The additional ımpact of simulation based medical training to traditional medical training alone in advanced cardiac life support: a scenario based evaluation

Objectives. The principal aim of medical education is to provide medical student with the fundamental knowledge and required skills that can be specifically used in real-life conditions such as high-quality cardiopulmonary resuscitation (CPR). Traditional medical training (TMT) is an effective method in Advanced cardiac life support (ACLS) training. Simulation-based medical training (SBMT), with the advancements in technology, is a relatively new, but a preferred ACLS training method since it implements a safe educational environment. We planned a scenario-based study to evaluate the additional impact of SBMT to TMT alone in ACLS training. Methods. This before-after type, comparative, cohort study was performed in a simulation center. One hundred thirty-six 6th grade medical students who took ACLS training with TMT on their emergency medicine clerkship were enrolled in 34 teams. All students managed a specific ACLS scenario before and after SBMT with a high-fidelity manikin. All data regarding chest compression, airway management, defibrillation and drug administration were recorded by the sensors of the high-fidelity manikin. Results. Median age was 23 and 51.5% were male. After SBMT, we found significant increases in the successful CPR cycle rate and successful scenario completion rate (60.3%; 61.8%, respectively). Median time to chest compression (Tcc) and defibrillation (Tdef) were significantly decreased after SBMT (1 sec., 1 sec., respectively). For the adequacy of chest compressions, compression depth, recoil, and frequency are all significantly increased after SBMT, 7.0 mm, 6.0 mm and 8.5/min, respectively. Conclusion. SBMT in combination with TMT is a promising ACLS training method when compared to TMT alone

Metastatic Serous Carcinoma Initially Presented As An Incarcerated And Strangulated Umbilical Hernia: A Rare Case Report

Introduction: We report a rare case of a metastatic serous ovarian carcinoma presented as an incarcerated and strangulated umbilical hernia.Presentation of case: A 54 year-old female was admitted to the hospital with a painful mass around the umblical region. It was elucidated during clinical history that the mass had been present for 3 to 4 years without pain. An incarcerated and strangulated umbilical hernia including a solid mass and mesenteric fat was detected on physical examination. She underwent an urgent operation for strangulated umbilical hernia. The pathological diagnosis of the hernia material was reported as carcinoma compatible with serous ovarian carcinoma metastasis. Concurrently, total abdominal histerectomy and bilateral salphingo-oopherectomy, pelvic and paraaortic lymph node dissection, omentectomy and sigmoid colon resection were performed. Histopathological evaluation confirmed the serous carcinoma originated from the left ovary.Conclusion: In the literature, some metastatic tumors have been reported to be presented as umbilical metastasis rarely. However, the present case is the first metastatic ovarian cancer that initially presented as an incarcerated and strangulated umbilical hernia in the literature, to the best of our knowledge. 

A Non-invasive method for assessment of intravascular fluid status: Inferior vena cava diameters and collapsibility index

Objective: To evaluate the correlation between central venous pressure (CVP) and inferior vena cava (IVC) diameters measured by ultrasonography (Ultrasound) in critically ill patients. Methods: Intubated critically ill patients were enrolled. The CVP values were measured using a U-tube manometer and were compared to the IVC diameters and collapsibility index, which were measured by bedside Ultrasound. Patients younger than 18 years old, who were not intubated, who had an abdominal pressure greater than 12 mmHg, and/or who were admitted for trauma were excluded from the study. Results: Eighty three patients with a mean age of 73.6 +/- 11.2 years were enrolled. The most common diagnosis was sepsis (21 patients, 25.30%). IVC inspiration measurements were statistically significantly correlated with CVP measurements (p0.05, r: 0.1). IVC collapsibility measurements showed a negative correlation with CVP measurements (p<0.01, r: 0.68). Conclusions: There is a strong correlation between CVP and IVC diameters and the collapsibility index. This is a new formula for evaluating CVP, based on our statistical analyses

Use of Ultrasound for Diagnosis of Clavicle Fractures in the Emergency Department

Background: Plain radiography is the method for diagnosing the fracture of the clavicle. The use of US to diagnose clavicle fracture has several advantages when compared to radiography. It could prevent the patient from radiation exposure, especially in vulnerable populations. It may also expedite the diagnosis and decrease the length of stay in the ED. In this study we aimed to discuss the diagnostic success of ultrasonography versus x-ray. Materials and Method: All patients admitted to the emergency department with a shoulder trauma were investigated for their eligibility to be included in the study. A standardized ultrasonography performed by the same investigator to vizualise clavicle from sternal junction through acromial junction. After ultrasonography, plain radiography was performed. Results: The mean age was 45.53 (min = 18; max = 86; SD = 18.791) years and 72.7% were male. Among all patients, 42 clavicula fractures were detected via graphy and 26 (62%) were seen in males and 57 patients with no clavicle fractures. The sensitivity of US to radiographically detected fracture was 92.86% (95%CI, 80.52% to 98.5%), and the specificity was 98.25% (95% CI = 90.61% to 99.96%). The PPV was 97.5% (84.8% to 99.63%) and the NPV was 94.92% (95% CI = 86.23% to 98.23%). Conclusions: Ultrasonography is a good alternative for diagnosing clavicle fracture. Future studies should examine the use of ultrasonography as a method for diagnosing of clavicle fracture by emergency physicians with only basic ultrasonographic training

Comparison of ketamine/propofol (ketofol) and etomidate/fentanyl (etofen) combinations for procedural sedation and analgesia in the emergency department: An observational study

Objectives: The primary aim of this study was to report the vital signs, hemodynamic parameters and pain scores of the patients who have received procedural sedation and analgesia (PSA) with either ketofol (combination of ketamine and propofol) or etofen (combination of etomidate and fentanyl) and compare the proportion of patients with airway or respiratory adverse events (AEs) requiring an intervention and calculate the relative risk of AEs with each combination. Methods: This study is a prospective observational study with survey analysis. All patients received procedural sedation and analgesia (PSA) with either ketofol (combination of ketamine and propofol) or etofen (combination of etomidate and fentanyl) were prospectively observed. Vital and hemodynamic parameters and pain scores of the patients were recorded by automated equipment and visual analog scale (VAS) charts. Results: 112 patients were enrolled, 55 received ketofol and 57 received etofen. All patients with a respiratory AE (n = 27) observed to receive a respiratory intervention. Respiratory AE rate and proportion of patient who required a respiratory intervention were significantly higher with ketofol (p = 0.0029). Overall AE rate, and rates of desaturation, emergence reaction were also significantly higher in ketofol group. Conclusion: Etofen is a promising combination for the PSA of adult patients with lower respiratory AE and intervention rates and with better hemodynamic profile. Copyright (C) 2017 The Emergency Medicine Association of Turkey. Production and hosting by Elsevier B.V. on behalf of the Owner

Which is more effective for the treatment of Acute Migraine Attack: Dexketoprofen, Ibuprofen or Metoclopramide?

Objective: The aim of this study was head-to-head comparison of the efficacy and rate of adverse events of metoclopramide, ibuprofen and dexketoprofen for the acute treatment of migraine attack in the real-life conditions of a busy emergency department (ED). Methods: This was a prospective, observational, cross-sectional study. All patients who presented to the ED with a headache fulfilling the inclusion criteria were enrolled. All patients were treated by the attending emergency physicians in their daily routine. If an IV treatment in the ED was found indicated by the EP, they selected one of the options in the written departmental migraine treatment protocol. Results: During the study period, 54 patients met the inclusion criteria. The median change in the pain score was significantly different among treatment options (p<0.0001). The median pain score change at the end of the 30 minutes for treatment groups were 7.5 mm (IQR: 7.0-8.0), 5.0 mm (IQR: 4.75-7.0), and 7.0 mm (IQR: 6.0-7.25), respectively (p=0.0002). All three groups were found to be significantly different from each other in the post-hoc analysis. Conclusion: All drugs compared in this study are effective in the relief of migraine headache. However, IV dexketoprofen seems to be faster and more effective than metoclopramide and ibuprofen

Acute Nontraumatic Spinal Subdural Hematoma due to Warfarin

Anticoagulant drugs have been identified in the etiology of acute nontraumatic spinal subdural hematoma. The number of new cases is increasing with the increased use of them around the worldwide. It is was reported that the risk of bleeding increases as INR rises for warfarin treated patients, particularly if the INR exceeds for