OBJECTIVE:To evaluate the effectiveness of the lactate/serum albumin (L/A) ratio in predicting 30- and 90-day all-cause mortality and 30-day all-cause readmissions in patients presenting to the emergency department (ED) with acute heart failure (AHF). STUDY DESIGN:An observational study. Place and Duration of the Study: Department of Emergency, Kocaeli Derince Training and Research Hospital and Kocaeli City Hospital, Turkiye, from November 2022 to October 2023. METHODOLOGY:Patients diagnosed with heart failure in the ED were prospectively enrolled. Demographic and clinical data, including serum lactate and albumin levels, were recorded at admission. The L/A ratio was calculated, and its association with 30- and 90-day all-cause mortality and 30-day all-cause hospital readmission was examined. Receiver operating characteristic (ROC) analysis was used to assess its predictive performance. RESULTS:A total of 410 patients were included. The L/A ratio showed statistical significance for predicting 30-day all-cause mortality but lacked clinical reliability. At a cut-off value of ≥0.85, sensitivity was 66.15%, specificity was 53.04%, and the area under the ROC curve (AUC) was 0.647. At ≥0.61, sensitivity was 56.3%, specificity was 66.32%, and AUC was 0.635. No significant relationship was found between the L/A ratio and 30-day all-cause readmissions. In multivariable logistic regression analysis, the L/A ratio remained independently associated with 30-day all-cause mortality (OR: 2.48, 95% CI: 1.33-4.60, p = 0.004). CONCLUSION:The L/A ratio was not a clinically reliable predictor of 30- and 90-day all-cause mortality or 30-day all-cause readmissions among patients presenting to the ED with AHF. KEY WORDS:Emergency department, Heart failure, Lactate, Albumin, Mortality.

The effect of the global healthcare events makes its initial impact to the emergency departments. As the vanguards of healthcare system emergency departments had handled the surge while undergoing physical changes to manage ongoing crisis. Therefore, for the preparation of further global events, admission rates and emergency department utilization of the pandemic requires further investigation. The aim of this study was to analyze the admissions in a multi-center scale and compare ICD codes and crude mortality rates during the early COVID-19 pandemic period and compare this data to the previous year of the outbreak. This was a multi-center study of 10 hospitals; including 2 tertiary and 8 secondary healthcare institutions. This study comparatively analyzed ED admissions between during pandemic and pre-pandemic periods. A total of 8,38,502 admissions were included in the study (5,72,443 vs 2,66,059; pre pandemic period vs during pandemic period, respectively). There was a significant difference between age, gender, ED waiting time, triage color, and hospitalization rates (P < .001) between 2 periods. Comparison of admission international statistical classification of diseases and related health problems 10th revision codes were significantly different between pre-pandemic and pandemic periods for trauma, cardiovascular, neurology, and respiratory codes (P < .001, P < .001, P < .001, P = .024, respectively). The findings of this study suggest that a pandemic affects many mechanisms in the emergency healthcare systems. This influence might have affected the ED admission rates, hospital admission rates, and mortality rates.

Objective: This study aimed to analyze the short- and long-term effects of musical memory created using a national popular song on achieving the recommended compression rate, depth, and compression-breath rate for nursing students who received cardiopulmonary resuscitation (CPR) training. Method: This study had an experimental, randomized post-test control group design. The study was conducted between February and June 2018 on 49 third-year nursing students who received CPR training for the first time. The control group received standard CPR training, whereas the intervention group received CPR training using a nationally popular song. The study evaluated compression rate and depth, satisfaction with CPR training, and arm pain during CPR. Data were collected immediately after CPR training (short-term) and six weeks after training (long-term). Results: The differences between the control and intervention groups regarding the correct and incorrect breath rates were not statistically significant (p>0.05). In addition, there was no significant difference between the control and intervention groups in terms of compression and breathing rates measured six weeks after CPR training was not statistically (p>0.05). Satisfaction with CPR training was higher in the control group. Conclusion: Although existing studies suggested that popular music is an effective tool for achieving the recommended compression rate, this study did not find any significant impact of popular national music on chest compression performance.

Background Intracranial pressure increases due to ischemic infarction caused by stroke. This study aimed to evaluate the pre-thrombolytic and post-thrombolytic optic nerve sheath diameter (ONSD) measurements in predicting clinical outcomes and complications for stroke patients. Methods ONSD was measured on computed tomography (CT) scans. The average ONSD (aONSD) was calculated from the right and left eyes. Pre-thrombolytic (ONSD-0) and post-thrombolytic (ONSD-24) values were compared according to right vs left eye, stroke-affected side of the brain, presence of complications, and mortality. Results Ninety-three patients were enrolled; 52.7% were female, and the mean age of all participants was 76 years. The aONSD-24 values were higher than the aONSD-0 values (5.5 ± 0.7 mm and 5.3 ± 0.7 mm, respectively, p < 0.001). There was no significant difference between right and left measurements (right ONSD-0 5.3 mm vs. left ONSD-0 5.3 mm, p = 0.257; right ONSD-24 5.6 mm vs. left ONSD-24 5.5 mm, p = 0.146; and ∆right ONSD 0.23 mm vs. ∆left ONSD 0.22, p = 0.717) and between the stroke-affected side and non-stroke-affected side measurements (stroke-affected ONSD-0 5.2 mm vs. non-stroke-affected ONSD-0 5.2 mm, p = 0.292; stroke-affected ONSD-24 5.5 mm vs. non-stroke-affected ONSD-24 5.4 mm, p = 0.124; and ∆stroke-affected ONSD 0.23 mm vs. non-∆stroke-affected ONSD 0.23 mm, p = 0.569). Intracranial complications occurred in 14 (15%) patients. There was no difference in ONSD values between patients with and without complications (p = 0.338 for aONSD-0, p = 0.216 for aONSD-24, and p = 0.902 for ∆a ONSD). There was no significant difference between the aONSD-0 and aONSD-24 values of surviving and non-surviving patients (aONSD-0: 5.3 ± 0.7 vs. 5.0 ± 0.5, p = 0.345; aONSD-24: 5.5 ± 0.7 vs. 5.3 ± 0.4, p = 0.522; and p = 0.386 for ∆ aONSD). Conclusions ONSD values on 24-h brain CT scans were higher than admission values in acute stroke patients receiving thrombolytic therapy, irrespective of the right or left side, stroke-affected side, presence of complications, and mortality. However, ONSD is not a sufficient parameter for predicting complications and death.

Altmetrics is a web-based measurement method that assesses the online dissemination and interactions of an article. We performed an altmetric analysis of 500 papers with the highest altmetric attention score (AAS) published in anesthesiology-related journals. Journals were identified from the Web of Science (WoS) Master Journal List by Clarivate using the category “Anesthesiology.” The altmetric data were obtained from the Altmetric Explorer database. The first 500 publications with the highest AAS scores among these journals were identified and analyzed. Using Spearman correlation, no correlation was observed between the AAS and either WoS or Google Scholar citations ( R = 0.188, P < .001 and R = 0.161, P < .001, respectively). There was a weak correlation between blog mentions and both WoS citations and Google Scholar citations ( R = 0.263, P < .001 and ( R = 0.241, P < .001). A very strong correlation was observed between the number of Mendeley readers and both WoS and Google Scholar citations ( R = 0.889, P < .001 and R = 0.905, P < .001). A significant difference in AAS and WoS citations was observed based on publication topic ( P = .036 and P = .005, respectively), with algology being the most common topic (n = 206, 41.2%). Although AAS did not significantly affect traditional scientific citations, the analysis of subgroup correlations revealed notable differences. Our results suggest that traditional scientific citations (WoS and Google Scholar citations) are strongly influenced by the number of Mendeley readers. Further research is needed to understand these dynamics in academic discourse.

BACKGROUND:Interest in artificial intelligence (AI) and machine learning (ML) has grown rapidly in recent years due to the success of modern algorithms across various domains. Emergency departments are fast-paced and resource-constrained environments where timely decision-making is critical. These characteristics make them ideal settings for the integration of AI technologies, which have shown potential to enhance diagnostic accuracy and optimize patient outcomes. This study aims to identify and characterize the scientific literature on AI and ML applications in emergency departments over the past decade. METHODS:A comprehensive search was conducted in the Web of Science database on June 20, 2024. Articles published between 2015 and 2024 were considered. The search was performed using the keywords "artificial intelligence" or "machine learning" in all fields, limited to the "emergency medicine" category. The analysis of the articles included descriptive data on primary publication characteristics, such as the number of authors, citations, country of origin of the coauthors, and journal names. Bibliometric indicators were analyzed to identify publication trends and research themes, cluster analyses of keywords, and thematic maps. RESULTS:A total of 321 articles were analyzed. The average number of citations per article was 10.04, and the annual growth rate was 37.87%. Most publications originated from the United States. Resuscitation, American Journal of Emergency Medicine, Injury-International Journal of the Care of the Injured, and Resuscitation Plus published 107 articles. In 2024, the trending topic of the articles was "health," while "care" was the most popular in the last 10 years. The top 5 niche themes were "medical," "digital transformation," "education," "database," and "emergency care systems." CONCLUSION:This bibliometric analysis highlights the growing role of AI in emergency medicine. The findings provide insight into current research directions and may help inform future investigations in this evolving field.

Introduction: Alternative metrics (altmetrics) have emerged as invaluable tools for assessing the influence of scholarly articles. In this study we aimed to evaluate correlations between Altmetric Attention Scores (AAS), and sources and actual citations in articles displaying the highest AAS within emergency medicine (EM) journals. Methods: We conducted an analysis of EM journals listed in the Science Citation Index Expanded (SCIE) using the Altmetric Explorer tool. We analyzed the journals that received the highest number of mentions, the sources of AAS, the regions most frequently mentioned, and the geographical distribution of mentions. In the subsequent stage of our analysis, we conducted an examination of the 200 top-ranked articles that had received high AAS and were published in SCIE EM journals from January 1, 2013–January 1, 2023. We sought to determine the correlations between the AAS and the citation counts of articles on Google Scholar and the Web of Science (WOS). Results: Of 40,840 research outputs evaluated, there were 510,047 shares across multiple platforms. The AAS were present for 36,719 articles (89.9%), while 10.1% had no score. In the review of the top 200 articles with the highest AAS, the median score was 382.5 (interquartile range 301.3–510.8). Of the research output evaluated, 38% were observational studies, 13% case reports, and 13% reviews/meta-analyses. The most common research topics were emergency department (ED) management and COVID-19. There was no correlation between AAS and WOS citation numbers (rs = −0.041, P = 0.563, 95% confidence interval [CI] −0.175–0.087). There was a weak correlation identified between WOS citations and mentions on X, and a moderate correlation observed for WOS citations and blog mentions(rs = 0.330, P < .001, 95% CI 0.174 to 0.458; rs2 = 0.109, and rs = 0.452, P < .001, 95% CI 0.320–0.566; and rs2 = 0.204, respectively). However, we found a strong positive correlation between WOS citations and the number of Mendeley readers (rs = 0.873, P < .001, 95% CI 0.82–0.911, rs2 = 0.762). Conclusion: While most articles in EM journals received an AAS, we found no correlation with traditional citation metrics. However, Mendeley readership numbers showed a strong positive correlation with citation counts, suggesting that academic platform engagement may better predict scholarly impact.

OBJECTIVES: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). METHODS: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. RESULTS: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. CONCLUSIONS: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.

BACKGROUND:Hyperlactatemia has been recognized as a significant prognostic indicator in critically ill patients. Nonetheless, there remains a gap in understanding the specific risk factors contributing to increased mortality among undifferentiated emergency department (ED) patients presenting with elevated lactate levels. OBJECTIVES:The objective of the study is to investigate potential risk factors for 30-day in-hospital mortality in ED patients with hyperlactatemia. METHODS:All nontraumatic adult presentations to the ED who had a lactate level of ≥2.5 mmol/L were included. Comorbidities, vital signs, lactate levels, lactate clearance, lactate normalization, and final diagnosis were compared with 30-day in-hospital mortality. RESULTS:A 30-day in-hospital mortality rate of 10.4% was observed in 979 patients. The mortality rate was higher in hypotensive patients (odds ratio [OR] 4.973), in nursing home patients (OR 5.689), and bedridden patients (OR 3.879). The area under the curve for the second lactate level (0.804) was higher than the first lactate level (0.691), and lactate clearance (0.747) for in-hospital mortality. A second lactate level >3.15 mmol/l had a sensitivity of 81.3% in predicting in-hospital mortality. The OR for mortality was 6.679 in patients without lactate normalization. A higher mortality rate was observed in patients with acute renal failure (OR 4.305), septic shock (OR 4.110), and acute coronary syndrome (OR 2.303). CONCLUSIONS:A second lactate measurement more accurately predicts in-hospital mortality than lactate clearance and the first lactate level in ED patients. Nursing home patients, bed-ridden patients, hypotensive patients on initial ED presentation, patients without lactate normalization, and patients with a final diagnosis of acute renal failure, septic shock, and acute coronary syndrome had a higher mortality rate.

OBJECTIVES:Supraglottic airway (SGA) devices are good alternatives for failed intubations or difficult airways. The aim of our study was to compare the success of intubation with SGA devices such as LMA Fastrach® (LMA Fastrach), Ambu Aura-i® (Aura-i), and Cookgas Air-Q® (Air-Q) in an airway manikin by novice practitioners. METHODS:This study was conducted in a randomized crossover design using a manikin model. Following training on the equipment used, 36 6th-year medical students were randomized into six groups. Participants performed three stages of intubation as follows: the first stage (1S) as SGA insertion, the second stage (2S) as intubation through the SGA, and the third stage (3S) as the removal of the SGA over the intubation tube. The primary outcomes were intubation success and duration. RESULTS:The successful intubation rate (Stage 1S + 2S + 3S) was 100% for LMA Fastrach and Air-Q and 83.3% for Aura-i (P = 0.002). The median time to intubation was 54.4 s, 55.8 s, and 58.7 s for LMA Fastrach, Aura-i, and Air-Q, respectively (P = 0.794). CONCLUSION:Our study shows that novice practitioners can proficiently utilize LMA Fastrach, Air-Q, and Aura-i as SGAs in airway management. LMA Fastrach and Air-Q are more successful for endotracheal intubation than Aura-i. While the successful intubation time with SGA is similar for all three devices, the successful SGA insertion time is shorter with LMA Fastrach and Aura-i compared to Air-Q. Practitioners preferred LMA Fastrach and Air-Q more than Aura-i.

Aim: Procalcitonin (PCT) is a biomarker for infection, which has grown in popularity in recent years. In our study, we investigated whether there was a relationship between procalcitonin levels and seven-day mortality in all patients whose procalcitonin levels were measured in the emergency department (ED). Material and Methods: In this single-center, cross-sectional, analytic, retrospective study, the patients whose PCT levels were measured in Dokuz Eylül University Hospital adult emergency department between 01.01.2016 and 31.03.2016 were included. PCT level and other parameters were evaluated in the survived and non- survived groups, Results: We analyzed 499 patients whose PCT levels were measured. The median age was 74 (IQR: 63-82) years, and 54% were male. Of the 499 patients, 6 (1.2%) had a low procalcitonin level (median 0.03: IQR 0.02-0.04), 407 (81.6%) had an intermediate procalcitonin level (median 0.26; IQR 0.16-0.54) and 86 (17.2%) had a high procalcitonin level (median 5.54; IQR 3.20-15.31). When the PCT level-high group was compared with the other groups; systolic blood pressure (SBP), diastolic blood pressure (DBP), platelet count, pCO2 were lower and pulse rate, WBC, lactate, base excess values were higher. It was found that 249 (49.9%) of the patients were discharged from the ED, 112 (22.4%) were hospitalized, 66 (13.2%) were hospitalized in the intensive care unit, and 72 (14.4%) died. The PCT level was higher in the non-survivor group than in the survivor group (0.29 ngr/mL vs 1.07 ngr/mL, p

Background: The emergency physician should diagnose and treat the critical illnesses that cause syncope/ presyncope in patients presenting to the emergency department (ED). Whole-body ultrasonography can detect the critical etiology of syncope with high diagnostic sensitivity. We aimed to reveal whether whole-body ultra-sonography for syncope (WHOBUS-Syncope) protocol recognizes high-risk syncope patients and the effect of WHOBUS-Syncope protocol on the management of patients.Method: This is a prospective, cross-sectional study. Patients over the age of 18 years who presented to the ED with syncope or near syncope were included consecutively. Carotid, lung, cardiac, collapsibility of inferior vena cava, abdominal and compression ultrasonography of the lower extremity veins was performed among the WHOBUS-Syncope protocol. Frequency of abnormal sonographic findings associated with syncope/presyncope and requirement of critical intervention for abnormal sonographic findings were assessed.Results: 152 patients were included in the study. The median age of the patients was 61.5 years (IQR: 41-71.8) and 52.6% were female. The most common (64.3%) abnormal sonographic finding was >50% collapse of vena cava inferior during inspiration. In addition, abnormal sonographic findings thought to cause syncope/ presyncope were detected in 35.5% of the patients. Bolus fluid resuscitation were given in in 62 patients (40.8%) with increased inferior vena cava collapse. Critical interventions other than fluid resuscitation were per-formed for abnormal sonographic findings in 35 (23%) of the patients. Advanced age, increased heart rate and the presence of high-risk criteria in the 'European Society of Cardiology Guidelines for Syncope' were independent risk factors for detection of abnormal ultrasonographic findings related to syncope/presyncope.Conclusion: WHOBUS-Syncope protocol can be included in emergency practice as part of the standard evaluation in patients with syncope or presyncope presenting to the ED.(c) 2023 Elsevier Inc. All rights reserved.

Aims: Procalcitonin (PCT) is a biomarker for infection, which has grown in popularity in recent years. In our study, we investigated whether there was a relationship between procalcitonin levels and seven-day mortality in all patients whose procalcitonin levels were measured in the emergency department (ED). Material and Methods: In this single-center, cross-sectional, analytic, retrospective study, the patients whose PCT levels were measured in XXXX University Hospital adult emergency department between 01.01.2016 and 31.03.2016 were included. PCT level and other parameters were evaluated in the survived and non- survived groups, Results: We analyzed 499 patients whose PCT levels were measured. The mean age was 74 (IQR: 63-82) years, and 54% were male. Of the 499 patients, 6 (1.2%) had a low procalcitonin level (median 0.03: IQR 0.02-0.04), 407 (81.6%) had an intermediate procalcitonin level (median 0.26; IQR 0.16-0.54) and 86 (17.2%) had a high procalcitonin level (median 5.54; IQR 3.20-15.31). When the PCT level-high group was compared with the other groups; systolic blood pressure (SBP), diastolic blood pressure (DBP), platelet count, pco2 were lower and pulse rate, WBC, lactate, baz excess values were higher. It was found that 249 (49.9%) of the patients were discharged from the ED, 112 (22.4%) were hospitalized, 66 (13.2%) were hospitalized in the intensive care unit, and 72 (14.4%) died. The PCT level was higher in the non-survivor group than in the survivor group (0.29 ngr/mL vs 1.07 ngr/mL, p

BackgroundWhile clinical decision rules have been developed to evaluate exacerbations and decisions on hospitalisation and discharge in emergency departments (EDs) in patients with chronic obstructive pulmonary disease (COPD), these rules are not widely used in EDs. In this study, we compare the predictive efficacy of the Ottawa Chronic Obstructive Pulmonary Disease Risk Scale (OCRS) and the Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation (DECAF) score in estimating the short-term poor outcome of patients in our ED with exacerbations of COPD.MethodsThis single-centre prospective observational study was conducted over 6 months. Patients with acute exacerbations of COPD admitted to the ED during the study period were included in the study. A poor outcome was defined as any of the following: readmission and requiring hospitalisation within 14 days of discharge, requiring mechanical ventilation on the first admission, hospitalisation for longer than 14 days on the first admission, or death within 30 days. The sensitivity and specificity of the OCRS and the DECAF score for a poor outcome and for mortality were calculated.ResultsOf the 385 patients who participated in the study, 85 were excluded based on the exclusion criteria. 66% of the patients were male, and the mean age was 70.15±10.36 years. A total of 20.7% of all patients (n=62) experienced poor outcomes. The sensitivity of an OCRS score <1 for predicting a poor outcome in patients was 96.8% (95% CI 88.8–99.6%) and the specificity was 18.5% (95% CI 13.8–24.0%). The sensitivity and specificity of an OCRS score <2 were 83.3% (95% CI 35.9–99.6%) and 65.5% (95% CI 59.6–70.7%), respectively. The sensitivity and specificity of a DECAF score <1 were 88.7% (95% CI 78.1–95.3%) and 34.5% (95% CI 28.4–40.9%), respectively. When the DECAF score was <2, sensitivity and specificity were 69.3% (95% CI 56.4–80.4%) and 74.8% (95% CI 68.8–80.2%), respectively.ConclusionOur physicians achieved high specificity but low sensitivity in predicting a poor outcome. The OCRS is the more sensitive of the two tools, while the DECAF score is more specific in predicting a poor outcome when all threshold values are evaluated. While both tools may results in unnecessary hospitalisation, they can reduce the incidence of hospital discharge of patients with exacerbations of COPD who will develop poor outcomes in the ED.

Introduction:To assess the association between cranial computed tomography (CCT) findings and Glasgow Coma scale (GCS), and abbreviated injury scale (AIS) and to investigate the efficacy of GCS for determination of the indication of CT in pediatric polytrauma patients.Methods:This retrospective study was performed using the data of patients who admitted to the emergency department between February 2017 and June 2018. The 120 pediatric patients due to polytrauma were reviewed for demographic, clinical and radiological information. The relationship between GCS, AIS, and the presence of findings consistent with polytrauma in CCT was evaluated.Results:Patients with positive findings on computed tomography (CT) had significantly higher AIS (p<0.001) and AIS squared (p<0.001) compared to those of patients without positive CT findings for trauma. The GCS and AIS squared scores were found to be significantly associated with positive findings for trauma in CT scans.Conclusion:Trauma score systems such as GCS and AIS were associated with the presence of trauma in CCT in pediatric patients.

Due to elderly residents, nursing homes/assisted living facilities were the most affected places in COVID-19 pandemic. Besides symptomatic patients, asymptomatic patients were detected during routine screening. This study aims to determine the factors that affect antibody response and viral shedding in stool samples after natural exposure to the virus in residents and staff who recovered from COVID-19 before the vaccine was available. This prospective cross-sectional study was conducted at the nation’s highest-capacity Residential and Nursing Home. Blood samples were collected between December 15, 2020 and January 15, 2021 from participating residents and staff for anti-SARS-CoV-2 antibody testing. Stool samples were obtained for SARS-CoV-2 PCR testing 2 months after COVID-19. The Social Sciences (SPSS) program version 15.0 was used for statistical analysis. The Mann–Whitney U test compared SARS‐CoV‐2 antibody concentration between two groups. Four hundred sixty-four (52.3%) residents and 424 (47.7%) staff participated. Entirely 259 (29.2%) participants were anti-SARS-CoV-2 IgG (+) and 255 (28.7%) were SARS-CoV-2 PCR (+). Both antibody and PCR positivity was detected in 196 (76.9%). In PCR (−) group, 63 (10.0%) participants were SARS-CoV‐2 IgG (+). Antibody titers were found highest in SARS-CoV-2 PCR (+) male residents. SARS-CoV-2 IgG titers were significantly high in SARS-CoV-2 PCR (+) and hospitalized participants regardless of age. Stool samples were obtained from 61(23.9%) participants and were found negative. A durable SARS-CoV‐2 IgG antibody response was monitored at least 9 months after the participants were diagnosed with COVID-19. SARS-CoV-2 antibody positivity was detected 76.9% in PCR (+) and 10.0% in PCR (−) participants. Knowing the duration of detectable antibodies is an important finding for developing disease prevention and public health strategies.

It’s known that head computed tomography (CT) is used excessively to exclude intracranial hemorrhage in patients with hepatic encephalopathy (HE) in the emergency department. However, the independent risk factors for abnormal head CT in patients with HE have not been studied extensively to date. In this retrospective study, patients with an ammonia level of >90 U/L who were clinically considered HE and had head CT were included. The characteristics of patients with abnormal head CT and independent risk factors for abnormal CT were investigated. Three hundred seventy-eight patients were included in the study. CT findings of 18 (4.8%) of the patients were abnormal: 12 had intracranial hemorrhage, 1 had an ischemic stroke, and 5 had an intracranial mass. Intracranial hemorrhage (odds ratio [OR] 12.5), history of recent trauma (OR 23.4), history of active malignancy (OR 10.3), thrombocyte count <100.000/μL (OR 4.3), and international normalized ratio ≥1.5 (OR 3.2) were found to be independent risk factors for abnormal head CT. Head CT scan may be considered in patients with HE if any of the following are present: intracranial bleeding history, recent trauma history, active malignancy, platelet count <100,000/μL, and international normalized ratio >1.5.

Aim: Hypercapnic respiratory failure is defined as a carbon dioxide (CO2) level >45 mmHg. High PaCO2 levels are related with increased mortality in acute exacerbation of COPD. In our study, we aimed to determine CO2 clearance value for predicting patients' prognosis. Material and Methods: 68 patients were included in the study. The patients were divided into two as, good and poor prognosis groups according to the outcome. The patients’ demographic information, comorbidities, vital parameters, blood gas results on admission (first measurement) and in the first sixth hour (second measurement), treatment, and outcomes were recorded in data forms. The relation between CO2 change and outcome was evaluated. Results: There was no statistically significant difference in CO2 clearance and delta pCO2 levels between the good and poor prognosis groups (11.7±12 vs. 6.2 ± 23, p=0.205 and -11.77±12.92 mmHg vs. -7.66±24.76 mmHg, p=0.281 respectively). NaHCO3 levels in the second measurement were higher than the first measurement in both good (23.89 ±5.28, 25.78±4.39, p<0.0001) and poor prognosis (23,26±6.05, 23.53 ± 5.05, p<0.0001) groups. And also, pCO2 levels in the second measurement was lower than the first measurement in the good (60.68 ± 11.89, 48.92 ± 14.02, p=0.007) and poor (68.04 ± 20.15, 61.76 ± 22.87, p=0.007) prognosis groups. There was also a significant decrease in lactate levels in the poor prognosis group between the first and the second measurements (p<0.001). Conclusion: Our study revealed that the CO2 clearance calculated in the first six hours in hypercarbic patients who came to the emergency department with shortness of breath was not useful in predicting the short-term prognosis of the patients. However, delta lactate and delta NaHCO3 levels significantly changed in the poor prognosis group.

Aim: We aimed to determine the incidence of post-contrast acute kidney injury (PC-AKI), the demographic characteristics of patients, and the reasons that facilitate the development of PC-AKI in patients who were admitted to the emergency department and underwent computed tomography (CT) with intravascular contrast media. Material and Methods: This study is a retrospective, cross-sectional and analytical study. Patients over the age of 18 who underwent CT with intravascular contrast media and were hospitalized for at least 48 hours were included in this study. The development of PC-AKI and the clinical and demographic characteristics of the patients were evaluated.Results: A total of 816 patients were included in the study. Thirty-six (4.4%) patients developed PC-AKI. We found that the average length of hospital stay was 22.2 +/- 41.7 days. Patients with a history of hypertension (HT) and diabetes mellitus (DM) and who had hypotension on admission to the emergency department were found to have a higher risk of developing PC-AKI (p<0.05 for all of them). The development of PC-AKI was significantly higher in patients receiving ACE inhibitors (p=0.004). When the clinical outcomes of the patients with PC-AKI were evaluated, it was observed that 47.2% (n=17) of them died. Mortality was statistically significantly higher in patients with PC-AKI than in the patients without PC-AKI (p<0.0001). Discussion: PC-AKI led to an increase in the length of hospital stay of patients. The patients with PC-AKI had a higher mortality rate compared with the patients without PC-AKI.

Objective We aimed to determine the effect of fibrinolytic therapy on hemodynamic parameters at 4 hours after treatment and bleeding complications in patients with intermediate- and high-risk pulmonary embolism. Methods This single-center, retrospective, cohort study included patients with intermediate- and high-risk pulmonary embolism treated with fibrinolytics. Their demographic and clinical characteristics, complications, and vital signs at the initiation of and 4 hours after fibrinolytic therapy were evaluated. The primary outcome was the change in the patients' vital signs at 4 hours after fibrinolytic therapy, compared by the Mann-Whitney U-test. Results Seventy-nine patients were included in this study. The systolic and diastolic blood pressures of the high-risk group at 4 hours after fibrinolytic therapy were higher than those at the initiation of fibrinolytic therapy (80 mmHg vs. 99 mmHg, P = 0.029; 49 mmHg vs. 67 mmHg, P = 0.011, respectively). In the intermediate-risk group, the oxygen saturation increased (94% vs. 96%, P = 0.004) and pulse rate decreased (104 beats/min vs. 91 beats/min, P < 0.001). Conclusion Blood pressure at 4 hours after fibrinolytic therapy increased in patients with high-risk pulmonary embolism. Also, oxygen saturation and pulse rate improved in intermediate-risk patients.