Hospital crisis management after a disaster: from the epicenter of 2023 Türkiye-Syria earthquake.

BACKGROUND: In such cases where sudden destruction and injury are very high, search and rescue teams and hospitals can be the most important determining factors between people's lives and deaths. METHODS: This study was conducted retrospectively, after the two catastrophic earthquakes (Türkiye-Syria Earthquakes) by taking the records of the patients who admitted to our hospital. Patients' admission times, diagnoses, demographic data, triage codes, medical interventions, hemodialysis needs, crush syndrome and mortality rates were analyzed. RESULTS: In the first 5 days after the earthquake, 247 earthquake-related patients were admitted to our hospital. The most intense period of admission to the emergency department was the first 24 h. The most intensive period of surgical procedures was 24-48 h. It was observed that Orthopedic surgical procedures were applied most frequently and the most common cause of mortality was crush syndrome. CONCLUSION: In terms of preparations for earthquakes, especially in hospitals in the earthquake zone it will be beneficial for each hospital to make hospital disaster plans. For this reason, we thought it would be useful to share our experiences during this disaster.

Factors influencing paramedics' and emergency medical technicians' level of knowledge about the 2015 basic life support guidelines.

BACKGROUND: This study aimed to determine the cardiopulmonary resuscitation (CPR) knowledge level and factors affecting the current CPR knowledge level among EMTs and paramedics working in the Kayseri 112 emergency health system. METHODS: This survey aimed to reach all paramedics and emergency medical technicians working in the 112 emergency health system in Kayseri province. The data collection consists of sociodemographic/occupational characteristics, CPR training and practice characteristics and 20 four-choice CPR knowledge questions. Multiple linear regression analysis was used to determine the independent variables that affect the number of correct answers given to the questionnaire. RESULTS: 305 healthcare professionals were included in this study. 57.0% (n = 174) of the participants were female and 56.1% were under the age of 30. It was found that 65.6% (n = 200) of the healthcare professionals were EMTs, and 48.6% (n = 148) had been working for 6-10 years. The mean number of correct responses based on the 20 questions asked was 12.76 ± 3.11. In multivariable analysis, it was determined that having received training on CPR after 2015, having participated in a course or seminar on CPR in the last 3 months and having practiced defibrillation/cardioversion during CPR significantly increased the level of knowledge regarding CPR (respectively, p < 0.01, p = 0.025, p = 0.045). CONCLUSION: CPR trainings, which have been received recently and based on the current guidelines, increase the level of CPR knowledge and the increasing knowledge level affects the use of defibrillation/cardioversion. Improving training increases knowledge and practice.

Retrospective analysis of patients with sternal fracture.

OBJECTIVES: Sternal fractures (SFs) are rare pathologies that mainly occur as a result of traffic accidents, which can cause mortality due to concomitant complications. In this study, we aimed to evaluate clinical processes and termination status of patients diagnosed with a SF in the emergency department. METHODOLOGY: Patients diagnosed with a SF in the emergency department during 8 years were retrospectively reviewed. The demographic and clinical characteristics of the patients were recorded, and standard data forms were created. RESULTS: In total, 128 patients were included in the study; 81 (63.3%) patients were male, and the mean age was 49.4 years. When the fracture mechanism was examined, car traffic accidents were the most common type and the cause of fracture in 85 (66.4%) patients. The most common thoracic pathology accompanying SFs was rib fractures (35.9%), and the most common extrathoracic pathology was cranial pathology (27.3%). Pericardial effusion was detected in 12 (9.4%) patients. Of the participating patients, one died and the others were hospitalized. CONCLUSION: Since SFs and associated complications can be life-threatening, emergency room physicians should consider it in the diagnosis. In particular, the necessary examinations and follow-up should be done to assess cardiac damage.

Desensitizing Effect of Frequently Witnessing Death in an Occupation: A Study With Turkish Health-Care Professionals.

This study aimed to investigate anxiety and fear of death created by the consciousness of death in professionals who frequently witness death and to determine variables related to the dimensions of mortality awareness. Data were gathered from 212 health-care employees, primarily those in emergency medicine and intensive care. Variance analysis was used to assess sex and experience groups using the Bonferroni post hoc test. Hierarchical multiple regression analysis was used to determine the predictive relationships. Health-care employees' fear of death decreased with experience. No significant difference was observed between the experience groups in terms of conservatism values such as conformity, tradition, and security in the theory of basic human values. Empathy level was determined to be significantly predictive of the mortality awareness dimensions. These findings indicate a desensitization effect of witnessing the death, contrary to that predicted by the terror management theory.

Mortality salience in professionals witnessing death: The effects of mortality manipulation on doctors' evaluations.

This study investigates whether frequently witnessing death leads to desensitization in terms of death anxiety. A total of 163 individuals, comprising 71 doctors from branches with high death rates and 92 doctors from branches where mortality is rarely seen, participated in this study. An experiment was conducted employing a classical version of mortality salience manipulation, which is often used in terror management research, to test the study's hypothesis. The results supported the hypothesis only with regard to altruism-egoism, providing partial support for the effect of desensitization. This subject needs to be studied further.

Intrahospital critical patient transport from the emergency department.

INTRODUCTION: Although intrahospital transportation of critical patients from the emergency department (ED) is inevitable, it could also result in life-threatening situations. These situations, referred to as unwanted or unexpected events, mainly happen during the transportation of patients for diagnostic imaging or invasive procedures and result in a wide spectrum from vital condition changes, mental condition changes to cardiopulmonary arrest and death. Emergency departments have a high risk of facing such situations because these units are the first admission door of critical patients. MATERIAL AND METHODS: This cross-sectional study was conducted prospectively, after interviewing the doctors who work in the ED actively, and by filling out the forms which were already prepared by the participants. Statistical analysis was performed according to the data received, and results were compared to the literature. RESULTS: Three hundred and forty-seven doctors from 52 hospitals were included in the study. 59.4% (n = 206) of them were working at EDs which had more than 500 patients admitted. 51.9% (n = 180) of doctors stated that they performed 10 or more critical patients' transport every day from their ED. 86.7% (n = 301) of the participants stated that usage of control checklists would decrease the rate of unwanted situations and stated that they wanted to use them. CONCLUSIONS: Intrahospital transportation of critical patients from the emergency room is a subject that should require attention by emergency room doctors, and using educated personnel, proper equipment, standardized protocols and control checklists will decrease the frequency of unwanted situations effectively.

An Analysis of Patients who Underwent Tube Thoracostomy in the Emergency Department: A Single Center Study.

OBJECTIVES: The aim of this study was to determine the demographic and clinical characteristics of patients who underwent tube thoracostomy in the emergency department (ED). The secondary aim of the study was to evaluate parameters such as the diagnosis for which the patients underwent tube thoracostomy, the imaging techniques used during diagnosis, and complications related to the procedure. MATERIALS AND METHODS: This prospective study was conducted in the ED between June 1, 2015 and May 31, 2016. The study included 125 patients aged >18 years, of both sexes, who presented to the ED during this period and who underwent tube thoracostomy. RESULTS: The patients comprised 91 (73%) males and 34 (27%) females. Of the 125 patients, 21 (17%) presented directly to the ED, 8 (6%) were referred from a polyclinic, 82 (66%) were brought by ambulance, and 14 (11%) were referred from another center. Reasons for presentation were traumatic in 64 (51%) and non-traumatic in 61 (49%) patients. The leading diagnosis was pneumothorax in 98 (78.4%) cases. The procedure of tube thoracostomy was performed by an emergency medicine (EM) resident for 26 (21%) cases and by a thoracic surgery resident for 99 (79%) cases. Complications were observed at the rate of 3.8% in the procedures performed by the EM residents and at 4% in those performed by the thoracic surgery residents. The mean follow-up time of the patients with tube thoracostomy was 7.5±4.4 days. CONCLUSION: In intensive trauma centers, in particular, and in centers where procedures such as central venous catheterization and diagnostic thoracentesis are frequently performed, it would be useful for EM physicians to undergo training in performing tube thoracostomy to a level where they are able to intervene in an emergency situation such as traumatic or iatrogenic pneumothorax.

Plasma copeptin levels in the patients with gastrointestinal bleeding.

INTRODUCTION: Gastrointestinal bleeding is a significant cause of morbidity and mortality worldwide. In addition, it constitutes an important part of health expenditures. In this study, we aimed to determine whether there is a relationship between plasma copeptin levels and the etiology, location and severity of gastrointestinal bleeding. MATERIALS AND METHODS: This study was performed prospectively in 104 consecutive patients who were admitted to an emergency department with complaints of bloody vomiting or bloody or black stool. To evaluate the level of biochemical parameters such as Full Blood Count (FBC), serum biochemistry, bleeding parameters and copeptin, blood samples were obtained at admission. For the copeptin levels, 2 more blood samples were obtained at the 12th and 24th hours after admission. The values obtained were compared using statistical methods. RESULTS: In terms of the etiology of bleeding, the copeptin levels in the patients with peptic ulcer were higher than the levels in patients with other gastrointestinal bleeding. However, the difference was not statistically significant. There were no significant differences among all groups' 0th, 12th and 24th hour levels of copeptin. DISCUSSION: We conclude that copeptin cannot be effectively used as a biochemical parameter in an emergency department to determine the etiology and location of gastrointestinal bleeding. It can, however, be used to make decisions on endoscopy and the hospitalization of patients with suspected gastrointestinal bleeding.

Serum Neutrophil Gelatinase-Associated Lipocalin Levels In Early Detection Of Contrast-Induced Nephropathy.

PURPOSE: The purpose of this study was to investigate the role of serum neutrophil gelatinase-associated lipocalin (NGAL) levels in the early detection of contrast-induced nephropathy (CIN). METHODS: This prospective study enrolled 74 patients undergoing abdominal tomography with contrast (1 November 2014 - 28 February 2015). Demographic properties (age and sex), symptoms and CT examination results were analysed. Sodium, potassium, urea, creatinine and NGAL levels were measured at 0th, 6th, and 72nd hours. P value < 0.05 was considered statistically significant. RESULTS: CIN developed in 16.2% of the study patients. The mean age was significantly higher in the patients who developed CIN (p0.05). Urea levels did not differ significantly between the groups at 0th and 6th hours (p>0.05) but was significantly higher in the patients with CIN at 72nd hour (p0.05). Creatinine level was not significantly different between the groups (p>0.05) but increased significantly over time (p>0.05). There were no significant differences between the groups with respect to NGAL levels at 0th and 72nd hours (p>0.05) whereas the group with CIN had a significantly higher NGAL level at 6th hour (p.

Evaluation of the diagnostic and prognostic use of gated myocardial perfusion single-photon emission computed tomography in patients with acute chest pain: comparison with the SYNTAX score.

OBJECTIVE: The aim of this study was to evaluate the diagnostic and prognostic efficacy of gated single-photon emission computed tomography (GSPECT) in patients with acute chest pain and to compare quantitative GSPECT parameters and the coronary angiographic SYNTAX score. MATERIALS AND METHODS: A total of 168 patients who presented with clinical symptoms of acute chest pain were enrolled in the study. Study participants were divided into two groups according to the risk of acute coronary syndrome (ACS): low-intermediate and high risk. All participants underwent rest or stress-GSPECT (R/S-GSPECT). Coronary angiography was performed in all high-risk patients and the SYNTAX score was determined. All patients were followed for 24 ± 3 months and monitored for the occurrence of major adverse coronary events (MACE). RESULTS: Among patients with low-intermediate ACS risk, R-GSPECT and S-GSPECT were associated with 100 and 86% sensitivity, 99 and 98% specificity, 100 and 98% negative predictive value, 80 and 86% positive predictive value, and 98 and 97% accuracy, respectively. At follow-up, MACE occurred in 16 patients. Among high-risk patients, GSPECT quantitative parameters were the most significant predictors of MACE in Cox regression analysis. CONCLUSION: R/S-GSPECT, a noninvasive diagnostic method, is associated with an excellent safety profile and exceptional diagnostic and prognostic accuracy in cases of ACS.

Importance of neutrophil gelatinase-associated lipocalin in differential diagnosis of acute and chronic renal failure.

BACKGROUND: Neutrophil Gelatinase-associated Lipocalin (NGAL) protein is easily detected in the blood and urine soon after acute renal injury. NGAL gains features of an early, sensitive and noninvasive biomarker for acute renal injury. Recent evidences suggest that its expression is also increased in CRF reflecting the severity of disease. OBJECTIVES: In the present study, we aimed to investigate whether blood NGAL level plays a role in the differential diagnosis of acute and chronic renal failure. PATIENTS AND METHODS: This was a prospective case-control study. Fifty patients presented to emergency department with acute renal failure (ARF), 30 with chronic renal failure (CRF) and 20 healthy individuals as control group were included in this study. Blood pH, HCO3(-), BUN, creatinine and potassium values were evaluated in all patients. Blood NGAL values were evaluated in all groups. BUN, serum creatinine and NGAL values were statistically compared between patients and controls. RESULTS: Median NGAL levels in patients was 304.50 (29), and 60 (0) in control, which was statistically significant between the two groups (Z = -6.477, P < 0.001). The median NGAL values were 261.50 ± 291 in ARF group and 428.50 ± 294 in CRF group. There was a significant difference in NGAL level between ARF and CRF groups (Z = -2.52, P = 0.012). Median BUN values were 153.46 ± 82.47 in ARF group and 169.40 ± 93.94 in CRF group. There was no significant difference in BUN value between ARF and CRF groups (P > 0.05). Median creatinine values were 2.84 ± 2.95 in ARF group and 4.78 ± 4.32 in CRF group. In serum creatinine values, a significant difference was found between ARF and CRF groups (P < 0.05). CONCLUSIONS: Serum NGAL levels of ARF and CRF patients were significantly higher than healthy individuals. In addition, NGAL values of patients with CRF were significantly higher than those of ARF. Serum NGAL values can be used to detect renal injury and differentiate ARF and CRF.

The accuracy rate of Alvarado score, ultrasonography, and computerized tomography scan in the diagnosis of acute appendicitis in our center.

OBJECTIVE: In this study, we aim to compare the relationship between the Alvarado score, ultrasonography, and multislice computerized tomography (CT) findings used for the diagnosis of the patients who presented to our emergency unit with clinical features suggestive of acute appendicitis. MATERIALS AND METHODS: Seventy-four patients operated with the diagnosis of acute appendicitis were included in the study. The demographic characteristics of the patients, physical findings, blood parameters, Alvarado scores, the radiological method used for the diagnosis, the surgical methods (open or laparoscopic) and the pathology results were recorded on the standard proforma. The collected data were analyzed with Statistical Package for Social Sciences (SPSS 15 for Windows, SPSS Inc., Chicago, Illinois, USA) computer program. RESULTS: During study period, the sensitivity of ultrasonography was found to be as 71.2%, specificity as 46.7%, the positive predictive value (PPV) as 82.2%, the negative predictive value (NPV) as 31.8%, and the accuracy rate was determined as 65.7%. The sensitivity of tomography was determined as 97.2%, the specificity as 62.5%, PPV as 92.1%, and NPV as 83.3%, and the accuracy rate was determined as 90%. The sensitivity of the Alvarado score was calculated as 54%, the specificity as 73.3%, the PPV as 88.2% and the NPV as 29.7%, and the accuracy rate was determined as 57.7%. CONCLUSION: In conclusion, computerized tomography (CT) was found to have higher specificity and sensitivity than Alvarado score and USG which are not sufficient on their own for taking the decision for surgery. We also found that CT scan had lower negative laparotomy rate when compared with the other two modalities.

Comparison of the Canadian CT head rule and the new orleans criteria in patients with minor head injury.

AIM: The aim of the study was to compare the New Orleans Criteria and the New Orleans Criteria according to their diagnostic performance in patients with mild head injury. METHODS: The study was designed and conducted prospectively after obtaining ethics committee approval. Data was collected prospectively for patients presenting to the ED with Minor Head Injury. After clinical assessment, a standard CT scan of the head was performed in patients having at least one of the risk factors stated in one of the two clinical decision rules. Patients with positive traumatic head injury according to BT results defined as Group 1 and those who had no intracranial injury defined as Group 2. Statistical analysis was performed with SPSS 11.00 for Windows. ROC analyze was performed to determine the effectiveness of detecting intracranial injury with both decision rules. p < 0.05 was considered statistically significant. RESULTS: 175 patients enrolled the study. Male to female ratio was 1.5. The mean age of the patients was 45 ± 21,3 in group 1 and 49 ± 20,6 in group 2. The most common mechanism of trauma was falling. The sensitivity and specificity of CCHR were respectively 76.4% and 41.7%, whereas sensitivity and specificity of NOC were 88.2% and 6.9%. CONCLUSION: The CCHR has higher specificity, PPV and NPV for important clinical outcomes than does the NOC.

Does usage of peritonism tests in an emergency department have any benefit?

AIM: To evaluate the usage of inspiration, expiration, cough, and heel drop jarring tests that are applied for determination of peritonism in cases with acute abdominal pain. METHODS: A prospective study based on observation of patients between 16-65 years of age and presented to the Emergency Department within a 3-month period starting from June 2007, was conducted. The patients were asked to rate their pain level between "0" and "10". Following the measurement of the vital signs, 4 tests were conducted by an emergency medicine resident. The medical records of all the patients were reviewed after 3 months. Data concerning clinical diagnosis, hospital admission and discharge processes, and surgical results, were all recorded. RESULTS: Seventy-seven patients had peritonism tests performed. Inspiration test was positive in 29 (of 51, 56.9%) patients admitted to the hospital. However, there was no correlation between the cases admitted to the hospital and the other 3 tests (p more than 0.05). Twenty-one (of 34, 61.8%) patients which have been subjected to surgical treatment, showed positive inspiration test results. Surgical treatment was performed on nine (of 11, 81.8%) patients who showed positive results for all 4 tests. CONCLUSION: The applied tests are helpful in determining a serious abdominal disease, particularly alongside findings of rebound, tenderness, and laboratory results.

Syncope Associated with Carbon Monoxide Poisoning due to Narghile Smoking.

Narghile smoking is a traditional method of tobacco use, and it has been practiced extensively for 400 years. Traditionally, narghile smoking is a matter of culture mainly in Middle East, Asia, and Africa. In recent years, its use as a social activity has increased worldwide, especially among young people. Narghile smoking is an unusual cause of carbon monoxide poisoning. Narghile smoking, compared to cigarette smoking, can result in more smoke exposure and greater levels of carbon monoxide. We present an acute syncope case of a 19-year-old male patient who had carbon monoxide poisoning after narghile smoking.

Traumatic floating clavicle.

We report a case of traumatic floating clavicula in a man aged 21 years. He was admitted to our emergency department with polytrauma sustained in a motor car accident, successfully treated 21 days after the accident with bipolar open reduction and wire stabilization.

Characteristics of acute adult poisonings in a university hospital emergency department in central Turkey: a three-year analysis.

OBJECTIVE: To evaluate the etiologic and demographic characteristics of acute adult poisoning cases and to obtain up-to-date information on acute poisonings. METHODS: A retrospective study was conducted to evaluate 1254 adults who presented with acute poisoning to the Emergency Department of our tertiary care university hospital in central Turkey from January 2007 to December 2009. The data extracted from each chart related to age, gender, marital status, agent involved in the poisoning, season of event, route of poisoning, time between ingestion or exposure and arrival at the casualty ward, mechanism of toxic exposure (unintentional or intentional), level of consciousness, length of stay in the ward, and outcome. RESULTS: Acute poisonings comprised 1.40% of Emergency Department patients; 65% were female, while 47% were between the ages of 16 and 25 years. Medicinal drugs were the most common cause of poisonings (68%), followed by gases (9.5%). Antidepressants were the most frequent drug ingested (18%), followed by analgesics (16%). Intentional poisonings constituted the majority of cases (78%). Most suicide attempts were made by women (68%) and majority of the patients were married (57%). Twenty patients (1.6%) died during their hospital stay, with organophosphate pesticides being the most common agent (n = 8) involved in fatal poisonings. CONCLUSION: Pharmaceutical agents, carbon monoxide and pesticides are the three most common poisoning agents. Deliberate self-poisoning is common in adults in the area of the study; the risk being highest in females and younger adults. These up-to-date data provide important information on the characteristics of acute poisonings and can guide activities such as professional training, preventive measures, community education and new research.

A rare entity in ED: posterior reversible encephalopathy syndrome.

Posterior reversible encephalopathy syndrome is a clinico-neuroradiologic entity with typical symptoms and symmetric high-signal intensity lesions in the bilateral parietooccipital lobes on T2-weighted or fluid-attenuated inversion recovery magnetic resonance imaging. In this presentation, we report a case of posterior reversible encephalopathy syndrome who was admitted to our emergency department because of seizure and deterioration of consciousness. The aim of this presentation is to alert the emergency physicians about one of the hypertensive emergencies with neurologic symptoms associated with hypertension.

Cervicofacial emphysema and pneumomediastinum after a high-speed air drill endodontic treatment procedure.

Cervicofacial subcutaneous emphysema is defined as the abnormal introduction of air in the subcutaneous tissues of the head and neck. It is mainly caused by trauma, head and neck surgery, general anesthesia, and coughing or habitual performance of Valsalva maneuver. The occurrence of subcutaneous emphysema after dental treatment is rare, and diffusion of gas into the mediastinum is much rarer, especially when the procedure is a nonsurgical treatment. The most common dental cause of pneumomediastinum is the introduction of air via the air turbine handpiece during surgical extraction of an impacted tooth. Only 6 cases of pneumomediastinum after endodontic treatment have been reported between 1960 and 2008. Pneumothorax is defined clinically as an "accumulation of air or gas between the parietal and visceral pleurae," and although it is often not a medical emergency, it can result in respiratory distress, tension pneumothorax, shock, circulatory collapse, and even death. Although there are many possible causes of dyspnea during a dental procedure, 1 rare complication is pneumothorax. Although specific closed turbine systems are available for oral surgical procedures, these drills may be used in exodontia to section teeth and facilitate tooth extraction. We report a case of cervical subcutaneous emphysema and pneumomediastinum occurring after an endodontic treatment of right first molar using an air-tribune drill. We present here in a case of massive pneumomediastinum and cervicofacial subcutaneous emphysema that occurred after opening the access cavity for endodontic treatment. We describe its etiologies and guidelines for its prevention during nonsurgical endodontic treatment.