A Rare Cause of Acute Abdomen: Ruptured Splenic Artery Aneurysm

Ruptured splenic artery aneurysm (SAA), rare in the emergency department (ED), is a cause of hypotension and abdominal pain. Physicians should consider the possibility of this condition especially in patients with abdominal pain and hypotension. In this paper, we report the case of a patient with ruptured SAA presenting to the ED as an intraabdominal catastrophe and review the key features of this entity

Vapocoolant spray for intravenous cannulation pain: a Prospective, randomized controlled trial

Introduction: Peripheral intravenous (IV) cannulation are routine procedures in emergency department (ED) admissions. Vapocoolant sprays have a potential advantage over other topical agents.We aimed to see how effective vapocoolant spray was in reducing pain during intravenous cannulation versus a control group in this study. Materials and Methods: This is a prospective, randomized control study consisting of patients who were admitted to the ED. The study included patients aged 18 and over who applied to the ED and had IV cannulation. The patients were divided into 2 groups as control and vapocoolant spray groups. Age, gender, and dominant hand status of all patient groups were recorded. Side effects were observed after the application. The Visual Analogue Scale (VAS), which is the most widely used scale to measure pain, was used. Results: 206 individuals were randomized. The mean age of the vapocoolant spray group was 46.40±16.44 years, while it was 46.75±17.49 years for the control group. The vapocoolant spray group was found to have significantly lower mean VAS values during IV cannulation than the control group (1.47±1.32 vs. 3.97±1.97 p<0.001). It was found that the vapocoolant spray-applied group had a significantly lower percentage in terms of moderate pain (VAS>3 cm) compared to the control group (7.8% vs 58.3%, p<0.001). Besides, the percentage of severe pain (VAS>5.4 cm) in the spray-applied group was found to be significantly lower than the control group (1% vs. 20.4%, p<0.001). Conclusion: The vapocoolant spray can be used effectively to mitigate the pain associated with the pre-IV cannulation procedure and can be an alternative method for reducing pain in emergency departments

Can NLR, PLR and LMR be used as prognostic indicators in patients with pulmonary embolism? A commentary

We read with great interest the article “Prognostic role of NLR, PLR, and LMR in patients with pulmonary embolism” by Köse et al.[1]. They found that the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR) were related to the prognosis and clinical severity of patients with pulmonary embolism (PE). First of all, we congratulate the authors for their invaluable contribution to literature. However, we think that some points should be discussed regarding the use of these laboratory parameters. White blood cell subtypes NLR, PLR, and LMR, have been associated with many inflammatory diseases, including PE [2,3]. These parameters, which can be easily determined by simple and easy measurement of systemic inflammation, maintain their importance today. However, these parameters are affected by many factors such as trauma, local or systemic infection, acute coronary syndromes, and malignancy [3-5]. For these reasons, it would be better for the authors to mention these factors and exclude them from the tables that included malignancy and trauma patients in the study. It is known that drugs, including steroids, can increase neutrophils and decrease lymphocytes and therefore affect NLR, PLR, and LMR values [6]. Consequently, it will be more valuable to exclude patients who use drugs that may affect laboratory parameters. Besides, plasma inflammatory biomarkers are time-dependent variables. The time of sample collection and the time from the onset of the symptom to the sampling may impact the parameters [3-6]. Therefore, it is essential to identify the time from the first symptom to sample collection and the factors that may affect it. In conclusion, because NLR, PLR, and LMR can be affected by many factors, prospective studies with large populations are needed to show the accuracy of use in critically ill patients

Attitudes of non-physician health workers working in the Emergency Department towards euthanasia, death, and the terminally patient

Aim: The use of the right to die in the center of the individual's own decision is called euthanasia. This decision, was evaluated from legal, religious, and medical perspectives. In different countries applied euthanasia, which can be performed actively or passively. In our study, we planned to investigate the perspectives of healthcare professionals working in the emergency department about euthanasia and their thoughts on diseases that can be applied to euthanasia. Material and methods: A survey was conducted from June to October 2022 on non-physician health workers working in the Emergency department. A questionnaire including demographic data, professional knowledge, and Attitude Scale towards Euthanasia, Death, and the Terminally Patient was administered to the healthcare professionals who agreed to participate in the study. The obtained data were analyzed. Results: In the study, the feedback of 60 participants, 37 of whom were women, was evaluated. The mean age of the entrants was found to be 39.07±10.11 years. 60% of the participants had received cardiopulmonary resuscitation training in the past year. 70% of the participants stated that they could be euthanized for coma, 38.33% for severe disability, and 36.67% for severe and incurable neurological diseases. Conclusion: In the process of euthanasia, which does not have a legal infrastructure in our country, different perspectives are seen from different departments of health services. Key words: emergency department, euthanasia, non-health worker

Karın ağrılı hastalarda ortalama trombosit hacmi bir belirteç olarak kullanılabilir mi?

Amaç: Kolay elde edilebilirlik ve yaygın kullanım imkanı akut karın ağrılı hastaların erken tanısında biyokimyasal belirteçleri oldukça önemli hale getirmektedir. Bu çalışmada akut karın ağrısı ile acil servise başvurup yatışı yapılan hastalarda ortalama trombosit hacmi MPV ’nin tanısal değerinin araştırılması planlandı. Gereç ve Yöntem: Ocak 2012 -Mart 2013 tarihleri arasında acil servise başvuran 812 hasta ile 45 sağlıklı kişinin kayıtları retrospektif olarak incelendi. Kayıtlardan olguların; yaş, cinsiyet, fizik muayene bulguları, 5.gün MPV, platelet, nötrofil lenfosit oranı, lökosit, C-reaktif protein CRP ile MPV değerleri aralarındaki ilişki incelendi.Bulgular: Çalışmaya alınan hastaların 467’sini %57,5 erkekler, 345’ini %42,5 kadınlar oluşturmuştur. Hastaların yaş ortalamaları 53,09±0,75’dir . Hastaların kesin tanıları incelendiğinde en sık safra kesesi ve koledok patolojileri %18,7 , ikinci sırada nonspesifik karın ağrısı %17,3 , üçüncü ise ileus-volvulus %13,8 idi. Çalışmaya alınan 812 hastanın 5. gün MPV ortalama değeri 8,358±1,046 fL, platelet değerleri ortalama 246,82±91,3 u/L, nötrofil lenfosit oranı ortalama değeri 10,025±12,75 u/L olarak bulundu. Çalışmadaki akut karın ağrılı hasta grubunda giriş MPV değerleri ortalama 7,869±1,071 fL, sağlıklı kontrol grubu MPV değerleri ortalama 8,47±1,058 fL olup, hasta grubunun ortalama MPV düzeyi, sağlıklı bireylerden daha düşüktü. Sonuç: Pankreatit ve ileus-volvulus tanısı alan hastalarda MPV’nin tanıya yardımcı bir belirteç olabileceğini düşünmekteyi

Incidental Findings of Computed Tomography Angiography in Patients Suspected to Pulmonary Embolism; a Brief Report

Introduction: Computed tomography pulmonary angiography (CTPA)  scans are increasingly used in emergency department (ED). Therefore, the observation of incidental findings (IFs) has also increased. This study aimed to evaluate the frequency of IFs in patients who underwent  CTPA. Methods: All consecutive patients that underwent CTPA scanning for pulmonary embolism (PE) rule out between January  2017 and June  2018  were analysed. Incidental findings were divided into and reported in three categories: group 1 potentially life-threatening, group 2 required follow up, and group 3 with limited clinical significance. Results: 151 cases with the mean age of  61.2 ± 17.6 years were studied (54.3% female). PE was documented in 77 cases (50.9%). 448 IFs were detected (3 IFs were found per patient). 60 (13.3%) IFs were classified as group 1, 180 (40.1%) as group 2, and 208 (46.6%) as group 3. Cardiomegaly was the most frequent finding in group 1 (n=32), followed by aortic aneurysm (n=13). In group 2, pleural effusion (n=58) and pneumonia (n=36) were the most frequent incidental findings. Lung structure changes (n=92) and thoracic bone related findings (n=43) were the most common IFs observed in group 3. Conclusion: IFs were detected in the majority of patients that underwent CTPA. Most of these findings do not require follow-up or treatment. However, more than 50% of cases may require further diagnostic evaluation (40.1%) or immediate treatment (13.3%).Â

Acil Servise Başvuran İş Kazalarının Değerlendirilmesi

Amaç: İş kazaları önemli bir mortalite ve morbidite nedenidir. Ayrıca meydana getirdiği tedavi giderleri ve iş gücü kayıpları nedeni ile ekonomik açıdan ciddi yüklere sebep olmaktadır. Bu çalışmanın amacı, hastanemize başvuran iş kazalı hastaların demografik bilgileri, yaralanmaların özellikleri, acil servis maliyetleri ve bunlar arasındaki ilişkiyi incelemektir.Gereç ve Yöntem: 01.01.2017–31.12.2017 tarihleri arasında hastanemiz acil servisine başvuran 18 yaş ve üzeri iş kazalı 323 hasta çalışma kapsamına alındı. Veriler hastane bilgi sistemi ve hasta dosyalarının geriye dönük olarak incelenmesiyle elde edildi.Bulgular: Çalışma grubunun yaş ortalaması 34,03±9,8 idi. Olguların %89,8’i erkekti. Yaralanmalar en sık 28-47 yaş grubunda %62,9 görüldü. Acil Servis başvurularında yıl içinde en çok Aralık ayında görüldü. Günlere göre dağılımda en sık Salı günü, gün içinde ise en sık 08.00-16.00 saatleri arasında artış göstermekteydi. Olguların %24,1’i inşaat alanında çalışmaktaydı. Yaralanmaların %66,6’sının işe başladıktan sonraki ilk dört saat içerisinde olduğu belirlendi. Çalışma grubunda taburculuk oranı %69 idi. En fazla konsültasyon işlemi plastik ve rekonstrüktif cerrahi ile yapıldı. Ortalama acil servis maliyeti 119,40±115,38 TL idi. Eğitim durumu azaldıkça kazanın maliyetinin anlamlı olarak arttığı saptandı. Sonuç: İş kazalarının ve kaza neticesinde oluşacak kayıpların azaltılabilmesi için koruyucu faktörlerin yanı sıra, yaralanmaya yatkınlık oluşturacak etmenlerin de sorgulanması ve kaydedilmesi gereklidi

Association of Platelet to Lymphocyte and Neutrophil to Lymphocyte Ratios with In-Hospital Mortality in Patients with Type A Acute Aortic Dissection

Abstract Objective: To evaluate the relationship between neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) with in-hospital mortality in type A acute aortic dissection (AAD). Methods: A total of 96 patients who presented to the emergency department between January 2013 and June 2018 with a diagnosis of type A AAD were enrolled in this study. White blood cell count subtypes such as NLR and PLR were calculated at the time of admission. The end point was in-hospital mortality. Results: Of the 96 type A AAD patients included in this analysis, 17 patients (17.7%) died during hospitalization. NLR and PLR were significantly elevated in patients with type A AAD (P<0.001 and <0.001, respectively). Based on the receiver operating characteristic curve, the best NLR cut-off value to predict in-hospital mortality was 9.74, with 70.6% sensitivity and 76.8% specificity, whereas the best PLR cut-off value was 195.8, with 76.5% sensitivity and 78.1% specificity. Conclusion: Admission NLR and PLR levels were important risk factors and independently associated with in-hospital mortality of type A AAD patients

Can the quick Sequential Organ Failure Assessment (qSOFA) score, combined with plasma lactate concentration, predict the mortality for patients with infections in the emergency department?

Aim: Few studies have looked at the predictive role of plasma lactate measure combined with the score of quick sequential organ failure assessment (qSOFA) on hospital mortality. The aim of the study was to investigate whether the score of qSOFA combined with plasma lactate is independently associated with in-hospital mortality among patients with infections in the emergency department (ED).Methods: Scores of qSOFA and plasma lactate measurements of 60 patients in ED were collected prospectively from May 2017 to March 2018. We used the area under receiver operating characteristic curve (AUC) and sensitivity analysis to compare the applicability of qSOFA score alone and qSOFA score combined with lactate level for patient mortality.Results: Thirteen patients (21.6%) died in the hospitalization period. According to the qSOFA alone, qSOFA score combined with lactate measurement was more successful (AUC = 0.798 vs. 0.885 p&lt;0.001, respectively). When qSOFA was used alone, sensitivity and specificity were 92% and 54%, otherwise those of the combined with lactate measurement were 100% and 43%, respectively (p&lt;0.001). Conclusion: Combining the qSOFA with lactate has higher sensitivity for patient mortality than that seen with qSOFA alone