Turkish Journal of Emergency Medicine最新文献

{"title":"Transient ischemic liver injury and respiratory failure in a COVID-19-positive patient after multiple bee stings.","authors":"Onder Yesiloglu,&nbsp;Ahmet Sonmez,&nbsp;Begum Seyda Avci,&nbsp;Hilmi Erdem Sumbul,&nbsp;Akkan Avci","doi":"10.4103/2452-2473.366488","DOIUrl":"https://doi.org/10.4103/2452-2473.366488","url":null,"abstract":"<p><p>We present a patient with multiple bee stings who developed lung and liver injuries and subsequently tested positive for coronavirus disease 2019 (COVID-19). A 65-year-old male patient presented to the emergency department after being stung by more than 100 honeybees. His physical examination revealed pustular lesions distributed across his chest, arms, back, legs, and head, marking the sting zones. While the patient had no history of liver disease, initial laboratory test results showed elevated liver enzyme levels. A chest computer tomography scan was ordered, revealing bilateral ground-glass opacities suggesting COVID-19. His condition worsened over the course of the following day, and when he was admitted to the intensive care unit (ICU), his SpO₂ decreased to 83% despite oxygen support with a mask. The second polymerase chain reaction test taken in the ICU was positive for COVID-19 infection. After stung with multiple bees, the patient developed acute liver injury and suffered from concomitant COVID-19-related respiratory insufficency, and he was treated accordingly. Starting on the 5^th day, the patient's liver markers began to improve, and on the 13^th day, he was discharged with normal vital signs and liver enzyme values. There seem to be varying outcomes across different studies with regard to the relationship between bee stings and COVID-19. Further research is needed to explore the possibility of this complementary treatment with bee venom in the prevention of severe acute respiratory syndrome coronavirus-2 infection.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"23 1","pages":"57-60"},"PeriodicalIF":0.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1d/0c/TJEM-23-57.PMC9930383.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10763935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of initial cardiac activity assessed by point-of-care ultrasonography in predicting cardiac arrest outcomes: A prospective cohort study.","authors":"Soumitra Thandar,&nbsp;Ankit Kumar Sahu,&nbsp;Tej Prakash Sinha,&nbsp;Sanjeev Bhoi","doi":"10.4103/2452-2473.366482","DOIUrl":"https://doi.org/10.4103/2452-2473.366482","url":null,"abstract":"<p><strong>Objectives: </strong>This study was conducted to investigate the association between visible cardiac activity in point-of-care ultrasound (POCUS) and outcomes of cardiac arrest such as the return of spontaneous circulation (ROSC), survival to inpatient admission (SIA), and survival to hospital discharge (STHD).</p><p><strong>Methods: </strong>This was a single-center, prospective cohort study conducted in the emergency department (ED). Adult (age >18 years) patients in cardiac arrest were included in the study. Exclusion criteria of the study were - traumatic arrest, out-of-hospital cardiac arrest resuscitated before ED admission, and patients presenting with initial shockable rhythm. Patients whose ultrasound images could not be obtained and whose resuscitation stopped following POCUS were also excluded from the study. POCUS examination was done after 2 min of initiation of cardiopulmonary resuscitation (CPR) and visible cardiac activity was defined as any visible movement of the myocardium, excluding movement of blood within cardiac chambers, or isolated valve movement. The duration of POCUS examinations was limited to 10 s. The association of initial cardiac activity in POCUS with the outcomes of cardiac arrest was investigated.</p><p><strong>Results: </strong>Out of 140 patients screened, 84 patients were included in the study. Rates of ROSC, SIA, and STHD were found in 23 (27.4%), 9 (10.7%), and 2 (2.4%) patients, respectively. Only 15 out of 84 (17.9%) patients had cardiac activity on the initial POCUS examination. Cardiac activity was seen in 52.2% of patients with ROSC, which was significantly higher (<i>P</i> < 0.001) as compared with the no-ROSC group (4.9%). Unlike the above association, there was no difference in the incidence of initial cardiac activity in patient groups who got admitted (SIA) and discharged (STHD) versus those who died. In the multivariate regression analysis, the duration of CPR and initial cardiac activity significantly predicted the rate of ROSC, with an adjusted odds ratio of 0.93 (95% confidence interval [CI]: 0.86-0.99, <i>P</i> = 0.04) and 24.8 (95% CI: 3.17-89.41, <i>P</i> = 0.002), respectively. None of the variables predicted SIA and STHD. The positive likelihood ratio of cardiac activity for predicting ROSC, SIA, and STHD were 10.6, 2.1, and 2.9, respectively.</p><p><strong>Conclusion: </strong>Integration of POCUS in cardiac arrest resuscitation was shown to be helpful in terms of prognostic significance of the presence of initial cardiac activity in terms of ROSC.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"23 1","pages":"24-29"},"PeriodicalIF":0.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b5/76/TJEM-23-24.PMC9930388.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10773215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scholarly impact of the dissertation requirement for postgraduate medical education and factors affecting transformation into publication: A bibliometric analysis of 2434 dissertations in the field of emergency medicine","authors":"İbrahim Ulaş Özturan, İbrahim Sarbay","doi":"10.4103/tjem.tjem_45_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_45_23","url":null,"abstract":"OBJECTIVES: In Turkey, conducting research for a dissertation is necessary to obtain a specialist degree, but publication of this research is not mandatory. Previous studies have shown a low rate of publication for dissertation-derived research. The aim of this study was to determine publication rates, factors affecting the transformation of the dissertations into high-quality publications, and bibliometric analysis of published articles in the field of emergency medicine (EM). METHODS: This was a retrospective bibliometric study of EM dissertations submitted between 1998 and 2021 to the National Thesis Center. Research characteristics, publication status, journal characteristics, indexing, citation analysis, and institution characteristics were recorded. Journals indexed in the web of science (WOS) were defined as high-quality journals. A logistic regression was performed to identify factors affecting publication in high-quality journals. RESULTS: A total of 2434 dissertations were included. Of these, 864 (35.5%) were published and 474 (54%) were published in WOS-indexed journals. The most common area of research was trauma (n = 150, 17%), and the most common journal was the American Journal of EM (n = 74, 8%). Prospective data collection (odds ratio [OR] = 2.5, 95% confidence interval [CI] = 1.8–2.5), experimental design (OR = 2, 95%, CI = 1.3–3), university-type residency program (OR = 1.4, 95% CI = 1.02–2.1), and duration between year of graduation and publication (OR = 0.9, 95% CI = 0.84–0.95) were associated with publishing in WOS-indexed journals. CONCLUSION: EM is a relatively successful specialty for publishing dissertation-derived studies. Prospective and experimental research design, graduation from a university-type residency program, and shorter duration between the graduation and publication may increase the chance of publishing in high-quality journals.","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135953353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of novel anteroposterior short-axis in-plane technique with conventional short-axis out-of-plane technique for ultrasound-guided internal jugular vein cannulation: A randomized-controlled trial.","authors":"Karma Ongmu Bhutia,&nbsp;Ankur Sharma,&nbsp;Shilpa Goyal,&nbsp;Nikhil Kothari,&nbsp;Kamlesh Kumari,&nbsp;Akhil Dhanesh Goel,&nbsp;Priyanka Sethi,&nbsp;Pradeep Bhatia","doi":"10.4103/2452-2473.366485","DOIUrl":"https://doi.org/10.4103/2452-2473.366485","url":null,"abstract":"<p><strong>Objectives: </strong>Various ultrasound (US)-guided probe positioning and needle procedures have been described in the literature for cannulation of the internal jugular vein (IJV). In the present study, we compared the conventional short-axis out-of-plane (SAX-OOP) method with a novel anteroposterior short-axis in-plane (APSAX-IP) technique for IJV cannulation under US guidance. The APSAX-IP method of IJV cannulation has not been compared to other IJV cannulation techniques.</p><p><strong>Methods: </strong>A total of 104 patients above 18-year-old were randomly allocated to one of two groups - APSAX-IP or SAX-OOP and evaluated for US-guided IJV cannulation in either the operating room or critical care unit. The primary outcome of this research was the access time for IJV cannulation using both approaches. The secondary outcomes were the number of attempts of needle insertion, success rate, and complications of IJV cannulation.</p><p><strong>Results: </strong>The access time for IJV cannulation was 13.0 (12.0-15.0) sec in the APSAX-IP group and 13.0 (12.0-14.0) sec in the SAX-OOP group; <i>P</i> = 0.947. The number of successful 1^st attempts was 90.91%, and the 2^nd attempts were 9.09% in the APSAX-IP group and 85.19% and 14.81% in the SAX-OOP group, respectively. Both techniques did not have any complications.</p><p><strong>Conclusions: </strong>We conclude that the US-guided APSAX-IP IJV cannulation method has comparable access time to the SAX-OOP technique.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"23 1","pages":"17-23"},"PeriodicalIF":0.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ad/ac/TJEM-23-17.PMC9930384.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10763938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive value of cardiovascular risk scoring systems for the detection of myocardial injury following carbon monoxide intoxication.","authors":"Mustafa Özkoç,&nbsp;Emrah Aksakal,&nbsp;Ömer Faruk Derman,&nbsp;Ibrahim Saraç,&nbsp;Yavuzer Koza","doi":"10.4103/2452-2473.366483","DOIUrl":"https://doi.org/10.4103/2452-2473.366483","url":null,"abstract":"<p><strong>Objectives: </strong>This single-center, retrospective study investigates the predictive value of cardiovascular (CV) risk-calculation systems in patients admitted to the emergency department with carbon monoxide (CO) intoxication for the identification of potential myocardial injury.</p><p><strong>Methods: </strong>The total CV risk of 558 patients presenting to the emergency department with CO intoxication were calculated on admission using different CV risk scoring systems, including SCORE Turkey, European Heart SCORE, and FRAMINGHAM to predict potential myocardial injury secondary to poisoning, and the risk levels were categorized based on the calculated scores. The presence of myocardial injury was identified based on the level of elevation of a cardiac biomarker (Serum cardiac troponin-I >99^th percentile upper reference limit).</p><p><strong>Results: </strong>Myocardial injury due to CO intoxication was detected in 132 (23.7%) of the patients. A comparison of the risk scoring systems' ability to detect the presence of myocardial injury revealed that all had significant, similar, but low predictive values (the \"area under the curve\" values of SCORE Turkey, European Heart SCORE and FRAMINGHAM were 0.653, 0.632, and 0.629, respectively; <i>P</i> < 0.001). Among the three risk scoring systems, SCORE Turkey was the most successful test in diagnosing myocardial injury with 87% specificity, while FRAMINGHAM scoring was the most successful test in excluding the presence of myocardial injury with 72.1% sensitivity.</p><p><strong>Conclusion: </strong>Among the tested CV risk-calculation systems SCORE Turkey, was found to be the most effective in the prediction of myocardial injury secondary to CO poisoning, but all produced similar and significant results.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"23 1","pages":"30-37"},"PeriodicalIF":0.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4b/bc/TJEM-23-30.PMC9930385.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10763939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of drooling, reluctance, oropharynx, others, and leukocytosis score as a predictor of mortality and complications following acute corrosive ingestion","authors":"Jamshed Nayer, Fawaz Poonthottathil, Soorya Suresh, Praveen Aggarwal","doi":"10.4103/tjem.tjem_128_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_128_23","url":null,"abstract":"OBJECTIVES: Esophagogastroduodenoscopy is considered the gold standard in assessing the severity of injury to the gastrointestinal tract following corrosive ingestion. Zargar’s endoscopic grading of injury helps in prognostication as well as guiding management. Since the major burden of cases lies in resource-limited settings, the availability of endoscopic evaluation is a limiting factor. Hence, it is prudent to develop bedside tools that can be used as screening tools to identify patients at high risk of mortality and complications so that timely referrals and judicious utilization of resources can be made. Literature in this regard is limited and published studies have shown that clinical features fail to predict the severity of injury. We aimed our study to find the role of Drooling, Reluctance, Oropharynx, Others, and Leukocytosis (DROOL) score as a predictor of mortality and complications following acute corrosive ingestion. METHODS: This was a diagnostic accuracy study conducted in the emergency department (ED) of a tertiary care hospital in North India. We screened all cases of acute corrosive ingestion presented to our ED. We collected the data on demographic profile, clinical features, investigations, endoscopy findings, treatment, and DROOL score. We followed patients for up to 12 weeks for outcomes including mortality and complications. RESULTS: We studied 79 patients of acute corrosive ingestion. The median age was 26 years with a female predominance. Nausea, vomiting, and pain abdomen were the common symptoms. The median DROOL score was 4. The majority of our patients had normal to Zargar grade 1 injury to the stomach and esophagus. Out of 79 patients, 27 patients developed some complications. The overall mortality up to 12 weeks was 10%. The receiver operating characteristics (ROC) analysis was performed, and the area under the ROC (AUROC) curve of Zargar classification in predicting overall complications was 0.909 (96% confidence interval [CI]: 0.842–0.975) and it was 0.775 (95% CI: 0.553–1.000) in predicting mortality. The AUROC of DROOL score in predicting overall complications was 0.932 (95% CI: 0.877–0.987) and the AUROC of DROOL score in predicting mortality was 0.864 (95% CI: 0.758–0.970). The ROC analysis showed that a DROOL score ≤4 has a sensitivity of 96.2% and a specificity of 77.8% in predicting overall complications. Similarly, DROOL score ≤5 has a sensitivity of 81.7% and a specificity of 62.5% in predicting the development of mortality. Delong test showed that there was no statistically significant difference in Zargar versus DROOL score in terms of prediction of mortality and overall complications (P > 0.05). CONCLUSION: DROOL score is comparable to Zargar score in identifying patients at high risk of mortality and complications. Hence, DROOL score can be used for risk stratification of patients presenting with corrosive ingestion.","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135953333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changing spectrum of acute poisoning in North India: A hospital-based descriptive study.","authors":"Ashok Kumar Pannu,&nbsp;Ashish Bhalla,&nbsp;Vitla Vamshi,&nbsp;Manish Kumar Upadhyay,&nbsp;Navneet Sharma,&nbsp;Susheel Kumar","doi":"10.4103/2452-2473.357627","DOIUrl":"https://doi.org/10.4103/2452-2473.357627","url":null,"abstract":"<p><strong>Objectives: </strong>Evaluating local trends and continued monitoring of patterns of acute poisoning are essential for prompt recognition of the toxidromes, the establishment of immediate treatment facilities (e.g., antidote availability), and effective preventive strategies (e.g., governmental regulation on hazardous substances marketing). We aimed to describe the prevalence of the various types of poisoning and associated case fatality in our academic hospital in North India.</p><p><strong>Methods: </strong>A prospective observational descriptive study was conducted, enrolling patients aged ≥13 years with acute poisoning for 17 months from December 2016 to December 2017 and from September 2019 to December 2019, for a total of 17 months.</p><p><strong>Results: </strong>Four hundred and two patients were enrolled (median age 28 years; 63.2% males). Majority of the acute poisoning cases resulted from ingestion (<i>n</i> = 391, 97.3%) and the primary intention was most commonly self-harm (<i>n</i> = 314, 78.1%). The major types of poisoning were pesticide (<i>n</i> = 264, 65.7%), drug overdose (<i>n</i> = 77, 19.2%), and corrosive ingestion (<i>n</i> = 31, 7.7%). Pesticides included insecticides (<i>n</i> = 146, 36.3%; cholinesterase inhibitors, <i>n</i> = 91), fungicides (<i>n</i> = 76, 18.9%; all aluminum phosphide), herbicides (<i>n</i> = 22, 5.5%; paraquat, <i>n</i> = 19), and rodenticides (<i>n</i> = 20, 5.0%; coumarin-derived substances, <i>n</i> = 12). Benzodiazepines (<i>n</i> = 33) and opioids (<i>n</i> = 25) were frequent causes of drug overdose. 95.3% (<i>n</i> = 379) received preliminary treatment at the previous health-care center, including gastric lavage (<i>n</i> = 239) and antidotes (<i>n</i> = 73). In-hospital case fatality rate was 17.3% (<i>n</i> = 58).</p><p><strong>Conclusion: </strong>Herbicide ingestion and opioid overdose are emerging threats with a gradual decline in organophosphate and aluminum phosphide poisoning. Despite improving management of acute poisoning, the overall case fatality rate remains substantial.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"22 4","pages":"192-199"},"PeriodicalIF":0.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/27/61/TJEM-22-192.PMC9639736.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10216899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare case: Descending necrotizing mediastinitis.","authors":"Barış Murat Ayvaci,&nbsp;Eren Gökdağ","doi":"10.4103/2452-2473.357345","DOIUrl":"https://doi.org/10.4103/2452-2473.357345","url":null,"abstract":"<p><p>Descending necrotizing mediastinitis (DNM) is one of the most critical, and often lethal forms of mediastinitis that develop because of the downward spread of deep neck infections. In this article, we wanted to discuss a case report with DNM secondary to retropharyngeal abscess detected in the emergency department, in accordance with the literature. A 51-year-old male patient presented to the hospital with complaints of fever, sore throat when swallowing, and swelling in the neck. He had no history of any disease, trauma, or surgical intervention. On physical examination of our patient, diffuse hyperemia and edema in the pharyngeal area were detected with swelling, edema, redness, and warmth in the neck, which can be felt on both sides of the trachea with palpation. DNM diagnosis was made by detecting retropharyngeal abscess extending to the mediastinum, mediastinal air images and increased density in adipose tissue with intravenous (IV) contrast-enhanced neck and thorax computed tomography (CT). DNM patients most frequently present with complaints of fever, odynophagia, dyspnea, cervical edema, and pain. The most important clinical finding is edema and hyperemia in the pharynx. Our patient presented to the emergency department with complaints of fever, sore throat when swallowing, and neck swelling, and on physical examination, edema, hyperemia, and temperature increase in the neck region were observed together with hyperemia and edema in the pharyngeal area. Laboratory examinations showed high leukocyte count and C-reactive protein levels. The patient was diagnosed with DNM by performing IV contrast-enhanced cervicothoracic CT imaging and underwent an operation. It should be borne in mind that patients who present to the emergency room with fever, odynophagia, and neck swelling may have a rare but seriously life-threatening DNM.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":" ","pages":"230-232"},"PeriodicalIF":0.9,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2d/70/TJEM-22-230.PMC9639737.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40454241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current status of acute ischemic stroke management in Iran: Findings from a single-center study.","authors":"Hesamedin Askari-Majdabadi,&nbsp;Zahra Basereh,&nbsp;Amin Soheili,&nbsp;Kelly Powers,&nbsp;Mohsen Soleimani,&nbsp;Majid Mirmohammdkhani,&nbsp;Tahoura Afshari Saleh","doi":"10.4103/2452-2473.357344","DOIUrl":"https://doi.org/10.4103/2452-2473.357344","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigated the current status of acute ischemic stroke (AIS) management in an Iranian emergency department (ED).</p><p><strong>Methods: </strong>A descriptive study using a retrospective chart review was conducted on medical records of 270 patients with AIS who presented to the ED of a tertiary university hospital in the northeast of Iran from March 22 to September 22, 2019. The steps of this review process included instrument identification, medical records retrieval, data extraction, and data verification.</p><p><strong>Results: </strong>Of patients with AIS, 88.9% (<i>n</i> = 240) did not receive stroke code activation. For the 11.1% of patients (<i>n</i> = 30) who received activation, 7% of codes (<i>n</i> = 19) were canceled by the acute stroke team and IV recombinant tissue plasminogen activator (r-tPA) was only administered for 4.1% of patients (<i>n</i> = 11). ED arrival outside 4.5 h from symptom onset was the main barrier to IV r-tPA administration for 83.8% of potentially eligible patients with AIS (<i>n</i> = 217). The median door-to-needle time was 70 min (interquartile range: 47-90 min).</p><p><strong>Conclusions: </strong>There was a better clinical performance in terms of critical time goals in potentially eligible patients with AIS if managed with stroke team activation compared to no stroke team activation.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":" ","pages":"213-220"},"PeriodicalIF":0.9,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/69/ea/TJEM-22-213.PMC9639744.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40463431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided estimation of internal jugular vein collapsibility index in patients with shock in emergency department.","authors":"Hannah Joyke Chawang,&nbsp;Nidhi Kaeley,&nbsp;Bharat Bhushan Bhardwaj,&nbsp;Udit Chauhan,&nbsp;Himanshi Baid,&nbsp;Reshma Asokan,&nbsp;Santosh Sadashiv Galagali","doi":"10.4103/2452-2473.357352","DOIUrl":"https://doi.org/10.4103/2452-2473.357352","url":null,"abstract":"<p><strong>Objective: </strong>To correlate ultrasound-guided estimation of Internal Jugular Vein Collapsibility Index (IJV-CI) with inferior vena cava CI (IVC-CI) and invasively monitored central venous pressure (CVP) in patients with shock in the emergency medicine department.</p><p><strong>Methods: </strong>A prospective observational study was done in the emergency department (ED). The study was conducted over 15 months (November 2019 to April 2021). It included patients more than 18 years presenting to the ED in shock. The IJV and IVC diameter and cross-sectional area were measured using ultrasound. The corresponding collapsibility indexes were then calculated and correlated with the invasively monitored CVP of the patient. Data were then analyzed using the Statistical Package for the Social Science (SPSS): Version 23 for windows. Pearson's correlation was used between CVP and collapsibility indexes.</p><p><strong>Results: </strong>The mean (±standard deviation) age of the patients was 49.01 (±15.6). There was a 47 (64%) male predominance which outnumbered females 26 (36%). The correlation coefficient was statistically significant between CVP and the collapsibility indices for various IJV and IVC parameters. The highest correlation (<i>r</i> = -0.541, <i>P</i> = 0.005) was seen between IVC-CI (CI 5) and CVP. This was followed by a correlation seen at a 30° position for IJV CI (cross-sectional area) with CVP (<i>r</i> = -0.453, <i>P</i> = 0.001). Similarly, the correlation between IJV CI (AP diameter) and CVP, followed (<i>r</i> = -0.412, <i>P</i> = 0.008) was statistically significant.</p><p><strong>Conclusion: </strong>Both IJV and IVC collapsibility indices correlated significantly with invasively measured CVP. Hence, they present as an effective tool in fluid resuscitation in patients with shock in ED.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":" ","pages":"206-212"},"PeriodicalIF":0.9,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ce/0a/TJEM-22-206.PMC9639735.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40454240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}