Turkish Journal of Emergency Medicine最新文献

Objectives: We aimed to study the association between prolonged boarding time in the emergency department (ED) and in-hospital mortality among patients triaged red at presentation.

Methods: It was a single-center prospective observational study conducted among 300 patients who presented to the ED of a tertiary care teaching institute in North India. The boarding time was calculated as the time interval between the time at which the patient was advised admission and the time at which the patient was admitted to the indoor bed. Risk stratification of patients was done based on National Early Warning Score 2 (NEWS2) at presentation. The patient was then followed up for the duration of their in-hospital course, till discharge or death.

Results: The mean boarding time was higher in patients who died, as compared to those who were alive, but the difference was not found to be statistically significant (14.13 h vs. 11.89 h, P = 0.053). Boarding time had a weak discriminatory power on receiver operating characteristic (ROC) analysis (area under the ROC: 0.59: 95% confidence interval [CI]: 0.51-0.67, P = 0.046). A boarding time of more than 9.98 h was found to be 70.8% specific and 43.6% sensitive for predicting in-hospital mortality. On logistic regression, an increase in boarding time was found to independently increase the odds of mortality, albeit weakly (adjusted odds ratio: 1.06; 95% CI: 1.00-1.12, P = 0.03). A NEWS2 score > 4 at presentation and a requirement of high-dependency unit (HDU)/ıntensive care unit (ICU) admission were found to be significant predictors of in-hospital mortality.

Conclusion: Prolonged ED boarding times may be weakly associated with in-hospital mortality. Patients with an increased NEWS2 score at presentation and those requiring HDU/ICU admissions were at higher risk of in-hospital mortality.

Stingray injuries, though common in coastal regions, rarely result in severe musculoskeletal complications such as tendon rupture. This case report presents the first documented instance of a 61-year-old male who sustained a stingray injury to the Achilles tendon, initially masked by a concurrent infection, leading to a delayed diagnosis and surgical repair. The patient presented to urgent care 5 days postinjury with pain, erythema, and chills, and was treated for a soft-tissue infection. Persistent symptoms prompted a referral to the emergency department (ED), where magnetic resonance imaging revealed a complete Achilles tendon rupture with associated infection. Surgical repair was delayed until the infection resolved, and a V-Y gastrocnemius advancement was performed 9 weeks postinjury. The patient achieved full recovery at 1-year follow-up. This case underscores the importance of a high index of suspicion for musculoskeletal injuries in marine trauma, the role of advanced imaging in the ED, and the need for interdisciplinary management to prevent long-term complications. Emergency physicians must consider tendon injuries in patients with persistent symptoms following stingray envenomation, ensuring timely diagnosis and treatment to optimize outcomes.

Objectives: Efficient pain control is important for patients with acute pancreatitis who visit the emergency department (ED). In this randomized controlled trial, the efficacy of erector spinae plane (ESP) block compared to intravenous tramadol was determined to provide effective pain relief in patients with acute pancreatitis in the ED.

Methods: A single-blind randomized controlled study was conducted in the ED enrolling 18-70 years old patients with acute pancreatitis and a numerical rating scale score of > 4/10. Fifty patients were allocated to two different groups: the control group received IV tramadol (1 mg/kg every 6 h) and the ESP group received an ESP block with ropivacaine 0.375% (40 mL). Both groups received fentanyl (1 µg/kg) for rescue analgesia. Pain scores, hemodynamic parameters, and rescue analgesia were assessed. Data were analyzed using SPSS v20, utilizing t-tests and Chi-squared tests where appropriate.

Results: Baseline demographics were similar between the ESP and control groups (age 41.56 ± 11.85 vs. 43.68 ± 11.55 years, P = 0.367). The ESP group had significantly lower pain scores up to 16 h (e.g. 1 h: 2.28 ± 1.08 vs. 6.12 ± 0.32; P < 0.001), reduced heart rate and mean atrial pressure at 1 h, and fewer patients requiring rescue analgesia (14% vs. 94%; P < 0.001) with lower analgesic consumption (66.14 ± 4.63 µg vs. 113.17 ± 33.24 µg; P < 0.001).

Conclusion: ESP block offers better pain relief and hemodynamic stability than IV tramadol in patients with acute pancreatitis, with significantly decreased opioid needs.

Objectives: This study aimed to examine the demographic and clinical characteristics of adult patients presenting with sudden, unexpected, and nontraumatic death to a high-volume tertiary emergency department in Türkiye, integrating clinical records with forensic autopsy findings.

Methods: We conducted a single-center, retrospective, cross-sectional study including 1555 adult patients who presented with sudden death between January 2015 and January 2023. Data were obtained from electronic medical records and forensic autopsy reports. Descriptive and inferential statistics were used to evaluate cause-of-death distributions by age, sex, and employment status.

Results: Cardiovascular diseases (CVDs) were the leading cause of sudden death (56.7%), followed by respiratory (12.8%) and infectious diseases (11.7%). Deaths due to central nervous system (CNS) pathologies, metabolic/endocrine disorders, and intoxications occurred at significantly younger ages (P < 0.001). Males accounted for 62.1% of deaths, with CNS- and respiratory-related deaths being more common in males. Unemployed individuals had higher rates of infectious and CVD-related deaths, while employed individuals showed a higher frequency of CNS, metabolic, and intoxication-related causes (P < 0.05).

Conclusion: Our findings confirm that CVDs remain the most frequent cause of sudden death. However, the significant presence of noncardiac causes, especially among younger and employed individuals, highlights the need for broader preventive strategies.

Objectives: Mechanical ventilation (MV) is frequently employed in acute care settings for severely ill children, but it may be associated with adverse events (AEs). This study investigated the AEs and comorbidities in children receiving invasive MV (IMV).

Methods: This retrospective cross-sectional study assessed pediatric patients admitted to the pediatric intensive care unit from January 2021 to December 2023 and received IMV. Demographics, clinical findings, concurrent medical conditions, ventilator settings, complications, and outcomes were collected. The predictors of MV-related AEs were assessed using multivariate logistic regression.

Results: One-quarter (24.1%) of the patients experienced at least one AE. Ventilator-associated pneumonia (VAP) was the most common consequence (13%), followed by postextubation stridor (7.9%) and air-leak syndrome (pneumothorax) (6%). Only 12.4% of cases had comorbidities and the death rate was 9.8%. The factors significantly associated with AEs included nonrespiratory causes for admission, prolonged MV duration, and the presence of comorbidities.

Conclusions: There is an elevated incidence of AEs, with VAP being the most frequent. Nonrespiratory causes for admission, prolonged MV, and preexisting comorbidities were the main predictors of AEs.

Aluminum phosphide (AlP) is a common pesticide known for extremely negative environmental, health, and work-related outcomes. Its high availability and easy accessibility have led it to become the chosen method of suicide in many low- and middle-income countries. When AlP reacts with moisture or water, it releases phosphine gas, which is quickly absorbed by the body and leads to severe toxic effects, even death. Occupational and environmental health risks are particularly high in cases of large-scale fumigation or accidental exposure. In Türkiye, two people, one of whom was a child, died due to AlP accidents that affected workplaces and the environment and caused hospitalizations in 2023. In 2024, further suspected cases have been reported, highlighting the ongoing risk. First responders, particularly emergency department team, paramedics, and firefighters, are at significant risk of exposure when managing these cases. The lack of awareness and appropriate protective measures during initial intervention can lead to secondary exposure, worsening the crisis. Medical staff taking care of victims are also at risk of being exposed, further emphasizing the need for stringent safety precautions. Besides, this pollution might cause irreversible damage to soil and water. Thus, this review provides insight into the physical and chemical properties, mechanism of toxicity, current treatment modalities, health-environmental effects, and preventive measures. Given its high toxicity and frequent usage, increased awareness and preparedness among first responders and healthcare professionals are essential. This is a lesson in practice for better safety protocols and emergency response to mitigate health hazards and environmental impacts.

Objectives: Sudden cardiac arrest is a significant cause of cardiovascular death. Basic life support (BLS) practitioners need training to provide effective, quality interventions. This study investigates the effectiveness of curriculum-based BLS training and measures the students' performance levels before and after training and their skill retention over time.

Methods: A total of 70 students were selected as the study population. Before their emergency medicine (EM) clerkship, participants performed BLS with 30 compressions and two rescue breaths on a simulation manikin (Measurement 1). Early posttraining skills were reassessed within the 1^st week after clerkship (Measurement 2), and skill retention was evaluated after 9 months (Measurement 3). All measurements were done by a single observer using the same manikin.

Results: Of the 70 enrolled students, 64 completed the study. Significant improvements were observed in overall cardiopulmonary resuscitation (CPR), compression, and ventilation scores posttraining and at 9 months (P < 0.05). Among 34 participants who performed ≥3 CPRs, posttraining and 9-month scores remained stable (P = 0.238). No significant change was found in compression scores among nonperformers (P = 0.982), and intergroup comparisons showed no statistical difference (P = 0.977; P = 0.900).

Conclusion: BLS training provided to medical faculty 5^th-year students in the EM clerkship program increased the effectiveness of chest compression, and this skill did not regress within 9 months.

Objectives: This study sought to identify risk factors linked to mortality, intensive care unit admission, and poor neurological outcomes among drowning victims and to find markers for safe discharge from the emergency department (ED).

Methods: This retrospective cross-sectional study evaluated all drowning victims presenting to both adult and pediatric EDs at a single center over an 11-year period. Variables such as arrival time at ED, age, type of water, comorbid diseases, vital signs, treatments given, and prehospital interventions were assessed.

Results: The study found that early basic life support (BLS) by bystanders significantly improves survival and neurological outcomes. Respiratory rate, oxygen saturation, and Glasgow Coma Scale (GCS) were identified as independent risk factors for poor clinical outcomes. While the Szpilman clinical score is useful, it alone is not sufficient for predicting poor clinical outcomes.

Conclusions: For optimal management of drowning victims, immediate BLS is crucial. In the ED, respiratory rate, oxygen saturation, and GCS should be closely monitored. Drowning victims with a GCS of 15, normal respiratory rate, normal oxygen saturation, and Szpilman score below 3 can be safely discharged from the ED.

Objectives: We aimed to identify the ability of end-tidal carbon dioxide (EtCO2) to predict inhospital mortality of patients presenting to the emergency department (ED) with nontraumatic circulatory shock. We also attempted to assess the correlation between EtCO2 and other traditional vital signs and laboratory parameters in this patient population at different time points during their resuscitation.

Methods: This was a single-center prospective observational study conducted among patients with nontraumatic circulatory shock who presented to the ED of a tertiary care teaching institute in India. EtCO2 measurement was done using mainstream capnography in both intubated and nonintubated patients at presentation and at 120 min of resuscitation. Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), respiratory rate, oxygen saturation, and laboratory parameters (lactate, base deficit [BD], and partial pressure of carbon dioxide) were measured at the same time points. All patients were followed up till hospital discharge.

Results: One hundred and ten patients were recruited to the study. An EtCO2 of ≤ 23 mm Hg at presentation was 87% sensitive (95% CI: 73-95 %) and 43% specific (95% CI: 31-56 %) in predicting in-hospital mortality of patients presenting with no-traumatic circulatory shock in emergency department [area under curve (AUC): 0.735 (95% CI: 0.638-0.832, p<0.001)]. EtCO2 ≥23 mmHg at presentation had a significant predictive value on the risk of in-hospital mortality with an adjusted odd's ratio of 0.08 (95% CI: 0.02-0.3, P < 0.001). EtCO2 values at presentation and 120 min as well as the change between the time points showed statistically significant weak-to-moderate positive correlations with corresponding values of MAP and BD. Similarly, a significant negative correlation was demonstrated with lactate levels at the same time points.

Conclusion: EtCO2 values at presentation are an independent predictor of inhospital mortality of patients with circulatory shock of nontraumatic etiology presenting to the ED.