Turkish Journal of Emergency Medicine最新文献

{"title":"High-risk electrocardiogram presentations in the acute coronary syndrome patient - Beyond ST-segment elevation myocardial infarction.","authors":"William J Brady, Andrew E Muck, James H Moak","doi":"10.4103/tjem.tjem_150_24","DOIUrl":"https://doi.org/10.4103/tjem.tjem_150_24","url":null,"abstract":"<p><p>This review considers high-risk electrocardiographic patterns in the acute coronary syndrome (ACS) patient; we review 7 electrocardiogram presentations lacking diagnostic criteria for ST-segment elevation myocardial infarction (STEMI) yet likely representing either STEMI equivalent syndromes or ACS presentations with significant short-and long-term risk. The STEMI equivalent presentations include acute posterior wall myocardial infarction, the hyperacute T-wave of early STEMI, de Winter syndrome, first diagonal of the left anterior descending artery occlusion, and left bundle branch block modified Sgarbossa positive findings. High-risk presentation, not felt to be STEMI equivalent entities yet still possessing significant risk of short-and long-term adverse outcome, include lead aVR ST-segment elevation and Wellens syndrome. The features of each presentation, highlighting the electrocardiographic abnormalities, are presented and discussed.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"25 1","pages":"1-9"},"PeriodicalIF":1.1,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068595","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":"Improved outcome prediction in acute pancreatitis with generated data and advanced machine learning algorithms.","authors":"Murat Özdede, Ali Batur, Alp Eren Aksoy","doi":"10.4103/tjem.tjem_161_24","DOIUrl":"https://doi.org/10.4103/tjem.tjem_161_24","url":null,"abstract":"<p><strong>Objectives: </strong>Traditional scoring systems have been widely used to predict acute pancreatitis (AP) severity but have limitations in predictive accuracy. This study investigates the use of machine learning (ML) algorithms to improve predictive accuracy in AP.</p><p><strong>Methods: </strong>A retrospective study was conducted using data from 101 AP patients in a tertiary hospital in Türkiye. Data were preprocessed, and synthetic data were generated with Gaussian noise addition and balanced with the ADASYN algorithm, resulting in 250 cases. Supervised ML models, including random forest (RF) and XGBoost (XGB), were trained, tested, and validated against traditional clinical scores (Ranson's, modified Glasgow, and BISAP) using area under the curve (AUC), F1 score, and recall.</p><p><strong>Results: </strong>RF outperformed XGB with an AUC of 0.89, F1 score of 0.82, and recall of 0.82. BISAP showed balanced performance (AUC = 0.70, F1 = 0.44, and recall = 0.85), whereas the Glasgow criteria had the highest recall but lower precision (AUC = 0.70, F1 = 0.38, and recall = 0.95). Ranson's admission criteria were the least effective (AUC = 0.53, F1 = 0.42, and recall = 0.39), probable because it lacked the 48^th h features.</p><p><strong>Conclusion: </strong>ML models, especially RF, significantly outperform traditional clinical scores in predicting adverse outcomes in AP, suggesting that integrating ML into clinical practice could improve prognostic assessments.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"25 1","pages":"32-40"},"PeriodicalIF":1.1,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068598","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":"Masquerading details behind a murmur and chest pain.","authors":"Alejandro Narvaez Orozco, Alberto Navarro Navajas, Alejandra Ramirez Roldan, Camilo Lopez Ocampo, Juan Manuel Senior Sanchez","doi":"10.4103/tjem.tjem_64_24","DOIUrl":"https://doi.org/10.4103/tjem.tjem_64_24","url":null,"abstract":"<p><p>Masquerading bundle branch block (MBBB) is a rare presentation of bifascicular blocks. It is the result of a right bundle branch block associated with an advanced left anterior fascicular block due to extensive damage to the conduction system. We present the case of a 75-year-old male with late onset presentation anterior wall myocardial infarction (MI) with ongoing ischemia (which evolved into a ventricular septal defect [VSD]). Electrocardiographically, the MBBB is characterized by a prominent R in V1, left axis deviation and absence of small S waves in I and aVL. Its presence confers a poor prognosis and high risk of progressing to advanced atrioventricular block (AAVB). A mortality rate between 18% and 38.9% has been found and 41.4%-59% of the patients develop AAVB requiring pacemaker implantation. To our knowledge, this is the first reported MBBB case in the setting of an MI complicated with VSD, demonstrating its association with the presence of critical anteroseptal ischemia. The patient rejected any kind of intervention, palliative care was offered, and he died 2 months later.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"25 1","pages":"59-62"},"PeriodicalIF":1.1,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068642","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":"Local envenomation by green pit viper complicated with airway obstruction.","authors":"Muhamad Akmal Selamat, Lee Kee Choon, Sazwan Reezal Shamsuddin","doi":"10.4103/tjem.tjem_60_24","DOIUrl":"https://doi.org/10.4103/tjem.tjem_60_24","url":null,"abstract":"<p><p>Snake-related injury (SRI) is one of the most common medical emergencies encountered in tropical countries such as Malaysia. The majority of snake bites are nonvenomous, while the less common venomous snakebite can cause major disability or even death. There are 16 pit viper species documented in Malaysia which can be categorized based on their habitat. We report a case of a 41-year-old male who presented to a district hospital 1 h after being bitten twice by a pit viper snake (<i>Trimeresurus sabahi fucatus</i>) on the left side of his face. He was given green pit viper anti-venom (GPAV). He later underwent an emergency tracheostomy due to progressive local swelling causing upper airway obstruction and required a second regime of antivenom. In our opinion, early recognition of snake species, clinical syndrome, and life-threatening conditions in patients with SRI is important. While careful clinical, laboratory, and patient observation is important in determining the need for anti-venom, a life-saving procedure such as intubation, in this case, should not be delayed. From our experience, SRI at the head with progressive swelling to zone 2 of the neck may signal a red flag to the attending clinician for the possibility of impending upper airway obstruction.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"25 1","pages":"55-58"},"PeriodicalIF":1.1,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068607","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":"<i>In vitro</i> fertilization-induced extreme hypertriglyceridemia with secondary acute pancreatitis in emergency department: A case report and literature review.","authors":"Nguyen Huu Thanh, Trinh Van Duong, Nguyen Thu Huyen, Pham Dang Hai","doi":"10.4103/tjem.tjem_27_24","DOIUrl":"10.4103/tjem.tjem_27_24","url":null,"abstract":"<p><p>Acute pancreatitis is one of the severe complications of hypertriglyceridemia, which needs to be recognized early to provide appropriate treatment. Hypertriglyceridemia-induced pancreatitis has several causes, in which <i>in vitro</i> fertilization (IVF) is a rare etiology that is becoming increasingly popular. We report a 33-year-old female patient with a history of hypertension who has failed an IVF cycle and started a new IVF procedure 1 month before admission. She was diagnosed with severe triglyceridemia-induced acute pancreatitis with extremely high serum triglycerides (TGs) levels (18,547 mg/dL). We combined plasmapheresis and intravenous (IV) insulin and significantly reduced blood TG over a short time. She was discharged with a TG level of 366.7 mg/dL on the 10^th day. It is essential to monitor serum TG levels in plasma before, during, and after this therapy, especially in the 1^st month after initiating IVF. Although plasmapheresis combined with IV insulin is not officially recommended for acute triglyceridemia-induced pancreatitis, the therapy can be considered in cases with extremely high serum TG levels.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 4","pages":"255-258"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677157","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":"ST-segment elevation myocardial infarction mimics: The differential diagnosis of nonacute coronary syndrome causes of ST-segment/T-wave abnormalities in the chest pain patient.","authors":"James H Moak, Andrew E Muck, William J Brady","doi":"10.4103/tjem.tjem_137_24","DOIUrl":"10.4103/tjem.tjem_137_24","url":null,"abstract":"<p><p>The evaluation of adult patients suspected of ST-segment elevation myocardial infarction (STEMI) includes a focused history and examination, 12-lead electrocardiogram (ECG), and cardiac serum marker analysis. The ECG plays a pivotal role in the early diagnosis and management of STEMI. A number of ECG entities in this patient population will present with ST-segment elevation and other electrocardiographic abnormalities which can mimic STEMI. In this article, we review the most frequent STEMI mimic patterns, highlight their ECG characteristics, and compare these individual ECG entities to the electrocardiographic abnormalities present with STEMI.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 4","pages":"206-217"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677266","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":"Comparative analysis of Glasgow Coma Scale, quick Sepsis-related Organ Failure Assessment, base excess, and lactate for mortality prediction in critically ill emergency department patients.","authors":"Gürbüz Meral, Şenol Ardıç, Serkan Günay, Kadir Güzel, Ahmet Köse, Hülya Gençbay Durmuş, Serhat Uysal, Aydın Coşkun","doi":"10.4103/tjem.tjem_45_24","DOIUrl":"10.4103/tjem.tjem_45_24","url":null,"abstract":"<p><strong>Objectives: </strong>It is crucial to promptly identify high-mortality patients in emergency departments and initiate their treatment as soon as possible. Although many parameters have been studied to select patients with high mortality, no comprehensive evaluation exists in previous literature on these parameters in critically ill patients, regardless of patient groups. The aim of this study is to evaluate the Glasgow Coma Scale (GCS), quick Sepsis-related Organ Failure Assessment (qSOFA), blood gas base excess (BE), and blood gas lactate in predicting mortality in critically ill patients admitted to the emergency department.</p><p><strong>Methods: </strong>This prospective observational cohort study included adult patients with Emergency Severity Index 1-2 (critically ill) admitted to the emergency department. All patients were evaluated by the physician within 10 min, and blood gas samples were taken. The data collection forms recorded the patients' GCS and qSOFA scores at the time of first evaluation by the physician. The qSOFA score assessment was performed in all patients with ESI levels 1 and 2, regardless of whether infective pathology was suspected. Blood gas BE and lactate values were also from laboratory test results. Patients or their relatives were contacted by phone at the end of the 1^st month to obtain information about the clinical condition (survival or mortality).</p><p><strong>Results: </strong>A total of 868 patients were included, with 163 deaths observed within 30 days. GCS score, qSOFA score, and lactate value were significant in predicting mortality within 30 days. While the BE value was significant for predicting 30-day mortality for values equal to or below the lower limit of -1.5 (<i>P</i> < 0.001), it was not significant for values equal to or above the upper limit of +3 (<i>P</i> > 0.05). The most successful prediction model for predicting 30-day mortality was found to be qSOFA with a cutoff value of ≥1.</p><p><strong>Conclusion: </strong>In emergency departments, each of the GCS, qSOFA scores, BE, and lactate values can be used independently as a practical mortality prediction model in critically ill patients. Among these four models, qSOFA is the most successful practical mortality prediction model in critically ill patients.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 4","pages":"231-237"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677124","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":"Diagnostic confusion caused by tension gastrothorax - Case series.","authors":"Mehmet Emin Boleken, Tansel Günendi, Mehmet Çakmak, Veysel Kaya, Osman Hakan Kocaman","doi":"10.4103/tjem.tjem_251_23","DOIUrl":"10.4103/tjem.tjem_251_23","url":null,"abstract":"<p><p>The presence of the stomach in the thorax is called gastrothorax. If excessive dilatation occurs due to a valve mechanism in the stomach which then is herniated into the thorax, it is called tension gastrothorax and the situation can be life-threatening. In late presentation, congenital diaphragmatic hernias or traumatic diaphragmatic hernias, if the stomach located in the thorax is severely distended, it can be confused with tension pneumothorax or pleural effusion/empyema. We presented tension gastrothorax in two patients with distended stomach in the thorax, in which tension pneumothorax and pleural effusion/empyema-like images were created, based on plain X-rays taken at the first admission in the emergency department, which may cause diagnostic confusion. The tension gastrothorax can cause mediastinal shift, which can lead to respiratory distress and eventually cardiac arrest secondary to obstructive shock. In case of mediastinal shift, it should reduce the tension of the stomach located in the thorax by inserting a nasogastric catheter, and if this fails, by aspiration with a needle.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 4","pages":"252-254"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677196","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":"Incidence and risk factors of acute mountain sickness during ascent to Hoh Xil and the physiological responses before and after acclimatization.","authors":"Qing Ouyang, Yuting Yang, Dongbo Zou, Yuping Peng, Wenxin Zhang, Yongjian Yang, Yuan Ma","doi":"10.4103/tjem.tjem_44_24","DOIUrl":"10.4103/tjem.tjem_44_24","url":null,"abstract":"<p><strong>Objectives: </strong>Ascending to altitudes >2500 m may lead to acute mountain sickness (AMS).</p><p><strong>Methods: </strong>The demographics, height, weight, body mass index (BMI), smoking, and alcohol consumption of 104 healthy controls were collected in Chengdu (500 m). Heart rate (HR), saturation of pulse oxygen (SpO2), and AMS-related symptoms were collected in Hoh Xil (4200 m). A headache with Lake Louise score ≥3 was defined as AMS.</p><p><strong>Results: </strong>The incidence of AMS was 60.58%. AMS group had a lower SpO2 and higher HR than non-AMS group. Alcohol consumption seemed a risk factor for AMS. There was no difference in the BMI, age, height, weight, and smoking between AMS and non-AMS groups. The most common AMS symptom was headache, followed by dyspnea, insomnia, dizziness, lassitude, and anorexia. Women were prone to suffer from dizziness. The value of SpO2 and HR was improved both in AMS and non-AMS groups after hypoxia acclimatization, and the value showed greater improvement in AMS group. Oxygen therapy decreased the AMS-induced tachycardia, which had no any effect on SpO2 and symptom alleviating time.</p><p><strong>Conclusion: </strong>Lower SpO2 and higher HR following exposure to high altitude were associated with AMS susceptibility. The anthropometric data changes were larger in AMS group than non-AMS group before and after hypoxia acclimatization.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 4","pages":"226-230"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677265","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":"The efficacy and application of tranexamic acid in emergency medicine: Emergency Medicine Association of Türkiye clinical policy- 2024.","authors":"Gökhan Aksel, Şeref Kerem Çorbacıoğlu, Mehmet Muzaffer İslam, Alp Şener, Fatma Nur Karaarslan, Merve Osoydan Satıcı, Enis Ademoğlu, Resul Çinpolat, Haldun Akoğlu, Faruk Danış, Fatma Sarı Doğan, Emre Kudu, Murtaza Kaya, Emir Ünal, Kamil Kayayurt","doi":"10.4103/tjem.tjem_164_24","DOIUrl":"10.4103/tjem.tjem_164_24","url":null,"abstract":"<p><p>The clinical policy of the Emergency Medicine Association of Türkiye (EMAT) provides guidance on the use of tranexamic acid (TXA) in emergency settings. TXA, an antifibrinolytic drug, is used to control bleeding by inhibiting plasminogen. Its applications have expanded from hemophilia and severe menstrual bleeding to include various forms of trauma and surgery-related bleeding. Despite its potential benefits, the use of TXA in emergency settings must be carefully evaluated due to its associated risks, including venous thromboembolism. This policy aimed to offer evidence-based recommendations on the indications and contraindications of TXA in different clinical scenarios encountered in the emergency departments. The guidelines were developed using the \"Grading of Recommendations, Assessment, Development, and Evaluations\" approach, incorporating systematic literature reviews, and expert consensus from the EMAT Research Committee. This document focuses on critical clinical questions regarding the efficacy and safety of TXA in situations such as gastrointestinal bleeding, multitrauma, traumatic brain injury, nontraumatic intracranial hemorrhage, hemoptysis, and epistaxis. By addressing these issues, the policy seeks to assist emergency physicians in making informed decisions about the use of TXA, ultimately aiming to improve the patient outcomes.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 4","pages":"185-205"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677267","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}