Turkish Journal of Emergency Medicine最新文献

Objectives: The domain of emergency medicine (EM) is not only rapidly evolving but also witnessing a significant surge in research publications, particularly in Türkiye. In this context, this study aimed to investigate the publication outcomes of abstracts presented at national EM conferences and evaluate the quality of these publications, thereby contributing to the understanding of the evolving landscape of EM research in Türkiye.

Methods: To ensure the accuracy and reliability of our findings, we meticulously examined abstracts presented at the annual conferences organized by the EM Association of Türkiye and Emergency Physicians Association of Türkiye from January 2015 to December 2021. We screened public databases such as Web of Science, SCOPUS, PubMed, Google Scholar, and ULAKBIM to identify any subsequent publications of these abstracts. The data on publication dates, and journal impact factors were thoroughly analyzed.

Results: The study included 10,055 abstracts, comprising 3794 (37.7%) oral presentations and 6261 (62.3%) poster presentations. Of these, 829 abstracts (8.2%) were later published as full publications in journals indexed in at least one major database. Among the published articles, 36 (4.3%) appeared in Q1 journals, while 346 (41.6%) were published in journals without quartile rankings. The median duration until publication was observed to be 12 months.

Conclusion: The publication rate for abstracts presented at EM conferences was 8%, with most articles published within 2 years. Oral presentations had a higher publication rate than poster presentations, indicating higher quality. The authors' affiliations and the studies' designs emerged as pivotal factors influencing the success of publication.

Objectives: The aim of this study was to evaluate the factors associated with non-invasive mechanical ventilation (NIMV) failure in acute cardiogenic pulmonary edema (ACPE) diagnosed in the emergency department.

Methods: This study was prospectively conducted at the Ege University Faculty of Medicine ED between February 19, 2021 and December 01, 2021. Patients who received NIMV with ACPE were included. Patients' clinical and laboratory parameters, treatments, NIMV mode, and settings were recorded. The primary endpoint was NIMV failure (intubation within 24 h). Secondary endpoints were early NIMV failure, early mortality (within 24 h), and in-hospital mortality. Early NIMV failure was defined as follows: if the patient had a respiratory rate of more than 25 per minute, oxygen saturation below 90%, PaCO₂ >50 mmHg in blood gas, and pH <7.35, 1 h after starting NIMV.

Results: Out of 347 patients in this study, 34 (10.7%) of them intubated within 24 h. Female sex percentage was 48.7%. Median age was 73 years. Risk factors for NIMV failure were respiratory rate >40.5, systolic blood pressure <122.5 mmHg, Glasgow Coma Score <14, pH <7.21, lactate level >5.2 mmol/L, base excess <-4.5 mmol/L, B-type natriuretic peptide level >3007 pg/mL (respectively area under the curve values; 0.723, 0.693, 0.739, 0.721, 0.690, 0.698, and 0.616).

Conclusion: Signs of hypoperfusion such as low systolic blood pressure (<122.5 mmHg) and high lactate (lactate level >5.2 mmol/L) are risk factors for NIMV failure. Evaluation of initial vital signs and arterial blood gas parameters is significantly important for prediction of NIMV success in ED.

Melioidosis is a disease endemic to India but often goes unrecognized, leading to considerable illness and death. We present the case of a 31-year-old man who had a fever of unknown origin, abnormal renal and liver function tests, and negative tests for dengue, typhoid, leptospirosis, and scrub typhus. Imaging revealed multiple splenic infarcts. Initially suspected to be malaria due to its prevalence in South India, further investigation uncovered pneumonia along with several liver and splenic abscesses, raising the possibility of melioidosis. Blood culture eventually identified Burkholderia pseudomallei, confirming the diagnosis. As malaria cases decline in Southeast Asia, emergency physicians should consider melioidosis in their differential diagnosis of acute febrile illnesses, especially in endemic areas. Early detection and prompt antibiotic treatment are vital for managing this often under-recognized disease with a high fatality rate. Thus, melioidosis should be considered in patients with unexplained fever in endemic regions, as early diagnosis and intervention can be life-saving.

Introduction: The initial 24-h period following admission to a hospital holds profound significance for pediatric patients, representing a critical window where proactive interventions can substantially influence outcomes. We devised a simple triage system, pediatric simple triage score (PSTS), to see whether rapid triage of sick pediatric patients with fever can be done using the new triage system in the emergency department (ED) to predict hospital admission.

Methods: This was a prospective observational study, conducted at the department of emergency medicine of a tertiary care teaching hospital in southern India. A prospective cohort of children presenting to the ED underwent assessment for temperature, oxygen saturation (SpO2), pulse rate, respiratory rate, sensorium, and hydration status. Sensorium was evaluated based on criteria such as poor cry, poor feeding, or decreased activity, while hydration status was assessed using indicators such as decreased urine output, dry mucous membranes, or reduced skin turgor. Subsequently, participants were triaged according to the National Institute for Health and Care Excellence (NICE) guidelines. We then monitored the admission outcomes, whether they were admitted to the intensive care unit (ICU), the ward, or discharged, based on clinical decisions made by the pediatric consultant.

Results: In this study involving 350 participants, the mean age was found to be 2.72 years (standard deviation [SD] ±1.78), with a range from 29 days to 5 years. The study population consisted of 60.86% males with a total of 213 patients. Examining vital signs, the mean heart rate was 135.07 beats/min (SD ± 21.58), with a range of 82-200 beats/min. The mean temperature was 37.57°C (SD ± 0.52), with values ranging from 36.80°C to 39.20°C. The mean respiratory rate was 36.28 breaths/min (SD ± 14.06), varying from 20 to 90 breaths/min. SpO2 averaged at 96.31% (SD ± 3.64), with values ranging between 70% and 100%. Abnormal sensorium was observed in 10.86% of the participants, while seizures were reported in 2.57%. Dehydration was present in 3.71% of the study population. Among the study participants, 24.57% were admitted to the ICU, 30.57% to the ward, and 44.86% were treated as outpatients. According to PSTS, 192 (54.86%) participants were triaged to green, 119 (34%) participants to yellow, and 39 (11.14%) participants to red. The PSTS demonstrated a sensitivity of 59.59% and a specificity of 72.61% in predicting hospital admission. The NICE triage system had a sensitivity of 80.31%, in predicting the admission (either ward/ICU), with a specificity of 72.61%.

Conclusion: The PSTS demonstrated fair agreement with the NICE; it exhibited lower sensitivity and positive predictive value. However, the simplicity of the new system renders it potentially useful, especially in resource-limited settings.

This review considers high-risk electrocardiographic patterns in the acute coronary syndrome (ACS) patient; we review 7 electrocardiogram presentations lacking diagnostic criteria for ST-segment elevation myocardial infarction (STEMI) yet likely representing either STEMI equivalent syndromes or ACS presentations with significant short-and long-term risk. The STEMI equivalent presentations include acute posterior wall myocardial infarction, the hyperacute T-wave of early STEMI, de Winter syndrome, first diagonal of the left anterior descending artery occlusion, and left bundle branch block modified Sgarbossa positive findings. High-risk presentation, not felt to be STEMI equivalent entities yet still possessing significant risk of short-and long-term adverse outcome, include lead aVR ST-segment elevation and Wellens syndrome. The features of each presentation, highlighting the electrocardiographic abnormalities, are presented and discussed.

Objectives: Traditional scoring systems have been widely used to predict acute pancreatitis (AP) severity but have limitations in predictive accuracy. This study investigates the use of machine learning (ML) algorithms to improve predictive accuracy in AP.

Methods: A retrospective study was conducted using data from 101 AP patients in a tertiary hospital in Türkiye. Data were preprocessed, and synthetic data were generated with Gaussian noise addition and balanced with the ADASYN algorithm, resulting in 250 cases. Supervised ML models, including random forest (RF) and XGBoost (XGB), were trained, tested, and validated against traditional clinical scores (Ranson's, modified Glasgow, and BISAP) using area under the curve (AUC), F1 score, and recall.

Results: RF outperformed XGB with an AUC of 0.89, F1 score of 0.82, and recall of 0.82. BISAP showed balanced performance (AUC = 0.70, F1 = 0.44, and recall = 0.85), whereas the Glasgow criteria had the highest recall but lower precision (AUC = 0.70, F1 = 0.38, and recall = 0.95). Ranson's admission criteria were the least effective (AUC = 0.53, F1 = 0.42, and recall = 0.39), probable because it lacked the 48^th h features.

Conclusion: ML models, especially RF, significantly outperform traditional clinical scores in predicting adverse outcomes in AP, suggesting that integrating ML into clinical practice could improve prognostic assessments.

Masquerading bundle branch block (MBBB) is a rare presentation of bifascicular blocks. It is the result of a right bundle branch block associated with an advanced left anterior fascicular block due to extensive damage to the conduction system. We present the case of a 75-year-old male with late onset presentation anterior wall myocardial infarction (MI) with ongoing ischemia (which evolved into a ventricular septal defect [VSD]). Electrocardiographically, the MBBB is characterized by a prominent R in V1, left axis deviation and absence of small S waves in I and aVL. Its presence confers a poor prognosis and high risk of progressing to advanced atrioventricular block (AAVB). A mortality rate between 18% and 38.9% has been found and 41.4%-59% of the patients develop AAVB requiring pacemaker implantation. To our knowledge, this is the first reported MBBB case in the setting of an MI complicated with VSD, demonstrating its association with the presence of critical anteroseptal ischemia. The patient rejected any kind of intervention, palliative care was offered, and he died 2 months later.

Snake-related injury (SRI) is one of the most common medical emergencies encountered in tropical countries such as Malaysia. The majority of snake bites are nonvenomous, while the less common venomous snakebite can cause major disability or even death. There are 16 pit viper species documented in Malaysia which can be categorized based on their habitat. We report a case of a 41-year-old male who presented to a district hospital 1 h after being bitten twice by a pit viper snake (Trimeresurus sabahi fucatus) on the left side of his face. He was given green pit viper anti-venom (GPAV). He later underwent an emergency tracheostomy due to progressive local swelling causing upper airway obstruction and required a second regime of antivenom. In our opinion, early recognition of snake species, clinical syndrome, and life-threatening conditions in patients with SRI is important. While careful clinical, laboratory, and patient observation is important in determining the need for anti-venom, a life-saving procedure such as intubation, in this case, should not be delayed. From our experience, SRI at the head with progressive swelling to zone 2 of the neck may signal a red flag to the attending clinician for the possibility of impending upper airway obstruction.

Acute pancreatitis is one of the severe complications of hypertriglyceridemia, which needs to be recognized early to provide appropriate treatment. Hypertriglyceridemia-induced pancreatitis has several causes, in which in vitro fertilization (IVF) is a rare etiology that is becoming increasingly popular. We report a 33-year-old female patient with a history of hypertension who has failed an IVF cycle and started a new IVF procedure 1 month before admission. She was diagnosed with severe triglyceridemia-induced acute pancreatitis with extremely high serum triglycerides (TGs) levels (18,547 mg/dL). We combined plasmapheresis and intravenous (IV) insulin and significantly reduced blood TG over a short time. She was discharged with a TG level of 366.7 mg/dL on the 10^th day. It is essential to monitor serum TG levels in plasma before, during, and after this therapy, especially in the 1^st month after initiating IVF. Although plasmapheresis combined with IV insulin is not officially recommended for acute triglyceridemia-induced pancreatitis, the therapy can be considered in cases with extremely high serum TG levels.

The evaluation of adult patients suspected of ST-segment elevation myocardial infarction (STEMI) includes a focused history and examination, 12-lead electrocardiogram (ECG), and cardiac serum marker analysis. The ECG plays a pivotal role in the early diagnosis and management of STEMI. A number of ECG entities in this patient population will present with ST-segment elevation and other electrocardiographic abnormalities which can mimic STEMI. In this article, we review the most frequent STEMI mimic patterns, highlight their ECG characteristics, and compare these individual ECG entities to the electrocardiographic abnormalities present with STEMI.