BackgroundWe wished to compare the San Francisco Syncope Rule (SFSR), Evaluation of Guidelines in Syncope Study (EGSYS) and the Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk scores and to assess their efficacy in recognising patients with syncope at high risk for short-term adverse events (death, the need for major therapeutic procedures, and early readmission to the hospital). We also wanted to test those variables to designate a local risk score, the Anatolian Syncope Rule (ASR).MethodsThis prospective, cohort study was conducted at the emergency department of a tertiary care centre. Between December 1 2009 and December 31 2010, we prospectively collected data on patients of ages 18 and over who presented to the emergency department with syncope.ResultsWe enrolled 231 patients to the study. A univariate analysis found 23 variables that predicted syncope with adverse events. Dyspnoea, orthostatic hypotension, precipitating cause of syncope, age over 58 years, congestive heart failure, and electrocardiogram abnormality (termed DO-PACE) were found to predict short-term serious outcomes by logistic regression analysis and these were used to compose the ASR. The sensitivity of ASR, OESIL, EGSYS and SFSR for mortality were 100% (0.66 to 1.00); 90% (0.54 to 0.99), 80% (0.44 to 0.97) and 100% (0.66 to 1.00), respectively. The specificity of ASR, OESIL, EGSYS and SFSR for mortality were 78% (0.72 to 0.83); 76% (0.70 to 0.82); 80% (0.74 to 0.85) and 70% (0.63 to 0.76). The sensitivity of ASR, OESIL, EGSYS and SFSR for any adverse event were 97% (0.85 to 1.00); 70% (0.52 to 0.82); 56% (0.40 to 0.72) and 87% (0.72 to 0.95). The specificity of ASR, OESIL, EGSYS and SFSR for any adverse event were 72% (0.64 to 0.78); 82% (0.76 to 0.87); 84% (0.78 to 0.89); 78% (0.71 to 0.83), respectively.ConclusionThe newly proposed ASR appears to be highly sensitive for identifying patients at risk for short-term serious outcomes, with scores at least as good as those provided by existing diagnostic rules, and it is easier to perform at the bedside within the Turkish population. If prospectively validated, it may offer a tool to aid physicians' decision-making.

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AMAÇTravmayı takiben acil servise başvuran hastalarda paramediklerce uygulanan travmaya odaklanmış ultrasonografi değerlendirmesinin (PFAST) serbest sıvı saptamadaki doğ-ruluğu araştırıldı. GEREÇ VE YÖNTEMDört saatlik teorik ve dört saatlik uygulamalı eğitim sonrası, dört paramedik travma hastalarını ileriye dönük inceledi. Altın standardımız ultrasonografi ve karın bilgisayarlı tomografisinin (KBT) resmi radyolog raporlarıydı. PFAST'in duyarlılık, seçicilik, pozitif ve negatif olabilirlik oranları ve tanısal odds oranı hesaplandı ve ki-kare testi ile SPSS 15.0 kullanılarak analiz edildi. BULGULARYüz yirmi yedi hasta paramedikler tarafından değerlendi-rildi. On dört hastada karında serbest sıvı vardı. Bunlardan 11 tanesi radyoloji raporlarıyla ve KBT ile uyumlu iken (gerçek pozitifler), üç tanesi negatif geldi (yanlış pozitifler). Yüz on üç olguda PFAST serbest sıvı için negatif idi. Bunlardan 111 tanesinde serbest sıvı yokken (gerçek negatifler), iki tanesinde KBT ile tespit edildi (yanlış negatifler). Sırasıyla duyarlılık, seçicilik, pozitif ve negatif olabilirlik oranları ve tanısal odds oranı 84,62, 97,37, 32,15, 0,16 ve 203,50 idi. SONUÇÇalışmamız, hastane acil servislerinde paramediklerin yük-sek doğruluk oranıyla FAST uygulayabileceklerini göster-mektedir.

IntroductiondCricothyroidotomy is an advanced and life-saving technique, but it is also a rare and a difficult procedure. The purpose of the present study was to produce a low-cost simulation model with realistic anatomic features to investigate its effectiveness in developing cricothyroidotomy skills. MethodsdThis study was performed at a university simulation center with 57 second-year student paramedics and a cricothyroidotomy simulation model. Total scores were assessed using a checklist. This consisted of 13 steps and was scored as misapplication/omission=0, correct performance and timing with hesitation=1, and correct performance and timing without hesitation=2. One of these steps, local anesthesia of the area if time is available, was not performed owing to time limitations. The highest possible score was 24. Data are presented as mean±SD with range, as appropriate. Normal distribution was evaluated using the Kolmogorov-Smirnov test, Student t test, and Mann-Whitney U test, and correlation analysis was used for statistical analysis. ResultsdStudents completed the cricothyroidotomy procedure steps in 116±46 (55e238) s. At performance assessment, the score achieved was 12±5 (2e24). The highest total score of 24 was achieved by 3 students (5%). Total scores exhibited negative and significant correlation with procedure time (r=-0.403, P=0.002). ConclusionsdThe model developed in this study is an inexpensive and effective method that can be used in cricothyroidotomy training for student paramedics. We think that repeating the cricothyroidotomy procedure on the model will increase success levels.