Turkish Journal of Emergency Medicine最新文献

{"title":"Association between calcium administration and outcomes during adult cardiopulmonary resuscitation at the emergency department","authors":"Wachira Wongtanasarasin, Nat Ungrungseesopon, Nutthida Namsongwong, Pongsatorn Chotipongkul, Onwara Visavakul, Napatsakorn Banping, Worapot Kampeera, Phichayut Phinyo","doi":"10.4103/2452-2473.342805","DOIUrl":"https://doi.org/10.4103/2452-2473.342805","url":null,"abstract":"OBJECTIVES: Calcium administration during cardiac arrest is limited in some circumstances, mainly due to lack of consistent evidence. This study aims to investigate whether calcium therapy administered during cardiac arrest at the Emergency Department is associated with good outcomes, including the probability of return of spontaneous circulation (ROSC), survival to hospital admission, survival to hospital discharge, and favorable neurological outcome at discharge. METHODS: We retrospectively reviewed 599 consecutive adult cardiac arrest events between 2016 and 2018. The primary outcome was the ROSC rate. Secondary outcomes included survival to hospital admission, survival to hospital discharge, and favorable neurologic outcome at hospital discharge. Multivariable logistic regression with inverse probability of treatment weighting was analyzed to examine the association between calcium administration and outcomes. RESULTS: Of 599 events, calcium was administered in 72 (12%) cases. The use of calcium during cardiopulmonary resuscitation (CPR) after adjusting for confounding factors was not associated with any better outcomes, including ROSC (adjusted odds ratio (aOR) 0.53, 95% confidence interval [CI] 0.24–1.17), survival to hospital admission (aOR 1.07, 95% CI 0.47–2.41), survival to hospital discharge (aOR 1.93, 95% CI 0.43–8.56), and favorable neurological outcome (aOR 6.60, 95% CI 0.72–60.74). Besides, calcium use in traumatic cardiac arrest patients was associated with unfavorable outcomes, including ROSC (aOR 0.02, 95% CI 0.00–0.09) and survival to hospital admission (aOR 0.16, 95% CI 0.03–0.84). CONCLUSION: The use of calcium during an adult cardiac arrest was not associated with better outcomes. Although associations drawn from this study did not indicate the causality, given calcium during CPR was linked to poorer outcomes in traumatic cardiac arrest patients, including ROSC and survival to hospital admission.","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"1 1","pages":"67 - 74"},"PeriodicalIF":0.9,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82347322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of mass casualty incidents in a tertiary care trauma center in eastern India: A retrospective observational study","authors":"C. Mohanty, R. Radhakrishnan, Shine Stephen, Mantu Jain, Asha P. Shetty, Alwin Issac, I. Shaji, Sebastian Chakola","doi":"10.4103/2452-2473.342806","DOIUrl":"https://doi.org/10.4103/2452-2473.342806","url":null,"abstract":"OBJECTIVES: Disasters and mass casualty incidents (MCIs) that cause substantial mortality and morbidity have been increasing worldwide. The emergency department (ED) services manage MCIs by optimizing triage and providing health care with required resources. The present study attempted to describe the epidemiological characteristics and outcomes of MCIs presenting to the ED. METHODS: The present retrospective observational study was conducted at the ED of a tertiary care hospital on patients of MCI for 4 years from 2017 to 2021. The data were extracted from the ED disaster records and other paper-based patient records. Information on patient demography, date and time of arrival, mode of transport, method of arrival (direct or referral), type and mechanism of MCI, ED management, and outcome were recorded. Statistical analysis was performed using R, version 4.1.0. RESULTS: Analysis of 21 MCIs was conducted. Road traffic accidents (RTAs) were the predominant cause of MCIs. The majority of MCI victims, except for those of blast injuries, were men. The victims in medical emergencies were significantly younger than those in other MCI groups (P < 0.001). The majority of patients were brought to ED through ambulance services (n = 120 [47.1%]), followed by private vehicles (n = 112 [44.2%]). Most of the MCI victims (n = 143 [56.2%]) were brought to the ED during evening hours (4 pm–8 pm). The majority of victims belonged to the “Red” triage category (n = 110 [43.3%]). The injury severity score was significantly higher (P = 0.014) in the disaster group than in other trauma MCI groups (20 vs. 17). Autorickshaw occupants were the most common victims of mass casualty RTAs (n = 38 [40%]). Suturing (n = 97 [50%]) and dressing (n = 167 [88%]) were the most common ED procedures required by the victims of trauma MCIs. Of the total, 167 (66%) patients were discharged from the ED, 47 (19%) patients were admitted to wards, 13 (5%) patients were admitted to intensive care units, and 24 (9%) patients got referred to other centers. In addition, two patients died in the ED during treatment, whereas one patient was brought dead. CONCLUSIONS: RTAs dominate the MCIs and are affecting the young producative male population. The present study exhibited the severity of the cases in MCIs and their impact in the health-care setting, therefore signifying the importance of standardized MCI management protocols.","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"85 1","pages":"96 - 103"},"PeriodicalIF":0.9,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90492235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Messenger ribonucleic acid vaccine-associated immune thrombocytopenia: A rare complication of vaccine.","authors":"Mehmet Sami Islamoglu,&nbsp;Mehmet Dokur,&nbsp;Betul Borku Uysal,&nbsp;Mehmet Gunduz","doi":"10.4103/2452-2473.342810","DOIUrl":"https://doi.org/10.4103/2452-2473.342810","url":null,"abstract":"<p><p>Coronavirus disease-2019 continues to have a serious impact in countries with the effect of new variant viruses emerging with mutations. While the effectiveness and protection of the vaccine have been determined all over the world, some vaccine-related side effects can be detected in the form of cases. In our case, the patient was admitted to the emergency department of our hospital with complaints of weakness and progressive rash on his legs. Diffuse petechiae purpura on the legs of the patient was observed and complete blood count revealed thrombocytopenia. Peripheral blood smear supported the blood count test results with thrombocytopenia, secondary causes of thrombocytopenia were excluded, and the patient was diagnosed with vaccine-induced immune thrombocytopenia.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"22 2","pages":"111-113"},"PeriodicalIF":0.9,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1a/47/TJEM-22-111.PMC9069924.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10249343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of emergency physicians' interpretation of computed tomography for urgent-emergent diagnoses in nontraumatic cases.","authors":"Omer Faruk Karakoyun,&nbsp;Nalan Kozaci,&nbsp;Mustafa Avci,&nbsp;Huseyin Uzunay","doi":"10.4103/2452-2473.342804","DOIUrl":"https://doi.org/10.4103/2452-2473.342804","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to evaluate the accuracy levels of the emergency physicians (EPs) managing the patient in the interpretation of the urgent-emergent pathological findings in thoracic and abdominal computed tomography (CT) scans.</p><p><strong>Methods: </strong>The EPs interpreted the CT scans of patients who visited the emergency department because of nontraumatic causes. Then, a radiology instructor made final assessments of these CT scans. Based on the interpretation of the radiology instructor, the false-positive rate, false-negative rate, sensitivity, specificity, positive predictive value, negative predictive value, and kappa coefficient (κ) of the EPs' interpretations of the CT scans were calculated.</p><p><strong>Results: </strong>A total of 268 thoracics and 185 abdominal CT scans were assessed in our study. The overall sensitivity and specificity of the EPs' interpretation of the thoracic CT scans were 90% and 89%, respectively, whereas the abdominal CT interpretation was 88% and 86%, respectively. There was excellent concordance between the EPs and the radiology instructor with regard to the diagnoses of pneumothorax, pulmonary embolism, pleural effusion, parenchymal pathology, and masses (κ: 0.90, κ: 0.87, κ: 0.71, κ: 0.79, and κ: 0.91, respectively) and to the diagnoses of intraabdominal free fluid, intraabdominal free gas, aortic pathology, splenic pathology, gallbladder pathology, mesenteric artery embolism, appendicitis, gynecological pathology, and renal pathology (κ: 1, κ: 0.92, κ: 0.96, κ: 0.88, κ: 0.80, κ: 0.79, κ: 0.89, κ: 0.88, and κ: 0.82, respectively).</p><p><strong>Conclusion: </strong>The EPs are successful in the interpretation of the urgent-emergent pathological findings in thoracic and abdominal CT scans.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"22 2","pages":"89-95"},"PeriodicalIF":0.9,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f9/29/TJEM-22-89.PMC9069923.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10241171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scrub typhus manifesting as electrocardiographic disturbance: A case report and review of literature","authors":"Samiksha Gupta, Gautam Jesrani, S. Gaba, Monica Gupta","doi":"10.4103/2452-2473.336103","DOIUrl":"https://doi.org/10.4103/2452-2473.336103","url":null,"abstract":"Scrub typhus (ST) has wide organ system involvement, but cardiac involvement is paramount in this spectrum due to early hemodynamic compromise. Various forms of cardiac involvement have been described in the literature, but we are describing rare electrocardiographic changes in the ST infection. A young male presented in our emergency department with complaints of restlessness and vomiting of 2 days' duration. The patient was having stable vitals on presentation, but his electrocardiogram (ECG) demonstrated second-degree atrioventricular block type 1 (also known Mobitz 1) and Osborn wave in the precordial leads. Further, he was having thrombocytopenia and eventually diagnosed with ST. For this, appropriate antibiotic treatment was given, which led to considerable symptomatic improvement and reversal of the ECG changes.","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"218 7 1","pages":"47 - 50"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90750432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catheter-directed thrombolysis in a COVID-19 patient complicated with pulmonary embolism","authors":"B. Kocas, K. Kılıçkesmez","doi":"10.4103/2452-2473.336102","DOIUrl":"https://doi.org/10.4103/2452-2473.336102","url":null,"abstract":"Since December 2019, the novel coronavirus (COVID-19) outbreak has become an important public health problem and one of the most common causes of morbidity and mortality worldwide. COVID-19 is highly associated with thromboembolic events, like deep venous thrombosis and pulmonary embolism (PE). Catheter-directed thrombolysis (CDT) provides effective reperfusion for the treatment of PE. We report a patient who was presented with intermediate-risk PE and had a saccular aneurysm of the anterior cerebral artery. The patient was suffered from recent COVID-19 infection and ischemic stroke. As the patient had high bleeding risk for full-dose systemic thrombolytic therapy, CDT was the preferred method for reperfusion. Finally, the patient was discharged from the hospital uneventfully 4 days later. In the setting of high bleeding risk, CDT seems to be an effective and safe approach in patients with intermediate-risk PE.","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"116 1","pages":"54 - 57"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75647195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resuscitation of hemorrhagic shock using normal saline does not damage the glycocalyx in the immediate resuscitation phase","authors":"A. Pudjiadi, A. Firmansyah, D. M. Gunanti Soeyono, S. Bardosono, S. A. Jusman, Minarma Siagian, M. Lubis","doi":"10.4103/2452-2473.336100","DOIUrl":"https://doi.org/10.4103/2452-2473.336100","url":null,"abstract":"OBJECTIVES: The objectives were to study the effect of aggressive resuscitation using normal saline on hemodynamics, serum atrial natriuretic peptide (ANP), syndecan-1 (marker of endothelial glycocalyx shedding), and extravascular lung water index (ELWI) following hemorrhagic shock. METHODS: Eleven male piglets (Sus scrofa) underwent blood drawing to create 20% drop in mean arterial pressure (MAP). Two-phase resuscitation was performed: Phase 1 using normal saline of an equal volume of blood drawn to create shock and Phase 2 using 40 ml/kg BW of normal saline to simulate hypervolemia and hemodilution. Heart rate, MAP, cardiac index (CI), systemic vascular resistance index, oxygen delivery (DO2), global end-diastolic volume index, ELWI, hemoglobin (Hb), lactate, ANP, and syndecan-1 at each phase and up to 60 min following Phase 2 resuscitation were recorded. RESULTS: Phase 2 resuscitation significantly decreased Hb concentration (P = 0.006), however, DO2 was maintained (P = 1.000). CI increased from shock to Phase 1 (P = 0.029) and further increase in Phase 2 resuscitation (P = 0.001). Overall, there was a transient increase of ANP following Phase 1 resuscitation, from 85.20 ± 40.86 ng/L at baseline to 106.42 ± 33.71 ng/L (P = 0.260). Serum syndecan-1 and ELWI change at all phases were not significant. CONCLUSIONS: We demonstrate compensatory protective mechanism despite overzealous fluid resuscitation. Compensatory increased CI despite decreased Hb maintained DO2. In the absence of inflammation, serum ANP did not increase significantly, no glycocalyx shedding occurred, subsequently no change in ELWI. We show that factors other than volume overload are more dominant in causing glycocalyx shedding.","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"340 1","pages":"23 - 28"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80756123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of in-hospital cardiac arrest in a tertiary hospital and factors related to 28-day survival: A retrospective cohort study","authors":"M. Yakar, N. Yakar, Müslüm Akkılıç, Rasim Onur Karaoğlu, Tarkan Mıngır, N. Turgut","doi":"10.4103/2452-2473.336101","DOIUrl":"https://doi.org/10.4103/2452-2473.336101","url":null,"abstract":"OBJECTIVES: The primary aim was to define factors related to the return of spontaneous circulation (ROSC) after in-hospital cardiac arrest (IHCA), and the secondary aim was to determine factors related to 28-day mortality in patients admitted to intensive care unit (ICU) after ROSC. METHODS: In this retrospective study, we included the patients who suffered from IHCA in a tertiary hospital between July 2016 and April 2019. Pre- and post-resuscitation characteristics of the patients and event characteristics were defined to reveal the independent factors associated with ROSC and 28-day survival. RESULTS: A total of 254 patients (median age 73 years, 58.3% males) underwent cardiopulmonary resuscitation (CPR). The ROSC rate was 45.7%. Of all, 51 patients (median age, 63 years, 54.9% males) were admitted to in-hospital ICUs. The 28-day survival rate was 31.4%. The independent risk factors were chronic kidney disease (odds ratio [OR], 3.18, 95% confidence interval [CI], 1.37–7.19, P = 0.007), chronic obstructive pulmonary disease (OR, 2.84, 95% CI, 1.23–6.61, P = 0.015), asystole as an initial rhythm (OR, 2.94, 95% CI, 1.27–6.79, P = 0.012), multi-trauma-related complications (OR, 21.11, 95% CI, 4.71–94.69, P < 0.001), and septic shock (OR, 4.10; 95% CI, 1.16–14.54, P = 0.029) for ROSC; and a cerebral performance category score >2 (OR, 20.86, 95% CI, 2.74–158.65, P = 0.003), Acute Physiology and Chronic Health Evaluation II score >14 (OR, 7.58, 95% CI, 1.06–54.23, P = 0.044) for 28-day mortality. CONCLUSIONS: Independent risk factors related to ROSC and 28-day mortality were defined in the study. However, further studies are needed to devise new strategies for increased hospital discharge with preserved neurologic functions.","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"8 1","pages":"29 - 35"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78312935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal membrane oxygenation experiences during COVID-19 pandemic, third wave with younger patients: A retrospective observational study","authors":"A. Küçük, M. Küçük, O. Ayçiçek, G. Altun, A. Özdemir","doi":"10.4103/2452-2473.336106","DOIUrl":"https://doi.org/10.4103/2452-2473.336106","url":null,"abstract":"OBJECTIVES: In this article, the results of severe coronavirus disease 2019 (COVID-19) cases followed with extracorporeal membrane oxygenation (ECMO) support in a 3-month period in the third wave when there were an increased number of cases of young patients in our intensive care unit (ICU) were presented. METHODS: The study was carried out with all COVID-19 patients who were given ECMO support in our tertiary referral hospital ICU after obtaining the consent of the Ministry of Health Scientific Research Platform and after the approval of the local ethics committee. Patient data were obtained retrospectively from intensive care bedside follow-up charts and computer records. The demographic and clinical characteristics of the patients were presented in average, median, and percentages. The data of the patients were evaluated and compared with the current literature. RESULTS: ECMO treatment was applied in seven patients who were followed up with severe COVID-19 pneumonia in the last 3 months. Venovenous extracorporeal membrane oxygenation (VV-ECMO) was applied to all patients. Five (71.5%) of seven patients were weaned from ECMO. Four (57.2%) of seven patients were discharged from the ICU and hospital in good health. While two of the patients had a cesarean section (C/S) before ECMO, one patient underwent C/S under ECMO. All three newborns were delivered via C/S and all were premature (C/S dates were 35 weeks, 32 weeks, and 27 weeks), and all were discharged from the hospital in good health. CONCLUSION: Our experience shows that ECMO in COVID-19 patients is a lifesaving treatment option that can be successfully applied in severe acute respiratory distress syndrome cases who do not respond to conventional treatments.","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"9 1","pages":"36 - 43"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76355183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abdominal twitches due to ICD lead dislodgement; A case report","authors":"Yusuf Oktay, Muhammed Rıdvan Ersoysal, Burcin Akgun, G. Kuş, E. Arslan","doi":"10.4103/2452-2473.336099","DOIUrl":"https://doi.org/10.4103/2452-2473.336099","url":null,"abstract":"Malfunctions of implantable cardiac devices have the potential to be catastrophic. A 63-year-old patient was admitted to our emergency department with new-onset abdominal pain and sensation of twitching on his abdominal wall. One month ago, an implantable cardioverter-defibrillator (ICD) was implanted in him to prevent malignant ventricular arrhythmias. An electrocardiogram was obtained that showed pace spikes unrelated to QRS complexes. The patient was diagnosed with ICD lead dislodgement and the lead was repositioned in another procedure. In conclusion, emergency physicians should be familiar with the problems of implantable cardiac devices.","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"1 1","pages":"44 - 46"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82301055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}