Emergency Management and Nursing Considerations of Carotid Blowout Syndrome.

INTRODUCTION: Carotid blowout syndrome is a rare but fatal complication often witnessed secondary to treating patients with head and neck cancer. It occurs when damage and necrosis lead to the carotid artery wall rupture. The symptoms encountered in these patients range from asymptomatic to cardiac arrest. Here, we present 5 cases of carotid blowout syndrome in the emergency department. CASE PRESENTATIONS: Patients demonstrated symptoms ranging from subtle bleeding to hemodynamic instability, highlighting the diverse nature of carotid blowout syndrome in this population. Notably, while all patients had a history of radiotherapy, some had additional risk factors for carotid blowout syndrome, including prior surgery (n = 2), malnutrition (n = 3), and tracheostomies (n = 2). Definitive diagnoses were established through clinical evaluation and computed tomography angiography. Immediate interventions included bleeding control, resuscitation, and consultations with relevant specialties. Four patients underwent interventional radiology procedures, and 1 patient received otolaryngology care. While 2 patients recovered completely, 1 died in the emergency department, and 1 in the intensive care unit. One patient's clinical course was complicated by a stroke. CONCLUSION: The approach to the carotid blowout syndrome patient includes complex steps that proceed in a multidisciplinary manner, starting from triage until discharge. Emergency nurses play crucial roles at every stage. They should be aware of carotid blowout syndrome when evaluating patients with head and neck cancer presenting with bleeding. When treating these patients, emergency nurses should be ready for airway interventions, bleeding control, and massive transfusion protocol. In this context, the multifaceted approaches made by nurses contribute significantly to carotid blowout syndrome management in the emergency department.

Usability of EtCO2 values in the decision to terminate resuscitation by integrating them into the TOR rule (an extended TOR rule): A preliminary analysis.

Objective: End tidal carbon dioxide (EtCO2) is measured to confirm the placement of an endotracheal tube and evaluate the efficacy of cardiopulmonary resuscitation (CPR), and as an assistive tool for terminating CPR. However, there are no highly accurate or definitive recommendations for its use when deciding on the termination of CPR. We aimed to merge EtCO2 values with existing termination of resuscitation (TOR) rules to obtain a more accurate combination for terminating resuscitation. Methods: This observational, prospective study included non-traumatic adult patients who were admitted to a tertiary university hospital Emergency Medicine Department due to cardiac arrest. EtCO2 cutoff values (at 5, 10, and 20 min) were integrated into currently used TOR parameters (arrest was not witnessed, no bystander CPR was provided, no return of spontaneous circulation (ROSC) after full advanced life support care in the field, and no shock was delivered) and the extended TOR rule was created. These extended TOR rules were compared at three different times (5, 10, and 20 min) for specificity and positive predictive value for ROSC. Results: We included a total of 86 cases. The cutoff value of EtCO2 from ROC analysis was 19.5, 23.5, and 20.5 mmHg at 5, 10, and 20 min, respectively. "The extended TOR rule created with the 20-min EtCO2 cutoff (20.5 mmHg) was the most accurate in detecting ROSC (-) patients. The specificity was 100% (95% CI 63.1-100.0) sensitivity was 20.0% (95% CI 9.1-35.7), positive predictive value was 100% and negative predictive value was 20.0% (95% CI 17.6-22.6) for ROSC (-) patients. The parameters of this rule were as follows: arrest was not witnessed, no bystander CPR was provided, no ROSC after full advanced life support care in the field, no shock was delivered, and EtCO2 value at 20 min of resuscitation <20.5 mmHg. Conclusions: Integration of EtCO2 values into the classically used TOR criteria increases the specificity to 100% without a significant decrease in sensitivity. These results need to be validated in larger groups before this rule is used clinically. EtCO2 seems to be a beneficial tool in establishing new TOR rules.

A rare dental complication caused by a rare pathogen: Preseptal Cellulitis caused by Pseudomonas Oryzihabitans: a case report.

Various infective complications can be seen after a dental procedure. They are rarely resistant to standard therapy. In the case we present, a case of preseptal cellulitis caused by pseudomonas oryzihabitans after tooth extraction in a male patient who did not have any underlying cause. As in our case, evaluation of the cases resistant to standard treatment in terms of drainage and multidisciplinary management of culture results together with infectious diseases will increase the treatment success rate.

Comparative Analysis of Perfusion Index and End-Tidal Carbon Dioxide in Cardiac Arrest Patients: Implications for Hemodynamic Monitoring and Resuscitation Outcomes.

BACKGROUND: During cardiopulmonary resuscitation (CPR), some parameters (e.g., intraarterial pressure measurement and end-tidal carbon dioxide (EtCO2)) indicate the quality and outcome of resuscitation. These parameters are generally based on monitoring the hemodynamic status. Perfusion index (PI) is a calculation from the photoplethysmography (PPG) signal and displays the proportion of pulsatile to non-pulsatile light absorption or reflection in the PPG signal. It helps to evaluate cardiac output and tissue perfusion in the care of a critical patient. Its most important advantages are that it can be easily measured with a pulse oximeter probe attached to the finger (non-invasive), can be objectively repeated, can be applied quickly, and is inexpensive. Normal PI values range from 0.2% to 20%. Despite being recognized as a valuable indicator of hemodynamics, there is limited information regarding its relevance in patients experiencing cardiac arrest. Although the PI is known to be a valuable parameter to indicate hemodynamics, information about its value in cardiac arrest patients is limited. This study aims to evaluate the performance of PI and EtCO2 in predicting the return of spontaneous circulation (ROSC) among cardiac arrest patients. METHODS: This was a single-center, prospective, observational clinical study including both out-of-hospital and in-hospital adult cardiac arrest patients. The study was conducted from November 1, 2018 to April 30, 2019 at the Emergency Department (ED) of the Hacettepe University Hospital, Ankara, Turkey. The EtCO2 values of the patients were recorded at the time they were intubated (t0) and every five minutes (t5, t10, t15...) during CPR. Along with these measurements, PI values were measured with the Masimo Signal Extraction Technology device (Masimo, California, United States). The study's primary outcome was PI's performance in predicting the ROSC among cardiac arrest patients. The secondary outcomes of the study were the performance of EtCO2 in predicting the ROSC among cardiac arrest patients and the association between PI and EtCO2 values. RESULTS: We included a total of 100 cases. The mean age of patients was 70.4 ± 13.4 years, and 65% were male. The ROSC was achieved in 29 patients. There was no statistical difference in PI values between the ROSC (+) and ROSC (-) groups at any minute. However, in the ROSC (+) group, EtCO2 values were observed to be high starting from the fifth minute (t5, p=0.010; t10, p<0.001; t15, p=0.014; t20, p=0.033; t25, p=0.003, respectively). There was no correlation between the PI and EtCO2 values at 0, 5, 10, 15, 20, and 25 minutes (t0, p=0.436; t5, p=0.154; t10, p=0.557; t15, p=0.740; t20 p=0.241; t25 p=0.201, respectively). CONCLUSION: Measuring PI values during resuscitation in intubated cardiac arrest patients does not help clinicians predict the outcome. In addition, no correlation was found with EtCO2 values. However, EtCO2 values remained high in patients with the ROSC from the fifth minute onward. Further larger-scale studies are needed regarding the optimal use of PI in cardiac arrest patients.

The Evolution of Gastrointestinal Bleeding: A Holistic Investigation of Global Outputs with Bibliometric Analysis.

BACKGROUND: Gastrointestinal bleeding is one of the main presentations in emergency department admissions. Although there has been much improvement in prevention, diagnosis, and treatment recently, patients with GIB still have high morbidity and mortality. This study aimed to analyze the scientific articles on gastrointestinal bleeding published between 1980 and 2020 using statistical and bibliometric methods. METHODS: Articles about gastrointestinal bleeding published between 1980 and 2020 were downloaded using the Web of Science data base and analyzed using statistical methods. Network visualization maps were used to identify trending topics. Correlation studies were evaluated using Spearman's correlation coefficient. Nonlinear regression analysis (exponential model) was used to estimate the number of articles in future years. RESULTS: A total of 12 568 publications about gastrointestinal bleeding were found. Forty percent (n = 5033) of these publications were articles. The top 3 contributing countries to the literature were the United States of America (1646, 32.7%), the United Kingdom (433, 9%), and Germany (391, 7.7%). The top three journals with the most publications were Gastrointestinal Endoscopy (172), American Journal of Gastroenterology (165), and Digestive Diseases and Sciences (161). The effect of countries' gross domestic product levels on article productivity on gastrointestinal bleeding was significant (r = 0. 770, P < .001). CONCLUSION: In this comprehensive study, a summary of 5033 articles was presented. We think that these detailed analyses will be a quick source to show the past, present, and future of this subject to those who are currently working on gastrointestinal bleeding.

The evolution of cardiopulmonary resuscitation: Global productivity and publication trends.

BACKGROUND/OBJECTIVE: There is still no comprehensive bibliometric study in the literature on cardiopulmonary resuscitation (CPR), an important topic in emergency medicine, the number of global studies on which is increasing day by day. In this study, it was aimed to analyze the scientific articles on CPR published between 1980 and 2020 by statistical methods and to evaluate the subject holistically. METHODS: Articles on CPR published between 1980 and 2020 were downloaded from the Web of Science (WoS) database and analyzed using statistical methods. Network visualization maps were used to identify trending topics. Nonlinear regression analysis (exponential model) was used to estimate the number of articles in the coming years. Correlation studies were conducted using the Spearman correlation coefficient. RESULTS: A total of 21,623 publications were found. Of these publications, 14,818 (68.5%) were articles. The top 3 contributing countries to the literature were the United States (5281, 35.6%), Germany (1458, 9.8%), and the United Kingdom (1152, 7.7%). The 3 most active institutions were the University of Washington (417), University of Pittsburgh (361), and University of Arizona (240). The 3 journals with the most publications were Resuscitation (2822), Critical Care Medicine (522), and the American Journal of Emergency Medicine (421). CONCLUSION: In this comprehensive study, a summary of 14,818 articles was presented. The trending topics in CPR research in recent years are out-of-hospital cardiac arrest, extracorporeal membrane oxygenation, cardio, simulation, in-hospital cardiac arrest, extracorporeal life support, extracorporeal cardiopulmonary resuscitation, targeted management temperature, and outcome. This article may be a useful resource on CPR global outcomes for clinicians and scientists.