Turkish Journal of Emergency Medicine最新文献

{"title":"Pediatric blast injuries: Distinguishing features and unique challenges.","authors":"Charlie Joe Layoun, Eveline Hitti, Rachelle El Helou","doi":"10.4103/tjem.tjem_381_25","DOIUrl":"10.4103/tjem.tjem_381_25","url":null,"abstract":"<p><p>Blast injuries are a major cause of morbidity and mortality in modern conflicts and terrorist incidents, placing children in particular danger in both combat and civilian settings. Pediatric blast trauma differs notably from adult presentations due to unique anatomical, physiological, and developmental factors. This review highlights the etiology, demographic distribution, and injury patterns in pediatric blast victims, emphasizing distinctions from adults and the implications for clinical management. Children are frequently injured in terrorism-related explosions, explosive remnants of war, and accidental incidents such as fireworks, with a consistent male predominance. Head injuries are more common and severe in children, reflecting larger head-to-body ratios, thinner skulls, and a lack of protective equipment. Ocular trauma, tympanic membrane rupture, and primary blast lung injury occur at higher rates than in adults. Abdominal trauma, though less frequent, contributes disproportionately to mortality due to thinner abdominal walls and larger solid organs. Extremity injuries are the most common overall, particularly upper limb amputations from unexploded ordnance and lower limb amputations from landmines. Burn and inhalation injuries, although less prevalent, are associated with markedly higher mortality in children compared to adults. Management poses unique challenges: pediatric airway anatomy predisposes to obstruction; permissive hypotension strategies used in adults are inappropriate; and surgical needs, including laparotomy and orthopedic interventions, are more frequent. Beyond the physical trauma, psychosocial consequences are profound and require early, age-appropriate support. Pediatric blast injuries, therefore, demand customized guidelines that address their distinctive injury patterns and management requirements, highlighting the need for pediatric-specific protocols in emergency medicine.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 2","pages":"87-93"},"PeriodicalIF":6.6,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correspondence: Comment on \"Efficacy of erector spinae plane block versus intravenous tramadol for pain management in acute pancreatitis\".","authors":"Swetha Ramesh, V T Amrithanand","doi":"10.4103/tjem.tjem_434_25","DOIUrl":"10.4103/tjem.tjem_434_25","url":null,"abstract":"","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 2","pages":"156-157"},"PeriodicalIF":6.6,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disulfiram-like reaction with ornidazole: A case report of a rare interaction.","authors":"Ertug Orhan, Busra Orhan, Cagrihan Ceylan","doi":"10.4103/tjem.tjem_308_25","DOIUrl":"10.4103/tjem.tjem_308_25","url":null,"abstract":"<p><p>A disulfiram-like reaction (DLR) associated with ornidazole is a rare but important adverse drug-alcohol interaction. We report a 44-year-old female with no known comorbidities or drug allergies who presented to the emergency department with palpitations, nausea, vomiting, facial flushing, and acral hyperemia. Her symptoms began approximately 30 min after consuming two glasses of raki while receiving ornidazole for a pilonidal cyst. On examination, she was found to be hypotensive and tachycardic. Laboratory results were within normal limits. Her symptoms improved significantly with supportive care over 16 h. A Naranjo Adverse Drug Reaction Probability Scale score of 7 indicated a probable relationship with ornidazole. This case represents a rare instance of a DLR due to ornidazole monotherapy in a patient without chronic alcohol use. Clinicians should be aware of this potential interaction and advise patients to avoid alcohol consumption during ornidazole therapy to prevent DLRs.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 2","pages":"150-152"},"PeriodicalIF":6.6,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Silent threat: The deadly face of acute respiratory symptoms in earthquake survivors.","authors":"Banu Katlan, Özlem Kahraman Çayan, Mesut Topdemir, İsmail Kızıldağ, Ümit Korkmaz","doi":"10.4103/tjem.tjem_208_25","DOIUrl":"10.4103/tjem.tjem_208_25","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate the underlying causes and clinical outcomes of acute respiratory symptoms in critically ill pediatric patients who survived the February 6, 2023, earthquake and were admitted to the pediatric intensive care unit (PICU) of a designated disaster hospital.</p><p><strong>Methods: </strong>This retrospective, longitudinal observational study included pediatric patients aged 1 month to 18 years admitted to the PICU of Mersin City Training and Research Hospital due to respiratory symptoms following the earthquake. Clinical, radiological, and laboratory data and treatment outcomes were analyzed. Ethics committee approval was obtained from the Toros University. Group comparisons were made between patients with and without respiratory involvement. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for key associations.</p><p><strong>Results: </strong>Of 140 children, 48 (34.3%) had respiratory involvement (mean age: 10.2 ± 5.2 years, 54.2% of males, and 67% admitted within 72 h). Major etiologies were chest trauma (41.7%), acute kidney injury-related pulmonary edema (14.6%), combined chest trauma + acute kidney injury (27.1%), and neurological causes (10.4%); infections (4.2%) and allergic reactions (2.1%) were less common. Respiratory support was needed in 19 (39.6%) patients. Respiratory involvement correlated with multisystem trauma (63% vs. 11%, <i>P</i> < 0.001), chest trauma (69% vs. 0%, <i>P</i> < 0.001), and acute kidney injury (50% vs. 32%, <i>P</i> = 0.048). PICU stay was longer (2.9 ± 2.2 vs. 2.2 ± 1.4 days, <i>P</i> = 0.014), while mortality was low (2% vs. 0%, <i>P</i> = 0.740). In multivariable analysis, acute kidney injury (OR: 5.2, 95% CI: 2.0-13.1, <i>P</i> < 0.001) and central nervous system injury (OR: 3.1, 95% CI: 1.2-8.0, <i>P</i> = 0.018) independently predicted respiratory involvement.</p><p><strong>Conclusion: </strong>In pediatric earthquake survivors, respiratory symptoms often indicate multisystem involvement. Beyond chest trauma, acute kidney injury and neurological causes are major contributors to respiratory compromise. A comprehensive, integrative approach is essential for timely diagnosis and intervention.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 2","pages":"102-109"},"PeriodicalIF":6.6,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A holistic approach to climate change in the emergency department: Direct impact of environmental factors on patients.","authors":"Sarper Yilmaz, Ali Cankut Tatliparmak, Bülent Erbil, Funda Karbek Akarca, Onur Karakayali, Seyran Bozkurt, Recep Dursun, Nurcan Bicakci, Mustafa Ferudun Celikmen, Serkan Yilmaz, Murat Orak, Mehmet Ali Karaca, Mehtap Bulut, Sila Sadillioglu, Yenal Karakoç","doi":"10.4103/tjem.tjem_280_25","DOIUrl":"10.4103/tjem.tjem_280_25","url":null,"abstract":"<p><p>Climate change is no longer a distant threat but a present and escalating burden on emergency departments (EDs) worldwide. Its direct and indirect effects, ranging from heatstroke and hypothermia to vector-borne disease resurgence and mass casualty incidents, challenge conventional models of emergency preparedness. This narrative review explores the intersection of climate dynamics with ED operational and clinical vulnerabilities. We summarize five core physiological mechanisms by which temperature extremes disrupt homeostasis and review high-risk medication classes that may exacerbate heat-related morbidity. In addition, we examine the World Health Organization's mass casualty triage framework and its relevance in climate-driven disasters such as floods, wildfires, and explosions. Special attention is given to low-resource settings and migration-heavy regions, where infrastructure strain and health inequity amplify the impact. We propose integrative, anticipatory planning models that combine clinical vigilance, environmental monitoring, and dynamic triage protocols. By identifying EDs as both front-line responders and sentinel systems, this study underscores the urgency of embedding climate resilience into emergency care strategies. Our synthesis aims to support clinicians, policymakers, and health systems in adapting emergency services to the realities of a warming world.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 1","pages":"1-18"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146020107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"End-of-life care knowledge and attitude in managing dying patients among healthcare workers in the emergency department.","authors":"Muhamad Faiz Mohd Fauzi, Shamsuriani Md Jamal, Nik Azlan Nik Muhamad, Muhammad Munawar Mohamed Hatta, Amsyar Daud","doi":"10.4103/tjem.tjem_155_25","DOIUrl":"10.4103/tjem.tjem_155_25","url":null,"abstract":"<p><strong>Objective: </strong>End-of-life care (EOLC) in the emergency department (ED) is a growing global necessity. This study aimed to assess the level of knowledge and attitudes toward EOLC among ED healthcare workers.</p><p><strong>Methods: </strong>A prospective and cross-sectional study was conducted involving 155 healthcare workers at a tertiary ED. The Palliative Care Knowledge Tool (PCKT) and the Frommelt Attitude toward Care of the Dying (FATCOD) Scale were adapted, translated into Malay, and validated for use. Participants completed validated, self-administered questionnaires assessing knowledge using FATCOD the PCKT and attitudes toward EOLC using the FATCOD Scale. The primary outcomes were the healthcare workers' knowledge and attitudes, with secondary analysis exploring associated factors.</p><p><strong>Results: </strong>The overall level of knowledge on EOLC among healthcare workers was poor with a mean score of 8.54 (±2.97) out of 17. Despite this, attitudes toward EOLC were positive with a mean score of 92.61 (±8.80) out of 120. A weak positive correlation was found between knowledge and attitudes (<i>r</i> = 0.186, <i>n</i> = 155, <i>P</i> = 0.020<i>)</i>. The factors such as education level, work experience, and profession were significantly associated with variations in knowledge and attitudes.</p><p><strong>Conclusion: </strong>This study revealed that despite poor knowledge of EOLC among healthcare workers in the ED, their attitudes toward managing dying patients were positive. The weak correlation between knowledge and attitudes suggests a modest link between these domains.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 1","pages":"19-27"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146020181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Musculoskeletal, airway, and vascular injuries in the patient with nonjudicial hanging: A narrative review for the emergency clinician.","authors":"","doi":"10.4103/tjem.tjem_465_25","DOIUrl":"10.4103/tjem.tjem_465_25","url":null,"abstract":"<p><p>[This corrects the article on p. 256 in vol. 25, PMID: 41104366.].</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 1","pages":"85"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First use of andexanet alfa in the management of massive delayed hemothorax.","authors":"Miroslaw Kozlowski, Julia Antkiewicz, Anna Choroszewska, Krystian Czolpinski, Pawel Niemynski","doi":"10.4103/tjem.tjem_25_25","DOIUrl":"10.4103/tjem.tjem_25_25","url":null,"abstract":"<p><p>In emergency medicine practice, massive hemothorax represents a life-threatening condition in patients with comorbidities. We present the case of a 75-year-old female patient with a massive delayed hemothorax, which developed following a chest injury sustained during a low-height fall. The patient had been on long-term rivaroxaban, a direct oral anticoagulant, due to underlying comorbid conditions. To reverse the anticoagulant effect, andexanet alfa was administered, followed by the placement of chest drainage. After evacuating the bloody pleural effusion from the pleural cavity, full lung reexpansion was achieved, with only minimal residual drainage within an hour. Following drainage removal, the patient was subsequently discharged without any complications. After follow-up, the patient remained in good condition. This case demonstrates that andexanet alfa can be an effective reversal agent in life-threatening cases of massive delayed hemothorax.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 1","pages":"71-74"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nontraumatic subdural hemorrhage due to arachnoid cyst rupture.","authors":"Hümeyra Karaömer Erdoğan, Ersin Aksay, Mustafa Can Güzelce, Sefer Özgür","doi":"10.4103/tjem.tjem_195_25","DOIUrl":"10.4103/tjem.tjem_195_25","url":null,"abstract":"<p><p>Arachnoid cysts (ACs) are benign congenital lesions that are often detected incidentally during imaging studies performed for various etiological reasons. These cysts are typically asymptomatic, and in most cases do not require surgical intervention. Although ACs are commonly encountered, they are rarely complicated by intracystic hemorrhage or subdural hematoma. In this report, we present a case of a nontraumatic rupture of an AC, which remained undiagnosed until the age of 52 years.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 1","pages":"82-84"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sepsis-induced coagulopathy and its association with mortality in patients with sepsis and septic shock.","authors":"Hoang Phu Quy, Nguyen The Thoi, Nguyen Huu Thanh, Pham Dang Hai","doi":"10.4103/tjem.tjem_36_25","DOIUrl":"10.4103/tjem.tjem_36_25","url":null,"abstract":"<p><strong>Objectives: </strong>Sepsis-induced coagulopathy (SIC) is a common complication in patients with sepsis and septic shock. Early detection of SIC is crucial for timely intervention, as it can significantly impact patient outcomes. This study aims to evaluate the prevalence of SIC and its impact on the 28-day mortality rate in patients with sepsis and septic shock.</p><p><strong>Methods: </strong>A single-center retrospective observational cohort study was conducted in Vietnam from January 2021 to August 2024. Adult patients diagnosed with sepsis or septic shock who were admitted to the intensive care unit within 24 h of initial presentation were included. Patients with do-not-resuscitate orders, coagulopathy, malignant blood disorders, incomplete data, or refusal of treatment were excluded. SIC scores were assessed, and 28-day mortality rates were recorded.</p><p><strong>Results: </strong>A total of 340 patients were included, with 216 (63.5%) exhibiting SIC (SIC score ≥4). The mean age of patients was 69.01 ± 17.04 years, and the majority were male (61.5%). Septic shock accounted for 79.7% of the cases. SIC patients had significantly higher mortality rates at both 4 days (17.6% vs. 4.8%, <i>P</i> = 0.001) and 28 days (40.3% vs. 24.4%, <i>P</i> = 0.005). Nonsurvivors exhibited higher SIC (73.9% vs. 57.9%, <i>P</i> = 0.003) and had worse disease severity scores. Multivariate analysis confirmed that SIC score ≥4 was strongly associated with increased 28-day mortality (odds ratio 1.799, <i>P</i> = 0.033).</p><p><strong>Conclusions: </strong>The prevalence of SIC is high in patients with sepsis and septic shock, especially in our cohorts. SIC score ≥4 is also a strong and independent predictor for 28-day mortality.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 1","pages":"28-36"},"PeriodicalIF":6.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}