An unanticipated diagnosis with bedside ultrasonography in patients with acute abdominal pain: rectus hematoma

Although abdominal pain is a common presentation in emergency departments, rectus sheath hematoma (RSH) is among the rarest diagnosis. Here we present 2 cases of RSH likely caused by coughing due to upper respiratory tract infection. The two described cases were diagnosed by bedside ultrasonography and confirmed as RSH by computed tomography. Review of patient history and use of ultrasonography are important to avoid misdiagnosisof RSH.Keywords: Abdominal pain, ultrasonography, hematom

Risk factors for adverse events in patients administered intravenous tramadol hydrochloride in Emergency Department

INTRODUCTION: The aim of the present study was to assess the adverse events developing in patients treating with intravenous(iv) tramadol to provide moderate to severe pain control in emergency department (ED) and to investigate the association of these adverse events with age, sex and vital signs and to compose a set of rules for the identification of patients in the risk group.  MATERIAL AND METHODS: In this prospective cohort study, patients older than 18 years, admitted to ED during a 1-year period and administered iv tramadol were included in a secondary care public hospital. Information about age, sex, vital signs and adverse events were recorded. Patients defined as group 1 or group 2 with respect to adverse event development status and the groups were compared in terms of age, sex and vital signs.  RESULTS: A total of 408 patients were included in the study. Adverse events ratio after treatment was 21.1%. Adverse events were nausea, dizziness and vomiting. The age and the pulse rate per minute of the patients in group 1 were found to be higher and systolic blood pressure (SBP) was found to be lower than the patients in group 2.  CONCLUSİONS: The risk of adverse events development is higher in patients who are hypotensive, tachycardic and older than 56 years. Multicenter, prospective studies with larger patient groups are needed to support our results

Is using metaproterenol sulfate reliable in hypertension management during the coronary artery bypass graft surgery in terms of graft patency?

INTRODUCTION: Coronary artery bypass graft (CABG) surgery that is a basic revascularization method is used commonly and hypertension appears frequently during and after CABG operations. In the treatment of hypertension, metaproterenol sulfate (MS) is one of the main agents; however, the effects of this agent on grafts are not known at an adequate level. The aim of the present study was to determine whether MS could be used safely in CABG operations by examining its effects on coronary grafts.   MATERIAL AND METHODS: This cross-sectional, prospective, experimental study was conducted at a University hospital. In this study, internal thoracic artery (ITA), radial artery (RA) and saphenous vein (SV) graft materials were studied in organ bath in patients who underwent CABG surgery between 2013 and 2016. In the organ bath, 10-6 phenylephrine was added to the grafts to ensure that the ITA, RA and SV grafts contracted submaximally. Then, by adding MS with the cumulative method, the resulting relaxation results were recorded and dose-response curves were created. The p < 0.05 was considered as significant.   RESULTS: A total of 30 patients were included in the study. The average age of the participants was 59.3 (45–81) years. Minimum 1 and maximum 6 grafts (2.96 in average) were taken from all patients. Relaxation response was formed in the ITA at a rate of 40.49% ± 13.52, in the RA at a rate of 28.41% ± 9.08 and in the SV at a rate of 23.87% ± 8.36 by adding MS with the cumulative method. In the statistical work that was done by comparing the relaxation values among the SV grafts, ITA and RA grafts, it was determined that the efficacy of MS in the SV grafts was significantly lower when compared with the ITA and RA grafts.   CONCLUSIONS: In the present study, it was concluded that the risk of developing vasospasm was low in all three grafts when MS was used in intraoperative and postoperative periods. However, in the long-term, this made us consider that better graft patency rates might be obtained. Multicenter in-vivo studies with larger patient groups are needed to support our findings

The impact of lung ultrasound on coronavirus disease 2019 pneumonia suspected patients admitted to emergency departments

Objective The aim of this study was to identify the sensitivity and specificity of lung ultrasound (LUS) and show its place in diagnosing patients with known coronavirus disease 2019 (COVID-19) pneumonia, according to chest computed tomography and the COVID-19 reporting and data system (CO-RADS). Methods Nineteen patients who admitted to a single university hospital emergency department between March 5, 2020, and April 27, 2020, describing dyspnea were included in the study and underwent LUS by a single emergency specialist. The patient population was divided into 2 groups, COVID-19 positive and negative, and the sensitivity and specificity of LUS according to chest computed tomography were calculated for COVID-19 pneumonia diagnosis. In the subgroup analysis, the patient group was divided into real-time reverse transcription-polymerase chain reaction positive (n = 7) and negative (n = 12), and sensitivity and specificity were calculated according to the CO-RADS. Results According to the CO-RADS, significant differences were detected between the LUS positive and negative groups in terms of COVID-19 pneumonia presence. Only 1 patient was evaluated as CO-RADS 2 in the LUS positive group, and 2 patients were evaluated as CO-RADS 4 in the LUS negative group (P = 0.04). The sensitivity of LUS according to the CO-RADS for COVID-19 pneumonia diagnosis was measured to be 77.78% (95% confidence interval [CI], 39.9%-97.1%), specificity was 90% (95% CI, 55.5%-99.75%), positive predictive value was 87.5% (95% CI, 51.35%-97.8%), and accuracy was 84.21% (95% CI, 60.4%-96.62%; P = 0.004). Conclusions In conclusion, LUS is easily used in the diagnosis of COVID-19 pneumonia because it has bedside application and is fast, easy to apply, reproducible, radiation free, safe for pregnant women, and cheap

Evaluation of the awareness of the physicians on negligence and abuse of the elderly patients admitted to emergency department

Introduction: With the increase in the population of the elderly, the negligence and abuse of the elderly (NAE) is increasing at a great pace. Although the rates of NAE in the elderly admitted to emergency depart- ment (ED) is more than the estimated rates, the diagnosis and reporting of such cases are extremely rare. The primary aim of the present study is to evaluate the NAE status in the elderly admitted to ED, the awareness in ED physicians, the attitudes towards these cases and the knowledge levels in this field.  Methods: An electronic questionnaire form that was used as the data collection tool consisted of 19 ques- tions and 2 sections. To call for participation, the questionnaires used in the study were shared with the ED physicians in an online manner between December 2017 and April 2018. The data were analyzed with the SPSS 23.0 Windows computer program with definitive statistics.  Results: A total of 69.4% of the participants faced NAE and 30% did not report this; 79.8% of the partic- ipants stated that they had received training in this field and 9% stated that there was a screening test for the abuse of the elderly. A statistically significant difference was determined between those who received course training in this field and those who received training during medicine faculty education and specialist training.  Conclusions: In this study, it was observed that the NAE rates were more than the estimated rates in the elderly admitted to ED. It was understood that ED physicians did not have adequate knowledge in this field. A new curriculum is needed for the training and education in this field. 

Retrospective analysis of thoracic trauma and evaluation of the factors affecting the duration of stay in the hospital

Background: The aim of this study is to evaluate the epidemiological and demographic features, treatment types of patients with thoracic trauma, as well as the duration of hospital stay and the factors affecting mortality.   Material and Methods: This retrospective cross-sectional study included patients who applied to the emergency room in a tertiary care hospital, between 2017–2019 and having thoracic trauma. Patients; age, gender, date of application, type of injury (blunt or penetran), arrival saturation, use of anticoagulants, type of injury, side of injury (right, left, bilateral) additional injury, hospitalization and mortality status were recorded. P < 0.05 was considered as statistically significant.   Results: Total of 113 people were included in the study. The average age was 52.15 ± 20.3. The most common reason of applying to the hospital was falling with 50 patients. A negative weak correlation was found between saturation and age and hospital stay. In terms of pathology and gender, there was no statistically significant difference in mortality.   Conclusion: As a result, in this study, thoracic trauma occurs mostly in men and due to falls and motor vehicle accidents, and the majority of injuries due to thoracic trauma can heal without follow- up or tube thoracostomy

The Impact of Lung Ultrasound on Coronavirus Disease 2019 Pneumonia Suspected Patients Admitted to Emergency Departments

Objective The aim of this study was to identify the sensitivity and specificity of lung ultrasound (LUS) and show its place in diagnosing patients with known coronavirus disease 2019 (COVID-19) pneumonia, according to chest computed tomography and the COVID-19 reporting and data system (CO-RADS). Methods Nineteen patients who admitted to a single university hospital emergency department between March 5, 2020, and April 27, 2020, describing dyspnea were included in the study and underwent LUS by a single emergency specialist. The patient population was divided into 2 groups, COVID-19 positive and negative, and the sensitivity and specificity of LUS according to chest computed tomography were calculated for COVID-19 pneumonia diagnosis. In the subgroup analysis, the patient group was divided into real-time reverse transcription-polymerase chain reaction positive (n = 7) and negative (n = 12), and sensitivity and specificity were calculated according to the CO-RADS. Results According to the CO-RADS, significant differences were detected between the LUS positive and negative groups in terms of COVID-19 pneumonia presence. Only 1 patient was evaluated as CO-RADS 2 in the LUS positive group, and 2 patients were evaluated as CO-RADS 4 in the LUS negative group (P = 0.04). The sensitivity of LUS according to the CO-RADS for COVID-19 pneumonia diagnosis was measured to be 77.78% (95% confidence interval [CI], 39.9%-97.1%), specificity was 90% (95% CI, 55.5%-99.75%), positive predictive value was 87.5% (95% CI, 51.35%-97.8%), and accuracy was 84.21% (95% CI, 60.4%-96.62%; P = 0.004). Conclusions In conclusion, LUS is easily used in the diagnosis of COVID-19 pneumonia because it has bedside application and is fast, easy to apply, reproducible, radiation free, safe for pregnant women, and cheap