According to the 2010 American Heart Association guidelines, quantitative waveform capnography is recommended as the most reliable method for confirming endotracheal tube (ET) placement 2.
Aim: This study aimed to evaluate the impact of Turkey’s first European accredited 2-day point-of-care ultrasonography (POCUS) course on the theoretical knowledge and practical skills of physicians. ...Materials and Methods: Forty physicians and five lecturers attended the course. All the lectures were arranged as per the POCUS Curriculum Guidelines given by the International Federation of Emergency Medicine. At the beginning and the end of the course, a theoretical exam was conducted with the same set of questions. Practical skills were evaluated at the hands-on training stations using checklists. Pre-test and post-test results were statistically compared. Results: All the attendants of the course were included in the study. The numbers of the correct pre-test and post-test answers were 1.23±0.89 and 1.95±0.64 for abdominal aorta ultrasound (USG), 3.23±1.27 and 5.08±1.07 for cardiac USG, 0.95±0.68 and 1.78±0.42 for USG physics, 3.03±1.42 and 4.48±1.11 for expanded-focussed assessment with sonography in trauma, 1.75±0.74 and 2.35±0.62 for hepatobiliary USG, 1.4±0.71 and 1.85±0.36 for inferior vena cava USG, 1.18±0.55 and 1.48±0.51 for renal USG and 1.88±1.04 and 2.7±0.82 for lung USG, respectively. All the differences were statistically significant. Conclusion: The study shows that our 2-day basic course has effectively conveyed the fundamental POCUS knowledge and skills.
The objective of this study was to determine whether bedside visual estimates of left ventricular systolic function (LVSF) by emergency physicians (EP) would agree with quantitative measurement of ...LVSF by the modified Simpson's method (MSM), as recommended by the American Society of Echocardiography.
After limited focused training, 2 trained EPs performed bedside echocardiography (BECH) procedures s between January and June 2012 to prospectively evaluate patients presenting to the emergency department (ED) with dyspnea. EPs categorized their visually estimated ejection fractions (VEF) as either low or normal. Formal echocardiography were ordered and performed by an experienced cardiologist using the MSM and accepted as the criterion standard. We compared BECH results for each EP using chi-squared testing and performed correlation analysis by Pearson correlation coefficient.
Of the 146 enrolled patients with dyspnea, 13 were excluded and 133 were included in the study. Comparison of EPs vs. cardiologist's estimate of ejection fraction yielded a Pearson's correlation coefficient of 0.77 (R, p<0.0001) and 0.78 (R, p<0.0001). Calculated biserial correlations using point-biserial correlation and z-scores were 1 (rb, p<0.0001) for both EPs. The agreement between EPs and the cardiologist was 0.861 and 0.876, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and the positive and negative likelihood ratios for each physician were 98.7-98.7%, 86.2-87.9%, 0.902-0.914, 0.980-0.981, 7.153-8.175, 0.015-0.015, respectively.
EPs with a focused training in limited BECH can assess LVSF accurately in the ED by visual estimation.
Image in medicine A 44-year-old woman presented to our emergency department with fever, right flank and abdominal pain for one week. Figure 1 (A) abdominal X-ray and computed tomography showing ...emphysematous pyelonephritis; (B) ultrasonography shows echogenic foci with ’'dirty’’ shadowing within the kidneys; on CT the collections of gas are seen directly as hypoattenuating foci in the renal lodge 1 Izmir Katip Çelebi University Atatürk Training and Research Hospital, Department of Emergency Medicine, Karabaglar, Izmir, Turkey 2 Izmir Karsiyaka State Hospital, Emergency Department, Karsiyaka, Izmir, Turkey
The aim of this study is to compare the diameter of the inferior vena cava with tricuspid annular plane systolic excursion (TAPSE) measurement in order to determine the volume loss before and after ...blood donation in healthy volunteers.
This Institutional Review Board-approved single center, prospective, cross-sectional study included 60 healthy blood donors donating in a tertiary care hospital's blood bank. After obtaining written consent, systolic, diastolic, and mean arterial blood pressures along with pulse rate of the donors were measured in sitting and supine positions by the attending physician, then, inferior vena cava (IVC) and TAPSE measurements were made before and after blood donation.
Statistically significant differences was found between standing systolic blood pressure and pulse rate, lying systolic blood pressure and pulse rate, IVC and TAPSE values before and after blood donation (p < 0.05). There was no difference between the other variables before and after blood donation.
Our study revealed that, low IVC and TAPSE values correlated in determining blood loss after blood donation. TAPSE may be useful to predict blood loss in early stages of hypovolemic shock.
The aim of this study was to investigate the effect of compression on the Visual Analog Scale (VAS) score following the application of 3-in-1 femoral nerve block (FNB), used for pain palliation in ...patients with hip fractures.
This was a randomized controlled trial study on application of pressure versus no pressure following FNB in patients with hip fractures. Their VAS scores were recorded and an ultrasound-guided 3-in-1 FNB was performed as a standardized procedure. After the procedure, patients were randomized into two groups and a weight with 2 kg pressure was applied to the treated area in one group. After 30 min, VAS scores were recorded again. VAS scores of all patients recorded before and after the procedure, and post-procedural VAS scores of pressure-applied and no pressure-applied groups were statistically compared.
34 patients were included in this study with 17 patients falling in the compression group (group C), and the remaining half in the non-compression group (group NC). The pre-procedural mean VAS scores were 9.35 (95% CI; 8.95–9.76)), while the post-procedural mean VAS scores dropped to 2.35 (95% CI; 1.65–3.06) in group C. The pre-procedural mean VAS score was 9.12 (95% CI; 8.64–9.59), while the post-procedural mean VAS score was 5.06 (95% CI; 4.09–6.03) in group NC.
When the average reductions in VAS score following the procedure were compared, the mean difference between the two groups was calculated to be 2.94 (95% CI; 1.69–4.19) which favours group C. This difference was statistically significant (p < 0.001).
Our study shows that, the application of simple compression after 3-in-1 FNB in patients with hip fractures provides a significant reduction in VAS scores.
Abstract Dyspnea is a common symptom among emergency department (ED) patients. The differential diagnosis of dyspnea in ED patients is broad, and pulmonary embolism (PE) is a crucial consideration ...among these. Recognition of right ventricular (RV) dysfunction is critical in patients with PE. Here, we present a 76-year-old male patient with the complaint of dyspnea. Focused cardiac ultrasonography performed by the emergency physician revealed enlarged RV, hypokinetic lateral wall and hyperkinetic apex of RV (McConnell's sign). We have screened the deep venous system of the patient with the linear probe for possible deep venous thrombosis and showed that the right dilated uncompressible popliteal vein had a thrombus formation. Computed tomography angiography of the thorax revealed filling defects in both main pulmonary arteries. Our case shows that bedside ultrasonography is a valuable tool for detecting PE and decision making in PE patients.
Radial artery puncture has been performed by palpation as a standard method in many emergency departments and intensive care units. Nurses play an important role in the care of patients in various ...settings. Ultrasonography can be performed and interpreted not only by physicians but also by nurses. This study aimed to evaluate whether emergency nurses would be more successful in radial artery puncture procedure by using ultrasonography instead of palpation.
This single-center, prospective, randomized controlled study was conducted in the emergency department. The patients included in the study were randomized into 2 groups as ultrasonography and palpation groups. Data were recorded on the number of interventions, the duration of the procedure in seconds, total time in seconds, whether the puncture was successfully placed, whether there were complications, the types of complications (hematoma, bleeding, and infection), or whether it was necessary to switch to an alternative technique.
A total of 72 patients, 36 patients in the ultrasonography group and 36 patients in the palpation group, participated in the study. The success rate at the first attempt was statistically significantly higher in the ultrasonography group. Although hematoma formation among the complications occurred in the entire palpation group, it was observed in 72.2% of the ultrasonography group. Puncture time and total time were statistically significantly lower in the ultrasonography group.
Our study shows that emergency nurses can use bedside ultrasonography for radial artery puncture successfully.
The earliest definition of transfusion-related acute lung injury (TRALI) included all patients who developed acute respiratory distress, moderate to severe hypoxemia, rapid onset of pulmonary edema, ...mild to moderate hypotension, and fever within 6 hours of receiving a plasma containing blood transfusion. The definition excluded patients if they had underlying cardiac or respiratory disease. The mechanism is not known exactly but it causes morbidity and mortality. Incidence of TRALI changes between 0.08% and 15% of patients receiving a blood transfusion. A 78 year old female patient with history of myelodysplastic syndrome, coronary artey disease and hypertansion, was admitted to the hospital because of dyspnea after the blood transfusion. She was managed as TRALI after diagnostic workup and transported to the intensive care unit. In the following days her clinical status changed dramatically with complete recovery.
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