Effect of pulmonary embolism location on electrocardiological parameters.

OBJECTIVE: Pulmonary thromboembolism is a disease with high morbidity and mortality. Various changes occur on the electrocardiogram secondary to pulmonary thromboembolism. The objective of this study was to investigate variations in QT dispersion, Tpeak-Tend duration, and Tpeak-Tend/QT ratio in relation to pulmonary thromboembolism localization and their impacts on 30-day mortality. METHODS: This study was carried out in a tertiary emergency medicine clinic between December 1, 2019 and November 30, 2020. We evaluated correlations between radiological outcomes of patients, QT dispersions, T-wave dispersions, Tpeak-Tend durations, and Tpeak-Tend/QT ratios. We sought statistically significant disparities between these values, considering the presence or localization of pulmonary thromboembolism. The 30-day mortality in pulmonary thromboembolism-diagnosed patients was reassessed. RESULTS: Electrocardiogramfindings revealed that T-wave dispersion (p<0.001), Tpeak-Tend duration (p=0.034), and Tpeak-Tend/corrected QT ratio (p=0.003) were lower in patients than controls. Conversely, QT dispersion (p=0.005) and corrected QT dispersion (p<0.001) were higher in patients. CONCLUSION: Electrocardiogram findings such as T-wave dispersion, QT duration, Tpeak-Tend time, and Tpeak-Tend/corrected QT ratio can detect pulmonary thromboembolism. More studies with larger cohorts are required to further understand the role of QT and corrected QT dispersion in pulmonary thromboembolism patient mortality.

Violence in the Emergency Department: What Can We Do?

BACKGROUND:  Violence in healthcare settings is a problem around the world, with hospital emergency departments (EDs) being the most common sites. The most important step in preventing violence is to determine the causes and characteristics of the problem. However, there is not enough information in the literature about the particular areas of EDs in which violence occurs. OBJECTIVES:  We aim to produce results that can contribute to violence prevention activities by gathering detailed information about violent incidents in EDs and the intensity of this violence. METHODS:  Our study was planned as a retrospective and descriptive study at a tertiary emergency medicine clinic. Our data include "code white" data between January 1, 2015, and December 31, 2019. The characteristics and types of violence were recorded and categorized. RESULTS:  We evaluated 141 incidences of severe violence reported during the study period. We determined that 55.2% of the violence was directed at physicians and 21.3% at nurses. Verbal violence was by far the most common type of violence, comprising 98.6% of the cases. We found that the violence cases occurred in examination rooms, observation areas, and triage units of the ED (58.2%, 24.1%, and 11.3%, respectively). CONCLUSION:  We determined that violence in the ED is most common after standard working hours, and the most frequent exposure to violence is in examination rooms, observation areas, and triage areas. These findings may be useful in determining preventive measures in EDs, where violence is most common.

Selective intubation with endotracheal tube introducer in difficult airway: A randomized, prospective, cross-over study.

BACKGROUND: Selective lung intubation is a life-saving procedure in emergency departments. While various equipment can be used in selective lung intubation, most of this equipment is not readily available; therefore, single-lumen endotracheal intubations are performed for rapid interventions. MATERIALS AND METHODS: This study was designed as a randomized, prospective, cross-over study using the 90° rotation technique for selective intubation on a manikin model with and without endotracheal tube introducer (ETI) in difficult airway settings. Forty-six emergency physicians were included in the study. The primary outcome was evaluating time to selective intubations, and secondary outcomes were first and second attempt success rates and the self-perceived difficulty level of each method according to the participants. RESULTS: The mean time to the first successful endotracheal intubation was significantly longer for both right selective and left selective intubations with ETI utilization than without ([39.71 ± 9.83 vs. 21.86 ± 5.94 s], [P < 0.001]), ([42.2 ± 10.81 vs. 26.23 ± 7.97 s], [P < 0.001], respectively). The first-pass success rate did not differ for right selective intubation with or without an ETI (45/46 [97.8%] and 45/46 [97.8%], respectively). However, the first-pass success rate for left selective intubation was significantly higher with ETI as compared to without an ETI (30/46 [65.2%] and 13/46 [28.3%], respectively) (P < 0.001). CONCLUSIONS: While the success rates of right selective intubation were the same, the left selective intubation success rates with ETI are higher than the styletted endotracheal tube, which can be strong evidence for this method's applicability in practice. Expanding the use of ETI and increasing the experience of the practitioners can contribute to further success.

The Comparison of Manual and Mechanical Chest Compression on Survival and Long-Term Neurological Outcome of Nontraumatic Out-of-Hospital Cardiac Arrest Patients.

BACKGROUND: High-quality chest compressions are an important determinant for favorable neurological outcome. Associations of long-term mortality and neurological outcomes with chest compression types still require investigation. OBJECTIVES: This study aimed to evaluate 'mechanical or manual CPR' provided in the emergency department after manual cardiopulmonary resuscitation (CPR) initiated in prehospital settings until admission. Efficacy of chest compression types on survival and favorable neurological outcomes were compared in out-of-hospital cardiac arrest (OHCA) patients. METHODS: A total of 818 nontraumatic OHCA patients were evaluated (345 in the manual CPR group and 473 in the mechanical CPR group) retrospectively. One-year survival with a modified Rankin scale (mRS) ≤ 3 was accepted as a favorable neurological outcome. RESULTS: There was no significant difference between the CPR methods (mechanical CPR vs. manual CPR) in terms of mortality at 1, 3, 6, and 12 months (p = 0.353, p = 0.660, p = 0.679, p = 0.034, respectively). mRS ≤ 3, which was accepted as a favorable neurological status, was found to be 12 (3.5%) and 19 (4%) for the manual CPR and mechanical CPR groups, respectively (p = 0.501). CONCLUSION: Comparisons of mechanical and manual chest compressions in terms of survival rates and favorable neurological outcomes showed no significant differences. Further investigation of long-term neurological outcomes with mechanical CPR utilization is required.

Effects of Using an Endotracheal Tube Introducer for Intubation During Mechanical Chest Compressions of a Manikin: Randomized, Prospective, Crossover Study.

BACKGROUND: Airway management methods during out-of-hospital cardiac arrest remain controversial. OBJECTIVES: This study aimed to compare the impact of using an endotracheal tube introducer with a Macintosh laryngoscope on the first-pass success rates of final-year medical students on a manikin during continuous chest compressions with a mechanical compression device. METHODS: Fifty-two final-year students of the faculty of medicine performed endotracheal intubations on a manikin using the Macintosh laryngoscope with and without the endotracheal tube introducer during chest compressions. First-pass success rates, the times of endotracheal intubations, the second endotracheal intubation attempt success rates, and the difficulty level of each method according to the participants' perceptions were measured. RESULTS: First-pass success rates did not differ using an endotracheal tube introducer as an adjunct to a Macintosh laryngoscope. Second endotracheal intubation attempt success rates also did not differ by endotracheal tube introducer use. The usage of an endotracheal tube introducer required significantly longer endotracheal intubation time than using only a Macintosh laryngoscope. The perception of difficulty was significantly lower with endotracheal tube introducer use. CONCLUSION: The use of an endotracheal tube introducer as an adjunct to a Macintosh laryngoscope is not associated with higher first-pass success rates during mechanical chest compressions in adult simulations performed by final-year medical students. © 2020 Elsevier Inc.

Role of Procalcitonin in Evaluation of the Severity of Acute Cholecystitis.

OBJECTIVE: The aim of this study is to investigate the relationship between procalcitonin (PCT) level and the severity of acute cholecystitis. MATERIALS AND METHODS: This study included 200 patients diagnosed with acute cholecystitis. To diagnose and assess the severity of acute cholecystitis; physical examination and abdominal ultrasound findings were evaluated and blood samples were taken to determine white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and levels of coagulation factors, blood gas, C-reactive protein (CRP) and PCT. Patients were classified into three stages, namely, mild, moderate, and severe, according to the severity of acute cholecystitis using the Tokyo guidelines. The role of PCT level in the assessment of severity of acute cholecystitis and the correlation between the stages and PCT level were statistically analyzed. RESULTS: Among patients with acute cholecystitis, 110 (55%) were classified as mild, 61 (30.5%) as moderate, and 29 (14.5%) as severe. Leukocytosis or leukopenia was positive in 48.5%, ESR elevation was found in 72.5%, CRP positivity in 55.5%, PCT elevation in 27%, and positive findings of ultrasonographic imaging in 54.5% of the patients. Serum WBC count, ESR, and CRP and PCT levels increased as the severity of disease increased (p<0.05). PCT could discriminate grade I from grade II-III with 95.45% sensitivity and 46.67% specificity at the best cut-off value of ≤0.52 (p<0.001). PCT could also discriminate grade III from grade I-II with 72.4% sensitivity and 90.06% specificity at the best cut-off value of >0.8 (p<0.001). CONCLUSION: PCT level may be considered to be a parameter that could be added to the assessment of the severity of acute cholecystitis in the Tokyo guidelines, although further studies are needed to support our findings.

The Analysis of Escherichia Coli Resistance in Urine Culture and in Antibiograms as Requested by Emergency Service.

OBJECTIVES: The aim of this study was to determine the antibiotic resistance of infectious and non-infectious E. coli species in order to increase the success of empirical antibiotic treatment in urinary system infections. METHODS: The antibiotic susceptibility of 464 E. coli strains that were isolated from urine samples of patients who visited Derince Training and Research Hospital Emergency Department between January 1 and December 31, 2012 were retrospectively evaluated from records. The antibiogram results were classified as susceptible, moderately susceptible or resistant. Moderately susceptible strains were assumed to be resistant. RESULTS: Bacterial proliferation was seen in 563 (28.1%) of the 1998 urine cultures tested. One hundred and twelve cultures could not be evaluated due to contamination, and there was no proliferation in 1323 cultures. E. coli strains were isolated in 464 (82.4%) of the cultures in which proliferation was seen. Three hundred and sixty seven (79%) of the patients were female, 97 (21%) were male, and the mean age of all of the patients was 41.1±24.1 years (min: 1, max: 90). The antibiograms of the E. coli strains revealed that meropenem had the lowest resistance (0%), while ampicillin-sulbactam had the highest resistance (36.8%). CONCLUSIONS: In this study, we investigated the antibiotic resistance of E. coli strains isolated from urine cultures in our region. Future studies, perhaps similar to this one, can be performed in the future to increase the success of treatments.

Comparison of success and pain levels of supination-flexion and hyperpronation maneuvers in childhood nursemaid's elbow cases.

OBJECTIVE: The aim of this study was to compare the hyperpronation (HP) and the supination-flexion (SF) reduction techniques for reducing nursemaid's elbow in terms of efficacy and pain. METHODS: This prospective, pseudorandomized, controlled, nonblinded study was conducted in an urban tertiary care emergency department between October 1, 2009, and October 1, 2010. A total of 150 patients (51 males [34%] and 99 females [66%] between the ages of 0 to 6 years) were included in the study. When the first reduction attempt failed, second attempt was performed using the same technique. After failure of the second attempt, reduction technique was changed to an alternate technique. Level of pain was evaluated using the Modified Children's Hospital of Eastern Ontario Pain Scale in 113 patients older than 1 year who had a successful reduction process on the first attempt. RESULTS: Successful reduction was accomplished in 121 (80.7%) of the patients during the first attempt, in 56 (68.3%) of the patients using the SF technique and in 65 (95.6%) of the patients using the HP technique (P < .001). At the end of total attempts, we found that the SF (59/84) technique was less successful than the HP (91/93) technique (P < .001). The pain levels of the both techniques were not statistically different. CONCLUSION: The HP technique was found to be more successful compared with the SF technique in achieving reduction. We were unable to find any significant difference in pain levels observed between the 2 techniques.