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.

Investigation of Vitamin B12 Deficiency in Patients with Acute Coronary Syndrome and its Relationship with Gensini Score.

BACKGROUND: Vitamin B12 deficiency is not an independent risk factor for cardiovascular disease. However, anemia due to vitamin B12 deficiency and also hyperhomocysteinemia are among the cardiovascular risk factors. The study aimed to determine the frequency of vitamin B12 deficiency in patients with acute coronary syndrome. We also aimed to ascertain whether there is a significant difference between obstructive coronary artery disease presence and its severity in patients with and without vitamin B12 deficiency using the Gensini score. METHODS: Patients who underwent coronary angiography due to acute coronary syndrome between June 1, 2018, and November 30, 2019, and whose vitamin B12 levels were measured were retrospectively analyzed. Coronary angiography results of the patients were evaluated with the Gensini scoring system. RESULTS: Anemia was observed in 32.6% (n = 135) of the patients who underwent coronary angiography with a diagnosis of acute coronary syndrome, and vitamin B12 deficiency was observed in 14.7% (n = 61). The median age was 69 years in anemic patients and 68 years in those with Vitamin B12 deficiency and was significantly higher than patients without anemia and vitamin B12 deficiency (p < 0.001 and p = 0.038, respectively). There was no statistically significant differences between the patients' Gensini scores with or without Vitamin B12 deficiency (p = 0.554). CONCLUSIONS: We concluded that anemia and vitamin B12 deficiency were higher in elderly patients with acute coronary syndrome. We found no significant difference when the Gensini score was used to evaluate obstructive coronary artery disease presence and its severity according to anemia and vitamin B12 deficiency. Investigating vitamin B12 levels in elderly patients with acute coronary syndrome should not be ignored.

Platelet Indices' Usefulness in Determining whether Patients with COVID-19 Should be Treated as an Outpatient or Inpatient: a Retrospective Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has affected the health system around the world. It is necessary to facilitate health care services with useful parameters in patient follow-up. In this study, we wanted to determine whether platelet indices can be used as an assistant parameter in the clinician's decision-making process regarding which of the patients diagnosed with COVID-19 should be treated by hospitalization. METHODS: This retrospective study was performed in a secondary care hospital in Mugla, Turkey. Demographic information such as age, gender, and comorbidities of patients admitted to the emergency pandemic outpatient clinic within five months and diagnosed with COVID-19, as well as discharge, hospitalization, or intensive care needs (ICU), and thirty-day mortality were noted. Also, patients with platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), thrombocytocrit (PCT), MPV/PLT, MPV/PCT, PDW/PLT, PDW/PCT values for outpatient follow-up, hospitalization, intensive care unit need, and 30-day mortality relationships were examined. RESULTS: A total of 93 patients diagnosed with COVID-19 were included in the study. It was observed that those with comorbidity had a statistically significant higher rate of hospitalization (p = 0.013). No statistically significant difference was found between outpatients and inpatients in terms of PLT, MPV, PDW, PCT, MPV/PLT, MPV/ PCT, PDW/PLT, and PDW/PCT (p > 0.05 for each). CONCLUSIONS: Platelet indices such as PLT, MPV, PDW, PCT, MPV/PLT, MPV/PCT, PDW/PLT, and PDW/PCT are not useful parameters for the clinician to distinguish between outpatient and inpatient treatment of patients with COVID-19.

Comparison of Clinical, Laboratory and Demographic Characteristics of Patients Diagnosed with COVID-19 as Symptomatic and Atypical Symptoms.

BACKGROUND: Clinical findings of COVID-19 have been observed with a wide spectrum ranging from asymptomatic disease and mild upper respiratory tract infection to severe viral pneumonia resulting in mortality. While clinical symptoms present in some COVID-19 patients, others have been incidentally identified. The objective of this study was to examine the clinical and laboratory features of patients diagnosed with COVID-19 who were symptomatic or had atypical symptoms and to make a contribution to the literature. METHODS: Patients with the likelihood of having COVID-19 pneumonia were evaluated with RT-PCR samples, other laboratory tests, and chest computed tomography. RESULTS: There were significant differences between these groups in terms of age, dyspnea, saturation, and comor-bidities including hypertension [HT] in 19 patients, cerebrovascular events [CVE] that were classified as other diseases in two patients (intracranial mass in one patient and Alzheimer's disease in one patient), and CRP and platelet counts (PLT) among the laboratory parameters (for all p < 0.05). CONCLUSIONS: Atypical symptoms have increased due to the progression of the outbreak. Infected people with atypical symptoms can act as sources of the infection. Therefore, the epidemiological history of these patients should be sought in detail, and individuals with atypical symptoms in society should be identified as soon as possible in order to control the spreading of the disease.

The Demographic Analysis of the Probable COVID-19 Cases in Terms of RT-PCR Results and Age.

BACKGROUND: Despite global prevention and quarantine efforts, the incidence of COVID-19 disease continues to increase. As a possible cause, our aim was to investigate which parameters increase the sensitivity or protection against COVID-19 between RT-PCR positive and RT-PCR negative cases in patients admitted to the emergency department. METHODS: In the pandemic process, patients admitted to the hospital with suspicion of COVID-19 were evaluated retrospectively. RT-PCR test was divided into + (for Group 1) and - (Group 2). The gender, age, clinical information, application symptoms, and comorbidity data of the patients were evaluated. RESULTS: One hundred and sixty-seven cases were evaluated in the study. Group 1: 88 cases, M/F ratio: 46/42 and average age 48 ± 17.3 years, Group 2: 79 cases, M/F ratio was approximately 3/2, and the average age was 48.3 ± 19.4 years. When the groups were compared in terms of symptoms, fever, cough, weakness, and headache were prominent in Group 1, whereas the contact was significantly higher in Group 2 (p < 0.05). Among the comorbid diseases, only COPD showed a significant difference between the groups, and it was found significantly higher in Group 2 (p < 0.05). CONCLUSIONS: Cough, headache, and fever were found valuable in the detection of cases. Attention should be paid to contact isolation to circumvent the pandemic process with less damage. Having chronic diseases, especially COPD, increases the risk of infection with SARS-CoV-2. Close monitoring and control of chronic diseases can positively change the course of COVID-19.

Endogenous Carboxyhemoglobin Concentrations in Predicting Prognosis of Patients with COVID-19 Pneumonia.

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak has caused great difficulties in providing healthcare services worldwide. Accurate and useful indicators are needed for the effective use of resources. Carbon monoxide (CO) is also produced endogenously without exogenous exposure. Studies confirm that endogenous CO increases in conditions such as pneumonia, sepsis, and trauma. This study aimed to compare patients diagnosed with COVID-19 pneumonia and healthy people to reveal whether endogenous carboxyhemoglobin (COHb) levels differ. It was also to determine whether it could be a helpful indicator for the clinician in predicting disease severity in combating the COVID-19 pandemic. METHODS: The study included 72 patients admitted to the hospital during the COVID-19 pandemic and diagnosed with COVID-19 pneumonia and a control group of 75 healthy people. The research data was collected retrospectively in a tertiary emergency department. The patients' demographic data, pneumonia severity index (PSI) score, CURB-65 score, 30-day mortality, hospitalization, need for mechanical ventilation (MV), and COHb levels were recorded. RESULTS: While the COHb level was 0.9% (min-max, 0.1 - 4.0) in patients with COVID-19 pneumonia, it was 1% (min-max, 0.1 - 2.6) in the control group. No significant difference was found between the patients and the control group in terms of COHb levels (p = 0.341). Also, there was no correlation between COHb levels and PSI and CURB-65 scores. No significant difference was detected between COHb levels and patients diagnosed with COVID-19 pneumonia in terms of mortality, need for MV, or hospitalization (p > 0.05). CONCLUSIONS: We concluded that COHb levels alone could not be used to diagnose COVID-19 pneumonia or predict disease severity. Besides, in COVID-19 pneumonia, the COHb level was not a useful indicator of mortality, need for MV, or hospitalization decision. Further studies are needed to find useful indicators to assist clinicians in their decision-making process in tackling the COVID-19 pandemic.

The Role of Lactate and Troponin-I Levels in Predicting Length of Hospital Stay in Patients with Carbon Monoxide Poisoning.

BACKGROUND: Carbon monoxide (CO) is one of the most common causes of unintentional poisonings resulting in death. Patients with more severe findings such as loss of consciousness and persistent neurological or cardiovascular dysfunction require hospitalization. Although there are clinical findings which determine hospitalization criteria in patients presenting with CO poisoning, there is some ambiguity regarding laboratory biomarkers which determine length of hospital stay (LOS) in these patients. In this study, we aimed to identify the effectiveness of initial blood gases and biochemical parameters in predicting LOS in patients presenting to the emergency department with CO poisoning by retrospective analysis of medical records. METHODS: This study was conducted in the Emergency Department (ED) of Samsun Training and Research Hospital by analyzing from medical records retrospectively of 275 patients who were admitted to the hospital following acute CO poisoning between January 2014 and July 2017. The patients were divided into 3 groups according to LOS: Group I, patients with LOS < 24 hours; group II, those with LOS > 24 hours and < 3 days; and group III, those with LOS > 3 days. RESULTS: In comparisons regarding lactate and troponin-I, it was found that there were significant differences in both parameters among the three groups (p = 0.000) and that both lactate and troponin-I levels were higher in group III than groups I and II, with group I being lowest (group III > group II > group I). While there was a mod¬erate positive statistically significant correlation between LOS and lactate (r: 0.43, p = 0.001) and troponin (r: 0.31, p = 0.001), a weak positive correlation was determined with CK (r: 0.19, p = 0.04). In this study, it was found that lactate and troponin-I values were more effective in predicting LOS when compared to carboxyhemoglobin levels and other biochemical parameters. CONCLUSIONS: The results of this study may guide clinicians to predict LOS in patients who present with CO poi-soning and have high troponin-I and lactate levels at the time of admission to EDs.