Article

Fluid resuscitation following rib fractures

1516 Correspondence / American Journal of Emergency Medicine 38 (2020) 1515-1539

Critical pancreatitis management associated with hypertriglyceridemia in pregnancy in emergency service

The author responds,

First of all, we thank Dr. Kokulu for reading and evaluating our arti- cle. There are 11 criteria used in the Ranson criteria in the literature, 5 applications are evaluated and 6 applications are evaluated within 48 h. In the first hours of the evaluation of our patient in the emergency department, Biochemical parameters were at the level of whether or not lipemic stimulation could be given.

Although we did not specify it in our article, we found it sufficient to give the 48th hour application score of the Ranson Criteria.

Thank you for your support and reminder.

Dilay Satilmis? Omer Faruk Turkoglu Ramazan Guven Basar Cander

University of Health Medicine Kanuni Sultan Suleyman Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey

?Corresponding author.

E-mail address: [email protected] (D. Satilmis).

16 March 2020

https://doi.org/10.1016/j.ajem.2020.03.037

Fluid resuscitation following rib fractures

Dear Editor,

I have read a manuscript about risk factors for pneumonia following rib fractures in American Journal of Emergency Medicine [1] and would like to highlight some errors which requires merit explanation/com- ment from the authors.

The abstract states that the authors studied the blood transfusions of pa- tients but nothing about this is mentioned in the manuscript. The reference numbers are not in correCT order; after the 7th reference, there is 13th ref- erence. In the manuscript in table 1, for control group it is said that there are 74 patients and when we look at the genders there are 42 male and 30 fe- male patients the sum is not 74, it is 72. Also, when we look at the alcohol usage of 78 cases, no group is 44, 1-5 per day is 26 and 6+ group is 3, the sum is 73 not 78. For the control group, again none is 43, 1-5 per day is 11, 6

+ is 6, the sum is 60 not 74. When we look at the side of rib fractures in con- trol group for 74 patients, 27 has left side, 25 has right sided and 21 has bi- lateral, the total number is again 73 not 74.

The authors also state in the manuscript that patients with pneumo- nia had a higher initial Volume of intravenous fluids in first 24 h and pa- tients with pneumonia were more likely to be treated with incentive spirometry. In rib fractures it is wrong to use spirometry and iv fluid treatment.

Fatih Cakmak

Cerrahpasa Medical Faculty, Istanbul, Turkey E-mail address: [email protected].

19 December 2019

https://doi.org/10.1016/j.ajem.2020.01.006

Reference

Marco CA, Hartman C, Bowers B, Holmes J, McCarthy M, Sorensen D. Risk factors for pneumonia following rib fractures. Am J Emerg Med 2020;38(3):610-2.

The author responds: Risk factors for pneumonia following rib fractures

Dear Dr. White:

We wish to thank Dr. Cakmak for the review of our manuscript, en- titled “Risk Factors for Pneumonia Following Rib Fractures” [1]. We ap- preciate the reader’s comments and questions.

Dr. Cakmak notes that the total N differs among various elements of the data analysis. This is due to missing data in some categories, due to the retrospective nature of this study.

Dr. Cakmak states “In rib fractures it is wrong to use spirometry and iv fluid treatment.” We respectfully disagree with this statement. Pub- lished literature demonstrates conflicting data regarding the potential benefit of incentive spirometry [2-5]. The optimum use of intravenous fluid resuscitation in the trauma setting is a complex therapeutic deci- sion and is dependent on multiple clinical variables [6-9].

This study found significant associations of spirometry and intrave- nous fluid administration with the development of pneumonia among inpatients with traumatic rib fractures. The precise nature of these asso- ciations is unknown and warrants future research to discern potential causation and variables that may contribute to these associations.

Catherine A. Marco, MD? Derek Sorensen, MD

Department of Emergency Medicine, Wright State University Boonshoft

School of Medicine, Dayton, Ohio

?Corresponding author.

E-mail addresses: [email protected],

[email protected].

Claire Hardman, RN Mary C. McCarthy, MD

Department of Surgery, Wright State University Boonshoft School of

Medicine, Dayton, Ohio E-mail addresses: [email protected],

[email protected].

Brittany Bowers, BS Jasmine Holmes, BS

Wright State University Boonshoft School of Medicine, Dayton, Ohio E-mail addresses: [email protected], [email protected].

27 December 2019

https://doi.org/10.1016/j.ajem.2020.01.001

References

  1. Marco CA, Sorensen D, Hardman C, Bowers B, Holmes J, McCarthy MC. Risk factors for pneumonia following rib fractures. Amer J Emerg Med 2019.
  2. Batomen Kuimi BL, Lague A, Boucher V, Guimont C, Chauny JM, Shields JF, et al. Poten- tial benefits of incentive spirometry following a rib fracture: a propensity score anal- ysis. CJEM 2019;21(4):464-7.
  3. Brown SD, Walters MR. Patients with rib fractures: use of incentive spirometry vol- umes to guide care. J Trauma Nurs 2012;19(2):89-91.
  4. Winters BA. Older adults with traumatic rib fractures: an Evidence-based approach to their care. J Trauma Nurs 2009;16(2):93-7.
  5. Martin TJ, Eltorai AS, Dunn R, Varone A, Joyce MF, Kheirbek T, et al. Clinical manage- ment of rib fractures and methods for prevention of pulmonary complications: a re- view. Injury 2019;50(6):1159-65.
  6. Roppolo LP, Wigginton JG, Pepe PE. Intravenous fluid resuscitation for the trauma pa- tient. Curr Opin Crit Care 2010;16(4):283-8.
  7. Mizushima Y, Tohira H, Mizobata Y, Matsuoka T, Yokota J. Fluid resuscitation of trauma patients: how fast is the optimal rate? Am J Emerg Med 2005;23(7):833-7.
  8. Ley EJ, Clond MA, Srour MK, Barnajian M, Mirocha J, Margulies DR, et al. Emergency department crystalloid resuscitation of 1.5 L or more is associated with increased mortality in elderly and nonelderly trauma patients. J Trauma 2011;70(2):398-400.

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