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    How to treat hemorrhagic shock and head trauma in the emergency department: isotonic or hypertonic saline?
    (E-Century Publishing Corp, 2019) Yucel, Neslihan; Sarikaya, Sezgin; Aktas, Can; Ay, Didem; Ekci, Baki; Comunoglu, Nil; Celikmen, Mustafa Feridun
    Aims: This study was performed to compare the effects of physiological saline and hypertonic saline administered at an early stage in a model of traumatic brain injury associated with hemorrhagic shock. Material and methods: Twenty-eight male Sprague Dawley rats were divided into four groups. The rats in the control group (S) underwent a sham experimental hemorrhagic shock followed by a sham operation. The rats in the trauma group (T) underwent a hemorrhagic shock followed by head trauma and no treatment. The rats in the NS group underwent a hemorrhagic shock followed by head trauma and received 0.9% NaCl. The rats in the HS group underwent a hemorrhagic shock followed by head trauma and received a 7.5% NaCl solution. The weight-drop method was used for achieving head trauma. After the head trauma, hypovolemia was induced by the controlled hemorrhage of 30% of the blood volume. The animals were exposed to hypovolemic shock for a further 30 min prior to fluid resuscitation. Each animal received a single volume infusion of their assigned fluid within few minutes. The effects of different fluids were evaluated after 24-hours by their brain water contents, and histological, and biochemical tests. Results: Group T had a significantly higher mean value for brain water content than did the NS group (P < 0.0001). Also, the HS group had significantly higher mean values for brain water content than the NS group (P = 0.003). Edema and bleeding were more marked in the HS group compared to the NS group (both, P < 0.001) in the histopathological evaluation. Leukocyte accumulation was significantly increased in the untreated rats compared to the HS and NS groups (both, P < 0.001). More red neurons were observed in the rats in the T group than in the NS and HS groups (both, P < 0.001). The mean serum osmolarity was higher in the T group compared to NS, HS, and S groups (all, P < 0.001). The mean plasma ADH levels and the mean plasma aldosterone levels were significantly higher in the T group than in the S, NS, and HS groups (all, P < 0.0001). Conclusion: Although not significantly different in biochemistry, animals treated with HS early in hemorrhagic shock secondary to head injury had more brain water than those the received NS as defined histopathologically. Therefore, in emergency settings, NS should be used safely in the early stage of hemorrhagic shock secondary to head trauma.
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    N-terminal pro-B-type natriuretic peptide as a marker of blunt cardiac contusion in trauma
    (E-Century Publishing Corp, 2015) Dogan, Halil; Sarikaya, Sezgin; Neijmann, Sebnem Tekin; Uysal, Emin; Yucel, Neslihan; Ozucelik, Dogac Niyazi; Okuturlar, Yildiz
    Cardiac contusion is usually caused by blunt chest trauma and, although it is potentially a life-threatening condition, the diagnosis of a myocardial contusion is difficult because of non-specific symptoms and the lack of an ideal test to detect myocardial damage. Cardiac enzymes, such as creatine kinase (CK), creatine kinase MB fraction (CK-MB), cardiac troponin I (cTn-I), and cardiac troponin T (cTn-T) were used in previous studies to demonstrate the blunt cardiac contusion (BCC). Each of these diagnostic tests alone is not effective for diagnosis of BCC. The aim of this study was to investigate the serum heart-type fatty acid binding protein (h-FABP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), CK, CK-MB, and cTn-I levels as a marker of BCC in blunt chest trauma in rats. The eighteen Wistar albino rats were randomly allocated to two groups; group I (control) (n=8) and group II (blunt chest trauma) (n=10). Isolated BCC was induced by the method described by Raghavendran et al. (2005). All rats were observed in their cages and blood samples were collected after five hours of trauma for the analysis of serum hFABP, NT-pro BNP, CK, CK-MB, and cTn-I levels. The mean serum NT-pro BNP was significantly different between group I and II (10.3 +/- 2.10 ng/L versus 15.4 +/- 3.68 ng/L, respectively; P=0.0001). NT-pro BNP level >13 ng/ml had a sensitivity of 87.5%, a specificity of 70%, a positive predictive value of 70%, and a negative predictive value of 87.5% for predicting blunt chest trauma (area under curve was 0.794 and P=0.037). There was no significant difference between two groups in serum h-FABP, CK, CK-MB and c Tn-I levels. A relation between NT-Pro BNP and BCC was shown in this study. Serum NT-proBNP levels significantly increased with BCC after 5 hours of the blunt chest trauma. The use of NT-proBNP as an adjunct to other diagnostic tests, such as troponins, electrocardiography (ECG), chest x-ray and echocardiogram may be beneficial for diagnosis of BCC.