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    Comparison of tricuspid and mitral annular plane systolic excursion in determination of acute blood loss in healthy volunteers
    (Springer Science and Business Media Deutschland GmbH, 2023) Sarıhan, Aydın; Güllüpınar, Birdal; Sağlam, Caner; Karagöz, Arif; Tandon, Shikha; Turhan, Ajda; Koran, Serhat; Ünlüer, Erden Erol
    Ultrasound is used more and more in determining acute blood loss. This study is to compare tricuspid annular plane systolic excursion (TAPSE) and mitral annular plane systolic excursion (MAPSE) measurement to determine volume loss pre and post blood donation in healthy volunteers. The systolic, diastolic and mean arterial blood pressures and pulses of the donors were measured in the standing and supine position by the attending physician, then, inferior vena cava (IVC), TAPSE and MAPSE measurements were made pre and post blood donation. Statistically significant differences were found in systolic blood pressure and pulse rate values that obtained in the standing position, and in the systolic blood pressure, diastolic blood pressure, mean arterial pressure and pulse values that obtained in the supine position (p < 0.05). The difference between IVC expiration (IVCexp) pre and post blood donation was 4.76 +/- 2.94 mm, and the difference in IVC inspiration (IVCins) was 2.73 +/- 2.91 mm. In addition, the MAPSE and TAPSE differences were 2.16 +/- 1.4 mm and 2.98 +/- 2.13 mm, respectively. Statistically significant differences were found between IVCins-exp, TAPSE and MAPSE values. TAPSE and MAPSE can be helpful in the early diagnosis of acute blood loss.
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    Verification of endotracheal tube position by emergency nurses using ultrasound: A repeated measures cadaver study
    (Elsevier Science Inc., 2022) Sağlam, Caner; Güllüpınar, Birdal; Karagöz, Arif; Tandon, Shikha; Bilge, Okan; Aykır, Merve; Vural, Ayşegül; Koran, Serhat; Ünlüer, Erden Erol
    Introduction: Endotracheal intubation is a lifesaving procedure frequently performed in emergency departments. It is associated with some potential risks. Rapid and reliable confirmation of endotracheal tube placement during intubation is critical. Nurses play an important role in the care of patients in various settings. Ultrasound can be performed and interpreted not only by physicians but also by nurses. The aim of this study was to evaluate how well nurses without previous ultrasound experience can determine both esophageal and tracheal localization of endotracheal tubes in cadavers after a short ultrasound training. Methods: This was a repeated measures study with an educational intervention and no control/contemporaneous comparison group. The study was performed to evaluate the ability of emergency nurses to confirm correct endotracheal tube placement and identify esophageal intubations. A total of 7 emergency nurses were given theoretical education and hands-on training about ultrasound. They diagnosed tracheal or esophageal intubation using ultrasound. Results: Four cadavers were used 8 times each for the study. A total of 32 intubation procedures were evaluated with ultrasound by each nurse. In the analysis based on 224 responses, sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and overall accuracy of ultrasound applied by nurses to detect tracheal intubation were 95.61% (90.06%-98.56%), 97.27% (92.24%-99.43%), 35.06 (11.48-107.10), 0.05 (0.02-0.11), and 96.43% (93.08%-98.45%), respectively. The mean time to evaluate the tube location by ultrasound was 6.57 seconds. Discussion: The results support that ultrasound can be performed by nurses for the confirmation for esophageal and tracheal intubations quickly and accurately.