Turkish Journal of Emergency Medicine最新文献

{"title":"Local envenomation by green pit viper complicated with airway obstruction.","authors":"Diksha Sabharwal, Santosh Govind Rathod","doi":"10.4103/tjem.tjem_110_25","DOIUrl":"10.4103/tjem.tjem_110_25","url":null,"abstract":"","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"25 3","pages":"250"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761771","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":"Chest compression quality and retention of skills in basic life support training given to medical school year 5 students.","authors":"Ramazan Sivil, Özlem Yiğit, Süleyman İbze, Erkan Göksu, Yeşim Şenol","doi":"10.4103/tjem.tjem_271_24","DOIUrl":"10.4103/tjem.tjem_271_24","url":null,"abstract":"<p><strong>Objectives: </strong>Sudden cardiac arrest is a significant cause of cardiovascular death. Basic life support (BLS) practitioners need training to provide effective, quality interventions. This study investigates the effectiveness of curriculum-based BLS training and measures the students' performance levels before and after training and their skill retention over time.</p><p><strong>Methods: </strong>A total of 70 students were selected as the study population. Before their emergency medicine (EM) clerkship, participants performed BLS with 30 compressions and two rescue breaths on a simulation manikin (Measurement 1). Early posttraining skills were reassessed within the 1^st week after clerkship (Measurement 2), and skill retention was evaluated after 9 months (Measurement 3). All measurements were done by a single observer using the same manikin.</p><p><strong>Results: </strong>Of the 70 enrolled students, 64 completed the study. Significant improvements were observed in overall cardiopulmonary resuscitation (CPR), compression, and ventilation scores posttraining and at 9 months (<i>P</i> < 0.05). Among 34 participants who performed ≥3 CPRs, posttraining and 9-month scores remained stable (<i>P</i> = 0.238). No significant change was found in compression scores among nonperformers (<i>P</i> = 0.982), and intergroup comparisons showed no statistical difference (<i>P</i> = 0.977; <i>P</i> = 0.900).</p><p><strong>Conclusion: </strong>BLS training provided to medical faculty 5^th-year students in the EM clerkship program increased the effectiveness of chest compression, and this skill did not regress within 9 months.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"25 3","pages":"216-222"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761767","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":"Predicting mortality and safe discharge in drowning victims: A comprehensive analysis of neurological and clinical outcomes in the emergency department.","authors":"Süleyman Gökhan Kara, Başak Bayram, Şebnem Şakar Halaç, Osman Sönmez, Neşe Çolak","doi":"10.4103/tjem.tjem_248_24","DOIUrl":"10.4103/tjem.tjem_248_24","url":null,"abstract":"<p><strong>Objectives: </strong>This study sought to identify risk factors linked to mortality, intensive care unit admission, and poor neurological outcomes among drowning victims and to find markers for safe discharge from the emergency department (ED).</p><p><strong>Methods: </strong>This retrospective cross-sectional study evaluated all drowning victims presenting to both adult and pediatric EDs at a single center over an 11-year period. Variables such as arrival time at ED, age, type of water, comorbid diseases, vital signs, treatments given, and prehospital interventions were assessed.</p><p><strong>Results: </strong>The study found that early basic life support (BLS) by bystanders significantly improves survival and neurological outcomes. Respiratory rate, oxygen saturation, and Glasgow Coma Scale (GCS) were identified as independent risk factors for poor clinical outcomes. While the Szpilman clinical score is useful, it alone is not sufficient for predicting poor clinical outcomes.</p><p><strong>Conclusions: </strong>For optimal management of drowning victims, immediate BLS is crucial. In the ED, respiratory rate, oxygen saturation, and GCS should be closely monitored. Drowning victims with a GCS of 15, normal respiratory rate, normal oxygen saturation, and Szpilman score below 3 can be safely discharged from the ED.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"25 3","pages":"208-215"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761700","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 utility of monitoring end-tidal carbon dioxide in emergency department to predict inhospital mortality of patients presenting with nontraumatic shock: A prospective observational study.","authors":"R Abhiraj, Meera Ekka, Aravind Sreekumar, Praveen Aggarwal, Nayer Jamshed, Sanjeev Kumar Bhoi, Maroof Ahmed Khan","doi":"10.4103/tjem.tjem_223_24","DOIUrl":"10.4103/tjem.tjem_223_24","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to identify the ability of end-tidal carbon dioxide (EtCO2) to predict inhospital mortality of patients presenting to the emergency department (ED) with nontraumatic circulatory shock. We also attempted to assess the correlation between EtCO2 and other traditional vital signs and laboratory parameters in this patient population at different time points during their resuscitation.</p><p><strong>Methods: </strong>This was a single-center prospective observational study conducted among patients with nontraumatic circulatory shock who presented to the ED of a tertiary care teaching institute in India. EtCO2 measurement was done using mainstream capnography in both intubated and nonintubated patients at presentation and at 120 min of resuscitation. Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), respiratory rate, oxygen saturation, and laboratory parameters (lactate, base deficit [BD], and partial pressure of carbon dioxide) were measured at the same time points. All patients were followed up till hospital discharge.</p><p><strong>Results: </strong>One hundred and ten patients were recruited to the study. An EtCO2 of ≤ 23 mm Hg at presentation was 87% sensitive (95% CI: 73-95 %) and 43% specific (95% CI: 31-56 %) in predicting in-hospital mortality of patients presenting with no-traumatic circulatory shock in emergency department [area under curve (AUC): 0.735 (95% CI: 0.638-0.832, p<0.001)]. EtCO2 ≥23 mmHg at presentation had a significant predictive value on the risk of in-hospital mortality with an adjusted odd's ratio of 0.08 (95% CI: 0.02-0.3, <i>P</i> < 0.001). EtCO2 values at presentation and 120 min as well as the change between the time points showed statistically significant weak-to-moderate positive correlations with corresponding values of MAP and BD. Similarly, a significant negative correlation was demonstrated with lactate levels at the same time points.</p><p><strong>Conclusion: </strong>EtCO2 values at presentation are an independent predictor of inhospital mortality of patients with circulatory shock of nontraumatic etiology presenting to the ED.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"25 3","pages":"199-207"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761701","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":"Capsular warning syndrome: Nighttime blood pressure drops, clinical awareness, and therapeutic approach.","authors":"Erum Shariff, Rizwana Shahid","doi":"10.4103/tjem.tjem_220_24","DOIUrl":"10.4103/tjem.tjem_220_24","url":null,"abstract":"<p><p>Capsular warning syndrome (CWS) is a rare condition marked by recurrent, stereotypical transient ischemic attacks (TIAs) affecting the face, arm, and leg, without cortical involvement. It is associated with a high risk of a full-blown stroke within 7 days. The exact pathophysiological mechanism and optimal management strategies remain debated. It is crucial to distinguish CWS from crescendo TIAs and consider reperfusion therapy if new episodes occur within the therapeutic window for systemic reperfusion, in order to prevent a disabling stroke. We present the case of a 53-year-old male who arrived at the emergency department (ED) with right hemiparesis and facial weakness lasting for 1 h. He had experienced four recurrent, stereotypical episodes over the past 7 h and was diagnosed with a TIA, despite being within the therapeutic window for thrombolysis. He was started on dual antiplatelet therapy, high-dose statins, and management of other vascular risk factors. However, within 24 h, his condition progressed to a complete stroke with severe hemiparesis and facial weakness. Magnetic resonance imaging confirmed infarction in the left hemisphere, while a computed tomography angiogram was normal. This case underscores the importance of prompt recognition of CWS in the ED, enabling activation of stroke services and the consideration of reperfusion therapy when appropriate, to minimize the risk of a disabling stroke.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"25 3","pages":"246-249"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761766","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":"Navigating the complexities of bilateral facial nerve palsy: A case report.","authors":"Caisha Nivenia Moses, Wan Syahmi Bin Wan Mohamad, Kamarul Aryffin Bin Baharuddin, Mohamad Masykurin Bin Mafauzy, Mohd Faiz Bin Mohd Shukri","doi":"10.4103/tjem.tjem_152_24","DOIUrl":"10.4103/tjem.tjem_152_24","url":null,"abstract":"<p><p>A 32-year-old male presented with a 2-week history of progressive bilateral facial weakness, initially diagnosed as unilateral Bell's palsy. Upon development of bilateral symptoms, further investigations revealed normal hematological, biochemical, and imaging results, ruling out common infectious and autoimmune causes. Electromyography and nerve conduction studies were normal, and lumbar puncture results excluded Guillain-Barré syndrome. The patient was ultimately diagnosed with idiopathic bilateral facial nerve palsy (FNP) after exhaustive exclusion of other etiologies. Treatment with corticosteroids led to symptomatic improvement. This case underscores the importance of a systematic approach in diagnosing rare presentations of FNP and highlights the favorable prognosis with appropriate management.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"25 3","pages":"239-241"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761699","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":"Comparing the National Institutes of Health Stroke Scale Scores between emergency medicine physicians and neurologists for timely decision-making for alteplase administration.","authors":"Osman Tecir, Mustafa Çiçek, Özgen Gönenç Çekiç, Şenol Ardıç, Ramazan Akpınar, Nuray Can Usta, Süleyman Türedi","doi":"10.4103/tjem.tjem_79_25","DOIUrl":"10.4103/tjem.tjem_79_25","url":null,"abstract":"<p><strong>Objectives: </strong>The National Institutes of Health Stroke Scale (NIHSS) is used to determine the severity of the disease and to make treatment decisions in ischemic stroke patients. However, the need for a neurologist to assess NIHSS before thrombolytic therapy may prolong the treatment process.</p><p><strong>Methods: </strong>This prospective, single-center, observational, planned study included patients who presented to the emergency department in the first 24 h after the onset of symptoms and were diagnosed with ischemic stroke between September 2022 and June 2023. The NIHSS was evaluated by the emergency medicine physicians and neurologists who evaluated the patients in the emergency department, and the decisions on whether to administer thrombolytics and the time taken for this decision were recorded and compared.</p><p><strong>Results: </strong>A very high agreement was found when the total NIHSS scores of emergency medicine physicians and neurologists were compared (intraclass correlation coefficient = 0.947 [95% confidence interval 0.92-0.96]). Emergency medicine physicians and neurologists showed high agreement with thrombolytic therapy decisions. In patients given thrombolytic therapy, emergency medicine physicians made the decision earlier than neurologists, and there was a significant difference of 14 ± 12 min between the decisions of emergency physicians and those of neurologists.</p><p><strong>Conclusions: </strong>There is high agreement between emergency medicine physicians and neurologists in the NIHSS evaluation and thrombolytic decisions for patients with acute ischemic stroke. According to our results, emergency medicine physicians can provide thrombolytic treatment in accordance with neurologists, thus shortening the time for thrombolytic treatment.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"25 3","pages":"223-229"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761768","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":"Emergency department pain management in special populations.","authors":"Katherine Vlasica, Amanda Hall, Mohammad Anzal Rehman, George Notas, Christina Shenvi, Sergey Motov","doi":"10.4103/tjem.tjem_141_25","DOIUrl":"10.4103/tjem.tjem_141_25","url":null,"abstract":"<p><p>Pain is a leading cause of emergency department (ED) visits globally, yet certain patient populations experience persistent disparities in their pain management due to physiological complexities, comorbidities, and gaps in evidence-based guidelines. This clinical review focuses on individualized, evidence-based approaches to ED pain management in four vulnerable groups: pregnant and breastfeeding patients, patients with sickle cell disease, geriatric populations, and patients with cancer pain and requiring palliative care. The practical recommendations presented in this review for optimal ED pain management in these special populations call for timely, effective, and multimodal analgesia; prioritization of nonpharmacologic and pain syndrome-targeted techniques; awareness of drug-disease and drug-drug interactions; interdisciplinary coordination; and education to mitigate ED clinicians' biases. This review emphasizes the importance of tailoring pain strategies to population-specific needs to improve outcomes, reduce harm, and advance equity in emergency care delivery.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"25 3","pages":"159-177"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761769","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":"Analysis of factors affecting fatigue in emergency medicine residents: A nationwide, cross-sectional, descriptive study.","authors":"Ali Batur","doi":"10.4103/tjem.tjem_277_24","DOIUrl":"10.4103/tjem.tjem_277_24","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency physicians may experience intense fatigue and burnout due to factors related to occupational conditions. The group experiencing burnout most frequently among physicians is emergency medicine (EM) physicians, with 63%. They also endure high levels of fatigue. This study evaluated the fatigue levels and factors of fatigue in EM residents nationwide. It aimed to determine the factors affecting fatigue.</p><p><strong>Methods: </strong>The study includes EM residents working across the country between January 2024 and April 2024. It was conducted using a survey. The survey included the Maslach Burnout Inventory (MBI), the Chalder Fatigue Scale, and questions about demographic characteristics. Multivariate logistic regression analysis was used to analyze the data.</p><p><strong>Results: </strong>The median age of participants was 28 years (interquartile range = 3), and 203 (56.4%) were male. Factors affecting the level of fatigue were analyzed by multivariate logistic regression analysis. The gender (male) (odds ratio [OR] =0.322, 95% confidence interval [CI] =0.128-0.812) and the daily sleep duration (OR = 0.589, 95% CI = 0.423-0.822) variables had a negative effect on fatigue. Depression in medical history increased the likelihood of fatigue (OR = 3.515, 95% CI = 0.930-13.287). Emotional exhaustion (EE) (OR = 1.082, 95% CI = 1.037-1.130) and depersonalization (OR = 1.097, 95% CI = 1.015-1.186) increased the fatigue level. However, personal accomplishment had no significant effect on fatigue (OR = 1.019, 95% CI = 0.966-1.075).</p><p><strong>Conclusions: </strong>Being female gender, having shorter daily sleep duration, having a diagnosis of depression in medical history, and having higher levels of depersonalization and EE from MBI subdimensions increase the level of fatigue. Optimizing the sleep duration of EM residents and supporting their psychological health will prevent fatigue and fatigue-related problems.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"25 3","pages":"191-198"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761765","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":"Extracorporeal cardiopulmonary resuscitation for sudden cardiac arrest induced by septic shock-related adrenal crisis.","authors":"Martin Pažitný, Matúš Maruniak, Martin Ilenin, Dušan Rybár, Tomáš Grendel","doi":"10.4103/tjem.tjem_213_24","DOIUrl":"10.4103/tjem.tjem_213_24","url":null,"abstract":"<p><p>Extracorporeal cardiopulmonary resuscitation is being increasingly used to treat refractory in-hospital cardiac arrest (IHCA). Etiologies of IHCA may differ from etiologies of out-of-hospital cardiac arrest. We report a case of a 50-year-old man who was admitted to a local hospital, presenting with drowsiness, hypotension, and severe metabolic acidosis. After being transferred to our tertiary center, he quickly progressed to cardiac arrest and required extracorporeal cardiopulmonary resuscitation (eCPR) with veno-arterial extracorporeal membrane oxygenation (VA ECMO). Initially, due to high levels of inflammatory markers, sepsis became the most probable diagnosis. The patient responded well to antibiotics and supplemental corticosteroid therapy. Subsequent investigation revealed sepsis-induced absence of cortisol based on previously unknown hypopituitarism. Following corticoid administration, rapid myocardial recovery occurred with successful ECMO weaning. The patient was discharged from the ICU after 13 days with a favorable neurological outcome. Therefore, VA ECMO seems to be a feasible method to provide a bridge to recovery in patients with sudden hemodynamic collapse due to an adrenal crisis.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"25 3","pages":"242-245"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761770","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}