Asymptomatic traumatic common carotid artery dissection

Common carotid artery (CCA) dissection is a rare emergency condition. Early diagnosis of these cases is important to prevent the ischemic emergencies. We presented a CCA dissection case, who was admitted to the hospital after taken out from under rubble with satisfactory outcome. (C) 2015 The Authors. Production and hosting by Elsevier B.V. on behalf of Daping Hospital and the Research Institute of Surgery of the Third Military Medical University

Asymptomatic traumatic common carotid artery dissection

Common carotid artery (CCA) dissection is a rare emergency condition. Early diagnosis of these cases is important to prevent the ischemic emergencies. We presented a CCA dissection case, who was admitted to the hospital after taken out from under rubble with satisfactory outcome

Retropharyngeal Hematoma due to Oral Warfarin Usage

SUMMARY: Retropharyngeal hematoma due to anticoagulant usage is a rare, life-threatening situation which must be immediately diagnosed and treated. Immediate control of the airway and coagulopathy are the bases of treatment management. Patients often respond to conservative treatment but occasionally urgent tracheostomy and endotracheal intubation may be necessary. We presented a case of retropharyngeal hematoma secondary to warfarin usage in a 49-year-old male. ÖZET: Antikoagülan kullanımına bağlı retrofaringeal hematom nadir görülen, hızlı tanı ve tedavi edilmesi gereken hayatı tehdit edici bir durumdur. Hava yolu ve koagülopatinin acil kontrolü tedavi yönetiminin esasını oluşturur. Olgular çoğunlukla konservatif tedaviye cevap verirken bazen endotrakeal entübasyon ve acil trakeotomi gerekebilir. Bu yazıda, varfarin kullanımına sekonder retrofaringeal hematom gelişmiş 49 yaşındaki erkek olguyu sunduk. Key words: Emergency department, retropharyngeal hematoma, warfarin overdose, Anahtar sözcükler: Acil servis, retrofaringeal hematom, varfarin aşırı doz

Retrograde cerebral air embolism

Pneumocephalus is a clinical condition caused by dysbarism, trauma, and iatrogenic causes. The most common iatrogenic causes of pneumocephalus are major interventions as a neurosurgery and cardiovascular operations, endoscopy, and minor interventions as a peripheral and central venous access. Especially during insertion of central venous line and intravenous drug and fluid infusion, the venous air embolism may occur in emergency department. In these patients, retrograde pneumocephalus occurs as a result of the air entering the right atrium to the brain. Clinical effects of the air delivery rates are known to be more specific than the total amount of air. In general, intravenous administration of 300 to 500 mL air in the speed of 100mL/min is considered to be lethal. Large amounts of air embolism can cause hypotension and acute circulatory collapse with intracardiac obstruction. The most common symptoms of venous air embolism are anxiety, dyspnea, chest pain, cyanosis, tachycardia, tachypnea, headache, confusion, agitation, syncope, slurred speech, blurred vision, seizures, and ataxia. The mortality of pneumocephalus caused by central venous catheters in patients presented with symptoms of focal neurologic was 8%, whereas the mortality of pneumocephalus in patients presented with encephalopathy was 36%. In our report, a case of pneumocephalus secondary to disconnection of catheter cap in chronic renal failure patient who has hemodialysis via catheter has been presented

The interrater reliability of ultrasound imaging of the inferior vena cava performed by emergency residents

Objective: Ultrasonography (US) has gained popularity in the emergency medicine to assess intravascular volume status in critically ill patients. However, there are a limited number of studies on the interrater reliability of US examination of the inferior vena cava (IVC) by emergency residents

The accuracy of bedside ultrasonography as a diagnostic tool for the fifth metatarsal fractures

Objectives: Musculoskeletal ultrasonography is a technique that is becoming more popular in diagnosing injuries of emergency department (ED) patients especially for the diagnosis of fractures. In this study, we determined the reliability of ultrasonography for the diagnosis of fractures of the fifth metatarsal

Can venous blood gas analysis be used for predicting seizure recurrence in emergency department?

BACKGROUND: Epileptic seizures account for 1%–2% of all admissions of patients to the emergency department (ED). The present study aimed to determine whether venous blood pH, bicarbonate, base excess, and lactate levels taken within 1 hour of the last seizure episode help to determine seizure recurrence in emergency departments. METHODS: A cross-sectional study was conducted in the emergency department (ED) between January and July, 2012. Patients who were admitted to the emergency department consecutively were included in the study if they were 14 years or older and within 1 hour after last seizure. Demographics, seizure type, use of antiepileptic drugs, observation period at the emergency department, seizure recurrence, pH, bicarbonate, base excess, and lactate levels from venous blood gas analysis were determined. RESULTS: A total of 94 patients aged 14 years or older were included in the study. Of these patients, 10.6% (n=10) experienced recurrent seizures in the observation period at the emergency department. To predict recurrent seizures in ED, threshold venous blood gas values were determined as follows: pH<7.245 [sensitivity 80% (95%CI: 44–96), negative predictive value 96.9% (95%CI: 88.3–99.4)], bicarbonate<17.1 mmol/L [sensitivity 80% (95%CI: 44–96), negative predictive value 97% (95%CI: 89–99.5)], base excess<–11.1 mEq/L [sensitivity 80% (95%CI: 44–96), negative predictive value 97% (95%CI: 89–99)], and lactate>7.65 mmol/L [sensitivity 80% (95%CI: 44–96), negative predictive value 96.6% (95%CI: 87–99)]. CONCLUSION: If venous blood gas analysis is made on pH, base excess, lactate and bicarbonate immediately one hour after the last epileptic seizure episode, it is possible to predict whether the patient will have seizure recurrence