Update This article was updated on June 17, 2022 because of a previous error. On page 33, in the section entitled “17 - Does administration of tranexamic acid (TXA) to patients undergoing orthopaedic procedures increase the risk of subsequent VTE?”, and in the note on page 161, the name “Armin Arish” now reads “Armin Arshi.” An erratum has been published: J Bone Joint Surg Am. 2022 Aug 3;104(15):e69. 

Recommendations from the ICM-VTE: General

Opioid analgesics are used commonly in end-stage cancer patients for pain treatment. Central nervous system adverse effects are rare. A73-year-old female patient was admitted to the emergency department for auditory and visual hallucinations. The patient had been receiving palliative treatment for liver, cervical, and lumbar bone metastases from an unknown origin. The patient used a transdermal fentanyl patch for palliative pain management and metoclopramide hydrochloride for nausea and vomiting. The patient had suffered weight loss of 10 kg within 5 months, and laboratory findings revealed hypoalbuminemia. The patient was considered to have experienced a fentanyl overdose, and the transdermal fentanyl patch treatment was stopped. The hallucinations improved during follow-up, and the patient was discharged with a dose adjustment. End-stage cancer patients with weight loss and hypoalbuminemia may be more prone to opioid adverse effects, such as hallucinations. The dose of fentanyl must be adjusted for weight loss, and correction of hypoalbuminemia may also lower the incidence of such adverse effects.

Neuropsychiatric side effects due to a transdermal fentanyl patch: hallucinations

There is probably not a year that goes by when injuries or deaths do not occur at incidents involving crowds. The internet resource of Still provides an insight into over 160 such incidents that have occurred between 1902 and December 2014 [1]. Examples of incidents covered at this site as well as within the published literature or accessible on Internet based resources include those involving football stadia, underground stations, gymnasia, nightclubs, access tunnels, religious and music festivals, as well as riverfronts, bridges and railway stations [2–22]. Although the cause of the incident may be suggested to be the action of the crowd, the crowd is often not the underlying cause. Rather it is the inappropriate utilisation of space and the failure of the organisers of the event or location to provide a safe environment for the crowd.

Death in Crowds

Introduction and aim. Acute cholecystitis is one of the most common hepatobiliary emergencies. We aimed to investigate the role of the initial hematological inflammatory index and systemic immuno-inflammation index in predicting short-term mortality in patients with acute cholecystitis. Material and methods. This study with a retrospective observational design was conducted at the emergency department of a tertiary teaching hospital. Patients admitted to our clinic between June 15, 2021, and March 15, 2022, according to the Tokyo criteria were included in the sample. The hematological inflammatory index and systemic immuno-inflammation index were calculated using the hematological test results of the patients evaluated at the emergency department. Survivor and non-survivor groups were formed according to all-cause 30-day mortality. The differences between survivor and non-survivor groups were investigated. Results. A total of 194 patients were included in the final analysis. The median age of the study population was 59 (25th–75th percentiles: 46.75–72) years. The rate of all cause-short-term mortality was 7.7. There were significant differences between the survivor and non-survivor groups in terms of the neutrophil count and the systemic immuno-inflammation index (p=0.007, 0.034, respectively; Mann-Whitney U test). No significant difference was found in the remaining laboratory parameters (lymphocyte count, platelet count, and hematological inflammatory index) (p=0.220, 0.489, 0.367 respectively; Mann-Whitney U test). Conclusion. The systemic immuno-inflammation index was determined to be significantly higher in the non-survivor group than in the survivor group among the patients with acute cholecystitis. However, there was no significant difference between these two groups in relation to the hematological inflammatory index.

The role of the hematological inflammatory index and systemic immuno-inflammation index in acute cholecystitis

Traumatic asphyxia is a rare syndrome caused by blunt thoracoabdominal trauma and characterized by cyanosis, edema, and subconjunctival and petechial hemorrhage on the face, neck, upper extremities, and the upper parts of the thorax. Traumatic asphyxia is usually diagnosed by history and inspection; however, the patient should be monitored more closely due to probable complications of thoracoabdominal injuries. Treatment is conservative, but the prognosis depends on the severity of the associated injuries. Herein we present a traumatic asphyxia due to an elevator accident in a 32-year-old male patient and discuss the diagnosis, treatment, and prognosis by reviewing the relevant literature.

/pdf/a-rare-and-serious-syndrome-that-requires-attention-in-h82mclfqdg.pdf

A Rare and Serious Syndrome That Requires Attention in Emergency Service: Traumatic Asphyxia

Traumatic asphyxia is a rare syndrome in which the thoracoabdominal region is exposed to pressure and it presents with cervicofacial cyanosis and oedema, subconjunctival haemorrhage, and petechial haemorrhage in the face, neck and upper part of chest. In this report we present a 28 year old male patient whose whole body except the head and neck stayed under soil for about 30 minutes as an example case in order to review traumatic asphyxia syndrome.

/pdf/review-of-traumatic-asphyxia-syndrome-with-a-case-504ramh3ry.pdf

Review of Traumatic Asphyxia Syndrome with a Case Presentation

SUMMARY Objektive: The purpose of our study was to investigate the relationship between the pulmonary artery obstruction index (PAOI) assessed with helical computed tomography (CT) and impairment in blood gases in patients with acute pulmonary embolism (PE). Method: This retrospective study design was carried out in the Tertiary Training and Research Hospital Emergency Clinic over a 6-month period with patients in whom PE was detected. The Alveolar–arterial (A-a) oxygen gradient for oxygen was calculated according to the formula 150 – 1.25 (PaCO2 – PaO2), and the PAOI for each patient was measured with the Qanadli score at the mediastinal window using chest CT angiography (CTA). Results: There were 113 patients included in the study; their mean age was 61.40 (±16.082) years and 51.4% of the patients were female. The mean Alveolar–arterial (A-a) oxygen gradient value was 65.13(±18.78) in massive embolism group. The mean PAOI was determined as 34.027 (min:7.5, max:83.7). The relationship between the radiologically measured PAOI and the Alveolar–arterial (A-a) oxygen gradient were compared, and an increase in the index was detected as the Alveolar–arterial (A-a) oxygen gradient level increased;this difference was found to be statistically significant (r=0.400; p<0.001). Conclusions: This retrospective observational study found a weak but positive correlation between the PAOI and the Alveolar–arterial (A-a) oxygen gradient. Our study showed that consideration of the Alveolar–arterial (A-a) oxygen gradient increases the sensitivity of blood gas analysis in documented pulmonary embolism.All data showed that the Alveolar–arterial (A-a) oxygen gradient values may be clinically beneficial, as such testing is easy to perform and cost-effective.Moreover, it can be performed at the bedside to detect which patients should be treated with thrombolytics. Keywords : Pulmonary Embolism, Arterial–Alveolar Gradient, Pulmonary Artery Obstruction Index OZET Amac: Calismamizin amaci akut pulmoner emboli saptanan hastalarda helikal bilgisayarli tomografi ile hesaplanan pulmoner arter obstruksiyon indeksinin (PAOI) kan gazi parametrelerinden alveolar-arterial oksijen gradienti ile iliskisinin arastirilmasidir. Yontem: Bu retrospektif calismaya 3. Basamak egitim arastirma hastanesi acil tip klinigine 6 aylik donemde basvuran ve pulmoner emboli tespit edilen hastalar dahil edildi. Alveolar-arterial oksijen gradient  ‘’150-1,25(PaCO2-Pa02)’’ formulu ile hesaplandi. Bulgular: Calismaya 113 hasta dahil edildi. Hastalarin yas ortalamasi 61.40 (±16,082) ve %51.4’ u bayandi. Alveolar-arterial oksijen gradient ortalamasi masif emboli grubunda 65,13 (±18,78) saptandi. PAOI ortalamasi 34,027 (min:7,5 max:83,7) idi. PAOI ile alveolar-arterial oksijen gradienti arasindaki iliski karsilastirildiginda alveolar-arterial oksijen gradienti yukseldikce pulmoner arter obstruksiyon indeksinin arttigi ve bu iliskinin istatistiksel olarak anlamli oldugu goruldu (r=0,400 p<0,001). Sonuc: Bu retrospektif gozlemsel calismada PAOI ile alveolar-arterial gradient arasinda zayif ancak pozitif bir korelasyon saptandi. Calismamiz pulmoner emboli saptanan hastalarda kan gazi analizinde P(A-a) O2 gradientinin sensitivitesinin arttigini gosterdi. Butun datalar alveolar-arterial oksijen gradientin kolay uygulanabilinir, dusuk maliyetli ve faydali olabilecegini gostermektedir. Dahasi yatak basi uygulamada trombolitik tedavi planlanan hastalarda tanisal alternatif bir secenek olarak kullanilabilir. Anahtar sozcukler: Pulmoner Emboli, Alveolar-arterial gradient, Pulmoner Arter Obstruksiyon indeksi

https://dergipark.org.tr/en/download/article-file/252552

Correlation of alveolar–arterial gradient with Computed Tomography Pulmonary Artery Obstruction index in acute Pulmonary Embolism

Objective: Our purpose in this study was to determine the accuracy and reliability of interpretation of basic arterial blood gas (ABG) values and ABG values related to metabolic and respiratory disease by emergency medicine residents (EMRs). We also aimed to determine their deficiencies and create a basis for training during patient care. Material and Methods: This study was carried out through a survey taken by EMRs in training/research and university hospitals located in Ankara. The levels of knowledge of EMRs on ABG evaluation were compared based on the institution, duration of residency, and training. A 14-question test about ABG knowledge was also applied to residents. Results: The study was conducted with 25 EMRs in university hospitals (UH) and 88 EMRs in training/research hospitals (TRH); a total of 113 residents participated to the survey. There was no statistical significant difference between training/research and university hospitals according to the number of correct answers given. Year of residency did not affect the number of correct answers; however, residents who had training on ABG analysis in the residency period had more correct answers. Also, in a small study group (n=17), a significant improvement of the number of correct answers was observed with a short institutional course. Conclusion: According to the results, ABG evaluation improves with personal training in the residency period independently of residency years. Based on this result, training should be given in and out of institutions, and EMRs should be encouraged to personally study ABG evaluation. (JAEM 2014; 13: 100-3)

Evaluation of Emergency Medicine Residents' Level of Knowledge of Arterial Blood Gases

Fentanyl is a potent and short-acting narcotic analgesic which is used in the treatment of acute and chronic pain. Transdermal fentanyl have been widely used in the treatment of cronic pain. The side effects of transdermal fentanyl are similar to other opioids side effects. In this report we presented an 80 years old patient with lumbago who developed opiate toxicity after using one dose of fentanyl patch.

Can Using Only A Single Transdermal Fentanyl Patch Be Fatal

GEREÇ ve YÖNTEM: Bu çalışmaya sağ üst kadran ağrısı ile başvuran 318 yetişkin hasta dahil edildi. Bu hastalar 1 Temmuz31 Aralık 2013 tarihleri arasında medikal kayıtları olan sağ üst kadran ultrasonografisi yapılan hastalardı. Hastalar AC, kolelitiazis ve patology olmayan grup olmak üzere 3 gruba ayrıldı. Ultrasonografik bulguları ve hastanın tam kan sayımı parametreleri kaydedildi. Grupların NLO skorları hastanın kan parametrelerinden hesaplandı.

Akut Kolesistit-Kolelitiazis Ayırıcı Tanısında Nötrofil/Lenfosit Oranının Klinik Önemi

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