Comparison of the Kron technique and digital manometry for measuring intra-abdominal pressure in emergency department patients diagnosed with ileus.

BACKGROUND: Numerous measurement techniques for intra-abdominal pressure have been explored, with the Kron Technique established as the gold standard. Despite its prominence, the search for alternative methods persists due to its lengthy application time, the requirement for additional equipment, and overall impracticality. This study investigated a quicker, more accessible method for effective intra-abdominal pressure measurement in the emergency department. It aimed to compare intra-abdominal pressure measurements in patients diagnosed with ileus using a digital manometer and the Kron Technique. METHODS: Conducted from October 2022 to February 2023, this single-center, prospective, single-blind method comparison study involved patients diagnosed with ileus at a tertiary emergency department. Intra-abdominal pressure was measured using both the Kron Technique and a digital manometer by separate practitioners blinded to the study results. RESULTS: The study included 30 patients. No statistically significant difference was observed in the intra-abdominal pressure measurements between the two methods (p<0.237). A very strong correlation existed between the two methods (Spearman's Rho = 0.998). Bland-Altman analysis showed a bias value of 0.091 mmHg for the digital manometer, with upper and lower agreement limits of -0.825 and 1.007 mmHg, respectively. The measurement time was significantly shorter with the digital manometer than with the Kron Technique (15 vs. 390.5 seconds; p<0.001). CONCLUSION: We believe that the intra-abdominal pressure measurement technique using a digital manometer is a method that can be effectively employed by healthcare professionals in emergency departments. This technique offers ease of use, requires minimal equipment, provides rapid results, and delivers reliable measurement values compared to the Kron Technique.

Comparison of thiol/disulphide homeostasis with modified Alvarado and RIPASA scores in the diagnosis of acute appendicitis.

BACKGROUND: This study aims to investigate the role of thiol/disulfide homeostasis parameters in the diagnosis of acute appendicitis and to determine whether it is beneficial to use these parameters in combination with the modified Alvarado and RIPASA scoring systems. METHODS: This study was prospectively carried out on 265 patients who presented to the emergency department with the complaint of right lower quadrant pain between 01.07.2017 and 31.12.2017, and met the inclusion criteria of this study. Oxidative stress markers were evaluated on two groups. The relationship between these parameters and the modified Alvarado and RIPASA scoring systems was analyzed. RESULTS: The mean levels of disulfide, disulfide/native thiol and disulfide/total thiol were found to be significantly higher in the appendicitis group (p<0.001). The mean levels of native thiol, total thiol and native thiol/total thiol were significantly lower in the same group (p<0.001, 0.001 and 0.007, respectively). The mean levels of disulfide, disulfide/native thiol and disulfide/total thiol were recorded to be significantly higher in the high-risk group according to the results of RIPASA (p=0.016, 0.003 and 0.001, respectively). CONCLUSION: Thiol/disulfide homeostasis parameters can be used with the modified Alvarado and RIPASA scoring systems in the diagnosis of acute appendicitis.

The thiol-disulphide homeostasis in patients with acute pancreatitis and its relation with other blood parameters.

BACKGROUND: Acute pancreatitis is a common disease seen in emergency departments because of abdominal pain. The present study aims to evaluate the relation between measurements of thiol-disulfide parameters in patients diagnosed with acute pancreatitis and other blood parameters. METHODS: A total of 56 (56%) patients, who were admitted to the emergency department, and 44 (44%) healthy volunteers participated in this study. A total of 100 samples were taken from the participants. Detailed blood samples were taken from the patients at the time of arrival at the hospital. The thiol-disulfide level in serum was examined using a brand new method that was developed by Erel and Neselioglu in the venous blood samples of the patients who were diagnosed with acute pancreatitis during the admission. The data were evaluated in the computer medium. RESULTS: Gallstones were defined as the etiology of AP in 41 patients (73.2%); in one patient, hypertriglyceridemia (1.7%); in four patients, alcohol use (7.1%), and idiopathic 10 patients (17.8%). While the blood thiol levels were low, the disulfide levels were high at a significant level. No statistically significant relations were detected between the amylase, lipase, neutrophil lymphocyte ratio (NLR), which are other blood parameters, and thiol-disulfide balance parameters. CONCLUSION: The disruption of the thiol-disulfide balance may play a role in the pathogenesis of acute pancreatitis. In acute pancreatitis, since the thiol level is decreased in the blood, administration of the complementary therapies for this thiol deficiency may contribute to the treatment of the disease.

Tissue adhesives to secure peripheral intravenous catheters: A randomized controlled trial in patients over 65 years.

INTRODUCTION: Peripheral venous catheterization is one of the most used medical procedures in hospitals worldwide. Recent researches state that using intravascular devices is a risk factor for both local and systemic complications. In this study, we aimed to test that addition of tissue adhesive to the insertion site of peripheral intravenous catheters (PIVC) in the emergency department (ED) would reduce the device failure rate at 6 h and 24 h following insertion. MATERIAL AND METHODS: We designed a single-site, two-arm, randomized, controlled trial. We inserted 115 PIVCs into 115 adult patients. RESULTS: PIVC device failure for the 6th hour follow up was 15.4% in the tissue adhesive group (95% CI: 4.1-26.7) vs. 25.6% with standard care group (95% CI: 11.9-39.3). There was no statistically significant difference between two groups (p = 0.33).The number of patients for 24 h follow-up was not enough and the obtained data could not be included in the study. DISCUSSION: In this study, the routine use of tissue adhesives in addition to standard care to reduce PIVC failure for patients 65 years or older in ED was not supported due to not clear benefits and cost effectivity. CONCLUSION: Even though the routine use of tissue adhesives is not recommended according to the study results, it may be reasonable to use tissue adhesives for long term hospitalization expected patients to protect from related complications due to current literature.

How can emergency physicians protect their work in the era of pseudo publishing?

Recently scientists have been targets of pseudo journals (fake, hijacked or predatory journals). These journals provide a low barrier to publication and quick publication times compared to high quality journals and exploit the pay-to-publish system in order to charge publication fees but they provide no formal peer-review. We aim to increase awareness among emergency physicians about pseudo journals. Trying to list all of fake, hijacked or predatory journals is not the solution because new journals are launched almost everyday and the fast proliferation of journals makes it difficult to identify and list all of them. Only an understanding of the practices and markers of legitimate and predatory publishers will allow the researcher to keep pace with danger because fraud is an ever-changing field. In this review we offer basic information (our top list of strategies and potential red flags) to recognize these journals to avoid submission and suggest some solutions if a paper has already been submitted or published in these journals.

Verifying the Placement of Nasogastric Tubes at an Emergency Center: Comparison of Ultrasound with Chest Radiograph.

The objective of this study was to verify the nasogastric tube position with neck ultrasound and subxiphoid ultrasound, by giving air-water mixture and auscultation and to compare the effectiveness of these methods with chest radiography. This is a single-center, prospective, single-blind study. Patients who were admitted to our emergency department and had an indication of nasogastric tube placement were included. Nasogastric tube localization was verified with neck ultrasound and subxiphoid ultrasound, by giving air-water mixture, auscultation, and direct radiography that was accepted as the 'gold standard technique'. A total of 49 patients (27 Male, 22 Female) with a mean age of 58.3±22.7 years were included. Sensitivity of neck ultrasound was 91.5%, and positive predictive value was 100%. As for the subxiphoid ultrasound sensitivity was 78.72%. When neck ultrasound + subxiphoid ultrasound and giving water-air mixture were combined sensitivity reached 95.74%. Sensitivity of neck ultrasound + subxiphoid ultrasound + air-water mixture + auscultation was 97.87% and positive predictive value was 100%. In the light of our results, neck and subxiphoid ultrasound seem to be an alternative method for verifying nasogastric tube localization. Combination of the air-water mixture and auscultation with ultrasound improves the sensitivity.

Transient vocal cord paralysis following central venous hemodialysis catheter insertion.

In this article, we present a case of recurrent laryngeal nerve palsy not caused by nerve injury but due to local anesthetic infiltration that was applied prior to central venous catheterization. A 47-year-old female patient was admitted to emergency room with fatigue and nausea and was diagnosed with acute renal failure. Right jugular venous catheterization was performed for emergency hemodialysis with Seldinger technique using middle approach. Within minutes and immediately after the procedure the patient complained of hoarseness and shortness of breath, and she had stridor in her physical exam. Awake flexible fibreoptic laryngoscopy revealed unilateral right-sided vocal cord paralysis with no edema. The patient was asked to remain nil per os and observed in ER with nasal oxygen. At the 3rd hour of follow-up without any other intervention, her symptoms resolved. Due to its proximity to the internal jugular vein injury to the recurrent laryngeal nerve while attempting to insert a central venous line can occur, particularly with difficult and repeated attempts. Local anesthesia led temporary ipsilateral vocal cord paralysis in patients undergoing carotid endarterectomy is described in literature. We think temporary vocal cord palsy in our case was due to local anesthetic infiltration rather than nerve injury, since it resolved spontaneously within only hours. Expectant treatment is a good choice ensuring the patient's airway is safe. Emergency physicians should be aware of this rare complication and its right management.

The role of ultrasonography in the diagnosis of metacarpal fractures.

INTRODUCTION: The aim of this study was to evaluate the efficiency of ultrasonography (USG) in identifying metacarpal bone fractures in patients admitted to the emergency department (ED) with hand injury. MATERIALS AND METHODS: Patients who were admitted to a training and research hospital's ED during the study period with hand trauma and had suspected metacarpal fractures were included in the study. They were examined for metacarpal fracture by USG and x-ray. Hand radiographs reviewed by an emergency physician were considered to be the criterion standard diagnostic tool. Ultrasonography results were compared to x-ray results. RESULTS: Ninety-eight ultrasound examinations were performed on 96 adult patients who were enrolled in the study. The mean age of the patients was 30.1±11.8 years; 79.2% of the patients were male. Right hand injury was observed in 69.4% of the cases. Forty metacarpal fractures were detected in 38 patients on x-ray. We found a sensitivity of 92.5% (95% confidence interval [CI], 78.5-98), a specificity of 98.28% (95% CI, 89.5-99.9), a positive predictive value of 97.37% (95% CI, 84.5-99.8), and a negative predictive value of 95% (95% CI, 85-98) for USG to detect metacarpal fractures when compared to x-ray imaging. CONCLUSIONS: Under the light of these results, we suggest that USG may be an option for detecting metacarpal fractures and prevent unnecessary x-ray imaging examinations in patients presenting to the ED with hand trauma.

Concurrent Spontaneous Sublingual and Intramural Small Bowel Hematoma due to Warfarin Use.

Introduction. We present a case of concurrent spontaneous sublingual and intramural small bowel hematoma due to warfarin anticoagulation. Case. A 71-year-old man presented to the emergency department complaining of a swollen, painful tongue. He was on warfarin therapy. Physical examination revealed sublingual hematoma. His international normalized ratio was 11.9. The computed tomography scan of the neck demonstrated sublingual hematoma. He was admitted to emergency department observation unit, monitored closely; anticoagulation was reversed with fresh frozen plasma and vitamin K. 26 hours after his arrival to the emergency department, his abdominal pain and melena started. His abdomen tomography demonstrated intestinal submucosal hemorrhage in the ileum. He was admitted to surgical floor, monitored closely, and discharged on day 4. Conclusion. Since the patient did not have airway compromise holding anticoagulant, reversing anticoagulation, close monitoring and observation were enough for management of both sublingual and spontaneous intramural small bowel hematoma.

Subcutaneous Emphysema, Pneumomediastinum, and Pneumorrhachis after Cocaine Inhalation.

Introduction. The most prominent complications of cocaine use are adverse effects in the cardiovascular and central nervous systems. Free air in the mediastinum and subcutaneous tissue may be observed less frequently, whereas free air in the spinal canal (pneumorrhachis) is a very rare complication of cocaine abuse. In this report we present a case of pneumorrhachis that developed after cocaine use. Case. A 28-year-old male patient was admitted to the emergency department with shortness of breath, chest pain, and swelling in the neck and face which started four hours after he had sniffed cocaine. On physical examination, subcutaneous crepitations were felt with palpation of the jaw, neck, and upper chest area. Diffuse subcutaneous emphysema, pneumomediastinum, and pneumorrhachis were detected in the computed tomography imaging. The patient was treated conservatively and discharged uneventfully. Discussion. Complications such as pneumothorax, pneumomediastinum, and pneumoperitoneum that are associated with cocaine use may be seen due to increased intrathoracic pressure. The air then may flow into the spinal canal resulting in pneumorrhachis. Emergency physicians should know the possible complications of cocaine use and be prepared for rare complications such as pneumorrhachis.

Herbal weight loss pill overdose: sibutramine hidden in pepper pill.

Supposedly herbal weight loss pills are sold online and are widely used in the world. Some of these products are found to contain sibutramine by FDA and their sale is prohibited. We report a case of a female patient who presented to the emergency department after taking slimming pills. 17-year-old female patient presented to the emergency room with palpitations, dizziness, anxiety, and insomnia. She stated that she had taken 3 pills named La Jiao Shou Shen for slimming purposes during the day. Her vital signs revealed tachycardia. On her physical examination, she was restless, her oropharynx was dry, her pupils were mydriatic, and no other pathological findings were found. Sibutramine intoxication was suspected. She was given 5 mg IV diazepam for restlessness. After supportive therapy and observation in emergency department for 12 hours there were no complications and the patient was discharged home. Some herbal pills that are sold online for weight loss have sibutramine hidden as an active ingredient, and their sale is prohibited for this reason. For people who use herbal weight loss drugs, sibutramine excessive intake should be kept in mind at all times.

Traumatic pseudocyst due to blunt trauma: Case report.

Damage to lung parenchyma due to blunt thoracic trauma often appears as contusion or hematoma. Cavitary lung lesions or pseudocyst formation due to trauma is a rare phenomenon. In the literature traumatic pseudocysts are also known as pseudocystic hematomas, traumatic lung cavity and traumatic pneumotocel. Traumatic pseudocysts usually have good clinical prognosis, recover spontaneously with supportive treatment and do not require surgery. In this article, we present the case of 52 year old male who was brought to the emergency department after a fall from height and was diagnosed with lung contusions and traumatic cyst.

The lucky patient who aspirated a needle.

Foreign body aspiration is seen frequently in pediatric and geriatric patients, but it can also be seen in adults. Needle aspiration is a common problem in our country. Foreign body aspiration can lead to complete airway obstruction, asphyxia and death but sometimes symptoms may not be evident during the early period of aspiration and patients may present with complications afterwards. Early diagnosis is important in foreign body aspiration for prevention of mortality and complications. Suspicion aroused by patient history is the first step towards a diagnosis. Plain radiography and tomography may be used for imaging. Bronchoscopy is performed for diagnosis if there is uncertainty after imaging and may also be used for the treatment of diagnosed cases. In this article, we present a foreign body aspiration case that presented with difficulty and pain while swallowing, subsequently found to be the result of a needle that was stuck between the oropharynx and epiglottis.

Nontraumatic massive spontaneous hemothorax with concomitant warfarin use.

Hemorrhagic complications due to warfarin use are frequently seen in emergency departments. However, nontraumatic massive hemothorax is an unexpected complication. We report a 59-year-old woman with warfarin overdose, who had massive hemothorax in right lung without any history of trauma. Her main complaint was significant dyspnea, which has gradually increased in three days. On her physical examination, she was tachypneic and had decreased lung sounds on her right hemithorax. She took warfarin regularly for aortic and mitral valve replacement for 18 years. Her INR level was 12.9 (0.8-1.2). Computed tomography of thorax revealed massive hemothorax with mediastinal shift. Fresh frozen plasma infusion was started immediately. Tube thoracostomy was performed for reexpansion of right lung and 2000 cc blood was drained in 5 minutes. Although hemorrhagic complications can be expected in warfarin therapy, thoracic hemorrhage related to warfarin therapy is relatively rare (3% of all hemorrhagic complications due to warfarin therapy). To our knowledge, massive hemothorax due to warfarin use is an extremely rare condition.