The value of ETCO2 measurement for COPD patients in the emergency department.

We aimed to determine the value of sidestream end-tidal carbon dioxide (SS-ETCO2) measurement in patients with chronic obstructive pulmonary disease (COPD) in the emergency department. Cross-sectional associations between ETCO2 and PaCO2 were examined in the study. This prospective cross-sectional study has been carried out over a 3-month period in a tertiary care university hospital emergency department with an annual census of 75 000 visits. During the study period, simultaneous SS-ETCO2 measurement using a Medlab Cap 10 sidestream capnograph was performed on every COPD patient requiring arterial blood gas analysis. The demographics, diagnosis, vital signs, laboratory test results and clinical outcomes of the patients were recorded. SS-ETCO2 measurement and arterial blood gas analysis were carried out on 118 patients. Mean arterial PCO2 levels were 43.24±14.73 and mean ETCO2 levels were 34.23±10.86 mmHg. Agreement between PCO2 and ETCO2 measurements was 8.4 mmHg and a precision of 11.1 mmHg.As there is only a moderate correlation between PCO2 and ETCO2 levels in COPD patients, ETCO2 measurement should not be considered as a part of the decision-making process to predict PaCO2 level in COPD patients.

Characteristics of tourist patients in an emergency department in a Mediterranean destination.

BACKGROUND: Tourists are exposed to traditional health problems of the host country, such as trauma and the exacerbation of previously existing illnesses during their travels. OBJECTIVE: The purpose of this study is to determine the clinical characteristics of tourist patients and any predictors of hospital admission. MATERIAL AND METHOD: This retrospective observational study was carried out in the tertiary care hospital emergency department (ED) of a Mediterranean destination city, Antalya, Turkey. Hospital data from all tourist patients presenting or transferred to the ED between August 2003 and September 2004 were evaluated. Tourist patients were defined as all non-Turkish citizens. RESULTS: A total of 961 tourist patients was studied, of whom 295 (31%) were admitted and 666 (69%) were discharged. Fifteen patients died in the hospital, 49 critically ill patients were transferred back to their home country, and 153 patients underwent a surgical intervention. The most common discharge diagnoses were trauma (405, 42%), nonspecific symptoms (106, 11%), and circulatory disorders (108, 11%). Admitted tourist patients were significantly older than those discharged; however, there were no differences in sex among the groups. Applying a logistic regression model, age, tachycardia, mode of arrival, and triage category were all found to be significant predictors of admission, but only the initial Glasgow Coma Scale was found to be a significant predictor of mortality. In total, 347 patients were from European Union (EU) countries, and 614 were from non-EU countries. A significant difference was found between the EU and non-EU patient groups according to age, mortality, admission rate, exposure to trauma, ED length of stay, hospital length of stay. Tourist patients from EU countries were older, had higher mortality, lesser trauma exposure, longer ED, and hospital length of stay. CONCLUSION: EDs can be expected to manage tourist patients presenting for traumatic injuries and circulatory disorders. Clinical differences relating to patients' nationality might help in the development of targeted patient education and injury-prevention programs. Emergency physicians and the tourism industry should recognize the challenges of caring for this growing and aged patient population.