Turkish Journal of Emergency Medicine最新文献

Objectives: Effective sedation and analgesia during procedures not only provide relief of suffering but also frequently facilitate the successful and timely completion of the procedure. The aim of the study was to evaluate the efficacy of fentanyl and dexmedetomidine compared to fentanyl and midazolam in procedural sedation for tube thoracostomy in the emergency department (ED) in terms of analgesia and patient satisfaction with sedation during the procedure using Pain Numerical Rating Scale and a 7-point Likert-like verbal rating scale for comfort rating of sedation.

Methods: A randomized control study was conducted in 64 subjects admitted to the ED. Tube thoracostomy was performed in patients after the decision for Intercostal drain (ICD) placement taken on radiographic and clinical assessment depending on their condition warranting it and after optimally stabilizing the patient in the ED. Of the total study participants that met the inclusion criteria, 32 participants randomly received dexmedetomidine and the other 32 received midazolam.

Results: Pain rating scale means were 2.3 ± 1.12 and 4.4 ± 1.72, respectively (P < 0.001), in dexmedetomidine and midazolam groups. With regard to adverse effects, a statistically significant difference was seen with dexmedetomidine causing hypotension (P = 0.04) and midazolam causing desaturation (P = 0.008). The results also suggested that midazolam achieved sedation levels quicker than dexmedetomidine and this finding was statistically significant (P < 0.001). A statistically significant difference was observed (P < 0.001) with regard to mean patient verbal ratings at recovery of sedation satisfaction between the two groups, 6 ± 0.77 (dexmedetomidine group) versus 4.7 ± 0.8 (midazolam group).

Conclusions: When observed in terms of analgesia, anxiolysis, and better sedation, dexmedetomidine proved to be superior. Our study shows that this drug could be a better alternative to traditional benzodiazepines for procedural sedation in ED.

In critical care, effective airway management, especially during cardiopulmonary resuscitation (CPR), is vital. Endotracheal intubation, although common, poses challenges in patients with difficult airways. Traditional methods for confirming tube placement, particularly during CPR, can be unreliable. Tracheal ultrasonography is emerging as a valuable tool for guiding intubation and confirming tube placement in real time. A case of a 72-year-old with respiratory distress, chronic obstructive pulmonary disease, and heart failure is described. Despite initial treatment, emergency intubation was necessary, but the initial attempt failed due to a difficult airway. Tracheal ultrasonography guided the intubation process and confirmed tube placement in real time, leading to successful intubation and improved outcomes. This technique shows promise in optimizing airway management during CPR, offering real-time visualization, and minimizing complications. This case underscores the potential of ultrasound-guided techniques in emergency airway management. Further research is needed to fully understand their benefits and limitations in such settings.

Objectives: Nontraumatic undifferentiated shock is difficult to manage in the emergency department due to unclear causes, lack of history, and rapid patient deterioration. Timely and appropriate resuscitation is crucial, but both inadequate and excessive resuscitation increase mortality risks. Focused cardiac ultrasound (FoCUS) offers a timely and noninvasive cardiac assessment. The echoSHOCK protocol is derived from FoCUS and improves the ability to identify the etiology of shock in patients at the emergency department. This study's primary objective was to validate the echoSHOCK protocol for diagnosing the cause of shock in patients arriving at the emergency department. This study's secondary objective was to determine the prevalence of different etiologies of shock in patients arriving at the emergency department.

Methods: Adult patients presenting to the emergency department in shock were included in the study after informed consent was obtained. The shock was defined as a systolic blood pressure of <90 mmHg or a mean arterial pressure of <65 mmHg with signs of poor tissue perfusion. Each patient underwent a detailed history, physical examination, and standard investigations. Clinicians reported a presumed etiology and management plan with a confidence level (0-10). The echoSHOCK protocol was then executed and its results were recorded with the respective confidence levels. The protocol used a phased array probe in B-mode solely and assessed left ventricle function, compressive pericardial effusion, right ventricular dilatation, interventricular septum flattening, and indicators of hypovolemia. The time taken to perform the protocol and the difficulty level were noted. An expert panel followed the patient till hospital discharge and provided the final diagnosis and intervention.

Results: The study enrolled 223 patients with a mean age of 49.12 years. The echoSHOCK protocol showed a 94.2% agreement with expert panel diagnoses on the cause of shock and proposed interventions, with a statistically significant near-perfect agreement (Cohen's Kappa -0.896, P < 0.001 and 0.897, P < 0.001, respectively). In contrast, the agreement between the clinical assessment, routine workup, and expert panel diagnoses was 46.2% on the cause of shock and 45.7% on the proposed interventions, respectively. The echoSHOCK protocol's median feasibility score was 7 (interquartile range [IQR]: 6-8), and its median performance time was 7 min (IQR: 6-10). Confidence in diagnoses was significantly higher with echoSHOCK (mean: 7.14) than with clinical examination (mean: 4.47) (Wilcoxon Test: P <0.001).

Conclusion: The echoSHOCK protocol rapidly identifies shock etiology in patients at the emergency department. This aids in rapid resuscitation.

Takotsubo syndrome (TTS), also known as stress cardiomyopathy, is a life-threatening condition characterized by transient left ventricular dysfunction with nonischemic abnormalities. This syndrome in scenarios of anaphylactic shock is quite rare, with only a few cases reported. Early diagnosis and treatment are crucial. We presented a rare case of 58-year-old woman presented to our hospital due to an anaphylactic shock. The patient was stable and in the de-escalation dose of adrenaline (0.05 µg/kg/h). Twenty-two hours from exposure, the patient experienced pulmonary edema that required intubation, both adrenaline and dobutamine to maintain blood pressure. Echocardiography revealed a reduced ejection fraction of 35%. Subsequent coronary angiography showed no signs of coronary obstruction and left ventriculography provided typical apical ballooning and hyperkinesia in the basal region, highly suggesting TTS. The patient was successfully treated with inotrope and vasopressor and was discharged in stable condition after 7 days and improved normal heart function after 4 weeks. This case demonstrates the delayed onset of adrenaline-induced takotsubo complicated with pulmonary edema in a patient with anaphylactic shock due to antibiotics despite a de-escalation dose of adrenaline. Regardless of the duration of the event or the optimal epinephrine dosage in patients with anaphylactic shock, physicians should be aware of the risk of TTS.

Amebiasis is a parasitic infection with amebic liver abscess (ALA) being the most common extraintestinal manifestation. Common complications of ALA include rupture into the pleural, pericardial, or peritoneal cavity. Uncommonly, they can cause vascular complications such as thrombosis of the hepatic vein and inferior vena cava which may further extend to the right atrium or may embolize resulting in pulmonary thromboembolism. In this study, we report three patients with vascular complications in ALA. The presence of vascular pathology in ALAs should not be missed. With its detection and prompt treatment, the progression of vascular complications can be prevented.

Objectives: Spinal cord injury (SCI) can lead to motor, sensory, or autonomic dysfunction and is associated with increased morbidity and mortality. This study aimed to investigate the impact of magnetic resonance imaging (MRI) and clinical findings in the Emergency Department (ED) on neurological outcomes in patients with traumatic SCI.

Methods: This observational study included 59 patients with traumatic SCI admitted to Dokuz Eylül University Hospital's ED between January 1 2009, and October 1, 2019. Clinical findings were assessed using the American Spinal Injury Association (ASIA) scale. Demographics, clinical findings, MRI parameters, treatment, and short-term (28 ± 7 days) neurological outcomes were compared between the complete (ASIA A) and incomplete (ASIA B, C, D, and E) injury groups.

Results: The incidence of SCI was 98.7 per million. The median age was 37 years (IQR: 27-52), with 86.4% of the patients being male. Common causes included diving into shallow water (30.5%) and falling from heights (25.4%). Complete injury (ASIA A) was observed in 40.7% of cases, while incomplete injury (ASIA B, C, D, and E) was found in 59.3%. The most frequently affected levels were C4 (18.6%) and C5 (23.7%). No improvement was observed in the complete injury group, whereas 44% of the incomplete injury group showed improvement (P < 0.001). Common MRI findings included cord edema (96.6%), vertebral fracture/dislocation (86.4%), and soft-tissue injury (84.7%). Significant differences in MRI findings between the complete and incomplete SCI groups were observed in vertebral fracture/dislocation (P = 0.016), cord compression (P = 0.003), canal stenosis (P = 0.008), intramedullary hemorrhage (P ≤ 0.001), hemorrhage/hemorrhagic contusion (P ≤ 0.001), anterior ligament damage (P = 0.001), posterior ligament damage (P = 0.01), maximum canal compression (MCC) (P = 0.006), and lesion length (P = 0.008).

Conclusion: Traumatic SCI primarily affects young males, often resulting from activities such as diving into shallow water, falls from heights, and motor vehicle accidents. Initial clinical assessments are insufficient for predicting neurological outcomes. Although MRI findings are more frequent in complete SCI, lesion length, and MCC do not reliably predict short-term neurological improvement.

Objectives: Workplace violence (WPV) is a critical issue affecting healthcare professionals, posing significant risks to their safety and well-being. This study investigates WPV among emergency physicians in Türkiye, examining the relationship between WPV and physicians' communication skills.

Methods: A cross-sectional study was conducted from March to June 2023, involving 63 emergency physicians recruited through a convenience sampling method. Participants completed an online survey that included demographic questions, the Turkish version of the Health Professionals Communication Skills Scale (HP-CSS-TR), and self-evaluation items on communication skills.

Results: The findings revealed high WPV prevalence, with 85.7% of participants reporting verbal aggression during their residency and 90.5% during their specialty period. Physical violence was reported by 31.7% of participants during residency and 27.0% during their specialty period. Participants' HP-CSS-TR scores averaged 86.08, indicating relatively high communication skills. No significant relationships were found between HP-CSS-TR scores and demographic characteristics such as gender, age, or years of experience. A moderate positive correlation was observed between participants' self-evaluations and their HP-CSS-TR scores in the dimensions of empathy and respect, suggesting alignment between perceived and actual communication skills in these areas. Weak correlations were found in informative communication and social skills, highlighting areas for improvement in communication training programs.

Conclusions: This study highlights the critical issue of WPV against emergency physicians and its association with communication skills, emphasizing the complexities of high-stress environments such as emergency departments. It underscores the need for continued research and systemic interventions to enhance workplace safety and the well-being of healthcare professionals.

Objectives: Delivering chest compressions (CCs) at the targeted depth and rate is a crucial aspect of maintaining the quality of cardiopulmonary resuscitation (CPR). Although administering CCs on a firm surface is recommended, it may not always be feasible. This study aimed to determine whether the underlying surface affects CC depth and rate using a real-time feedback device.

Methods: An observational study was conducted on a manikin (ResusciAnne; Laerdal). 25 volunteer emergency medicine physicians performed 2 min of continuous CCs without feedback on the floor, emergency department stretcher (EDS), and ambulance stretcher (AS). The following day, all participants performed an additional 2 min of CCs while receiving audiovisual real-time feedback (ZOLL M2 series). Compression depths and rates were measured and recorded in a real-time feedback device.

Results: A total of 150 CC intervals were analyzed. The mean values of compression depths and rates on all surfaces are within the targeted range for high-quality CPR, except for the mean depth without feedback on the EDS (mean: 6.37 cm). There were a statistically significant difference, with both AS and EDS were achieved deeper compressions than those on the floor (P < 0.05). When examining the mean compression depths on three different surfaces with feedback, no statistically significant difference was observed. However, CCs performed without feedback on both AS and EDS were statistically significantly deeper than those on the floor. The mean compression rates both on the floor and the AS were statistically significantly faster compared to EDS. When examining the mean compression rates during CCs performed on three different surfaces with feedback, no statistically significant difference was observed but in the without feedback compressions, both on AS and floor were found to be statistically significantly faster than EDS.

Conclusions: CC's depth are influenced by the underlying surface. It appears more feasible to minimize surface-related differences while maintaining appropriate targets for depth using real-time feedback devices. The mean compression rate could be kept within the targeted range regardless of the surface.

Mushrooms have been consumed frequently worldwide since ancient times. In addition to edible and harmless species, there are also poisonous species that cause a wide range of clinical syndromes, from simple gastrointestinal (GI) irritation to death. However, it is not possible to distinguish the poisonous species from some edible species morphologically. Therefore, the unintentional consumption of mushrooms is an important public health problem. Mushrooms can be categorized according to their toxins, such as cyclopeptides, gyromitrin, muscarine, coprine, orellanine, psilocybin, and GI irritants. Mushrooms containing cyclopeptide-amatoxin are responsible for more than 90% of deaths due to mushroom poisoning. Amanita phalloides is responsible for many fatal cases because of the toxicity of this species. This article reviews the clinical syndromes that may develop after the consumption of various poisonous mushroom species, the mechanisms of action of their toxins, and the current treatments applied.