Background and objective We aimed to determine the diameters and respiratory variability of the subclavian vein (SCV), internal jugular vein (IJV), and femoral vein (FV), which are more superficial and easier to visualize with point-of-care ultrasound (PoCUS) in the detection of volume overload, and to investigate whether they can be an alternative to analyzing an inferior vena cava (IVC) to determine volume load. Methodology We prospectively evaluated volume-overloaded and normovolemic patients admitted to the emergency department using PoCUS for six months. Inspiratory-expiratory diameters and collapsibility indices (CI) of IVC and SCV, IJV, and FV were evaluated. The correlation between IVC and SCV, IJV, and FV was analyzed. Results A total of 176 patients were included in the study, including 88 volume-overloaded patients in the study group and 88 normovolemic patients in the control group. The median values of the maximum and minimum diameters of the IVC, SCV, IJV, and FV in the study group were statistically higher compared to the control group. A moderate correlation was found between IVC and SCV, IVC and IJV, and IVC and FV for maximum diameters in all patients (p = 0.447, p = 0.515, and p = 450, respectively). There was a very weak correlation between the IVC-CI and the FV-CI in all patients (p = 0.160), and no correlation was found with the other veins. Conclusion The IVC-CI was not correlated with the SCV-CI, the IJV-CI, or the FV-CI in volume-overloaded patients; therefore, superficial venous vessels cannot be an alternative to the IVC.
11 June 2021 in Journal of Emergency Medicine Case Reports
Lemierre's syndrome is a syndrome with high mortality, causing internal jugular vein (IJV) thrombophlebitis, septic lung and other organ embolism, which often develops as a complication of oropharyngeal infections. Mortality can be reduced with early diagnosis and appropriate antibiotic treatment. It is a rare syndrome and the case we have presented here differs from the cases with lemierre syndrome previously reported because of the involvement of superior vena cava (SVC) and subclavian vein.
1 January 2025 in Revista da Associação Médica Brasileira
OBJECTIVE: The aim of this study was to determine the relationship between visceral fat thickness measurements obtained via computed tomography and clinical outcomes in order to predict the outcomes of oncology patients diagnosed with acute pulmonary embolism at the emergency department.
Background/Objectives: Estimating mortality risk in older adults presenting to the emergency department (ED) is challenging because risk is shaped by comorbidity burden, frailty, and systemic inflammation. We examined the individual and combined prognostic contributions of the Age-adjusted Charlson Comorbidity Index (CCI), the Clinical Frailty Scale (CFS), and the Systemic Immune-Inflammation Index (SII) to 30-day mortality. Methods: This prospective observational cohort included 326 adults aged ≥65 years evaluated in a tertiary ED from September 2025 through April 2026. CCI, CFS, and SII were assessed at admission, with SII analyzed after logarithmic transformation [ln(SII)]. Associations with 30-day mortality were examined using logistic regression. Discriminative performance was evaluated by receiver operating characteristic analysis, and the integrated model underwent bootstrap internal validation and calibration assessment. Results: Thirty-day mortality occurred in 60 patients (18.4%). CCI, CFS, and ln(SII) were each independently associated with mortality in the integrated multivariable model (all p < 0.05). Individual AUCs were 0.741 for CCI, 0.703 for CFS, and 0.662 for ln(SII), with CCI showing the highest value. The integrated model achieved the highest observed discrimination (AUC 0.793; optimism-corrected AUC 0.783) and showed acceptable internal calibration (Brier score 0.127; bootstrap-corrected calibration intercept 0.003; calibration slope 0.957). Conclusions: Comorbidity burden, frailty, and systemic inflammation each provided independent prognostic information for 30-day mortality in older ED patients. Although CCI was the strongest individual predictor, the integrated model achieved the highest observed discrimination. However, its incremental benefit over some two-predictor models was modest and not statistically significant.