Turkish Journal of Emergency Medicine最新文献

Climate change is no longer a distant threat but a present and escalating burden on emergency departments (EDs) worldwide. Its direct and indirect effects, ranging from heatstroke and hypothermia to vector-borne disease resurgence and mass casualty incidents, challenge conventional models of emergency preparedness. This narrative review explores the intersection of climate dynamics with ED operational and clinical vulnerabilities. We summarize five core physiological mechanisms by which temperature extremes disrupt homeostasis and review high-risk medication classes that may exacerbate heat-related morbidity. In addition, we examine the World Health Organization's mass casualty triage framework and its relevance in climate-driven disasters such as floods, wildfires, and explosions. Special attention is given to low-resource settings and migration-heavy regions, where infrastructure strain and health inequity amplify the impact. We propose integrative, anticipatory planning models that combine clinical vigilance, environmental monitoring, and dynamic triage protocols. By identifying EDs as both front-line responders and sentinel systems, this study underscores the urgency of embedding climate resilience into emergency care strategies. Our synthesis aims to support clinicians, policymakers, and health systems in adapting emergency services to the realities of a warming world.

Objective: End-of-life care (EOLC) in the emergency department (ED) is a growing global necessity. This study aimed to assess the level of knowledge and attitudes toward EOLC among ED healthcare workers.

Methods: A prospective and cross-sectional study was conducted involving 155 healthcare workers at a tertiary ED. The Palliative Care Knowledge Tool (PCKT) and the Frommelt Attitude toward Care of the Dying (FATCOD) Scale were adapted, translated into Malay, and validated for use. Participants completed validated, self-administered questionnaires assessing knowledge using FATCOD the PCKT and attitudes toward EOLC using the FATCOD Scale. The primary outcomes were the healthcare workers' knowledge and attitudes, with secondary analysis exploring associated factors.

Results: The overall level of knowledge on EOLC among healthcare workers was poor with a mean score of 8.54 (±2.97) out of 17. Despite this, attitudes toward EOLC were positive with a mean score of 92.61 (±8.80) out of 120. A weak positive correlation was found between knowledge and attitudes (r = 0.186, n = 155, P = 0.020). The factors such as education level, work experience, and profession were significantly associated with variations in knowledge and attitudes.

Conclusion: This study revealed that despite poor knowledge of EOLC among healthcare workers in the ED, their attitudes toward managing dying patients were positive. The weak correlation between knowledge and attitudes suggests a modest link between these domains.

[This corrects the article on p. 256 in vol. 25, PMID: 41104366.].

In emergency medicine practice, massive hemothorax represents a life-threatening condition in patients with comorbidities. We present the case of a 75-year-old female patient with a massive delayed hemothorax, which developed following a chest injury sustained during a low-height fall. The patient had been on long-term rivaroxaban, a direct oral anticoagulant, due to underlying comorbid conditions. To reverse the anticoagulant effect, andexanet alfa was administered, followed by the placement of chest drainage. After evacuating the bloody pleural effusion from the pleural cavity, full lung reexpansion was achieved, with only minimal residual drainage within an hour. Following drainage removal, the patient was subsequently discharged without any complications. After follow-up, the patient remained in good condition. This case demonstrates that andexanet alfa can be an effective reversal agent in life-threatening cases of massive delayed hemothorax.

Arachnoid cysts (ACs) are benign congenital lesions that are often detected incidentally during imaging studies performed for various etiological reasons. These cysts are typically asymptomatic, and in most cases do not require surgical intervention. Although ACs are commonly encountered, they are rarely complicated by intracystic hemorrhage or subdural hematoma. In this report, we present a case of a nontraumatic rupture of an AC, which remained undiagnosed until the age of 52 years.

Objectives: Sepsis-induced coagulopathy (SIC) is a common complication in patients with sepsis and septic shock. Early detection of SIC is crucial for timely intervention, as it can significantly impact patient outcomes. This study aims to evaluate the prevalence of SIC and its impact on the 28-day mortality rate in patients with sepsis and septic shock.

Methods: A single-center retrospective observational cohort study was conducted in Vietnam from January 2021 to August 2024. Adult patients diagnosed with sepsis or septic shock who were admitted to the intensive care unit within 24 h of initial presentation were included. Patients with do-not-resuscitate orders, coagulopathy, malignant blood disorders, incomplete data, or refusal of treatment were excluded. SIC scores were assessed, and 28-day mortality rates were recorded.

Results: A total of 340 patients were included, with 216 (63.5%) exhibiting SIC (SIC score ≥4). The mean age of patients was 69.01 ± 17.04 years, and the majority were male (61.5%). Septic shock accounted for 79.7% of the cases. SIC patients had significantly higher mortality rates at both 4 days (17.6% vs. 4.8%, P = 0.001) and 28 days (40.3% vs. 24.4%, P = 0.005). Nonsurvivors exhibited higher SIC (73.9% vs. 57.9%, P = 0.003) and had worse disease severity scores. Multivariate analysis confirmed that SIC score ≥4 was strongly associated with increased 28-day mortality (odds ratio 1.799, P = 0.033).

Conclusions: The prevalence of SIC is high in patients with sepsis and septic shock, especially in our cohorts. SIC score ≥4 is also a strong and independent predictor for 28-day mortality.

Objective: To assess the effectiveness of tranexamic acid (TXA) in the treatment of angiotensin-converting enzyme inhibitor-induced angioedema.

Methods: A systematic review was conducted using PubMed, Scopus, Embase, and ProQuest databases from inception to January 2025, following PROSPERO registration (CRD42025524300). We included observational studies that evaluated the use of TXA in angiotensin-converting enzyme inhibitor-induced angioedema. Proportion meta-analyses were performed on the data obtained from the selected studies.

Results: Only four retrospective studies met the inclusion criteria, including two cohort studies, one retrospective study, and one case series, encompassing a limited sample size of 133 patients. Meta-analysis showed that approximately 98% of patients treated with TXA did not require intubation, and 76% avoided intensive care unit admission. However, the absence of randomized controlled trials and the retrospective nature of the studies substantially limit the strength and generalizability of these results.

Conclusion: TXA may be a potential treatment option for angiotensin-converting enzyme inhibitor-induced angioedema by lowering intensive care unit admission and intubation; however, current evidence is limited and primarily retrospective. Robust prospective, randomized controlled trials are needed to draw definitive conclusions.

Intercostal drainage (ICD) tube insertion is a life-saving procedure through which blood, fluid, or air is drained out of the pleural space surrounding the lungs. This treatment is essential to manage conditions such as hemothorax, pleural effusion, and pneumothorax. In addressing the severe pain accompanying these conditions and pain caused by ICD tube insertion, emergency physicians are increasingly turning to newer techniques for pain management. We are presenting one such technique, which is the serratus anterior plane block (SAPB) guided by ultrasonography. This emerging approach holds promise in improving pain management and patient comfort, making it a crucial consideration in individuals requiring an ICD. In this case series, we present cases that required an ICD tube insertion for which SAPB was administered to manage the pain caused by the ICD tube. The pain reduced significantly in all patients following SAPB administration, and they did not require any additional analgesics for an average of 6-8 h after the block. This case series shows a more efficient way of managing pain in patients requiring ICD tube insertion.

Objectives: Venous congestion is increasingly recognized as a contributor to acute kidney injury (AKI) in critically ill patients. The venous excess ultrasound (VExUS) score has been proposed to assess systemic venous congestion, but its role in emergency department (ED) sepsis remains underexplored. This pilot study investigated the association between VExUS scores, development of AKI, and other outcomes in septic ED patients.

Methods: This was a prospective observational pilot study conducted from July 2023 to December 2023 in a university-affiliated tertiary ED. Adult patients with sepsis and an inferior vena cava diameter ≥2 cm after initial resuscitation were enrolled. VExUS was assessed at enrolment. The primary outcome was AKI within 72 h based on the Kidney Disease Improving Global Outcomes criteria. Secondary outcomes included mortality, organ dysfunction scores, and other outcomes. Associations were analyzed using Kendall's tau-b correlation and group comparisons with Mann-Whitney U-test.

Results: Thirty-one patients were included, mean age 64.2 years. VExUS scores were Grade 1 in 64.5%, Grade 2 in 25.8%, and Grade 3 in 9.7%. Median VExUS scores did not differ between patients with and without AKI (2.0 [2.0-3.0] vs. 2.0 [2.0-3.0], P = 0.729), died and survived at 28 days (2.0 [2.0-2.25] vs. 2.0 [2.0-3.0], P = 0.419) or 60 days (2.0 [2.0-3.0] vs. 2.0 [2.0-3.0], P = 0.693). VExUS showed moderate correlations with creatinine (τ = 0.392, P = 0.004), sequential organ failure assessment (τ =0.267, P = 0.041), and inotrope requirements (τ = 0.299, P = 0.041).

Conclusion: In septic ED patients, VExUS was not associated with AKI or mortality but correlated with markers of organ dysfunction.

Objective: Glenohumeral dislocation is the most common type of shoulder dislocation and a leading cause of shoulder instability. Adequate muscle relaxation and pain control are essential for successful reduction. This study compared the effectiveness and safety of ketamine-midazolam (KM) versus ketamine-propofol (KP) for procedural sedation in anterior shoulder dislocations in the emergency department (ED). Effectiveness was evaluated using Ramsay sedation scale (RSS) scores, sedation onset, total procedure and recovery times, and reduction success. Safety was assessed by recording adverse events.

Methods: This prospective, single-blind, randomized trial included patients ≥18 years presenting to a tertiary ED with anterior shoulder dislocation. Patients were randomized into two groups: KM (ketamine plus midazolam) and KP (ketamine plus propofol). Demographic and clinical characteristics, RSS scores, procedure and recovery times, adverse events, and additional sedation requirements were recorded.

Results: Sixty-four patients were analyzed, 32 in each group. The overall mean RSS score was 4.5 ± 1.0, significantly higher in the KP group (P < 0.001). Adverse events were more common in the KM group, including higher rates of respiratory depression (P = 0.023) and tachycardia (P < 0.001). The mean procedure time was 5.7 ± 4.7 min, and recovery time was 36.3 ± 14.4 min, both significantly shorter in the KP group (P = 0.025 and P < 0.001, respectively).

Conclusion: In the ED, the ketamine-propofol combination appears to be a safe and effective option for procedural sedation and analgesia, particularly in interventions such as shoulder reduction.