Introduction: Anisocoria is a significant clinical sign that may indicate serious neurological conditions such as third cranial nerve palsy, intracranial hemorrhage, or uncal herniation. However, it can also be caused by benign disorders like Adie-Holmes syndrome. Adie pupil is characterized by a tonically dilated pupil with poor or absent light reaction and preserved, though often slow, near response. It is caused by postganglionic parasympathetic denervation at the level of the ciliary ganglion. The condition typically affects young women and is unilateral in 80% of cases. When accompanied by diminished or absent deep tendon reflexes, the condition is referred to as Adie-Holmes syndrome. We report a case of a man diagnosed with Adie pupil after comprehensive emergency evaluation. Case:A 39-year-old man presented to the emergency department with the complaint of blurred vision and a dilated right pupil noticed on awakening. He denied any history of trauma, headache, diplopia, nausea, or systemic illness. His vital signs were within normal limits. Neurological examination revealed normal motor and sensory function with intact cranial nerves, except for anisocoria. The right pupil was enlarged, and nonreactive to light. The left pupil was normal in size and response (Picture 1). Ophthalmology consultation was requested. Optical coherence tomography revealed retinal nerve fiber layer (RNFL) thickness of 87 μm in the right eye and 86 μm in the left, within normal limits. A non-contrast cranial CT was performed as part of the differential diagnosis to rule out acute intracranial pathology, and results were unremarkable. Given the persistent anisocoria and absence of mass lesion, a contrast-enhanced cranial MRI was obtained, which was also normal. To further investigate the etiology, the patient was referred to the neuro-sensory laboratory where dilute pilocarpine testing was performed. The patient was diagnosed with Adie pupil syndrome and discharged with outpatient follow-up recommendations in neuro-ophthalmology. Discussion and Conclusion: Adie syndrome is generally idiopathic but may rarely be linked to infections (e.g., syphilis, varicella, Lyme disease), autoimmune diseases (e.g., Sjögren’s, lupus), or neoplastic processes. The key pathophysiology involves degeneration in the ciliary ganglion, leading to cholinergic denervation hypersensitivity of the iris sphincter. This explains the pupil’s abnormal response to light and positive reaction to dilute pilocarpine. In the acute setting, it is crucial to exclude life-threatening causes of anisocoria. Neuroimaging should be considered when patients present with headache, diplopia, ptosis, or neurologic deficits. In our case, normal cranial CT and contrast-enhanced MRI ruled out structural brain lesions. Normal RNFL thickness further excluded optic nerve pathology. The diagnosis was confirmed by a positive pilocarpine test. Adie syndrome may also involve progressive areflexia and autonomic dysfunction such as segmental anhidrosis, known as Ross syndrome. Although our patient did not show these features initially, long-term follow-up is recommended due to the possibility of progression. Conclusion: Adie-Holmes pupil is a rare but important differential diagnosis in patients presenting with unilateral mydriasis. Emergency physicians should be familiar with its clinical features and diagnostic approach to prevent unnecessary interventions and to provide appropriate referrals.

This study evaluated the effectiveness of history, electrocardiogram, age, risk factors, and troponin (HEART), troponin-only Manchester acute coronary syndromes (T-MACS), and history and electrocardiogram-only Manchester acute coronary syndromes (HE-MACS) in diagnosing and managing acute coronary syndrome in patients presenting with chest pain in the emergency department. These scoring systems are crucial for risk stratification and the prediction of major adverse cardiac events (MACEs) and mortality within 30 days. A single-center prospective analytical study was conducted following the STROBE guidelines, with 560 patients presenting with chest pain or ischemic equivalent symptoms at the Ege University Faculty of Medicine Hospital from August 2020 to March 2021. The HEART, T-MACS, and HE-MACS scores were calculated for each patient, and their predictive values for MACE and mortality were analyzed using receiver operating characteristic analysis. The HEART score demonstrated an area under the curve (AUC) of 0.929 for predicting mortality, with 100% sensitivity and 81% specificity. It has been identified as the most reliable predictor of mortality. The T-MACS score showed an AUC of 0.875 for mortality prediction with 85.7% sensitivity and 83.9% specificity. It is particularly effective for high-risk patients, predicting 30-day MACE development rates, which is consistent with the literature. The HE-MACS score yielded an AUC of 0.729 for mortality prediction, with 71.4% sensitivity and 80.7% specificity. Although it effectively excludes MACE in very-low-risk patients, it is limited by its application to a highly isolated group. The discussion interprets the results and compares them with existing literature. The study confirms the high effectiveness of the HEART score in mortality risk assessment, the specificity of the T-MACS score for high-risk patients, and the utility of the HE-MACS score for excluding very-low-risk cases. The limitations of each scoring system are discussed and recommendations for their application in clinical practice are provided. The study concluded that selecting the most appropriate scoring system based on individual patient characteristics is essential for optimal patient management in the emergency department. For optimal patient management, it is essential to select the most appropriate scoring system based on the individual patient characteristics.

Background: Sepsis secondary to infections is a critical health issue with limited preventive treatments. Various studies have shown that Daucus carota L. ssp. Atrorubens (black carrot) possesses antibacterial, antifungal, anti-inflammatory, antiseptic and hepatoprotective effects. This study investigated the therapeutic potential of black carrot, focusing on its anti-inflammatory and antioxidant effects in an experimental sepsis model. Methods: Thirty two Wistar Albino rats were divided equally into four groups. Group I served as the control without any treatment. The caecal ligation and perforation (CLP) procedure was performed on Groups II, III and IV. Group II underwent only the CLP procedure. Group III received 3 mL intraperitoneal isotonic sodium chloride, and Group IV was administered 3 mL black carrot solution every 24 h for 7 days post-CLP. On day 7, all rats were sacrificed, and blood, kidney, and liver samples were collected for analysis. Data were evaluated using GraphPad Prism 6.0 software and analysed by one-way analysis of variance and Tukey multiple comparison tests. Results: Biochemical analysis showed similar Aspartate Transaminase (AST) and Alanine Aminotransferase (ALT) values between the control and black carrot groups. Histopathological examination revealed minimal polymorphonuclear leukocyte infiltration in the CLP + black carrot group, and normal-appearing arteria hepaticus interlobularis, vena interlobularis and ductus biliferi, similar to the control group. Despite no significant decrease in serum urea levels, histopathological findings indicated a nephroprotective effect. The CLP + black carrot group showed reduced tubular dilatation and brush border loss and appeared similar to the control group. Conclusions: Overall, black carrot showedhepatoprotective, nephroprotective, anti-inflammatory and antioxidant effects, as supported by both biochemical and histological data. These findings suggest that black carrot may offer therapeutic benefits in managing sepsis- induced organ damage.

It is possible that cyberchondria may be linked to anxiety and hospitalization. The aim of this study was to determine whether there are relationships between cyberchondria, the frequency of emergency department admission, and death anxiety in patients with arrhythmia. This descriptive, correlational study was conducted in 225 patients with arrhythmia the majority of whom were Muslim. The data were collected via the “Patient Description Form,” “Cyberchondria Severity Scale Short Form (CSS-15),” and “Abdel-Khalek Death Anxiety Scale (ASDA)”. The mean scores on the Cyberchondria Severity Scale Short Form 15 and Abdel-Khalek Death Anxiety Scale were 55.82 ± 6.20 and 75.25 ± 10.03, respectively. The frequency of emergency department visits and the mean scores of the Cyberchondria Severity Scale Short Form and the Abdel-Khalek Death Anxiety Scale were not significantly related. The mean scores between the Cyberchondria Severity Scale Short Form and the Abdel-Khalek Death Anxiety Scale showed a statistically significant positive and moderate relationship (r =.343, p <.05). The simple linear regression model, in which the CSS-15 score was the independent variable and the ASDA score was the dependent variable, was statistically significant (F = 21.260; p <.001). The severity of cyberchondria was not related to the frequency of emergency department admission, but death anxiety increased with the severity of cyberchondria.

Background The COVID-19 pandemic, which has killed millions of people worldwide, continues to be marked by waves of reinfections. We aimed to assess the incidence and clinical characteristics of reinfection in COVID- 19 cohort. Material and Methods A single-center descriptive study was conducted. Data were collected from all patients who tested positive for SARS-CoV-2 via PCR from March 18, 2020, the onset of the first major COVID-19 wave, until the end of 2020. All PCR-positive patients were followed-up, and those who had SARS-CoV-2 PCR positivity again at least 90 days after the initial onset were contacted via telemedicine. Results 5814 patients diagnosed with COVID-19 with PCR positive in the first wave were included. The incidence of reinfection among the cohort of patients infected with SARS-CoV-2 during the initial wave of COVID-19 was 0.73%. Among healthcare workers, the 1-year reinfection rate was 2.14%, 3.9 times higher than non-healthcare workers. We observed that the clinical course was milder and less complicated in patients who had reinfection. In cases of reinfection among fully vaccinated individuals, statistically significantly fewer symptoms were observed. Conclusions We observed that healthcare workers are at approximately four times greater risk of reinfection. Reinfections generally presented with a milder clinical course.

Atrial fibrillation is the most common type of arrhythmia diagnosed in the emergencydepartment. Many patients are diagnosed with new-onset atrial fibrillation in theemergency department. The 2024 European Society of Cardiology guidelines(ESC) introduce a new approach for management of atrial fibrillation called as AF-CARE.While atrial fibrillation with rapid ventricular response disrupts the hemodynamicstatus of the patient or rate control is an important problem to be solved acutelyin emergency departments, also early and accurate diagnosis, selection ofappropriate rate and rhythm control agents and identification of patients in need ofanticoagulation will be important milestones for the management of atrial fibrillationin the emergency departments to better prevent important complications such asstroke and heart failure. Nowadays, emergency physicians also play an important rolenot only in the proper management of atrial fibrillation in the emergency department but also in initiating a teamwork based management as recommended in the AF-CARE approach.

The diagnosis of central nervous system (CNS) infections is challenging and time-consuming. The FilmArray meningitis/encephalitis panel (BioFire Diagnostics®, Salt Lake City, UT, United States of America) (FA-ME) is designed for the rapid detection of 14 microorganisms that are common causative agents of community-acquired meningitis/encephalitis. The aim of this study was to evaluate the effectiveness of the FA-ME panel by comparing panel test results of cerebrospinal fluid (CSF) samples of 1588 patients who admitted to our hospital with a preliminary diagnosis of CNS infection between 01.06.2018-31.08.2022 with conventional microbiological tests, CSF biochemical tests, clinical findings and radiological imaging results. The results of the FA-ME panel from the 1588 patients tested were assessed together with Gram staining, culture-antibiogram, cryptococcal antigen tests, other viral multiplex polymerase chain reaction tests performed for confirmation, CSF biochemical test results, clinical findings, and radiological imaging results. The results were obtained through the examination of archive and confirmation test records from our hospital medical microbiology laboratories, as well as electronic patient files. The data were evaluated using IBM SPSS Statistics version 25.0. An average positivity rate of approximately 10% was found among the 1588 samples. The most frequently detected agent was herpes simplex virus type 1. In this study, 10 samples (7.8%) were evaluated as false positive and 17 positive samples (13.4%) were found to be clinically insignificant. When evaluating 1488 negative samples, microorganisms not included in the panel were identified in 27 cases using conventional methods. Additionally, one Cryptococcus neoformans was assessed as a false negative. The neurology clinic was the department sending the most samples (728) with 28 positive samples but this number decreased to 14 when false positive and clinically insignificant results were excluded. The average time from sample acceptance in the laboratory to diagnosis was found to be 3.2 hours (200 minutes). When the FA-ME panel results obtained from the CSF samples of 1588 patients were evaluated together with traditional test results, the overall positivity rate was determined approximately as 10% which was consistent with the literature. In the analysis of corrected positive results, it was found that the positivity rate was significantly higher in male patients (p= 0.008), which was consistent with the literature. In neurology patients, when considering modified Reller criteria, the positivity of the FA-ME panel did not indicate a true CNS infection, leading to the conclusion that the test was unnecessarily applied to exclude infection. By ensuring that the FA-ME test requested only upon the opinion of an infectious disease specialist, unnecessary use of an expensive test was prevented. It has been concluded that human herpesvirus-6 positivity detected in the panel should be carefully evaluated with the patient’s age, symptoms, immunosuppression status, laboratory findings and radiological imaging results. Furthermore, negative panel results for C.neoformans/Cryptococcus gattii should be carefully evaluated along with the patient’s clinical findings, necessary conventional tests and radiological imaging. In 27 cases, microorganisms identified as causes of meningitis/encephalitis by conventional methods were detected which were not included in the panel. Therefore, it has been concluded that using the panel when necessary, by evaluating the patient’s clinical findings and symptoms, would be an effective approach in terms of diagnosis and cost. Although careful evaluation of the results is required, it has been determined that the panel successfully detects pathogens directly and rapidly from CSF on a large scale.

Merkezi sinir sistemi (MSS) enfeksiyonlarının tanısı zor ve zaman alıcıdır. FilmArray menenjit/ ensefalit paneli (BioFire Diagnostics®, Salt Lake City, UT, Amerika Birleşik Devletleri) (FA-ME), yaygın toplum kaynaklı menenjit/ensefalit etkeni olan 14 mikroorganizmanın hızlı tespiti için tasarlanmıştır. Bu çalışmada, 01.06.2018 ile 31.08.2022 tarihleri arasında MSS enfeksiyonu ön tanısıyla hastanemize başvuran 1588 hastanın beyin omurilik sıvısı (BOS) örneklerinin FA-ME test sonuçlarının; konvansiyonel mikrobiyolojik testler, BOS biyokimyasal testleri, klinik bulgular ve radyolojik görüntüleme sonuçlarıyla birlikte karşılaştırılarak panelin etkinliğinin değerlendirilmesi amaçlanmıştır. BOS örnekleri FA-ME paneliyle test edilen 1588 hastanın sonuçları Gram boyama, kültür-antibiyogram, kriptokok antijen testi, doğrulama amacıyla uygulanan diğer viral multipleks polimeraz zincir reaksiyonu testleri, BOS biyokimyasal test sonuçları, klinik bulgular ve radyolojik görüntüleme sonuçlarıyla birlikte değerlendirilmiştir. Sonuçlar, Ege Üniversitesi Tıp Fakültesi Tıbbi Mikrobiyoloji Anabilim Dalı Laboratuvarlarının arşiv ve doğrulama testi kayıtlarıyla elektronik hasta dosyalarının incelenmesi yoluyla elde edilmiştir. Verilerin değerlendirilmesinde IBM SPSS Statistics 25.0 programı kullanılmıştır. 1588 örnekte ortalama %10 pozitiflik oranı bulunmuştur. En sık tespit edilen etken herpes simpleks virüs tip 1'dir. Bu çalışmada, 10 örnek (%7.8) yanlış pozitif olarak değerlendirilmiş ve 17 pozitif örnek (%13.4) klinik olarak anlamlı bulunmamıştır. Negatif 1488 örnek değerlendirildiğinde, panelde yer almayan mikroorganizmalar 27 olguda konvansiyonel yöntemlerle tespit edilmiştir. Ayrıca, bir klinik örnekte Cryptococcus neoformans yanlış negatif olarak tespit edilmiştir. Nöroloji kliniği 28 pozitif örneğe sahip olan en fazla örnek gönderen bölüm (728) olmakla birlikte, yanlış pozitif ve klinik olarak anlamlı olmayan sonuçlar hariç tutulduğunda bu sayı 14'e düşmüştür. Örneğin laboratuvara kabulünden sonra tanıya kadar geçen süre ortalama 3.2 saat (200 dakika) olarak tespit edilmiştir. Öte yandan 1588 hastanın BOS örneklerinden elde edilen FA-ME panel sonuçları geleneksel test sonuçlarıyla birlikte değerlendirildiğinde genel pozitiflik oranı yaklaşık %10 olarak bulunmuş ve bu oranın literatürle uyumlu olduğu belirlenmiştir. Düzeltme yapılmış pozitif sonuçların analizinde, literatürle uyumlu olarak erkek hastalarda pozitiflik oranının anlamlı derecede daha yüksek olduğu (p= 0.008) saptanmıştır. Nöroloji hastalarında, FA-ME panel pozitifliği, modifiye Reller kriterleri göz önüne alınarak değerlendirildiğinde, gerçek bir MSS enfeksiyonu göstergesi olmamış ve enfeksiyonu dışlamak amacıyla testin gereksiz yere uygulandığı sonucuna varılmıştır. FA-ME testinin yalnızca enfeksiyon hastalıkları uzmanının görüşü doğrultusunda istenmesi sağlanarak pahalı bir testin gereksiz kullanımı önlenmiştir. Panelde saptanan insan herpes simpleks virüs-6 pozitifliklerinin hastanın yaşı, semptomları, immünsupresyon durumu, laboratuvar bulguları ve radyolojik görüntüleme sonuçlarıyla birlikte; ayrıca C.neoformans/Cryptococcus gattii negatif panel sonuçlarının da hastanın klinik bulguları, gerekli konvansiyonel testler ve radyolojik görüntülemeyle birlikte dikkatli değerlendirilmesi gerektiği sonuçlarına varılmıştır. Yirmi yedi olguda, panelde bulunan mikroorganizmalar dışında konvansiyonel yöntemlerle menenjit/ensefalit etkenleri olarak belirlenen mikroorganizmalar tespit edilmiştir. Bu nedenle hastanın klinik bulgularını ve semptomlarını değerlendirerek paneli gerektiğinde kullanmanın, tanı ve maliyet açısından etkili bir yaklaşım olacağı görüşüne varılmıştır. Sonuçların dikkatle değerlendirilmesini gerektirse de, panelin başarılı olduğu ve patojenleri BOS'tan doğrudan ve geniş ölçekte hızlı bir şekilde tespit ettiği belirlenmiştir.

Introduction: This study aimed to evaluate the effectiveness of lung ultrasonography (US) in detecting the cause of acute respiratory distress in the emergency department. Methods: This cross-sectional analytical study was carried out on 195 adult patients who were admitted to the Emergency Department of a University Hospital with acute respiratory failure in 6months period. The validity of the US diagnoses was assessed by comparing the decisions made by researchers according to the BLUE protocol classification with the final judgments made by the primary doctors using gold-standard diagnostic techniques suggested by the guidelines. Results: The diagnostic accuracy of lung US was 89.7%. While Congestive Heart Failure (CHF) (n=91), Chronic Obstructive Pulmonary Disease (COPD) (n=53), pneumonia (n=69), and Pneumothorax (PTX) (n=5) could be diagnosed by ultrasound with high sensitivity and specificity, its specificity in the diagnosis of Pulmonary Thromboembolism (PTE)(n=18) was low (67%). Ultrasonography could also diagnose combined pathologies such as pneumonia associated with CHF, or pneumonia associated with COPD, with high sensitivity and specificity. It has been determined that the diagnostic accuracy of the routine physical examination and lung radiography used in the emergency room to assess bedside respiratory distress is lower than that of ultrasonography. Discussion: In this study, we found that lung US was effective in the diagnosis of CHF, COPD, pneumonia, PTE, and PTX. Compared to the gold standard tests, it shortened the duration of the diagnosis. Finally, US can also be applied safely in centers where advanced diagnostic facilities are not available.

Amaç: COVID-19 salgını dünya genelinde tüm sağlık sistemini etkilemiştir. Birçok ülke ile birlikte, ülkemizde de kısıtlamalar getirilmiştir. Bu çalışma, sokağa çıkma yasağının olduğu dönemlerde acil servise başvuran travma hastalarının özelliklerini incelemeyi amaçlamaktadır. Gereç ve Yöntem: Kısıtlamaların yoğun olduğu üç aylık period (1/3/2020 – 1/6/2020) ile bir önceki yılın aynı periyodundaki (1/3/2019 - 1/6/2019) travma nedenli başvuruların klinik özellikleri karşılaştırıldı. Demografik özellikleri, yaralanma mekanizması, hastaneye yatış ihtiyacı ve hasta sonlanımları değerlendirildi. Bulgular: Pandeminin kısıtlama döneminde bir öncesi yıla göre hasta başvuru oranında % 17,25’lik düşüş belirlendi. Bu düşüşün özellikle 85 yaş ve altında anlamlı olduğu bulundu (

Aim: To evaluate the effect of timing of antimicrobial therapy on clinical progress of patients with septic shock.Materials and Method: We included 204 adult patients diagnosed with septic shock according to Sepsis-3 criteria between March 2016 and April 2021. One-month survival was evaluated using univariate and logistic regression analysis.Results: Antibiotic treatment was initiated within 1 h of the vasopressors in 26.4 % of patients. One-month mortality did not differ significantly between patients with and without empirical therapy coverage on etiological agents. Univariate factors that significantly affected one-month survival were starting antibiotics at the first hour, the unit where the case was diagnosed with septic shock, SOFA scores, qSOFA scores, and lactate level. In multivariate analysis, diagnosis of septic shock in the Emergency Service, SOFA score >= 11, qSOFA score of three and lactate level >= 4 were significantly associated with one-month mortality.Conclusion: Training programs should be designed to increase the awareness of septic shock diagnosis and treatment in the Emergency Service and other hospital units. Additionally, electronic patient files should have warning systems for earlier diagnosis and consultation.

OBJECTIVES:There is no sufficient data to provide a clear picture of out-of-hospital cardiac arrest (OHCA) across Türkiye. This study is the first to present the prognostic outcomes of OHCA cases and the factors associated with these outcomes. MATERIALS AND METHODS:The study was conducted in a prospective, observational, multicenter design under the leadership of the Emergency Medicine Association of Turkey Resuscitation Study Group. OHCA cases aged 18 years and over who were admitted to 28 centers from Türkiye were included in the study. Survived event, return of spontaneous circulation (ROSC), survival to hospital discharge, and neurological outcome at discharge were investigated as primary outcomes. RESULTS:One thousand and three patients were included in the final analysis. 61.1% of the patients were male, and the average age was 67.0 ± 15.2. Cardiopulmonary resuscitation (CPR) was performed on 86.5% of the patients in the prehospital period by emergency medical service, and bystander CPR was performed on only 2.9% by nonhealth-care providers. As a result, the survived event rate was found to be 6.9%. The survival rate upon hospital discharge was 4.4%, with 2.7% of patients achieving a good neurological outcome upon discharge. In addition, the overall ROSC and sustained ROSC rates were 45.2% and 33.4%, respectively. In the multiple logistic regression analysis, male gender, initial shockable rhythm, a shorter prehospital duration of CPR, and the lack of CPR requirement in the emergency department were determined to be independent predictors for the survival to hospital discharge. CONCLUSION:Compared to global data, survival to hospital discharge and good neurological outcome rates appear to be lower in our study. We conclude that this result is related to low bystander CPR rates. Although not the focus of this study, inadequate postresuscitative care and intensive care support should also be discussed in this regard. It is obvious that this issue should be carefully addressed through political moves in the health and social fields.

Amaç: Literatürde ultrasonografik olarak optik sinir kılıf çapı ölçümünde saptanan değerler, kafa içi basınç artışı ile ilişkilendirilmektedir. Kafa içi basıncı ölçümü yapılan hastalar kritik alan ya da yoğun bakım hastalarıdır. Hafif ya da orta şiddette kafa travmasında patolojiyi ya da operasyona gidişi öngörmede ultrasonografi ile optik sinir kılıf çapı ölçümünün etkisi değerlendirilmemiştir. Çalışmamızda kafa travması ile başvuran hastaların, ultrasonografi ile optik sinir kılıf çapı ölçüm değerlerini, kraniyal tomografi bulguları ve hastaların klinik sonlanımları ile karşılaştırmayı hedefledik. Gereç ve Yöntem: Prospektif kesitsel planlanan çalışmada acil servise başvuran kafa travmalı hastalar hafif, orta ve şiddetli beyin hasarı olarak değerlendirildi. Çalışmaya dahil edilen hastaların ultrasonografi ile optik sinir kılıf çapları ölçüldü. Bulgular hastaların sonlanımları ve kraniyal tomografi özellikleri ile karşılaştırıldı. Bulgular: Acil servise kafa travması ile başvuran 58 hastanın incelemesinde en sık hafif şiddette travmatik beyin hasarına rastlandı. Hastaların %51,7 (30)’sinde yatış ya da operasyon ihtiyacı vardı. Optik sinir kılıf çapı ölçümlerinin ortalaması sağda 4,96±1,02 mm (3,1-7,3) solda ise 4,92±1,02 mm (3,3-7,8) olarak bulunmuştur. Optik sinir kılıf çapı ölçüm değerlerinin 5 mm ve üzerinde saptanması hastaneye yatışı öngörmede istatistiksel olarak anlamlı olarak saptandı (p<0,05). Kraniyal tomografide patoloji varlığını ve kafa içi basınç artışını öngörmede optik sinir kılıf çapı ölçüm değerinin 5 mm üzerinde olması istatistiksel olarak anlamlı saptandı (p<0,05). Sonuç: Kafa travması ile acil servise başvuran orta ve hafif kafa travması sınıfında da optik sinir kılıf çapı ölçüm değerleri, hastanın yatış ya da operasyon ihtiyacı hakkında bilgi verebilir, hastaların acil serviste monitörize izlem ihtiyacının belirlenmesi, görüntüleme önceliklerinin saptanmasında bir triaj kriteri olarak kullanılabilir.

Introduction: Focused Assessment with Sonography for Trauma (FAST) has attracted attention for its use in the detection of intra-abdominal pathology for pediatric patients. However, computed tomography (CT) remains the gold standard for the assessment of blunt torso trauma. The study examines the effectiveness of FAST both in the detection of intra-abdominal pathology in pediatric patients (<19 years) with blunt torso trauma and in the determination of the need for CT for further examination. Methods: The study was designed as a retrospective observational investigation of diagnostic value. The pediatric patients who were admitted to the Emergency Department with blunt torso trauma between January 2013 and October 2016 were included in the study. The sample of the study comprised 255 patients who met the inclusion criteria. The primary outcome was the effectiveness of FAST in the detection of intra-abdominal pathology and the determination of the need for CT. The secondary outcome was to identify the agreement between CT and FAST for intra-abdominal injuries. The Chi-square test and Fisher's exact test were used for comparisons. A logistic regression model was developed to determine the variables that independently affect the agreement between FAST and CT. Results: FAST was determined to have low sensitivity (20.3%) despite its high specificity (87%). However; FAST had a good negative likelihood ratio. There was a poor agreement between CT and FAST in terms of the presence of both intra-abdominal and intrathoracic injuries in pediatric patients with blunt trunk trauma. The error rate of FAST increased by five-fold, especially in the presence of concomitant thorax trauma. However, FAST had a good negative likelihood ratio. Conclusion: FAST should not be regarded as an equivalent tool to CT for pediatric patients with blunt torso trauma. It is, instead, a noteworthy complementary tool that is a negative predictor.

This study aimed to investigate the clinical status, outcomes, and healthcare costs of older patients who presented at the emergency department (ED) with falls in the periods before and during the Coronavirus disease-2019 (COVID-19) pandemic. Though the number of fall-related presentations of older persons to the ED, comorbidity burden, consultations, and the length of stay in the ED was lower, direct costs were higher during the pandemic period than the pre-pandemic period, particularly for COVID-19 positive older patients admitted to the ED with falls, and those patients were with poorer outcomes. As older patients with falls and multi-comorbidities might have experienced difficulties to reach the ED or avoided to apply during the pandemic period, strengthening community-based health services, and organizing EDs according to the needs of older patients are critical measures for crises situations. This study aimed to investigate the clinical characteristics, outcomes and healthcare costs of older patients presented to the emergency department (ED) with falls in the periods before and during the Coronavirus disease-2019 (COVID-19) pandemic. Hospital records one year before and after the onset of the COVID-19 pandemic were retrospectively analyzed through “International Statistical Classification of Diseases-10th Revision” codes. Age, gender, falls, triage classification, length of stay (LOS) in the hospital and the ED, COVID-19 status, Glasgow Coma scale, consultations-comorbidities, injury status, outcomes in the ED, and costs were recorded. The study comprised of 3187 patients aged ≥ 65 years admitted to the ED of a university hospital between March 2019 and 2021. In terms of pre-pandemic and pandemic periods; older patients presenting with falls to the ED, consultations, Charlson Comorbidity Index, and LOS in the ED were lower in the pandemic period, but costs were higher (p = 0.03, p = 0.01, p = 0.01, p = 0.01 and p = 0.02, respectively). Hospitalization/mortality rates were higher in COVID-19 positive patients (77.2

Objective: Ultrasonographic measurements of optic nerve sheath diameter is associated with increased intracranial pressure. Intracranial pressure measurements are usually performed on critical areas or intensive care unit patients. The effect of ultrasonographic measurement of optic nerve sheath diameter in predicting pathology or the need for surgery in mild or moderate head trauma has not been evaluated. In our study, we compared ultrasonographic optic nerve sheath diameter measurements with cranial computed tomography (CT) findings and clinical outcomes of patients with head trauma. Materials and methods: Patients with head trauma admitted to the emergency department who were diagnosed with mild, moderate, and severe brain injury were selected for this retrospective study. The optic nerve sheath diameters were measured by ultrasonography. The findings were compared with the outcome and cranial tomography characteristics of the patients. Results: Of the 58 patients admitted to the emergency department with head trauma, mild traumatic brain injury was most common. Hospitalization or operation was required in 51.7% of the patients (30 patients). The mean optic nerve sheath diameter was 4.96 ± 1.02 mm (3.1–7.3 mm) on the right and 4.92 ± 1.02 mm (3.3–7.8) on the left. Optic nerve sheath diameter of 5 mm or more were statistically significant in predicting hospitalization, the presence of pathology, and increased intracranial pressure on cranial CT (P < 0.05). Conclusion: Optic nerve sheath diameters of patients with moderate and mild head trauma may provide information about the need for hospitalization or surgery and can be used as a triage criterion in determining the need for monitoring and follow-up and imaging priorities.

BACKGROUND: This article aims to provide an up-to-date resource on disaster management by reporting about the destructive fea-tures of the earthquake that occurred on October 30, 2020, and about the hospital and emergency service organization during a pandemic. METHODS: This study was carried out with a multicentered, cross-sectional retrospective design on the victims of the 2020 Aegean Sea - Izmir earthquake. Local ethics committee approval was obtained. The data obtained by obtaining permission from two hospitals and ambulance services (transport data) located in the region where earthquake-related destruction was most prominent were evalu-ated. Patient data including demographic data, time of arrival to the emergency department, duration of stay under the debris, triage codes (green: not urgent, slightly injured; yellow: may be delayed, injured; red: critically injured; and black: dead), type of injuries, dura-tion of stay in the emergency department, crush syndrome, rhabdomyolysis, need for invasive procedures (e.g., surgery and dialysis), intensive care admission, hospital admission, and discharge were evaluated. RESULTS: In total, 313 patients (60.4% females) were included in the study according to the inclusion criteria. The mean age of the participants was 38.0 +/- 21.0 years, with the youngest being a 6-month-old baby and the oldest a 91-year-old individual. Approximately 41.5% of the earthquake victims presented to the emergency department within the first 3 h of the earthquake, and patients with yellow triage code were the most common in the 1st h. Further, 35.2% of the patients who were rescued from under the debris were discharged alive. Four patients were discharged alive after being rescued from under the debris 24 h following the earthquake, of whom three were rescued after >48 h (longest duration, 91 h). Further, 32 (15.9%) patients who survived upon presentation to the emergency department had rhabdomyolysis, 4 (1.9%) underwent hemodialysis in the emergency department due to acute renal failure, and 8 (3.8%) underwent other emergency operations such as fasciotomy and amputation. In total, 122 patients died and 191 patients were discharged from the hospitals. Furthermore, 139 patients were discharged from the emergency department, 15 were admitted to the intensive care unit, 41 were hospitalized in the relevant clinics, and 112 were directly transferred to the morgue following preliminary evaluation. CONCLUSION: Emergency services should be ready in terms of accurate registration, correct data entry, correct triage assignment, sufficient resources, adequate team, sufficient equipment, and adequate treatment areas for disasters such as earthquakes. Further, ade-quate disaster trainings should be provided, feasible disaster relief plans should be prepared, and regular exercises should be conducted.

Amaç: Risk skorlaması üst gastrointestinal sistem (GİS) kanamalarında hastanın tedavi ve takibini belirleyen anahtar roldedir.Bu çalışmada amaç üst GİS kanamalarında Rockall skoru (RS

Acil tıbbı, tüm yönleriyle tanı, tedavi ve uygulamalar açısından irdelediğimiz kitabımızın, üçüncü ve genişletilmiş basımını sizlerle paylaşmaktan büyük mutluluk duymaktayım

Objective: Early recognition of acute coronary syndromes (ACSs) is crucial in the emergency department. This study was designed to determine the diagnostic value of echocardiography, which was performed by an emergency medicine (EM) physician, to diagnosis ACS. Materials and Methods: This prospective and cross-sectional study was conducted between June 2011 and December 2011. All patients who were admitted with chest pain, to the EM department, and fulfilled the inclusion criteria were enrolled in this study. The focused echocardiography was performed by the EM physician. All echocardiography videos recorded were shown to the cardiologist. The final comments were compared with EM physician’s early findings. Results: Out of 48 patients, four were diagnosed with ACS. Three out of four patients diagnosed with ACS were detected by the EM physician with echocardiography. The EM physician’s prediction value with echocardiography in ACS diagnosis was 75% (95% confidence interval [CI] range 59%–100%), and the negative predictive value was 97% (95% CI range 77,9%-100%). There was no major cardiac event in the patient in whom the EM physician failed to detect a wall motion defect. Conclusion: Echocardiography is a bedside, noninvasive test for diagnosis of ACS. The EM physician who participated in this study was able to recognize ACS with the absence of a segmental wall motion defect, as well as the cardiologist providing the final report.