This study demonstrates substantial reliability of Turkey's Ministry of Health's mandatory three-level triage instrument. Significant association was also observed between the triage levels and the validity parameters measured in the study.

BackgroundThere is no evidence regarding the several short‐term prophylaxis protocols for contrast‐induced nephropathy (CIN) that may be most feasibly convenient in emergency settings.ObjectivesThe purpose of this study was to compare the efficacies of short‐term CIN prophylaxis protocols of normal saline, N‐acetylcysteine (NAC) plus saline, and sodium bicarbonate plus saline in emergency department (ED) patients at moderate or high risk of CIN after receiving intravenous (IV) contrast agent.MethodsThis single‐center, randomized, nonblinded clinical trial was conducted in the ED with adult patients requiring contrast‐enhanced computed tomography (CT). Patients with moderate to high risk of CIN according to the Mehran risk score, who consented to participate, were eligible. Patients with continuous renal replacement therapy or who reported contrast allergy were excluded. Enrolled patients were randomly assigned to receive 150 mg/kg NAC in 1000 mL of 0.9% sodium chloride (NaCl), 150 mEq of sodium bicarbonate in 1000 mL of 0.9% NaCl, or 1000 mL of IV saline infusion, all given at 350 mL/hr for 3 hours. All of the patients were administered less than 100 mL of nonionic, low‐osmolality contrast agent. The primary outcome of CIN was defined as a 25% increase or a greater than 0.5 mg/dL increase in the serum creatinine level 48 to 72 hours later compared with the baseline measurement.ResultsA total of 107 patients were randomized to NAC (n = 36), sodium bicarbonate (n = 36), and saline prophylaxis (n = 35). The mean age of the patients was 71 years (95% confidence interval [CI] = 65 to 77 years), and 58 (54.2%) were male. The groups were similar regarding baseline characteristics and nephropathy risks. Of the 16 (14.9%) patients who eventually developed CIN, seven (19.4%) were in the NAC plus saline group, four (11.1%) were in the sodium bicarbonate plus saline group, and five (14.2%) were in the saline group. There were no significant differences between the groups in terms of the prevention of CIN (p = 0.60).ConclusionsNone of the short‐term protocols with normal saline, NAC, or sodium bicarbonate was superior in ED patients requiring contrast‐enhanced CT who had a moderate or high risk of CIN.

SUMMARYObjectivesThis study aims to evaluate the features of rabies suspected animal contact cases in the emergency department and the appropriateness of administering post-exposure prophylaxis procedures according to World Health Organization (WHO) instructions.MethodsRabies suspected animal contact cases that applied to the emergency department between August 2012 and December 2013 were included in the study. Patients’ data were obtained retrospectively from patient files, records of hospital automation system, and the “Rabies Suspected Animal Contact Cases Examination Form”. The post-exposure prophylaxis recommended by the WHO were compared to the prophylactic applications administered by the emergency department.ResultsA total of 515 cases were included in the study. According to WHO classification, cases involving category 3 injuries (n=378, 73.4%) were more common than the others (p>0.0001). Compared to post-exposure prophylaxis recommendations by the WHO, 44.7% of all cases (n=230) were administered inappropriate prophylaxis. Thirty-seven percent of cases received less rabies Ig than recommended, despite category 3 contact. Six percent of cases with category 2 contact were given unnecessary rabies Ig and all cases with category 1 contact (1.5% of all cases) were given unnecessary rabies vaccine.ConclusionsWe observed that in 44.7% of cases, post-exposure prophylaxis was applied inappropriately according to WHO instructions. Not only were there unnecessary vaccine and Ig applications, there were also missing prophylaxis procedures. Updating the current “Rabies Prevention and Control Directive” plus educating and controlling healthcare personnel on a regular schedule may help prevent inadequacies in prophylactic application.

Despite its relatively protected position, the liver is the most frequently injured solid intra-abdominal organ. 1 Most liver injuries can be managed conservatively, but about 5% to 10% require urgent laparotomy, usually when the mechanism of injury involves a vehicle accident and hemodynamic instability persists, in spite of 40 mL/kg of blood transfusion. 2,3 In particular, grades IV and V liver injuries may pose a challenge to the surgeon trying to control hemorrhage, the leading cause of mortality. 4 Traumatic injuries to the portal vein are rare but devastating. The mortality rate for portal vein injury ranges from 50% to 70%. A recent study of portal triad injuries has highighted the higher mortality rates associated with combination injuries involving multiple portal triad components, especially those that include portal vein injury. 5 This case study describes a unique case of relatively minor trauma in a child resulting in portal triad injury, sudden demise, and surgical repair. RÉSUMÉMalgré sa position relativement bien protégée, le foie est l'organe solide, intra-abdominal le plus souvent lésé (1). Dans la plupart des cas de lésion traumatique du foie, un traitement conservateur suffit, mais, dans environ 5 à 10 % des cas, il faut procéder à une laparotomie d'urgence, généralement lorsque ces lésions résultent d'un accident de véhicule et qu'elles entraî-nent une instabilité hémodynamique persistante, malgré des transfusions de sang à raison de 40 ml/kg (2,3). Les lésions hépatiques du 4 e ou 5 e degré en particulier peuvent compliquer la tâche du chirurgien, qui tente de réprimer l'hémorragie, cause principale de mortalité (4).Les lésions traumatiques de la veine porte sont rares, mais elles peuvent être mortelles. Le taux de mortalité lié aux lésions de la veine porte varie de 50 à 70 %. D'après une étude récente sur les lésions des espaces portes, les taux de mortalité les plus élevés sont associés à la concomitance de blessures touchant plusieurs constituants des espaces portes, notamment la veine porte (5). Sera exposé ici le cas plutôt exceptionnel d'un enfant ayant subi un trauma relativement peu important, qui a causé une lésion des espaces portes, s'est soldé par un effondrement soudain et a nécessité une réparation chirurgicale. CASE REPORTA 9-year-old boy was admitted to our hospital with abdominal pain after falling from his bike. His medical history revealed that he fell from his bike facedown 15 minutes before admission. His Glasgow Coma Scale (GCS) was normal at 15. Abdominal examination revealed tenderness on all abdominal quadrants by palpation. Initial vital signs were normal; however, focused assessment with sonography for trauma (FAST) showed common free fluid in the abdomen mainly on perihepatic, Morrison's pouch. His general condition was stable, so abdominal computed tomography (CT) was ordered. The CT scan showed a grade IV liver laceration on the falciform ligament enhancing left portal vein 6 cm in diameter, leading to free fluid

AIM: We aimed to investigate whether there is a role of platelet number and mean platelet volume in the prediction of colorectal cancer in emergency ileus patients. METHODS: