Evaluation of postictal optic nerve sheath diameter at epileptic patients.

INTRODUCTION: During a seizure, metabolic rate and, consequently, cerebral blood flow increase to provide the required maintenance energy. It is thought that this causes an increase in intracranial pressure, but there is no comprehensive research on this subject. In this study, we aimed to measure and follow optic nerve sheath diameter (ONSD) in patients who applied to the emergency department (ED) after generalized tonic-clonic (GTC) seizures and to gain information about intracranial pressure changes in epilepsy patients in the postictal period. MATERIALS AND METHODS: This was a prospective observational study. Patients already diagnosed with epilepsy who applied to the ED within one hour after GTC seizures were included. The ONSD of the patients was measured by the same radiologist three times in both eyes using ultrasonography at the time of admission and the fourth hour of follow-up. The seizure characteristics and measurements of the patients were recorded, and the changes in ONSD over time and correlations between seizure characteristics and ONSD were examined. RESULTS: Sixty-six patients were included in the study. Thirty-four (51.5%) of the patients had seizures with auras. For both eyes, the first-hour ONSD values of the patients [right: 5.90 (5.73-6.16) mm, left: 5.86 (5.73-6.13) mm] were significantly higher than the fourth-hour ONSD values [right: 5.26 (5.19-5.40) mm, left: 5.28 (5.16-5.36) mm)] (p < 0.001 for both eyes). Additionally, the first- and fourth-hour ONSD values of patients with seizures with auras were significantly higher than those with seizures without auras (p < 0.001 for each condition). There was no correlation between other variables related to seizure type and ONSD. CONCLUSION: This study showed that after GTC seizures in epilepsy patients, ONSD increases in the first hour postictal and decreases over time. Another important result is that the increase in ONSD values in seizures with auras is significantly higher than in seizures without auras.

Impact of COVID-19 pandemic on visits of an urban emergency department.

OBJECTIVE: The aim of this study was to reveal how the pandemic process affected the number of ED visits and the reasons for application. METHODS: The daily number of ED visits during the pandemic were analyzed in 3 different periods; prepandemic period (February 1st to March 11th, declaration of the first COVID-19 case in Turkey), early pandemic period (March 12th to May 31th, period of strict measures), and late pandemic period (June 1st to July 31st, period of new norms). The pandemic periods were compared with the same timeframes in 2019 (comparison periods). Demographic variables and complaints of the patients on admission were investigated. RESULTS: The total number of ED visits in the study period in 2020 was 78,907, which was only the half of the applications in the same period in 2019 (n: 149,387). Data showed a sharp decrease at the number of daily visits to green and yellow zones after the announcement of the first case however red zone applications were more than twice that of the previous year. During pandemic nonspecific complaints was decreased and there was an increase at the percentages of respiratory, cardiac, and neurological complaints. CONCLUSION: Number of ED visits during the pandemic were decreased by half when compared to the previous year. It was an advantage of the pandemic to decrease ED visits due to "nonemergent" complaints, and thus, unnecessary patient burden. However, on the other hand, patients avoided seeking medical attention, even for life-threatening conditions which led to increased mortality and morbidity.

Effectiveness of the CRISP Method on the Primary Cardiac Arrhythmia Interpretation Accuracy of Nurses.

BACKGROUND: Accurate electrocardiogram (ECG) interpretation is key to quickly providing attention to patients, and the first health staff who evaluate ECGs are nurses. METHOD: This was a prospective study with a pre-posttest design. The study test included 15 ECGs related to primary cardiac arrhythmias. After pretest nurses were instructed on arrhythmia interpretation using the Cardiac Rhythm Identification for Simple People (CRISP) method, posttests were completed. RESULTS: There was a significant difference between the pretest scores of nurses who had postgraduate education on ECG interpretation and who did not (p = .002). Median test score increased from 3 (interquartile range [IQR] = 2-5) to 7 (IQR = 5-9) (p < .001). Participants mostly missed questions about heart blocks and were most successful with questions about fatal arrhythmias after education. CONCLUSION: The CRISP method is an effective, simple, and easy method for accurate ECG interpretation by nurses. The posttest scores of the participants, especially accurate interpretation of fatal arrhythmias, increased significantly after training. [J Contin Educ Nurs. 2020;51(12):574-580.].

Retrospective analysis of forensic cases in refugees admitted to emergency department.

INTRODUCTION: The aim of this study was to compare the distribution and frequency of forensic medical events in a refugee group with that of the general population, and thus, extrapolate the problems encountered in the immigrant population. METHODS: Those cases admitted to the emergency department (ED) for any reason that required a forensic examination between January 2016 and June 2018 were investigated retrospectively. RESULTS: A total of 310 refugees were admitted to the ED for forensic medical events. The most common nations of origin of the refugees were Iraq (n = 167), Syria (n = 65), and Afghanistan (n = 28). The median age of the refugees was 24 years old (interquartile range = 17-33). With regard to forensics, the most common reasons for the refugees to present to the ED were motor vehicle accidents 27.4%, assaults 25.8%, employment and industrial accidents 16.1%, and suicide attempts 10.3%. Other than suicide attempts, all of the forensic presentations were more common in the males. The outcomes of the refugee group were as follows: 92.3% were discharged, 5.8% were admitted to the hospital, 1% were admitted to the intensive care unit (ICU), and 1% were transferred. Suicide attempts were the most common reasons for the ICU admissions, while the most common reasons for the hospital admissions were orthopedic injuries. CONCLUSION: In general, the forensic event frequency in the refugee group was lower (p = 0.001); however, this was a single center study, and there could have been unrecorded cases due to an inability to access healthcare assistance, so these results may not be reliable.

Copeptin levels in carbon monoxide poisoning.

BACKGROUND/AIM: The aim of this study is to identify the copeptin levels in patients presenting with carbon monoxide (CO) poisoning to the emergency department and to investigate its correlation with the neurological effects. MATERIALS AND METHODS: The study group consisted of patients presenting with CO poisoning and carboxyhemoglobin levels >10%. Blood samples for copeptin levels were obtained twice, first at presentation then at the fourth hour of observation. The data were analyzed using SPSS 16 for Windows. RESULTS: The median copeptin levels of the patient group were identified as 0.63 (0.39-1.06) ng/mL at hour 0 and 0.41 (0.31-0.49) at hour 4. The copeptin levels of the control group were 0.34 (0.25-0.42) ng/mL and were significantly lower than those of the patient group (P < 0.000). According to our results, 0.345 ng/mL for plasma copeptin level as the best cut-off level may be used with sensitivity of 94.0% and specificity of 60%. The copeptin levels at hour 0 were statistically significantly higher in the neurologically affected patients than those not affected (P < 0.001). CONCLUSION: In this study it was shown that blood copeptin levels increase in patients presenting to the emergency department with CO poisoning.