Mortality rate associated with carbon monoxide poisoning in Turkey: A national database study.

OBJECTIVE: To investigate non-fire and unintentional deaths caused by carbon monoxide poisoning in the light of official national data, and to calculate the national mortality rate associated with carbon monoxide poisoning in Turkey. METHODS: The retrospective cross-sectional study was conducted in Ankara, Turkey, from January to March 2019, and comprised data of deaths registered with the Turkish Statistical Institute between January 1, 2013, and December 31, 2017. Data was analysed using SPSS 21and Microsoft Excel. RESULTS: Of the 1896 deaths, 1310(69.1%) were males, and the highest number of deaths 622(33%) was recorded in 2014. Deaths were most common in the 18-64 years age group 1071(56.6%). Overall, there were 1841(97.1%) Turkish citizens and 55(92.9%) foreign nationals. Manisa had the highest number of deaths 266(14%) at a mortality rate of 3.84 per 100,000 population. CONCLUSIONS: The factual situation of death associated with carbon monoxide in Turkey will lead to steps to reduce the risk.

Myocardial Repolarization Parameters and Neutrophil-to-Lymphocyte Ratio are Associated with Cardiotoxicity in Carbon Monoxide Poisoning.

The present study aims to examine the clinical values of complete blood count (CBC) bioindicators and corrected QT (QTc), Tpeak - Tend interval (Tp-e), Tpeak dispersion (Tp disp), and Tp-e/QT ratio that are the parameters of myocardial repolarization (M-rep) for cardiotoxicity, which develops due to acute carbon monoxide (CO) intoxication in patients admitted to the emergency service. This retrospective, cross-sectional, observational, and single-center study was conducted between April and June 2019. Statistical analysis was performed using the SPSS 23.0 software. Data of 234 participants were analyzed. Of these, 54.9% (n = 129) were female. Neutrophil-to-lymphocyte ratio (NLR), QTc, Tp-e values were significantly high in the CO intoxication group (p < 0.001, p < 0.001, and p < 0.001, respectively), whereas Tp-e/QTc ratio was significantly lower in the CO intoxication group than that in the control group (p < 0.001). NLR, Tp-e, Tp disp values were significantly high in the myocardial injury (M-inj) group (p < 0.001, p = 0.003, and p = 0.018, respectively). Furthermore, Tp-e/QTc ratio was significantly low in the M-inj group (p = 0.002). M-rep parameters and NLR are associated with CO intoxication and the development of M-inj. Moreover, these bioindicators and can provide clinicians an early indication of M-inj.

Evaluation of residents' thoughts about giving the news of death.

OBJECTIVE: To assess behaviours and attitudes of residents toward giving news of death in emergency department and other departments. METHODS: The study was conducted between 1st and 7th December, 2012, in an urban hospital in Ankara, Turkey. It used a questionnarie that was filled by 100 residents from different disciplines of medicine. Categorical variables were analysed with Chi-square and Fisher's exact tests and continuous variables were analysed with Mann Whitney test. The level of statistical significance was set at 0.05. RESULTS: The most difficult cases to notify were those of unexpected and sudden deaths (n = 51; 51%) followed by deaths of children (n = 36; 36%). While 60% (n = 60) of the study group reported a need for training in this area, but there was no association between having difficulty in notifying a death and expressing the need for training (p = 0.187). Residents who had difficulty in notifying death informed the patient's close ones more often during resuscitation (p = 0.049) and requested for security staff more often during the final briefing compared with the group that did not express having difficulty (p < 0.001). CONCLUSION: Notifying death is still a challenging issue in medicine. Instead of educational efforts, security measures may be more beneficial and comforting for residents who have difficulty in conveying the news.

The accuracy of mainstream end-tidal carbon dioxide levels to predict the severity of chronic obstructive pulmonary disease exacerbations presented to the ED.

INTRODUCTION: The end-tidal carbon dioxide (ETCO2) measurement was considered as an essential tool for the assessment of several conditions in emergency medicine. However, the diagnostic role of capnography in dyspneic patients still remains unclear. We aimed to analyze the alteration of the ETCO2 levels in chronic obstructive pulmonary disease (COPD) exacerbations and its role in the decision-making process. METHODS: All the individuals who were presented to the emergency department (ED) after COPD exacerbations were prospectively enrolled in the study. The patients were excluded if they refused to give informed consent, intubated after initial assessment, and had uncertain COPD diagnosis. The ETCO2 measurement using a mainstream capnometer was undertaken in the pretreatment and post-treatment period of COPD exacerbations. RESULTS: A total of 102 patients were enrolled in the study. Pre-ETCO2 and post-ETCO2 levels were positively correlated with arterial partial carbon dioxide pressure levels (r=0.756, P<.001 and r=0.629, P<.001, respectively). The median pre-ETCO2 level was 32.0 (30.5-40.5) in discharged patients and 39.0 (31.0-53.5) in admitted patients. After the initial therapy in the ED was completed, the median post-ETCO2 level was found to be 32.0 (28.0-37.5) in discharged patients and 36.0 (32.0-52.0) in admitted patients. Although a statistically significant difference was observed in the pretreatment period (P=.043), no difference was observed in post-treatment period between ETCO2 levels (P=.107). CONCLUSION: End-tidal carbon dioxide levels were higher in admitted patients when compared with discharged patients on arrival to the ED. ETCO2 measurement has very little contributions while evaluating patients with COPD exacerbation in the ED.