Turkish Journal of Emergency Medicine最新文献

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Acute pancreatitis due to hypertriglyceridemia: Plasmapheresis versus medical treatment. 高甘油三酯血症引起的急性胰腺炎:血浆置换与药物治疗
IF 0.9
Turkish Journal of Emergency Medicine Pub Date : 2023-04-01 DOI: 10.4103/tjem.tjem_276_22
Gonca Koksaldi Sahin, Muge Gulen, Selen Acehan, Nurdan Unlu, Yilmaz Celik, Deniz Aka Satar, Mustafa Sencer Segmen, Salim Satar
{"title":"Acute pancreatitis due to hypertriglyceridemia: Plasmapheresis versus medical treatment.","authors":"Gonca Koksaldi Sahin,&nbsp;Muge Gulen,&nbsp;Selen Acehan,&nbsp;Nurdan Unlu,&nbsp;Yilmaz Celik,&nbsp;Deniz Aka Satar,&nbsp;Mustafa Sencer Segmen,&nbsp;Salim Satar","doi":"10.4103/tjem.tjem_276_22","DOIUrl":"https://doi.org/10.4103/tjem.tjem_276_22","url":null,"abstract":"<p><strong>Objective: </strong>Hypertriglyceridemia (HTG) is the third-most common cause of acute pancreatitis. Plasmapheresis is an extracorporeal treatment method used for treatment. This study aimed to investigate the efficacy of medical treatment and plasmapheresis in patients with acute pancreatitis due to HTG.</p><p><strong>Methods: </strong>This was a retrospective cross-sectional study. The patients were divided into two groups according to the treatment they received as those who received only medical treatment and those who performed plasmapheresis with medical treatment. According to the treatment received by the patients; clinical, demographic, and laboratory data, Ranson scores, and bedside index of severity in acute pancreatitis (BISAP) scores, decrease in triglyceride levels in 24 h, length of hospital stay, and outcomes were recorded.</p><p><strong>Results: </strong>Forty-seven patients were included in the study. The level of triglyceride decreases at the 24<sup>th</sup> h was 59.7% ±17.3% in those who received medical treatment and was 70.4% ±15.1% in those who received plasmapheresis (<i>P</i> = 0.032). Receiver operating characteristic curve analysis was performed to predict the need for plasmapheresis treatment, area under the curve (AUC) value of the triglyceride level was the highest (AUC: 0.822, 95% confidence interval: [0.703-0.940]; <i>P</i> < 0.001), the sensitivity and specificity were 83.3% and 72.4%, respectively, and the cut-off value of triglyceride was accepted as 3079.5 mg/dL.</p><p><strong>Conclusion: </strong>Plasma triglyceride levels and BISAP score on admission may help physicians to predict the need for plasmapheresis. Plasmapheresis helps to rapidly reduce triglyceride levels in patients with HTG-associated acute pancreatitis.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"23 2","pages":"111-118"},"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/bf/54/TJEM-23-111.PMC10166288.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9508166","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}
引用次数: 2
Traumatic lingual hematoma after generalized tonic-clonic seizure in a patient with an acquired coagulopathy. 一例获得性凝血病患者全身性强直-阵挛性发作后的外伤性舌血肿。
IF 0.9
Turkish Journal of Emergency Medicine Pub Date : 2023-04-01 DOI: 10.4103/tjem.tjem_130_22
Branislav Ralić, Mirjana Ždraljević, Aleksandar J Ristić, Ivana Berisavac
{"title":"Traumatic lingual hematoma after generalized tonic-clonic seizure in a patient with an acquired coagulopathy.","authors":"Branislav Ralić,&nbsp;Mirjana Ždraljević,&nbsp;Aleksandar J Ristić,&nbsp;Ivana Berisavac","doi":"10.4103/tjem.tjem_130_22","DOIUrl":"https://doi.org/10.4103/tjem.tjem_130_22","url":null,"abstract":"<p><p>Oral lacerations are common complications of seizures and account for 92% of all oral injuries. Seizures are relatively commonly associated with chronic alcohol consumption. It is already known that provoked seizures can occur after a sudden cessation of prolonged alcohol intoxication. Meanwhile, chronic alcohol consumption can disrupt the blood coagulation process on several levels. This report aims to present a case of generalized tonic-clonic seizure in a man with chronic alcoholism and acquired coagulopathy who suffered severe tongue injury during a seizure. A 45-year-old man was brought to the emergency department after a first-in-life generalized tonic-clonic seizure. He gave information that he bit his tongue during the seizure. Shortly afterward, the patient had another generalized seizure during which he stopped breathing and was intubated. On admission, the patient was sedated, intubated, and on mechanical ventilation, with no signs of focal neurological deficit. A detailed physical examination revealed massive tongue swelling, which was significantly moved forward. Laboratory tests revealed coagulopathy (INR 2,10) severe thrombocytopenia with a platelet count of 50x109/L. Electrolyte values were in the reference range. According to the maxillofacial surgeon's recommendation, he was treated conservatively, and after 2 weeks, he was clinically stable with a significant reduction of lingual hematoma and without new epileptic events. In our case, decreased platelet count and probable platelet dysfunction associated with chronic alcohol consumption and tongue bite during generalized tonic-clonic seizure played a significant role in developing lingual hematoma. These fast-developing lingual hematomas can lead to possible airway obstruction; therefore, careful observation and timely intubation are mandatory to prevent possible fatal complications.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"23 2","pages":"123-126"},"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/10/33/TJEM-23-123.PMC10166286.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9508167","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}
引用次数: 0
Is gray-white matter ratio in out-of-hospital cardiac arrest patients' really early predictor of neurological outcome? 院外心脏骤停患者的灰质白质比真的是神经预后的早期预测指标吗?
IF 0.9
Turkish Journal of Emergency Medicine Pub Date : 2023-04-01 DOI: 10.4103/tjem.tjem_255_22
Emine Emektar, Fatmanur Karaarslan, Cansu Öztürk, Selma Ramadan
{"title":"Is gray-white matter ratio in out-of-hospital cardiac arrest patients' really early predictor of neurological outcome?","authors":"Emine Emektar,&nbsp;Fatmanur Karaarslan,&nbsp;Cansu Öztürk,&nbsp;Selma Ramadan","doi":"10.4103/tjem.tjem_255_22","DOIUrl":"https://doi.org/10.4103/tjem.tjem_255_22","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the association between neurological outcome and gray-white ratio (GWR) in brain computed tomography (CT) in patients with return of spontaneous circulation (ROSC) who were brought to the emergency department (ED) due to out-of-hospital cardiac arrest (OHCA).</p><p><strong>Methods: </strong>This study has a retrospective design. Patients with ROSC who were brought to the ED due to OHCA and who underwent brain CT in the first 24 h were included in the study. Demographic data, brain CT results (intensities of gray matter and white matter in Hounsfield units and calculated GWR), and hospital outcome were recorded. The cerebral Performance Categories (CPC) score was used as the outcome of the study.</p><p><strong>Results: </strong>A total of 160 patients were included in the study. 55% of the patients were male and the median age was 75.5. The median brain CT time of the patients was 120 min. 16.3% of the patients were in the good neurological outcome group. When attenuation values and GWRs of the patients were compared according to CPC of patients (good-poor), no statistically significant difference was detected in any parameter except MC2 attenuation (<i>P</i> > 0.05 for all values). The patients were separated into groups geriatric and nongeriatric and GWRs were compared. GWRs were lower in the geriatric groups (<i>P</i> < 0.05 for all values).</p><p><strong>Conclusion: </strong>Although it is emphasized in the literature that detection of low GWR in brain CT can help the clinical decision process in patients surviving comatose arrest, we think that it is not valid for especially in geriatric patients and in patients who underwent early brain CT after ROSC.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"23 2","pages":"104-110"},"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/1b/d8/TJEM-23-104.PMC10166289.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9508168","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}
引用次数: 1
Acute hyperkalemia in adults. 成人急性高钾血症。
IF 0.9
Turkish Journal of Emergency Medicine Pub Date : 2023-04-01 DOI: 10.4103/tjem.tjem_288_22
Emine Emektar
{"title":"Acute hyperkalemia in adults.","authors":"Emine Emektar","doi":"10.4103/tjem.tjem_288_22","DOIUrl":"https://doi.org/10.4103/tjem.tjem_288_22","url":null,"abstract":"<p><p>Hyperkalemia is a common, life-threatening medical situation in chronic renal disease patients in the emergency department (ED). Since hyperkalemia does not present with any specific symptom, it is difficult to diagnose clinically. Hyperkalemia causes broad and dramatic medical presentations including cardiac arrhythmia and sudden death. Hyperkalemia is generally determined through serum measurement in the laboratory. Treatment includes precautions to stabilize cardiac membranes, shift potassium from the extracellular to the intracellular, and increase potassium excretion. The present article discusses the management of hyperkalemia in the ED in the light of current evidence.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"23 2","pages":"75-81"},"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/62/80/TJEM-23-75.PMC10166290.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9508170","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}
引用次数: 0
Clinical assessment and risk stratification for prehospital use of methoxyflurane versus standard analgesia in adult patients with trauma pain. 院前使用甲氧氟醚与标准镇痛对创伤性疼痛成人患者的临床评估和风险分层
IF 0.9
Turkish Journal of Emergency Medicine Pub Date : 2023-04-01 DOI: 10.4103/tjem.tjem_229_22
Hany Zaki, Süha Türkmen, Aftab Azad, Khalid Bashir, Amr Elmoheen, Eman Shaban, Haris Iftikhar, Nabil Shallik
{"title":"Clinical assessment and risk stratification for prehospital use of methoxyflurane versus standard analgesia in adult patients with trauma pain.","authors":"Hany Zaki,&nbsp;Süha Türkmen,&nbsp;Aftab Azad,&nbsp;Khalid Bashir,&nbsp;Amr Elmoheen,&nbsp;Eman Shaban,&nbsp;Haris Iftikhar,&nbsp;Nabil Shallik","doi":"10.4103/tjem.tjem_229_22","DOIUrl":"https://doi.org/10.4103/tjem.tjem_229_22","url":null,"abstract":"<p><p>Oligoanalgesia, the undertreatment of trauma-related pain using standard analgesics in prehospital and emergency departments, has been extensively documented as one of the major challenges affecting the effective treatment of trauma-related pain. When administered in low doses, methoxyflurane has been highlighted by numerous medical works of literature to provide an effective, nonopioid, nonnarcotic treatment alternative to standard analgesics for prehospital and emergency department use. Low-dose methoxyflurane has been associated with fast-pain relief in adult patients manifesting moderate-to-severe pain symptoms. This systematic review and meta-analysis aimed to assess the clinical implication of low-dose methoxyflurane use in prehospital and emergency departments in adult patients with moderate-to-severe trauma-related pain. Moreover, the review aimed at assessing the risk stratification associated with using low-dose methoxyflurane in prehospital and emergency departments. The systematic review and meta-analysis performed a comprehensive search for pertinent literature assessing the implications and risks of using low-dose methoxyflurane in adult patients exhibiting moderate-to-severe trauma-related pain in prehospital settings. A comparison between the use of low-dose methoxyflurane and standard-of-care analgesics, placebo, in prehospital settings was reported in four clinically conducted randomized controlled trials (RCTs). These RCTs included the STOP! trial, InMEDIATE, MEDIATA, and the PenASAP trials. A meta-analysis comparing the time taken to achieve first pain relief on initial treatment of patients with moderate-to-severe trauma-related pain favored the use of low-dose methoxyflurane to the standard-of-care analgesics (mean difference = -6.63, 95% confidence interval = -7.37, -5.09) on time taken to establish effective pain relief. Low-dose methoxyflurane has been associated with superior and faster pain relief in prehospital and emergency departments in adult patients exhibiting moderate-to-severe trauma-related pain compared to other standard analgesics.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"23 2","pages":"65-74"},"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/64/36/TJEM-23-65.PMC10166294.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9508169","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}
引用次数: 1
A case series of accidental xylazine intoxication in humans; Is there a role of naloxone as an antidote? 人意外二甲肼中毒系列病例纳洛酮有解毒剂的作用吗?
IF 0.9
Turkish Journal of Emergency Medicine Pub Date : 2023-04-01 DOI: 10.4103/tjem.tjem_198_22
Lee Kee Choon, Ain Izzati Khiruddin, Wan Masliza Wan Mohd Annuar, Sazwan Reezal Shamsuddin
{"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}
引用次数: 2
Mediastinal extension of amoebic liver abscess: A case report on the rare thoracic complication of Entamoeba histolytica 阿米巴肝脓肿纵隔延伸:罕见的胸腔溶组织内阿米巴并发症1例
Turkish Journal of Emergency Medicine Pub Date : 2023-01-09 DOI: 10.4103/tjem.tjem_294_22
Samiksha Gupta, Gautam Jesrani, Jaspreet Kaur, YuvrajSingh Cheema, Prashant Ahlawat
{"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}
引用次数: 0
Monkeypox: A current emergency global health threat. 猴痘:当前全球健康面临的紧急威胁。
IF 1.1
Turkish Journal of Emergency Medicine Pub Date : 2023-01-02 eCollection Date: 2023-01-01 DOI: 10.4103/2452-2473.366487
Mohamud Sheek-Hussein, Ahmed R Alsuwaidi, Emma A Davies, Fikri M Abu-Zidan
{"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}
引用次数: 0
Prognostic significance of poison-related factors and consumption patterns in acute aluminum phosphide poisoning. 急性磷化铝中毒中毒相关因素及摄入方式的预后意义。
IF 2.3
Turkish Journal of Emergency Medicine Pub Date : 2023-01-02 eCollection Date: 2023-04-01 DOI: 10.4103/tjem.tjem_253_22
Lokhesh Chockalingam Anbalagan, Ashok Kumar Pannu, Ashish Bhalla, Deba Prasad Dhibar, Navneet Sharma
{"title":"Prognostic significance of poison-related factors and consumption patterns in acute aluminum phosphide poisoning.","authors":"Lokhesh Chockalingam Anbalagan, Ashok Kumar Pannu, Ashish Bhalla, Deba Prasad Dhibar, Navneet Sharma","doi":"10.4103/tjem.tjem_253_22","DOIUrl":"10.4103/tjem.tjem_253_22","url":null,"abstract":"<p><strong>Objectives: </strong>The prognosis of acute aluminum phosphide poisoning is usually based on toxidrome features, with little focus on poison-related factors. We aimed to study the prognostic significance of poison-related factors, consumption patterns, and time delays to treatment.</p><p><strong>Methods: </strong>We performed a prospective cohort study in an academic hospital in North India in patients aged ≥ 13 with aluminum phosphide poisoning from July 2019 to December 2020. During data collection, a particular emphasis was made on the poison formulation, the ingested dose, the reconstitution of poison, vomiting, and time intervals to initiate various treatments. The primary outcome was inhospital mortality.</p><p><strong>Results: </strong>Fifty-eight patients were enrolled (median age, 32 years; 37 males). The mean dose of the ingested poison was 6.56 (±5.42) g. The predominant formulation of poison was pellet (<i>n</i> = 41), followed by powder (<i>n</i> = 16). Twenty patients performed reconstitution of poison before consumption, and 13 stirred the poison while reconstituting. All patients but three developed vomiting after consumption. Inhospital mortality (<i>n</i> = 23, 39%) was significantly high with a higher ingested dose (<i>P</i> < 0.001), nonstirred reconstitution before consumption (<i>P</i> = 0.042), fewer vomiting episodes (<i>P</i> = 0.010), a delay in detection of the victim by someone (<i>P</i> = 0.001), and delayed initiation of intravenous fluids (<i>P</i> = 0.043). The secondary outcomes (shock and requirement of vasopressor or ventilation) remained unaffected by the stirring in the reconstitution group.</p><p><strong>Conclusions: </strong>Poison-related factors and time intervals determine early risk stratification at admission in aluminum phosphide poisoning.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"23 2","pages":"88-95"},"PeriodicalIF":2.3,"publicationDate":"2023-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5e/78/TJEM-23-88.PMC10166291.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9839259","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}
引用次数: 0
Prehospital management of earthquake crush injuries: A collective review 地震挤压伤的院前处理:综述
Turkish Journal of Emergency Medicine Pub Date : 2023-01-01 DOI: 10.4103/tjem.tjem_201_23
FikriM Abu-Zidan, Kamal Idris, ArifAlper Cevik
{"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}
引用次数: 0
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