaziantep, Turkey between January 2016 and January 2017 was used for this study. A total of three hundred patients (n=300), who presented to the ER with complaints most common to renal colic whose diagnoses were subsequently confirmed with Computerized Tomography were included in the study. Patients' pain scores were recorded using the Visual Analogue Scale, at admission (immediately before drug administration), then at the 15th, and 30th minutes. SPSS 22.0 software package was used for analysis. p<0.05 was considered significant. RESULTS: At the 15th minute comparison, the efficacies of the three groups of drugs were not superior to one other, but at the 30th minute, dexketoprofen trometamol was statistically more effective than paracetamol and fentanyl. There was no statistically significant difference between fentanyl and paracetamol. The need for additional analgesia in the group receiving dexketoprofen trometamol was found to be lower. Dexketoprofen trometamol was statistically superior to the other two agents in achieving full analgesia at the end of the thirty-minute period. Fentanyl was found to be statistically significant in achieving moderate analgesia. CONCLUSION: As a Non-steroidal antiinflammatory drug dexketoprofen trometamol is superior to paracetamol and fentanyl in achieving analgesia and reducing the need for additional drugs for the treatment of renal colic.

Serum paraoxonase, arylesterase, and glutathione-s-transferase activities and oxidative stress levels in patients with mushroom poisoning

OBJECTIVES: Consumption of toxic species of mushrooms may have detrimental effects and increase oxidative stress. Paraoxonase, arylesterase and glutathione-S-transferase are antioxidants that resist oxidative stress. In this study, we analyzed the changes in these enzymes during intoxication due to mushrooms. METHODS: The study enrolled 49 adult patients with a diagnosis of mushroom poisoning according to clinical findings and 49 healthy volunteers as the control group. The patients with mild clinical findings were hospitalized due to the possibility that the patient had also eaten the mushrooms and due to clinical findings in the late period, which could be fatal. Paraoxonase, arylesterase, and glutathione-S-transferase concentrations, as well as total antioxidant and oxidant status, were determined in the 49 patients and 49 healthy volunteers by taking blood samples in the emergency department. RESULTS: While paraoxonase, arylesterase, and total antioxidant status were significantly decreased in the patient group (p<0.05), glutathione-S-transferase, total oxidant status and the oxidative stress index were significantly higher (p<0.05). There was a positive correlation between the hospitalization time and the oxidative stress index (r=0.752, p<0.001), whereas a negative correlation was found with glutathione-S-transferase (r=-0.420, p=0.003). CONCLUSION: We observed a significant decrease in paraoxonase and arylesterase and an increase in glutathione-S-transferase and oxidative stress indexes in patients with mushroom poisoning, indicating that these patients had an oxidative status. In particular, a low total antioxidant status and high oxidative stress index may gain importance in terms of the assessment of hospitalization duration.

Clinical severity in forecasting platelet to lymphocyte ratio in Crimean-Congo hemorrhagic fever patients.

Crimean-Congo hemorrhagic fever (CCHF) is a life-threatening disease that develops as a result of infection by a member of the Nairovirus genus of the Bunyaviridae family, and its initial symptoms are not specific. In patients with severe clinical progression, in particular, the neutrophil rate is high, whereas lymphocyte and monocyte levels are low. A total of 149 patients, in whom the diagnosis was confirmed with reverse transcriptase PCR, were included in the study. In order to compare patient clinical progression severity, we divided the patients into two groups. For group 1, Çevik's severity score was used. The patients who had a platelet/lymphocyte ratio (PLR) <41 constituted group 2. Of 149 patients, 20 (13.4 %) were determined as group 1 (Çevik's classification) and 38 (25.5 %) were determined as group 2 (PLR <41). Of 11 deaths, 4 (36.4 %) patients were from group 1 and 7 (63.6 %) were from group 2. This is the first study to our knowledge to analyse the relationship between severity and PLR in patients with CCHF. PLR is a simple laboratory test that can aid in determining the prognosis of individuals with this disease.

Comparison of trauma scores for predicting mortality and morbidity on trauma patients.

BACKGROUND: In this study, we compared the anatomical, and physiological scoring systems trauma revised injury severity score (TRISS), revised trauma score (RTS), injury severity score (ISS), new injury severity score (NISS) to each other, to find out the most accurate and reliable trauma score for the risk classification of morbidity and mortality among the trauma patients. METHODS: This is a cross-sectional study, which included 633 patients who admitted to our University Hospital Emergency Department during an 8-month period due to trauma. All blunt and penetrating traumas (traffic accident, assault, etc.) patients above 16 years were included. RESULTS: Arrival time trauma scores (ISS, NISS, RTS, and TRISS) of the patients was calculated. Mean trauma score for the mortality prediction was calculated, and the p value was equal for all (p=0.001). Trauma scores were also analyzed for the hospitalization time in intensive care unit (ICU). While NISS, RTS, and TRISS values were significant (p=0.048, p=0.048, and p=0.017, respectively), ISS value was not significant (p=0.257) for predicting the ICU hospitalization time. Only TRISS was a good predictor for the mechanically ventilation time in ICU patients (p=0.01). CONCLUSION: In conclusion, we determined that the anatomical trauma scores (NISS, ISS) predicted the hospitalization and ICU necessities better, whereas TRISS, an anatomo-physiological trauma score, defined the ICU hospitalization and mechanically ventilation time better.

Baseline characteristics and the association between hyponatraemia and pulmonary embolism prognosis.

OBJECTIVE: To evaluate the effect of hyponatraemia on pulmonary thromboembolism mortality rates. METHODS: The retrospective study was conducted at the Cumhuriyet University Medicine Faculty's Emergency Department, and involved the analysis of records related to all patients who were diagnosed with acute pulmonary thromboembolism between January 2005 and June 2011. Diagnoses were confirmed by pulmonary angiography, multi-slice computed tomography or high-probablity ventilation/perfusion scintigraphy. All patients (n=260) were over 16 years of age. SPSS 14 was used for statistical analysis. RESULTS: Plasma sodium level, platelet count and hospitalisation time were significiantly lower among those who died (n=16; 6.29) (p<0.005, p<0.035, p<0.035). Pearson correlation analysis found a negative correlation between plasma sodium level and C-reactive protein, white blood cells and pulmonary artery pressure (r = -0.238, p<0.001; r = -0.222, p<0.001; r = -0.444, p<0.018 respectively). A positive correlation was found between plasma sodium level and hospitalisation time (r=0.130; p<0.039). CONCLUSION: While mortality rates in hyponatraemic pulmonary thromboembolism patients increases, low plasma sodium is an easy parameter that should be kept in mind for the prognosis of pulmonary thromboembolism disease.

Quail consumption can be harmful.

BACKGROUND: Intoxication due to quail consumption is rarely seen. Such a toxicological syndrome (also called coturnism) occurs during the migration of quails from north to south, when they consume hemlock seeds. The clinical symptoms and laboratory results are indicative of acute rhabdomyolysis. OBJECTIVES: Acute rhabdomyolysis has a wide range of etiologies. Coturnism is a rare cause of acute rhabdomyolysis that can be lethal due to renal failure and shock. To avoid severe complications, coturnism may be considered if the history is appropriate. CASE REPORT: We report four cases of coturnism from quail consumption; the patients were admitted with some combination of symptoms including muscle tenderness, extremity pain, nausea, and vomiting. They were treated with vigorous isotonic crystalloid hydration and urine alkalinization. Consequently, the laboratory results returned to normal ranges and the clinical symptoms disappeared. CONCLUSION: Although coturnism is a rarely seen toxicological syndrome that causes rhabdomyolysis, we present this case to increase awareness that it may present with symptoms of muscle tenderness, extremity pain, nausea, and vomiting after quail consumption.

Evaluation of respiratory findings in Crimean-Congo hemorrhagic fever.

Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic disease with a high mortality rate causing viral hemorrhagic fever. We studies the respiratory system findings, demographics, clinical and laboratory findings of patients with CCHF admitted to our hospital. In this retrospective study we evaluated 108 patients with CCHF confirmed by laboratory findings. The charts of all hospitalized patients were reviewed, and the age, sex, occupation, city of residence, history of tick bite or of removing a tick, smoking history, chest X-ray results, outcome and clinical and laboratory findings were recorded for each patient. Sixty of the chest radiographs were read as normal, 33 were read as showing unilateral pathology and 15 showed bilateral pathology. Seven of the 108 patients died due to severe pulmonary infection and hemorrhage. The frequency of pathological chest radiographs was higher among the CCHF patients who died than among the survivors, but the difference was not significant. Pulmonary parenchyma hemorrhage can occur in CCHF patients with hemoptysis, dyspnea, chest pain and infiltration on chest radiographs and may lead to morality.

Mushroom poisoning: retrospective analysis of 294 cases.

OBJECTIVE: The objective of this study was to present special clinical and laboratory features of 294 cases of mushroom poisoning. MATERIALS AND METHODS: In this retrospective study, 294 patients admitted to the Pediatric and Adult Emergency, Internal Medicine and ICU Departments of Cumhuriyet University Hospital were investigated. RESULTS: Of 294 patients between the ages of 3 and 72 (28.97 +/- 19.32), 173 were female, 121 were male and 90 were under the age of 16 years. One hundred seventy-three patients (58.8%) had consumed the mushrooms in the early summer. The onset of mushroom toxicity symptoms was divided into early (within 6 h after ingestion) and delayed (6 h to 20 d). Two hundred eighty-eight patients (97.9%) and six (2.1%) patients had early and delayed toxicity symptoms, respectively. The onset of symptoms was within two hours for 101 patients (34.3%). The most common first-noticed symptoms were in the gastrointestinal system. The patients were discharged within one to ten days. Three patients suffering from poisoning caused by wild mushrooms died from fulminant hepatic failure. CONCLUSION: Education of the public about the consumption of mushrooms and education of health personnel working in health centers regarding early treatment and transfer to hospitals with appropriate facilities are important for decreasing the mortality.

Mushroom poisoning: retrospective analysis of 294 cases

OBJECTIVE: The objective of this study was to present special clinical and laboratory features of 294 cases of mushroom poisoning. MATERIALS AND METHODS: In this retrospective study, 294 patients admitted to the Pediatric and Adult Emergency, Internal Medicine and ICU Departments of Cumhuriyet University Hospital were investigated. RESULTS: Of 294 patients between the ages of 3 and 72 (28.97 ± 19.32), 173 were female, 121 were male and 90 were under the age of 16 years. One hundred seventy-three patients (58.8 percent) had consumed the mushrooms in the early summer. The onset of mushroom toxicity symptoms was divided into early (within 6 h after ingestion) and delayed (6 h to 20 d). Two hundred eighty-eight patients (97.9 percent) and six (2.1 percent) patients had early and delayed toxicity symptoms, respectively. The onset of symptoms was within two hours for 101 patients (34.3 percent). The most common first-noticed symptoms were in the gastrointestinal system. The patients were discharged within one to ten days. Three patients suffering from poisoning caused by wild mushrooms died from fulminant hepatic failure. CONCLUSION: Education of the public about the consumption of mushrooms and education of health personnel working in health centers regarding early treatment and transfer to hospitals with appropriate facilities are important for decreasing the mortality.

[Effects of co-morbid disease and drug consumption on trauma patients 65 years of age and older: a university emergency department experience]. / Altmisbes yas ve üstü travmali hastalarda yandas hastalik ve ilaç kullaniminin travma üzerine etkileri: Universite acil servis deneyimi.

BACKGROUND: The objective of this study was to evaluate the causes and demographics of trauma patients 65 years of age and older, and also the effects of co-orbidities and drug use on trauma. METHODS: This study was performed in Medicine Faculty of Yeditepe University Hospital Department of Emergency Medicine Outpatients Clinic between January 2005 - February 2006. Ninety-one trauma patients (48 males [52.7%], 43 females [47.3%]; mean age 73+/-5.42; range 65 to 92 years) 65 years of age and older were included into the study. Age, gender, trauma causes, injury types, co-morbidities, drug consumption and injury severity scores were recorded onto the study form. RESULTS: Fifty-seven (62.6%) patients were admitted to the emergency department because of low-energy fall, 13 patients (14.3%) for high-energy falls, 6 patients (6.6%) for low-energy motor vehicle crush, and 14 patients (15.4%) for high-energy motor vehicle crush. Hypertension was significantly more frequent in falls than the other trauma mechanisms (p=0.003). There was a higher rate of femur fracture in low-energy falls than the others (p=0.026). However, the rate of vertebral fracture was higher in high-energy falls (p=0.037). Soft tissue injuries were seen most often in low-energy motor vehicle crush injuries (p=0.01) while rib fractures were seen most frequently in high-energy motor vehicle crush injury (p<0.01). CONCLUSION: Acute or chronic disease and drug side effects may facilitate the exposure of elderly people to trauma. Drug consumption, co-morbid diseases and trauma causes should be taken into consideration during the evaluation of elderly trauma patients.