Turkish Journal of Emergency Medicine最新文献

{"title":"A case series of accidental xylazine intoxication in humans; Is there a role of naloxone as an antidote?","authors":"Lee Kee Choon,&nbsp;Ain Izzati Khiruddin,&nbsp;Wan Masliza Wan Mohd Annuar,&nbsp;Sazwan Reezal Shamsuddin","doi":"10.4103/tjem.tjem_198_22","DOIUrl":"https://doi.org/10.4103/tjem.tjem_198_22","url":null,"abstract":"<p><p>Xylazine is a type of sedative commonly used in veterinary medicine. It acts on the central alpha-2 receptor and suppresses norepinephrine release from the peripheral nerve terminal. It is also reported to have action on cholinergic, serotogenic, H2-histamine, dopaminergic, and opioid receptors. Once administered in animals, it causes hypotension, bradycardia, central nervous system depression, and respiratory depression. The effect will start within minutes after absorption and last up to 4 h depending on the dosage given. Till date, it is only exclusively used in animals as approved by the Food and Drug Administration. Human intoxication is uncommon, and no specific antidote is available. Naloxone, a competitive opioid receptor antagonist, was postulated to have an antidotal effect on xylazine. We report two cases of accidental human injection with xylazine. Naloxone was administered in one of the cases. Acute hypertension and mydriasis were observed; however, no apparent reversal of toxidrome was seen. This finding reveals the question regarding the efficacy and benefit of naloxone usage in xylazine intoxication. General management remains supportive of care focusing on ventilation and hemodynamics. Attending physicians should be aware of potential xylazine intoxication incidents in the area of livestock or veterinary activities.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"23 2","pages":"119-122"},"PeriodicalIF":0.9,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f6/41/TJEM-23-119.PMC10166292.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9806950","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":"Mediastinal extension of amoebic liver abscess: A case report on the rare thoracic complication of Entamoeba histolytica","authors":"Samiksha Gupta, Gautam Jesrani, Jaspreet Kaur, YuvrajSingh Cheema, Prashant Ahlawat","doi":"10.4103/tjem.tjem_294_22","DOIUrl":"https://doi.org/10.4103/tjem.tjem_294_22","url":null,"abstract":"Amoebic liver abscess is one frequently encountered intra-abdominal infection, caused by Entamoeba histolytica and has various abdominal and thoracic life-threatening complications. Herein, describe a case of a 30-year-old female, who suffered from multiple amoebic liver abscesses and presented with massive right-sided pleural effusion. She was managed with recommended antibiotics and pigtail catheter for liver abscess and an intercostal drainage tube for massive pleural effusion. However, postintercostal drainage, her chest X-ray demonstrated a right mediastinal shadow, which was confirmed as an intrathoracic extension of the hepatic liver abscess on computed tomography. An ultrasound-guided pigtail catheter was manipulated and placed at the site of thoracic communication. This led to clinical and radiological improvement, but unfortunately, she developed ventilator-acquired pneumonia and died due to her illness. The case represents an uncommon complication of amoebic liver abscess, which is rarely described and adds more knowledge on the thoracic complexities of this infectious disease.","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"9 1","pages":"250 - 253"},"PeriodicalIF":0.0,"publicationDate":"2023-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135953608","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":"Monkeypox: A current emergency global health threat.","authors":"Mohamud Sheek-Hussein, Ahmed R Alsuwaidi, Emma A Davies, Fikri M Abu-Zidan","doi":"10.4103/2452-2473.366487","DOIUrl":"10.4103/2452-2473.366487","url":null,"abstract":"<p><p>Monkeypox (MPXV) is an emerging zoonotic disease carrying a global health threat. Using a multi-disciplinary approach, we review the current MPXV virus infection outbreak including virology, prevention, clinical presentation, and disaster management. MPXV is caused by a double-stranded deoxyribonucleic acid virus. Despite its clinical similarities with smallpox, it is less severe with low mortality. Human-to-human transmission occurs through prolonged direct or close contact, or through blood, body fluids, or mucosal lesions. Risk groups include frontline health workers who care for MPXV patients, household members of an infected patient, and men who have sex with men. Skin lesions are usually, but not always, at the same stage. They may affect the face followed by the distal extremities with fewer lesions on the trunk (centrifugal distribution). Lesions may involve the mouth, genitalia, conjunctiva, and rectum. The majority of cases are mild. Nevertheless, the disease may have long-term effects on the skin, the neurological system, and the eye. Vaccination against MPXV is available but meanwhile should be limited to those who are at high risk. Those vaccinated against smallpox (usually older than 40 years) might be immune against MPXV. Infectious diseases are without borders. If proper action is not taken, there is considerable risk that MPXV will be entrenched worldwide. Our world has a delicate balance between animals, environment, and humans reflecting the need for a \"one globe, one health approach\" to address this risk. Following the principles of disaster management and using the lessons we have learned from the COVID-19 pandemic will reduce the impact of the MPXV outbreak.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"23 1","pages":"5-16"},"PeriodicalIF":1.1,"publicationDate":"2023-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bd/ba/TJEM-23-5.PMC9930390.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10768814","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":"Prehospital management of earthquake crush injuries: A collective review","authors":"FikriM Abu-Zidan, Kamal Idris, ArifAlper Cevik","doi":"10.4103/tjem.tjem_201_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_201_23","url":null,"abstract":"Earthquakes are natural disasters which can destroy the rural and urban infrastructure causing a high toll of injuries and death without advanced notice. We aim to review the prehospital medical management of earthquake crush injuries in the field. PubMed was searched using general terms including rhabdomyolysis, crush injury, and earthquake in English language without time restriction. Selected articles were critically evaluated by three experts in disaster medicine, emergency medicine, and critical care. The medical response to earthquakes includes: (1) search and rescue; (2) triage and initial stabilization; (3) definitive care; and (4) evacuation. Long-term, continuous pressure on muscles causes crush injury. Ischemia–reperfusion injury following the relieving of muscle compression may cause metabolic changes and rhabdomyolysis depending on the time of extrication. Sodium and water enter the cell causing cell swelling and hypovolemia, while potassium and myoglobin are released into the circulation. This may cause sudden cardiac arrest, acute extremity compartment syndrome, and acute kidney injury. Recognizing these conditions and treating them timely and properly in the field will save many patients. Majority of emergency physicians who have worked in the field of the recent Kahramanmaraş 2023, Turkey, earthquakes, have acknowledged their lack of knowledge and experience in managing earthquake crush injuries. We hope that this collective review will cover the essential knowledge needed for properly managing seriously crushed injured patients in the earthquake field.","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"60 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":"135953963","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":"A young boy with severe pulmonary-renal syndrome: Will you suspect IgA nephropathy?","authors":"Tejinderpal Singh Grewal,&nbsp;Dipesh Soni,&nbsp;Ritambhra Nada,&nbsp;Navneet Sharma,&nbsp;Ashok Kumar Pannu","doi":"10.4103/2452-2473.357334","DOIUrl":"https://doi.org/10.4103/2452-2473.357334","url":null,"abstract":"<p><p>IgA nephropathy is a renal-limited form of systemic vasculitis, and pulmonary manifestations are uncommon. An initial presentation with severe diffuse alveolar hemorrhage (DAH) or pulmonary-renal syndrome is rare and only confined to a few case reports. Herein, we present a young male admitted with acute-onset dyspnea, hemoptysis, and rapidly progressive renal failure. With an initial diagnosis of an immune-mediated pulmonary-renal syndrome, he was treated with high-dose corticosteroids and therapeutic plasmapheresis along with intensive organ support (including hemodialysis, red cell transfusion, and high-flow oxygen). After a detailed laboratory evaluation and kidney biopsy, IgA nephropathy was diagnosed. The patient continued to worsen with persistent DAH and died. IgA nephropathy-associated severe DAH or pulmonary-renal syndrome is rare but increasingly recognized. The condition is difficult to diagnose early and has no proven disease-targeted therapy.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"23 1","pages":"52-56"},"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/3d/86/TJEM-23-52.PMC9930386.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10763936","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":"Poor adherence to the recommended pulmonary embolism diagnostic pathway in the emergency department: A retrospective cohort study.","authors":"Alia M Hadid,&nbsp;Ala Jalabi,&nbsp;Mahmoud Anka,&nbsp;Arif Alper Cevik","doi":"10.4103/2452-2473.366486","DOIUrl":"https://doi.org/10.4103/2452-2473.366486","url":null,"abstract":"<p><strong>Objectives: </strong>Pulmonary embolus (PE) is a form of venous thromboembolism associated with increased morbidity and mortality if not diagnosed and treated early. Variations in clinical presentation make the diagnosis challenging. The gold standard for diagnosing PE is a computed tomography pulmonary angiogram (CTPA). Physicians show a low threshold for over-investigating PE. The evaluation of patients with suspected PE should be efficient, including but not limited to the use of risk stratification methods. This study aims to assess the adherence to the recommended diagnostic pathways of ordering CTPAs in patients with suspected PE.</p><p><strong>Methods: </strong>This retrospective cohort study included patients above 18 years of age who received a CTPA for a suspected PE in the emergency department (ED) of a hospital between 2015 and 2019. Patient demographic data, chief complaint, variables of the Wells and pulmonary emboli rule-out criteria scores, pregnancy status, investigations, and the patient's final PE diagnosis were extracted from the hospital electronic medical records. Diagnostic pathways that took place were compared to the internationally recommended pathway.</p><p><strong>Results: </strong>Four hundred and eighty-six patients were included in this study. The mean age was 51.01 (±19.5) years, and 377 (69.3%) patients were female. The recommended PE diagnostic pathway to order CTPA was incorrectly followed in 288 patients (59.3%). Seventy-five (15.4%) patients received an unnecessary CTPA. D-dimer test was ordered unnecessarily in 144 patients (29.6%). The overall prevalence of PE in our population was 9.47% (<i>n</i>: 46). Out of the 75 unnecessarily ordered CTPAs, 2 (2.7%) showed PE, while CTPAs ordered using the correct pathway showed 31 (10.9%) PEs.</p><p><strong>Conclusion: </strong>Our study revealed that approximately two-thirds of all CTPA requests did not adhere to the recommended PE clinical decision pathway. There was a significant improper and unnecessary utilization of CTPA imaging and D-dimer testing. Improvements seem imperative to enhance physicians' clinical approach to PE diagnosis.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"23 1","pages":"44-51"},"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/f6/dc/TJEM-23-44.PMC9930389.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10763934","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":"Accuracy of airway ultrasound parameters to predict difficult airway using the LEMON criteria as a reference: A cross-sectional diagnostic accuracy study.","authors":"Mehran Sotoodehnia,&nbsp;Najmeh Abbasi,&nbsp;Razman Arabzadeh Bahri,&nbsp;Atefeh Abdollahi,&nbsp;Alireza Baratloo","doi":"10.4103/2452-2473.366484","DOIUrl":"https://doi.org/10.4103/2452-2473.366484","url":null,"abstract":"<p><strong>Objectives: </strong>Ultrasound (US) airway indexes were frequently compared with other scoring systems such as Mallampati score and Cormack - Lehane classification system, but to the best of our knowledge never with LEMON. Here, in this study, we evaluated the accuracy of some recommended airway US parameters in terms of screening difficult airway using the LEMON criteria as a reference.</p><p><strong>Methods: </strong>This was a cross-sectional diagnostic accuracy study in which people with at least 18 years old coming to the emergency departments for any reason who had consent for participation, were enrolled with the simple random sampling method. Hyo-mental distance (HMD), skin to epiglottis distance (EP), and peri-epiglottic space to epiglottis to vocal cord ratio (PEP/E. VC) were the US indexes that were calculated in all participants. Using a preprepared checklist, measured US parameters were recorded. For each participant, the LEMON score variables were also assessed and recorded, and the cutoff point for considering as a difficult airway case, based on LEMON score, was 2. Demographic characteristics of the participants were also registered.</p><p><strong>Results: </strong>A total of 299 cases with a mean age of 41.1 years (95% confidence interval [CI]: 39.3-42.9), were participated. Based on LEMON score ≥2, 20 participants (6.7%) were categorized in difficult airway group. Comparison of the PEP/E. VC (<i>P</i> = 0.007) and EP distance (<i>P</i> = 0.049) of the participants based on LEMON score showed a statistically significant difference; but comparison of the means of HMD in the two groups was not statistically significant (<i>P</i> = 0.144). The median of EP of the participants was 7.70 mm (interquartile range [IQR]: 6.70-9.40). The best cutoff point of EP distance for evaluating a difficult airway was 12.27 mm and more with the sensitivity of 35% and the specificity of 86.96% (accuracy = 0.614; 95% CI: 0.492-0.736). The median of PEP/E. VC was 1.01(IQR: 0.79-1.23). The best cutoff point of PEP/E. VC for evaluating a difficult airway was 0.88 and less with the sensitivity of 70% and the specificity of 67.38% (accuracy = 0.701; 95% CI: 0.583-0.818).</p><p><strong>Conclusion: </strong>As per our results, PEP/E. VC and EP distance measured with sonography can be used in distinguishing the difficult airway, using the LEMON criteria as the reference. However, further studies are needed to use PEP/E. VC and EP distance as a part of reliable indexes.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"23 1","pages":"38-43"},"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/66/75/TJEM-23-38.PMC9930393.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10273599","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":"Receiver operating characteristic curve analysis in diagnostic accuracy studies: A guide to interpreting the area under the curve value","authors":"ŞerefKerem Çorbacıoğlu, Gökhan Aksel","doi":"10.4103/tjem.tjem_182_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_182_23","url":null,"abstract":"This review article provides a concise guide to interpreting receiver operating characteristic (ROC) curves and area under the curve (AUC) values in diagnostic accuracy studies. ROC analysis is a powerful tool for assessing the diagnostic performance of index tests, which are tests that are used to diagnose a disease or condition. The AUC value is a summary metric of the ROC curve that reflects the test’s ability to distinguish between diseased and nondiseased individuals. AUC values range from 0.5 to 1.0, with a value of 0.5 indicating that the test is no better than chance at distinguishing between diseased and nondiseased individuals. A value of 1.0 indicates perfect discrimination. AUC values above 0.80 are generally consideredclinically useful, while values below 0.80 are considered of limited clinical utility. When interpreting AUC values, it is important to consider the 95% confidence interval. The confidence interval reflects the uncertainty around the AUC value. A narrow confidence interval indicates that the AUC value is likely accurate, while a wide confidence interval indicates that the AUC value is less reliable. ROC analysis can also be used to identify the optimal cutoff value for an index test. The optimal cutoff value is the value that maximizes the test’s sensitivity and specificity. The Youden index can be used to identify the optimal cutoff value. This review article provides a concise guide to interpreting ROC curves and AUC values in diagnostic accuracy studies. By understanding these metrics, clinicians can make informed decisions about the use of index tests in clinical practice.","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"16 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":"135953352","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":"Erratum: Current status of acute ischemic stroke management in Iran: Findings from a single-center study.","authors":"","doi":"10.4103/2452-2473.366481","DOIUrl":"https://doi.org/10.4103/2452-2473.366481","url":null,"abstract":"<p><p>[This corrects the article on p. 213 in vol. 4.].</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"23 1","pages":"64"},"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/57/0e/TJEM-23-64.PMC9930391.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10763937","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":"Self-ingestion of vasmol dye.","authors":"Jaspreet Kaur,&nbsp;Aman Garg,&nbsp;Baldeep Kaur","doi":"10.4103/2452-2473.357330","DOIUrl":"https://doi.org/10.4103/2452-2473.357330","url":null,"abstract":"<p><p>Vasmol, a commonly used hair dye, is becoming apparent as one of the major causes of suicidal poisoning in India. The toxic components in the dye include paraphenylenediamine, sodium ethylenediaminetetraacetic acid, resorcinol, and propylene glycol. Acute poisoning by consumption of dye leads to characteristic angioedema of the cervicofacial region along with multiorgan dysfunction. Early intervention with tracheostomy can be lifesaving in such cases and helps in preventing the morbidity and mortality associated with it.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"23 1","pages":"61-63"},"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/07/9d/TJEM-23-61.PMC9930392.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10773214","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}