Turkish Journal of Emergency Medicine最新文献

Purulent pericarditis is a rare but severe complication of bacterial pericarditis, often secondary to intrathoracic infections, and can cause a hepatic abscess that ruptures into the pericardium, which is an uncommon symptom with a high mortality rate if untreated. We report on a 52-year-old man with a poorly differentiated hepatocellular carcinoma who presented with chest pain and pericardial effusion caused by a hepato-pericardial fistula. Imaging revealed hepatic microabscesses extending into the pericardium. The patient underwent a pericardial window procedure with purulent fluid drainage and was treated with meropenem for Enterobacter cloacae. Postoperatively, the bilateral pleural effusions required chest drains. After 3 weeks of multidisciplinary care, the patient was discharged in a stable condition. This case highlights the importance of early diagnosis and a multidisciplinary approach in managing rare complications of purulent pericarditis caused by hepatic abscesses. Timely surgical intervention and appropriate antibiotic therapy are crucial for favorable outcomes.

Objective: Acute flank pain is a common complaint in the emergency department (ED), with urolithiasis being a major cause. This prospective observational study evaluated the performance of the STONE, modified STONE, and CHOKAI scores in predicting ureteric stones in Indian ED patients with acute flank pain.

Methods: The study included adult patients who underwent noncontrast computed tomography for suspected urolithiasis. Clinical scores were calculated independently, and their diagnostic accuracy was assessed using receiver operating characteristic (ROC) curve analysis.

Results: Ureteric stones were diagnosed in 58.3% of the patients. The CHOKAI score demonstrated the highest accuracy (area under the curve [AUC] 0.89), followed by the modified STONE (AUC 0.84) and STONE (AUC 0.65) scores. Optimal cutoffs were identified using Youden's index. DeLong's test revealed that CHOKAI and modified STONE scores outperformed the STONE score, while the difference between CHOKAI and modified STONE was not significant. The Hosmer-Lemeshow test showed good calibration for the CHOKAI and modified STONE scores.

Conclusions: The CHOKAI score demonstrated the highest diagnostic accuracy in our cohort and may be the preferred tool for predicting ureteric stones in this clinical setting. Further validation in larger multicenter studies is warranted.

Mass casualty incidents (MCIs) pose significant challenges to the healthcare systems, particularly in low-and lower-middle-income countries where prehospital triage is often limited, and hospitals face sudden surges of casualties. While triage tools have been widely studied for field use, their effectiveness in hospital-based MCI response remains unclear. This review examines peer-reviewed studies on hospital-based triage tools used during mass casualties, focusing on their accuracy and applicability. A comprehensive search of MEDLINE identified six relevant studies, conducted across various income settings and utilizing different methodologies, including simulation-based research, retrospective analyses, and real-world debriefings. Several tools were assessed, including Simple Triage and Rapid Treatment, the Modified CareFlight system, and homegrown triage models developed in Berlin and Iran. While some tools showed potential in prioritizing critically ill patients and managing resource allocation, their application in the real-world hospital settings remains insufficiently studied. Existing research is limited by small sample sizes, reliance on simulations, and a lack of validation in live MCI scenarios. Given these gaps, further research is essential to evaluate triage models in real-time, high-volume, and resource-limited environments to ensure effective hospital-based mass-casualty response.

This case report presents a rare clinical manifestation of digoxin toxicity in a 73-year-old female with acute kidney injury, bradycardia, and unique sensory disturbances, including phantosmia (floral scent hallucinations) and photopsia (seeing sparkles of light). The patient, with a history of hypertension and atrial fibrillation, had been on digoxin for 2 weeks, raising concerns about possible digoxin intoxication. Upon admission, bradycardia, hypokalemia, and elevated serum digoxin levels confirmed toxicity. The patient's olfactory and visual hallucinations, rare symptoms in such cases, gradually resolved after stopping digoxin. This case emphasizes the importance of recognizing subtle and unusual symptoms, like changes in smell and vision, which can enhance early detection, especially in older patients, leading to quicker interventions and better patient outcomes.

Objectives: In acute pancreatitis (AP), the variable clinical course and high mortality have led to the use of complex and time-consuming scoring systems. This study aimed to evaluate the diagnostic performance of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score in predicting mortality and intensive care unit (ICU) admission in patients with AP, and to compare it with the Atlanta classification and the Bedside Index for Severity in AP (BISAP).

Methods: This single-center retrospective study included 455 patients diagnosed with AP. Demographic data, laboratory findings, and clinical course of the patients were recorded, and HALP, BISAP, and Atlanta classification scores were calculated.

Results: The Atlanta classification showed the highest predictive accuracy for both mortality and ICU admission (mortality: sensitivity 91%, specificity 96%; ICU admission: sensitivity 77%, specificity 99%). The HALP score demonstrated a moderate predictive ability for both mortality (sensitivity = 0.64; specificity = 0.79) and ICU admission (sensitivity = 0.74; specificity = 0.67). The sensitivity of the HALP score was significantly higher than that of the BISAP score for both outcomes (P < 0.001).

Conclusion: Although the HALP score has a lower overall predictive power compared to the Atlanta and BISAP scores, its higher sensitivity and easily calculable structure compared to the BISAP score suggest that it may serve as a supportive tool for early prognostic assessment of AP patients in emergency department settings.

The airway management of a patient with a large thyroid swelling is challenging, especially when complicated by airway deformity, compression of the trachea, retrosternal extension, and respiratory difficulty. Awake airway management using a fiberoptic bronchoscope is the safest technique in patients with anticipated difficult airways. We hereby discuss the emergency airway management of a patient with large thyroid swelling with tracheal compression and retrosternal extension using awake fiberoptic bronchoscopy in a lateral position.

Non-judicial hanging events presenting to emergency healthcare providers exhibit a wide range of severity, from cardiac arrest to minor soft tissue neck contusions, making it essential for providers to anticipate potential injuries. This review investigated the frequency of musculoskeletal, neurologic, airway, and vascular injuries to neck structures following such events. A narrative review of the PubMed database was conducted, selecting hypothesis-testing articles based on criteria including non-judicial hanging, emergency department evaluation, and consideration of at least one of the four injury areas. Two reviewers selected the final articles, analyzed the data, and investigated three questions focusing on the frequency of these injury types. The reference lists of the selected articles were also reviewed for additional relevant studies. The analysis included 30 articles (3809 patients) for musculoskeletal and neurologic injuries, 20 articles (2047 patients) for airway injuries, and 13 articles (2717 patients) for vascular injuries. The overall injury rates in the neck region among the study population were musculoskeletal 3.0%, neurologic 0.5%, airway 5.2%, and vascular 2.5%. In conclusion, among patients surviving to emergency department arrival after a non-judicial hanging event, the rates of injury to neck structures are low, with airway injuries being the most frequent at approximately 5% of cases. Injuries were observed to be more common in adults compared to pediatric patients, and the medical significance of these injuries varied considerably. Further research is necessary to more comprehensively define the expected pathologies associated with this patient presentation and to guide the most appropriate evaluation strategies.

Objectives: Accurate differentiation between ventricular tachycardia (VT) and supraventricular tachycardia (SVT) with aberrant conduction in wide complex tachyarrhythmias (WCT) remains a significant challenge in emergency medicine. This study aimed to evaluate the efficacy of deep learning (DL) models, specifically pretrained residual network (ResNet) architectures, in classifying these arrhythmias using electrocardiography (ECG) data.

Methods: A retrospective cross-sectional study was conducted, analysing 652 WCT ECGs and 248 normal sinus rhythm ECGs from an emergency medicine clinic. Three ResNet models ResNet-18, ResNet-34, and ResNet-50 were fine-tuned using transfer learning. Model performance was assessed via 10-fold cross-validation, evaluating accuracy, sensitivity, and precision.

Results: All ResNet models demonstrated high and consistent performance, achieving 95% accuracy, precision in distinguishing VT from SVT with aberrant conduction. The models exhibited robust generalization across validation folds.

Conclusion: DL models, particularly ResNet architectures, show promise in enhancing ECG-based diagnosis of WCT. Their integration into emergency care could improve diagnostic accuracy, especially in settings with limited access to specialized cardiac expertise.

Objectives: The aim of this study is to determine the most appropriate locations for the effective use of automated external defibrillators (AEDs) by examining the locations and frequency of out-of-hospital cardiac arrests (OHCAs) in a metropolitan city in Izmir.

Methods: This research is a retrospective cross-sectional study. The data of the study were obtained from the Emergency Health Automation System. Data belonging to OHCA cases intervened by emergency aid ambulances were analyzed. The data were recorded and mapped by matching the regions where deaths occurred with the address records. Geographic Information Systems technologies were used in mapping the data. Kernel density analysis was used to produce density maps of point cases. Data analyses were performed with IBM SPSS Statistics 25.0 Statistical Program, and binary logistic regression analysis was used to determine the factors affecting the frequency of arrest. The significance value was accepted as P < 0.10 for logistic regression analysis and P < 0.05 for other tests.

Results: In the study, a total of 1790 OHCA cases were identified in public areas in the center of the metropolitan city between 2015 and 2020. Of the 1790 OHCAs, 34.5% were female and 65.5% were male. 49.4% of the deaths were seen in public areas and on streets and avenues where human movement is high. Approximately 34.5% of the deaths were seen in nursing homes. Only one cardiac arrest case was seen at the international airport in the city. The average arrival time of ambulances was found to be 7.3 min in the city center.

Conclusion: This study is the first AED location determination study conducted in Turkey based on OHCA cases. Each country and region should reveal its sociocultural differences and make its plans by taking population mobility into account. Instead of making decisions based solely on the number of deaths, population mobility should be the determining factor. Countries should evaluate their AED installation policies in this context.