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Central venous catheterization (CVC) remains a common practice in the emergency setting. Routine flushing 10-20 ml of normal saline to maintain the patency of CVC could affect the accuracy of laboratory tests. Typically, physicians require peripheral vein phlebotomy when more blood sampling is needed. One alternative method, the Pull-push method, could avoid the trauma associated with venipuncture and unnecessary peripheral vein phlebotomy. However, there has been no recent study analyzing the accuracy of blood sampling using this technique. We evaluate laboratory tests' accuracy between blood samples drawn by the Pull-push method from CVC after routine flushing with 10 ml of normal saline versus control. We conducted a diagnostic accuracy study from May to September 2019. After exclusion, 72 patients were eligible for analysis. Promptly after central venous catheterization, we drew blood samples, stored them in blood collecting tubes, and labeled them for the gold standard group. We flushed with 10 ml of normal saline before blood sampling using the Pull-push method's completed three times; then, we drew blood samples again, labeled Pull-push group. We compared the laboratory results between two groups by paired t-test. The accuracies were analyzed based on an allowable error by Clinical Laboratory Improvement Amendments (CLIA) and presented by a modified Bland-Altman plot. The 72 patients were primarily male (n ¼ 47, 65.3%), had a mean age 60.1 AE 14.0 years, and were diagnosed with sepsis (n ¼ 4, 5.6%) or septic shock (n ¼ 65, 90.3%). For almost all the laboratory values, including hemoglobin, hematocrit, white blood cell count, platelet count, blood urea nitrogen, creatinine, sodium, potassium, chloride, bicarbonate, prothrombin time, international normalized ratio, and blood sugar, the accuracy was more than 90% (92.8-98.6%), except aPTT (85.5%) and aPTT ratio (86.7%). Laboratory tests drawn by the Pull-push method could replace peripheral vein phlebotomy to avoid the trauma associated with venipuncture and infection risk.

Background The standard treatment of acute ischemic stroke patients is thrombolytic therapy within 60 minutes of a patient’s arrival in stroke center hospitals. Based on the policy of the Lampang Referral System Committee, blood samples of suspected stroke patients need to be collected before transfer to the stroke center (Lampang Hospital). It was still questionable as to whether these blood samples are valid for clinical use and the present study aimed to confirm or deny their validity. Methods A diagnostic study was conducted from June 2015 to May 2016. After exclusion, 340 patients were deemed eligible for analysis. Blood samples were collected just before normal saline infusion at referring hospitals and stored in blood collecting tube boxes set during transportation. At the stroke center, informed consents was requested, blood samples were re-collected to serve as a ‘gold standard’. Prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), platelet count, hemoglobin (Hb), hematocrit (Hct), blood urea nitrogen (BUN), and creatinine (Cr) were compared using paired t-tests. Binary regression was used to analyze for accuracy (%) to adjust for extraneous influences and was presented by modified Bland-Altman plots. Results The laboratory results of referring hospitals vs. the stroke center were: PT, 12.4±3.2 vs. 12.5±3.0 sec; INR: 1.0±0.3 vs. 1.0±0.3; and platelet count: 239.8±77.1 vs. 239.8±74.8 (x103/μL). The adjusted accuracy of the PT, INR, and platelet counts were 96.8%, 96.8%, and 95.3% respectively. Conclusion Laboratory tests from referring hospital were determined to be valid. Blood samples should thus be collected at referring hospitals in order to avoid unnecessary blood collection at the stroke center.

Motorcycle accidents accounted for the most common prevalence of Road traffic collision (RTC). Therefore, identifying the rider or passenger is crucial for ensuring fairness. However, patients who suffered from RTC frequently could not provide any information due to loss of consciousness, memory loss, or death. We aim to develop two separately multivariable prediction models based on the differences in the facture pattern and demographic data between the rider and passenger in collision with another vehicle and non-collision motorcycle accident. A total of 1,816 patients had fractures from motorcycle accidents. 1,583 and 233 were riders and passengers, respectively. After a multivariable logistic regression with stepwise backward elimination, six final predictors, including Age, sex, femur fracture, wrist and hand fracture, leg including ankle fracture, and pelvis and lumbar spine fracture, were required for the final models. The prediction models had an acceptable level of discrimination (auROCs of 0.79 and 0.77 for collision and non-collision accidents, respectively) and appeared well-calibrated. Overall, the prediction model is potentially useful as an assisting tool for identifying seat positions.

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Background: Central venous catheterization (CVC) remains a common practice in the emergency setting. Routine flushing 10 - 20 ml of normal saline to maintain the patency of CVC could affect the accuracy of laboratory tests. Typically, physicians require peripheral vein phlebotomy when more blood sampling is needed. One of the alternative methods, the Pull-push method, could avoid too much pain and unnecessary peripheral vein phlebotomy. However, there has been no recent study analyzing the accuracy of blood sampling using this technique. Objective: We evaluate laboratory tests' accuracy between blood samples drawn by the Pull-push method from CVC after routine flushing with 10 ml of normal saline versus control. Methods: We conducted a diagnostic accuracy study from May to September 2019. After exclusion, 72 patients were eligible for analysis. Promptly after central venous catheterization, we drew blood samples, stored them in blood collecting tubes, and labeled them for the gold standard group. We flushed with 10 ml of normal saline before blood sampling using the Pull-push method's completed three times; then, we drew blood samples again, labeled Pull-push group. We compared the laboratory results between two groups by paired t-test. The accuracies were analyzed based on an allowable error by Clinical Laboratory Improvement Amendments (CLIA) and presented by a modified Bland-Altman plot. Results: The 72 patients were primarily male (n=47, 65.3%), had a mean age 60.1±14.0 years, and were diagnosed with sepsis (n=4, 5.6%) or septic shock (n=65, 90.3%). For almost all the laboratory values, including hemoglobin, hematocrit, white blood cell count, platelet count, blood urea nitrogen, creatinine, sodium, potassium, chloride, bicarbonate, prothrombin time, international normalized ratio, and blood sugar, the accuracy was more than 90% (92.8-98.6%), except aPTT (85.5%) and aPTT ratio (86.7%) Conclusion: Laboratory tests drawn by the Pull-push method could replace peripheral vein phlebotomy to avoid too much pain and infection risk.

Objective This study aimed to conduct a randomized placebo-controlled trials to examine the clinical efficacy of prophylactic metoclopramide in reducing the incidence of nausea and vomiting in ED patients with acute pain and were treated with intravenous tramadol. Results The study protocol was registered in Thai Clinical Trials Registry (TCTR) [TCTR20220525001] in 21 October 2021. The Institutional Review Board of Lampang Hospital approved the study protocol (CERT NO. 103/64). A total of 99 ED patients presented with acute pain were recruited. Sixty-four patients were randomized, 31 patients in the treatment arm and 33 in the control arm. Overall, there were no significant differences in baseline characteristics between treatment arm and control arm. Only one patient within each arms reported having nausea symptoms. No patients reported vomiting episode. There was no statistically significant difference in the proportion of patients with nausea or vomiting symptoms between the two groups (3.1% in the treatment arm vs. 3.2% in the control arm, p = 1.000). The administration of prophylactic metoclopramide may not provide additional benefit in reducing the occurrence of nausea and/or vomiting episode in ED patients with acute pain treated with intravenous tramadol.