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Purpose: The purpose of this study is to describe long COVID-19 symptoms in patients receiving outpatient treatment. Materials and Methods: This prospective, observational, descriptive study was conducted in the COVID-19 clinic of a university hospital in February-May 2022. Patients who applied to the outpatient clinic and were diagnosed with COVID-19 were included in the study. Patients were follow up for prolonged COVID-19 symptoms for a 12-week period. It was investigated whether there was a relationship between long COVID-19 symptoms frequency and gender, age and blood type. Results: At least one long COVID symptom was observed in 23% of 7139 patients included in the study. Myalgia was the most common symptom detected in 4.33% of all patients. Cough and loss of taste/smell were the most common symptoms in women, and dizziness in men. The frequency of 26 of 29 symptoms varied with age. While the symptoms most affected by the Body Mass Index were peripheral neuropathy and tinnitus, the least affected symptoms were loss of taste/smell, anxiety and depression. Conclusion: Long COVID symptoms were widely detected in COVID-19 outpatients. Age, gender and BMI may be factors affecting long COVID symptoms.

Amaç: Antitrombotik ilaçlar ağır COVID-19 hastalarının tedavisinde kendine rutin bir yer edinmiş olmasına rağmen, enfeksiyona maruz kalmadan önce herhangi bir sebeple antitrombotik ilaç kullanımının hastalığın prognozuna ve klinik seyrine bir etkisi olup olmadığı henüz bilinmemektedir. Bu çalışmanın amacı SARS COV-2’ye maruz kalmadan önce antitrombotik ilaç kullanımının hastalığın klinik seyri ve mortalitesi üzerine etkisi olup olmadığını belirlemektir. Gereç ve Yöntemler: Hastanemiz COVID-19 polikliniğine başvuran COVID-19 tanısı yapılan RT-qPCR test sonucu ile doğrulanan ve bir akciğer görüntülemesi ile COVID-19 pnömonisi tanısı alan tüm hastalar çalışmaya dahil edilmiştir. Covid-19 pnömonisi olan hastaların anamnez bilgileri, hastanede ve yoğun bakımda yatış süreleri hastane kayıt sisteminden elde edildi ve kayıt altına alındı. Tüm hastaların klinik sonlanımları; sağkalım veya exitus olarak sınıflandırılarak kayıt altına alındı. Bulgular: PCR testi pozitif olup aynı zamanda viral pnömonisi olan hasta sayısı toplam 415 idi. Hastaların yaş ortalaması 53±19 ve 234’ü (56%) erkek idi. 415 hastanın 168’i (40%) en az bir çeşit antitrombotik ilaç kullanmakta iken 247’si (60%) herhangi bir antitrombotik ilaç kullanmıyordu. COVID-19 öncesi antitrombotik ilaç kullanan 168 hastada mortalite oranı %4,5 iken, antitrombotik kullanmayan 247 hastada mortalite oranı %12,5 olarak bulundu (p=0.008). Antitrombotik ilaç kullanan 168 hastada yoğun bakıma yatış oranı %10,1 iken, antitrombotik kullanmayan 247 hastada yoğun bakıma yatış oranı %13,7 olarak (p=0.31). Sonuç: Erken hastalıkta, özellikle ayaktan hastalarda antitrombotik tedavi, koagülopatiyi ve endotelyal ilişkili hastalığı önleyebilir, ancak trombo-inflamatuar faz sırasında çok geç bir antitrombotik tedavi uygulaması gerekli koruyucu etkiyi sağlamayabilir. Bu hipotezin uygun prospektif randomize çalışmalarda test edilmesi gerekmektedir.

Aim: Numerous bedside ultrasound protocols have been developed for the evaluation of critically ill patients with bedside ultrasound. The most widely known of these protocols is the "Rapid Ultrasound for Shock and Hypotension (RUSH)’’ protocol. Diastolic dysfunction is the cause of nearly half of left ventricular dysfunctions, but no ultrasound protocol includes diastolic dysfunction. The aim of this study is to evaluate the contribution of the addition of diastolic assessment to the RUSH protocol to the diagnosis and treatment of critically ill patients. Material and Methods: This prospective, observational study was conducted in a tertiary training and research hospital emergency medicine clinic critical care area for 1 year. Non-traumatic non-pregnant adult patients with systolic blood pressure below 90 mmHg or shock index >1 with signs of circulatory disorder were included in the study. Complaints, clinical findings, and vital signs of all patients included in the study were recorded. With the primary evaluation of the patients, the RUSH protocol was applied, and the findings were recorded. All clinical, laboratory, imaging, and consultation procedures of the patients, as well as the type of shock and its treatment were planned. After the diagnosis of the patients, a second cardiac ultrasound was performed maximum 2 hours later, and diastolic parameters were evaluated and recorded. Whether there was a difference between the diagnoses and treatments of the patients before and after the diastolic parameters were measured, was compared with McNemar and paired T test. Results: A total of 69 patients with a mean age of 67 ± 13 years were included in the study, 54% of whom were females. Before the diastolic parameters of the patients were evaluated, distributive shock was detected in 20.3%, hypovolemic shock in 18.8%, obstructive-type shock in 8.7% and mixed type shock in 40.6% of the patients and their treatment was arranged accordingly. After evaluating the diastolic dysfunction parameters, distributive shock was found in 15.9% of the patients, hypovolemic shock in 18.8%, obstructive-type shock in 5.7% and mixed type shock in 47.8%. However, this change in diagnoses was not statistically significant (p=0.135). On the other hand, the treatment plans were changed in a total of 13 patients by re-adjusting the volume status due to the determination of the diastolic parameter in those patients, and the change was statistically significant (p

Introduction COVID-19 is caused by a newly discovered corona virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 patients often present with fever, myalgia or fatigue and dry cough. Although most patients' prognosis is thought to be benign, it is known that poor results can be observed in elderly patients and those with chronic underlying diseases. Our aim in this study is to investigate the factors that progress to ARDS and cause mortality in patients with COVID-19 pneumonia, based on symptoms, laboratory findings, Computed Tomography (CT) findings, chronic diseases and continuous medications they use. Material Method Demographic characteristics of patients with Covid-19 pneumonia such as age, gender, complaints, vital signs, physical examination findings, smoking and other habits, chronic disease histories, laboratory and imaging examination results, treatment regimen applied in the hospital, hospitalization and intensive care durations were obtained and recorded in the hospital registration system. Clinical outcomes of all patients; Acute Respiratory Disitress (ARDS) has been recorded by classifying it as discharge or exitus. The definition of ARDS was made according to the Berlin criteria updated in 2012. Result and Conclusion In this study, low oxygen saturation at admission, chronic diuretic use, hypocalcemia, thrombocytopenia were found to be significant parameters that increase the risk for both ARDS and mortality in patients with Covid-19 pneumonia. In addition, high D-Dimer was found to be a significant risk factor for the development of ARDS, while advanced age was found to be a significant risk factor for mortality.

Right-sided heart failure (RHF) diagnosed at point-of-care-ultrasonography examination of critical patients may reveal an acute disease, such as pulmonary embolism (PE), requiring emergency thrombolytic treatment. However, acute respiratory distress syndrome (ARDS) and PE leading to acute RHF may exhibit very similar echocardiographic features. We report the case of a 27-year-old pregnant woman diagnosed with ARDS due to septic abortion, and in whom ARDS mimicked PE both clinically and on echocardiography. Such similarity may lead to inappropriate administration of thrombolytic therapy and/or delay the correct treatment. Lung ultrasonography may help avoiding this pitfall.

The local anesthetic dosages used in the current literature in regional applications of local anesthetics are frequently high for surgical purposes, and there are no sufficient dosage studies for emergency department (ED) management.The aim of this study was to determine the success of lower local anesthetic dosages capable of reducing costs and excessive exposure to drugs in pain control in patients with femoral neck fractures (FNFs) in the ED.Patients ≥65 years of age with FNFs and reporting Wong-Baker Pain Rating Scales scores ≥8 were included in this prospective, interventional study. Patients underwent ultrasound-guided regional femoral block with 5 mL 2% prilocaine. Pain scores before the procedure and at 30 min and 2 h postprocedure were compared with the Friedman test and Wilcoxon test with Bonferroni correction.Forty patients, 20 with intracapsular and 20 with extracapsular FNFs, were enrolled. The initial pain scores of patients with both intra- and extracapsular fractures were 8 (range 8-10). A statistically significant 50% decrease in pain scores was observed in both groups 30 min after the regional block procedure (p 0.001). A statistically significant 75% decrease in pain scores was observed in both groups 2 h after the regional block procedure (p 0.001). No statistically significant difference was determined in the change in 30-min and 2-h pain scores between the groups.The administration of 5 mL 2% prilocaine for pain control in FNFs in elderly patients in the ED can reduce systemic analgesic requirements by establishing effective analgesia in both intracapsular and extracapsular fractures.

The primary aim of this study was to determine the value of the inferior vena cava (IVC) ultrasound in the decision to hospitalise acute decompensated heart failure (ADHF) patients. Our secondary aim was to find the most successful IVC measurement method in monitoring volume status.ADHF patients were accepted over a 1-year period in this study. Patients' vital signs, laboratory tests and IVC measurements measured by six methods (in B- and M-mode; maximum, minimum diameter and caval index) performed on an hourly basis were recorded. The presence of any statistically significant difference between the IVC measurement methods, laboratory tests and vital parameters between the hospitalised and discharged patients was calculated. ROC curves were produced in order to determine the ability of parameters to differentiate two groups. Spearman's correlation test was used to investigate correlation between the IVC measurement methods and patients' urine outputs.A total of 71 patients were included in the study; 42 of these were hospitalised and 29 were discharged. Potassium, brain natriuretic peptide, respiration rate, urine output, maximum and minimum IVC diameters differed significantly between the two groups. Minimum IVC diameter measured in M-mode was identified as a weak marker with 65% sensitivity and 64% specificity (+PPV: 73%; -NPV:54%) for hospitalisation. Change in maximum IVC diameter measured in B-mode exhibited a high degree of correlation with change in body fluid (cc: 0.802).IVC ultrasound may have a limited value in the decision to hospitalise ADHF patients. But Maximum IVC diameter may be an ideal method for monitoring hypervolemic patients' volume status.NCT02725151.

Noninvasive mechanical ventilation (NIMV) has a relevant role in the treatment of critically ill patients displaying severe dyspnea. Continuous positive airway pressure (CPAP), a method of NIMV, is also widely used in the management of acute heart failure, chronic obstructive pulmonary disease (COPD) exacerbation, and symptomatic sleep apnea. However, numerous traumatic complications of CPAP treatment in the face region, head, and thorax have been reported and may be related to the application of a continuous positive high pressure to the airway. Conversely, we have observed no complications due to CPAP-related increased intra-abdominal pressure. In this article, we describe a clinical case of a patient with an acute rectus sheath hematoma during CPAP treatment. This previously unreported complication demonstrates that CPAP should be carefully used in patients with exacerbated COPD with difficulty in expiration.

Background Emphysematous cholecystitis (EC) is a form of cholecystitis with high mortality rates more commonly seen in patients with medical histories such as diabetes, hypertension, and peripheral vascular disease. The common features of these medical diseases are impaired pain perception, particularly abdominal pain, due to advanced age and peripheral neuropathies. Accurate evaluation of characteristics observed at ultrasonography, the method of first choice in the diagnosis of EC, is therefore highly important in these patients. Case Report This study reports a case of the champagne sign, rarely seen in EC, together with other EC findings. Why Should an Emergency Physician Be Aware of This? The champagne sign is a little-known sonographic finding that is evidence of the presence of gas in the gallbladder. The champagne sign that will be detected while evaluating the hepatobiliary system on bedside ultrasound is one of the valuable findings in the diagnosis of emphysematous cholecystitis with high mortality.

Objective Recently, a cardiac sonography finding, early systolic notching (ESN), was reported with high sensitivity and specificity for the diagnosis of pulmonary embolism (PE) in a limited population. The aim of this study was to determine the diagnostic accuracy of ESN finding for PE in emergency department (ED) patients. Method This prospective multicenter study was conducted in 4 academic EDs. All patients who underwent computed tomography angiography for suspected PE were included in the study. After inclusion, cardiac ultrasound including the right ventricular outflow tract Doppler signal was performed. The diagnostic tests of ESN finding were used for PE and its subgroups. Results In the study, 183 of 201 patients met the study criteria. Of all patients, 52.5% had PE (n = 96), and 19.7% (n = 36) had ESN finding. In all ED patients, the sensitivity of ESN for PE was 34% (95% CI 25-45), and the specificity was 97% (95% CI 90-99). In the subgroup analysis, the sensitivity of ESN for PE with high or intermediate-high risk was 69% (95% CI 49-85), and the specificity was 90% (95% CI 84-94). Inter-rater reliability for ESN finding between the cardiologist and emergency physician was strong with a kappa statistic of 0.87. Conclusion The pulmonary Doppler flow of ESN was moderate to high specific but low sensitive for PE in all ED patients. In the subgroup analysis, this finding was moderate specific and low sensitive.

Aim: The purpose of this study is searching the effect of BMI and BMW on the quality of CPR and the state of exhaustion applied by the professionals in the emergency department. Material and Method: The software of the CPR education manikin was used in order to count and measure the number and the depth of the compressions and their correspondence to each other during the first and the second minutes of the procedure. Five cycles of chest compressions were asked to do from the rescurers. Each rescuer has handed the task of applying pressure over to his/her following team member after two minutes. Borg tiredness scores were asked to the rescuers and recorded at the end of each-minute period. Results: The mean depth of pressure, the number of pressure attempts applied and the number of superficial compressions of the participants who were grouped due to their BMI showed no statistically meaningful difference. Both in the mean values of Borg tiredness scores which were calculated at the end of the first and second minutes; the group with lower BMW showed higher exhaustion significantly and this group couldn’t make sufficient compressions by means of depth and number, and also the latter showed more exhaustion compared to the first. Conclusion: It is considered that choosing the health workers who are going to apply CPR among individuals with higher BMW or encouraging the workers in those departmnets who frequently apply CPR to be more interested in sports activities could be a promoting factor for having good quality CPR and reducing mortality as well.

OBJECTIVE: Suicide is a preventable cause of death. Good analysis of case data is essential for the prevention of suicide. The aim of this study is to investigatethe clinical and socio-demographic characteristics of suicide cases admitted to emergency department. MATERIALS and METHODS: This is a descriptive study performed retrospectively. The files, suicide forms and electronic records of patients who admitted to a public hospital emergency department between 1 January 2015 and 31 October 2018 due to suicide or attempted suicide were analyzed. RESULTS: Ninety-two of the 168 cases with appropriate records were analyzed. Women represented 65.2% of the suicide cases, 69.6% were aged 15-29, and 40% were students. The most common method of suicide was drug-toxic substance use (84.8%), and the most common reasons for suicide were family problems (26.1%) and mental illnesses (16.3%). No previous history of attempted suicide was present in 89.1% of cases, while 13% had a history of medication use due to psychiatric disease within the previous six months. CONCLUSION: Detailed analysis of cases must constitute the first step in suicide prevention. The quality of data obtained from hospitals’ electronic databases and patient records therefore needs to be increased.

OBJECTIVES Although inferior vena cava diameter (IVCD) measurement can be useful as a noninvasive method for monitoring the volume status, the benefit of abdominal aorta diameter (AAD) measurement is unclear. The purpose of this study was to determine the value of the combined use of the IVCD and AAD in blood loss monitoring. METHODS This prospective observational study was conducted at the blood donor center of a training and research hospital. Standard blood donation criteria were followed during volunteer enrollment. Vital signs and ultrasound IVCD and AAD measurements were obtained before and after blood donation and after fluid resuscitation with 500 mL of 0.9% sodium chloride. Measurements before and after blood donation and after fluid resuscitation were compared by the paired t and Wilcoxon matched-pair tests. RESULTS Thirty-nine volunteers were included in the study. With 500 mL of blood loss, percent changes in the shock index (SI; mean ± SD, 7% ± 6%), IVCD (6% ± 2%), and caval/aorta index (IVCD/AAD; 6.1% ± 3%) were similar and were higher (P

Glasgow coma scale (GCS) is one of the most important parameters in deciding rapid sequential intubation (RSI) in emergency department (ED). The aim of this study is to determine the effectiveness of the GCS and each of its parameters in making RSI decisions in non-traumatic patients brought to the ED.Methods: This prospective observational study was conducted in an ED of a tertiary training and research hospital, which accepts approximately 250.000 patients annually. The value of GCS and GCS parameters in deciding to intubation in patients with an RSI indication was compared with the Pearson χ2 test. Multivariate logistic regression analysis was used for assessment of combinations of GCS parameters.Results: A total of 276 patients were included in the study. It was found that the mortality rates was statistically significantly higher in the cases with GCS 4-10 (including) in the combinations with the low motor response. Motor scoring was more statistically significant for mortality in the evaluation made by creating 120 combinations between the remaining 4-14 GCS scores after the 3 and 15 GCS scores of the cases were removed from the GCS scores.Conclusion: It was found that the motor response showed more linear progress compared to the verbal response and eye response evaluation, and the other parameters were not linear in the evaluation between the GCS total score and GCS combinations of the cases. Motor response was determinant in the total GCS score.

ObjectivesThe aim of this study was to determine the value of blood gas parameters in predicting return of spontaneous circulation (ROSC) in patients with in-hospital cardiopulmonary arrest (CPA). MethodsAdult patients with in-hospital cardiac arrest, and with blood gas analysis obtained on the first 10 min of CPR were included in the study. Patients were divided into two groups based on CPR outcomes, ROSC and non-ROSC. The ability of blood gas parameters to differentiate these two groups was subjected to statistical analysis. ResultsSixty-seven patients, ROSC was achieved in 14 and could not achieved in 53, were accepted to study. The ability of PH, HCO3, PaCO2, PaO2, lactate, base deficit and potassium to differentiate the two groups was calculated, and only bicarbonate to found to exhibit a statistically significant difference between the two [ p:0.040; Area under ROC: 0.672; 64.2% sensitivity (95% CI; 35.1% - 87.2%), 58.4% specificity (95% CI; 44.1% - 71.8%)]. PaCO2 values of ROSC patients concentrated in the 57-108 mmHg range. Sensitivity of 75.4% (41.9-91.6%) and a positive predictive value of 88.9% (79.5-94.2%) in predicting ROSC were calculated for this range.ConclusionNo statistical value was determined for any blood gas parameter, apart from bicarbonate, in predicting ROSC and non-ROSC. The value of bicarbonate was also limited. However, there may be a secondary relation between PaCO2 values and CPR outcomes. Moderate-high (57-108 mmHg) PaCO2 values may be useful in the establishment of ROSC. This hypothesis now needs to be confirmed with more extensive studies.

New substances are constantly being added to the content of synthetic cannabinoids (SCs). SCs can affect the cardiovascular system and cause hypotension and bradycardia, myocardial infarction, atrial fibrillation, prolonged QTc, and Mobitz type II atrioventricular block. However, no cases associated with ventricular fibrillation (VF) have been reported to date. We report a case of a 26-year-old male patient admitted to the emergency department due to altered consciousness after SC use and requiring prolonged cardiopulmonary resuscitation due to resistant VF and cardiogenic shock.

Mehmet Yigit,1 Ozgur Sogut,1 Özlem Tataroglu,1 Adnan Yamanoglu,1 Eda Yigit,2 Eray Metin Güler,3 Omer Faruk Ozer,3 Abdurrahim Kocyigit3 1Department of Emergency Medicine, Haseki Training and Research Hospital, University of Health Sciences, 2Department of Emergency Medicine, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, 3Department of Biochemistry, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey Background: The present study investigated the potential roles of plasma lymphocyte DNA damage, the urotensin-2 receptor (UTS2R), and oxidative changes in patients with varying degrees of migraine-related disability who were in the ictal phase and presented to our emergency department. Methods: This study enrolled 40 consecutive adult patients with migraine attack and 40 age- and sex-matched healthy controls. The same health care professional determined the headache-related disability of each patient’s migraine attack using the Migraine Disability Assessment Scale (MIDAS); patients were divided into three groups based on MIDAS score. Plasma lymphocyte DNA damage; UTS2R, malondialdehyde (MDA), and catalase (CAT) levels; total oxidant status (TOS); total antioxidant status (TAS); and the oxidative stress index (OSI) were used as predictors of early oxidative changes. Results: Plasma lymphocyte DNA damage, TOS, MDA levels, and OSI values were significantly higher in patients with migraine compared to controls. Conversely, TAS and CAT and UTS2R levels were markedly lower in patients with migraine compared to controls. Comparisons of the patient groups by MIDAS score revealed significant differences in plasma lymphocyte DNA damage and CAT levels but no differences in TOS, MDA levels, OSI, TAS, or UTS2R levels. MIDAS scores were positively correlated with the degree of lymphocyte DNA damage, but neither of these factors was significantly related to CAT levels. Conclusion: The present data suggest that lymphocyte DNA damage and changes in oxidative/antioxidative status may reflect an enhanced oxidative damage and an ineffective antioxidant defense system in migraineurs during headache attacks. In addition, lymphocyte DNA damage levels may be an indicator of the degree of migraine-related disability as assessed by MIDAS score. Keywords: migraine attack, oxidative/antioxidative changes, lymphocyte DNA damage, urotensin-2 receptor, Migraine Disability Assessment Scale

The use and content of synthetic canibinden (SCs) has been rapidly increased in the last decades. The complex content of these substances bring along a wide spectrum of side effects. In addition to the expected neuropsychological side effects of pleasure-inducing substances such as agitation, anxiety, panic attack and hallucinations, rare cases of cerebrovascular diseases, seizures, acute renal injury, myocardial infarction and chronic lung injury have also been previously reported. Here we report a 19-year -old male who was presented with acute respiratory distress syndrome (ARDS) within hours of inhaled SC use with the rarely preferred bucket method. There is limited information in the literature about pulmonary effects of SCs and we could not detect any other ARDS case that develoed within hours after consumption of SC with the bucket method.

Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with heart failure (HF) secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause of HF is found. The symptoms and signs of this rare disorder mimic those of the physiological changes of pregnancy or other cardiovascular diseases. Consequently, its diagnosis is frequently delayed, which worsens an already poor prognosis. Here, we report a young adult who was diagnosed with PPCM, early, with the help of focused cardiac ultrasonography, performed after presenting to the emergency department with nonspecific respiratory complaints, including dyspnea and hemoptysis, which suggested at first pulmonary embolism. Keywords: Acute heart failure, Echocardiography, Cardiomyopathy, Ultrasound

OBJECTIVES Blood hemoglobin concentration measurements using a spectrophotometric method (SpHb), and inferior vena cava ultrasonography (IVC-US) are noninvasive methods used to follow-up hemorrhages. We compared their efficacy using voluntary blood donation as a model of moderate (approx. 500 mL) blood loss. METHODS In this prospective observational study enrolling blood-donor volunteers (BD) and matched controls, we recorded SpHb, IVC diameters, and vital signs. Changes in variables from baseline were compared between BD and controls using the paired t test and Wilcoxon signed rank test. RESULTS We included 118 subjects in the BD group and 95 healthy subjects in the control group. Changes in IVC maximum diameter, IVC minimum diameter, pulse rate, mean arterial pressure, pulse pressure, and shock index, but not in other variables, were significantly different in the BD and the control group (P

OBJECTIVES The purpose of this study was to determine the success of mitral valve movements in the estimation of left ventricular ejection fraction (LVEF). METHODS Adult patients whose principal symptom was dyspnea were included in this prospective observational study. The distance from the anterior mitral valve (AMV) to the interventricular septum (IVS) during early diastole was measured first in B-mode in the parasternal long axis (PLAX) named parasternal long axis-anterior leaflet septal separation. Second, the AMV-IVS distance was measured in M-mode in the PLAX named E-point septal separation. Third, AMV-IVS distance was measured in B-mode in the apical 4-chamber view named apical 4-chamber view-anterior leaflet septal separation. Finally, maximum distance between the 2 mitral leaflets in the apical 4-chamber view was measured and named mitral valve leaflet separation. Comprehensive echocardiography was performed by an experienced cardiologist. Correlation was calculated between mitral valve measurements and LVEF. Cutoff values were determined using receiver operating characteristic curves and the chi-square test. RESULTS A total of 118 patients were included in the study. Parasternal long axis-anterior leaflet septal separation, E-point septal separation, and apical 4-chamber view-anterior leaflet septal separation were highly correlated with LVEF (correlation coefficient, -0.848, -0.833, and-0.822 [P

This study aims to determine the site of and the best sonographic method for measurement of inferior vena cava (IVC) diameter in volume status monitoring.This observational before-and-after study was performed at the intensive care unit of the emergency department. It included hypotensive adult patients with suspected sepsis who were recommended to receive at least 20 mg/kg fluid replacement by the emergency physician. The patients were fluid replaced at a rate of 1000 mL/h, and maximum and minimum IVC diameters were measured and the Caval index calculated sonographically via both B-mode and M-mode. Hence, IVC's volume response was assessed by a total of 6 parameters, 3 each in M-mode and B-mode. Freidman test was used to assess the change in IVC diameter with fluid replacement. Wilcoxon test with Bonferroni correction was used to determine which measurement method more sensitively measured IVC diameter change.Twenty-eight patients with a mean age of 71.3 were included in the final analysis.The IVC diameter change was significant with all 6 methods (P.001). The IVC minimum diameter change measured on M-mode during inspiration (M-mode i) was the only measurement method that significantly showed diameter change with each 500-mL fluid replacements. The initial and the subsequent M-mode i values after each 500 mL of fluid were 5.65 ± 3.34; 8.05 ± 3.66; 10.16 ± 3.61, and 11.21 ± 2.94, respectively (P.001, P.002, and P.003, respectively).Inferior vena cava diameter was changed by fluid administration. The M-mode i method that most sensitively measures that change may be the most successful method in volume status monitoring.

Study objective We aimed to determine the role of inferior vena cava (IVC) diameter in making a differentiation between dyspnea of cardiac (acute heart failure [AHF]) and pulmonary origin. We also attempted to determine the best sonographic method for the measurement of IVC diameter. Methods This prospective observational study was conducted at the intensive care unit of the emergency department of a training and research hospital. This study enrolled patients with the main symptom of dyspnea who were categorized into 2 groups, cardiac dyspnea and pulmonary dyspnea groups, based on the final diagnosis. All patients underwent sonographic measurement of minimum and maximum diameters of IVC, and the caval index (CI) was calculated in both M-mode and B-mode. The sensitivity, specificity, and likelihood ratios (LR) of the IVC values for the differentiation of the 2 groups were calculated. Results This study included a total of 74 patients with a mean age of 72.8 years. Thirty-two patients had dyspnea of cardiac origin, and 42 patients had dyspnea of pulmonary origin. The IVC diameter measured with B-mode during inspiration (B-mode i) was the most successful method for differentiation of the 2 groups. B-mode i values greater than 9 mm predicted dyspnea of cardiac origin with a sensitivity of 84.4% and a specificity of 92.9% (+ LR: 11.8, LR: 0.16). Conclusion Sonographic assessment of the IVC diameter may be used as a rapid, readily, nonexpensive, complication-free, and reproducible technique for the differentiation of cardiac and pulmonary causes of dyspnea. B-mode i measurement may be more successful in the differentiation of dyspnea compared with other IVC diameters and calculations.