Introduction: Aggressive pain management with opioids has contributed to an opioid abuse epidemic. Although there is a substantial body of research in Western literature, data pertaining to Türkiye remain limited. The aim of our study was to examine the usage patterns of narcotic analgesics in the emergency department (ED). Methods: This retrospective study analyzed patients assessed in the red zone between January 1, 2024, and December 31, 2024, who were prescribed narcotic analgesics or other potentially addictive drugs for any reason. Demographic information, patient complaints, reasons for drug administration, and specific drugs used were recorded. Results: During the study period, 16,062 patients were admitted to the red zone. The study examined 1,171 drug applications administered to 1,062 distinct patients. In 63% of the patients, the primary reason for drug administration was pain management. Tramadol was the most commonly used narcotic, administered 601 times. It was given to 296 patients for managing pain related to abdominal pathologies, as a first-line medication in 67.6% of these cases. Fentanyl was administered to 100 patients, for whom trauma was the leading indication. During the study period, 24 patients were admitted to the ED due to drug abuse. Naloxone was required for only 3 of these patients, while the remaining were managed with benzodiazepines. Conclusion: This study provides valuable insights into the current trends and challenges associated with narcotic analgesic use in emergency care. Continued efforts to refine protocols will be crucial in optimizing pain management, addressing the opioid epidemic, and implementing strategies to prevent it.

Background: Prognostication after return of spontaneous circulation (ROSC) in comatose patients following out-of-hospital cardiac arrest (OHCA) remains challenging. This study aimed to evaluate the relationship between brain computed tomography (CT) derived optic nerve sheath diameter/eyeball transverse diameter (ONSD/ETD) measurements and mortality in this patient population.Methods: This retrospective, single-center observational study included adult comatose OHCA patients who achieved ROSC and underwent brain CT between January 2019 and January 2023. ONSD and ETD measurements were obtained from early post-arrest CT scans, and ONSD/ETD ratios were calculated. The primary outcome was 30-day mortality. Demographic, clinical, laboratory, and imaging variables were compared between mortality groups.Results: A total of 159 patients were included; 82 (51.6%) were male, and the median age was 76 years (IQR 67–84). Overall mortality was 80.5% (128/159), and patients in the mortality group were older than those in the non-mortality group (p=0.003). Median right and left ONSD values were 6.33 mm (5.91–6.98) and 6.37 mm (5.93–6.93), respectively, while median right and left ETD values were 2.25 cm (2.19–2.33) and 2.26 cm (2.20–2.33). The ONSD/ETD ratios in the mortality group were 0.28 (0.26–0.30) for both the right and left eyes. No significant differences were observed between mortality and non-mortality groups regarding ONSD, ETD, or ONSD/ETD measurements.Conclusions: In this study comatose patients after ROSC, early CT-derived ONSD and ONSD/ETD measurements did not differ between mortality groups. These findings suggest limited utility of early CT-based optic nerve metrics for mortality assessment in the immediate post–cardiac arrest period.

Aim: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is an important cause for admission to the emergency departments (EDs). The search for appropriate biomarkers for the determination of prognosis in these patients is still ongoing. The prognostic value of platelet activation markers such as plateletcrit (PCT) has been shown in various inflammatory diseases. COPD acute exacerbation is a condition in which both systemic inflammation and thrombotic events occur. In this study, we aimed to investigate the prognostic value of plateletcrit, which reflects the total platelet volume in acute exacerbations of COPD. Materials and Methods: In this retrospective diagnostic/prognostic study, all patients who were admitted to the critical care area of our emergency department (ED) with COPD exacerbation were included between January 2015 and January 2020. The primary outcome (reference test) was determined as a composite outcome consisting of ICU admission and 30-day mortality. Results: 282 patients were included in our study. PCT and CRP were found to be significantly higher in patients with the composite outcome. In the ROC analysis, the area under the curve (AUC) values of PCT and CRP were found to be ; 0.975 (95% CI; 0.956 to 0.994), 0.984 (95% CI;0.972 to 0.995). Conclusion: According to our results, we think that PCT may be a good prognostic indicator in acute exacerbations of COPD, at least as much as CRP. It can provide additional information about prognosis when used together with clinical parameters.

Aim: This study aimed to evaluate the diagnostic accuracy of the STONE score and hydronephrosis detected by point-of-care renal ultrasonography (USG) in predicting urinary tract stones and/or hydronephrosis confirmed by non-contrast abdominal computed tomography (CT) in patients presenting to the emergency department (ED) with suspected renal colic. Materials and Methods: This prospective observational study included patients aged 18 years and older who presented to the ED with unilateral flank pain and were scheduled for non-contrast abdominal CT. Before CT imaging, all patients underwent point-of-care renal USG performed by emergency medicine specialists to assess for hydronephrosis. Demographic and clinical data were recorded, and STONE scores were calculated. CT was subsequently performed to confirm the presence of urinary tract stones and/or hydronephrosis. Results: A total of 191 patients were enrolled. CT confirmed stones and/or hydronephrosis in 70.7% of cases. The area under the curve (AUC) for the STONE score was 0.716, with a sensitivity of 58.3% and specificity of 76.1%. Hydronephrosis detected by USG showed a markedly higher diagnostic performance, with an AUC of 0.915, sensitivity of 95.2%, and specificity of 98.5%. Discussion: Although the STONE score showed good specificity, particularly in high-score patients, its sensitivity remained limited. Hydronephrosis detected by point-of-care renal USG performed by experienced emergency physicians demonstrated both high sensitivity and specificity, indicating that USG may be a more reliable tool than the STONE score for predicting urinary tract stones in ED patients.

Background: Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality, with only a small percentage of patients achieving return of spontaneous circulation (ROSC). Predicting ROSC and determining when to cease resuscitation efforts are crucial in clinical decision-making. The Leuko-Glycemic Index (LGI), which combines blood glucose and leukocyte count, has been proposed as a potential prognostic tool in various conditions, but its role in predicting ROSC in OHCA patients has not been thoroughly evaluated.Objective: This study aims to assess the predictive role of LGI for ROSC in OHCA patients.Methods: A retrospective study was conducted on 249 OHCA patients admitted to a training and research hospital. The primary outcome was the prediction of ROSC, with secondary outcomes including survival and mortality prediction, as well as differences in LGI prediction between diabetic and non-diabetic patients. Statistical analyses included ROC curve analysis, p value of

Background: Pediatric trauma remains a leading cause of morbidity and mortality worldwide. Whole-body computed tomography (WBCT) has been increasingly utilized in adult trauma care; however, its routine use in pediatric patients remains controversial due to radiation risks. This study aims to evaluate the clinical utility and outcomes associated with WBCT in pediatric blunt trauma cases.Methods: This retrospective observational study included pediatric patients (

Background & Objective: Migraine headaches are a frequent reason for emergency department (ED) visits. While oxygen therapy has demonstrated effectiveness for cluster headaches, its role in other primary headaches remains a topic of research. This study aimed to investigate the effectiveness of supplemental oxygen therapy, when added to standard treatments, for pain management in patients presenting to the ED with acute migraine without aura. Methods: This study was a randomized, controlled trial. Patients were randomized using the 'Random Allocation' program and divided into two groups. All patients presenting to the ED with migraine without aura received 50 mg dexketoprofen + 10 mg metoclopramide HCl in 100 mL normal saline intravenously as standard treatment. The study group also received humidified oxygen at 10 L/min via a simple face mask for 60 minutes. Data collected included patients' demographic information, pain characteristics, comorbid diseases, medications used, presence of aura, visual analog scale (VAS) scores at 0, 15, 30, and 60 minutes post-treatment, and the need for rescue treatment. Results: A total of 160 participants were included: 79 in the oxygen group and 81 in the non-oxygen group. No significant differences were found in demographic data or baseline VAS scores between the groups. VAS scores at 15, 30, and 60 minutes did not show a significant difference between the two groups (p > 0.05 for each measurement using either per-protocol [PP] or intention-to-treat [ITT] analysis). One patient in the oxygen group and two patients in the non-oxygen group required rescue treatment, but this difference was not statistically significant (p = 0.57). Conclusion: This study suggests that supplemental oxygen therapy does not augment the effectiveness of conventional migraine treatment. Current evidence is insufficient to support the routine use of oxygen in emergency departments for the management of migraine headaches.

BACKGROUND/AIM:Anaphylaxis is a rapidly onset, life-threatening hypersensitivity reaction, and in some patients, a biphasic reaction may develop following initial treatment. This study aims to investigate the prognostic value of the peripheral perfusion index (PPI) in predicting biphasic reactions among patients presenting to the emergency department with anaphylaxis. MATERIAL AND METHODS:The study is prospective and single-centered. A total of 104 patients aged 18 years and older, diagnosed with anaphylaxis in the emergency department, were included. PPI values, along with other vital signs, were measured at 0, 10, 20, and 30 min, as well as after symptom resolution. All patients were observed for a minimum of 6 h to monitor for the development of biphasic reactions. RESULTS:The median PPI value at the 0-min mark was 2.20 (IQR, 1.52-3.67), while the median PPI value after symptom resolution was 4.20 (IQR, 3.10-6.35). A biphasic reaction occurred in 10.6 % of patients. Among patients who developed a biphasic reaction, PPI values at 0, 10, 20, and 30 min were significantly lower compared to those who did not (p < 0.05). In ROC analysis, a PPI cutoff of ≤2.17 for predicting biphasic reactions yielded 57 % sensitivity and 91 % specificity (AUC = 0.75). CONCLUSION:PPI may serve as an accessible and cost-effective test in emergency departments for continuous monitoring of patients diagnosed with anaphylaxis, allowing for assessment of treatment response, early detection of biphasic reactions, and risk evaluation.

Aim: This study aimed to investigate the diagnostic value of blood urea nitrogen-to-albumin (B/A) and blood urea nitrogen-to-creatinine (B/Cr) ratios in predicting in-hospital mortality, active bleeding, and differentiating gastrointestinal bleeding (GIB) types in patients presenting to the emergency department. Materials and Methods: This retrospective study was conducted in a tertiary care hospital between June 1, 2019, and June 30, 2024. Patients over 18 years old diagnosed with GIB and undergoing endoscopy/colonoscopy were included. Demographic, laboratory, and clinical outcomes were analyzed. The B/A and B/ Cr ratios were calculated and evaluated for their prognostic significance using ROC curve analysis. Results: A total of 864 patients were included. Active bleeding was observed in 16.3%, and in-hospital mortality occurred in 7.1%of patients. The threshold values for mortality prediction were determined as 10.15 for the B/A ratio and 28.53 for the B/Cr ratio. The B/A ratio showed a high prognostic value for mortality (AUC: 0.822) and active bleeding (AUC: 0.720), while the B/Cr ratio was particularly effective in differentiating upper GIB. Discussion: The findings suggest that B/A and B/Cr ratios may provide useful prognostic information in GIB patients. The B/A ratio appears to be particularly relevant for predicting mortality and active bleeding, while the B/Cr ratio could assist in distinguishing upper GIB.

Background: Considering the aging society, there are few studies on the development of contrast-induced nephropathy (CIN) in emergency departments (EDs), especially in geriatric age groups. The aim of this study was to evaluate the effects of intravenous contrast media use for computed tomography on the development of acute kidney injury (AKI) in geriatric patients admitted to the ED. Methods: This was a single-center, retrospective study. Patients aged ≥65 years presenting to the ED with an indication for contrast-enhanced computed tomography with serum Creatin and urea values within 8 h before imaging and 24–48 h after imaging were included in the study. The contrast agent used was IOHEKSOL (100 ml/300 mg). Patients with elevated serum creatine values 24–48 h after contrast-enhanced computed tomography were considered as contrast-induced acute kidney injury (CI-AKI). Results: This study included 420 patients. The number of patients who developed CI-AKI was n = 35. When the characteristics of the patients were compared according to the development of CI-AKI, significant differences were found in terms of baseline creatinine value, eGFR and all severity indicators of CI-AKI (hypotension, hypoalbuminemia, and intensive care unit admission) ( p < 0.05 for all). Conclusion: Our study showed that the development of CIN in geriatric patients presenting to the ED was the same as in the general population and that the basal urea, sCr, and eGFR values of the patients also influenced the development of CIN. We believe that this study may be useful to know the comorbidities and laboratory values of patients before contrast extraction in order to be prepared for a possible complication.

Objective:This study aimed to evaluate changes in anxiety and self-esteem among emergency department (ED) staff at the beginning and end of their shifts. Materials and Methods:A cross-sectional study was conducted at a tertiary hospital's ED in between September 2022-March 2023.Participants, including all ED staff with more than 6 months of experience, completed the State-Trait Anxiety Inventory (STAI), Rosenberg's Self-Esteem Scale (RSES), and the Self-Esteem Rating Scale-Short Form (SERS-SF) at start and end of their shifts.Data were analyzed with comparisons made using paired t-tests and Wilcoxon tests for dependent groups and independent t-tests and Mann-Whitney U tests for independent groups.Correlations between STAI-2 and SERS-SF scores were examined using Spearman's correlation test. Results:Mean STAI-2 score was 40±8, indicating moderate trait anxiety, while STAI-1 scores at shift start averaged 39±11 in 108 participants.Self-esteem scores, measured by SERS-SF (median 108) and RSES (median 3), were high.No significant changes in anxiety or self-esteem scores were observed.A weak negative correlation was found between STAI-2 and SERS-SF scores (r = -0.484, p < 0.001), but no correlation existed between STAI-2 and RSES. Conclusion:ED staff experienced moderate levels of anxiety, which remained stable throughout their shifts.High self-esteem among participants may contribute to stable anxiety levels.

Objective: Biphasic anaphylaxis, defined as the recurrence of symptoms after initial resolution without re-exposure to the trigger, remains a significant clinical challenge. Identifying laboratory-based predictors of biphasic reactions may help optimize monitoring and management strategies. This study aimed to investigate the relationship between systemic inflammatory markers-neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammation index (SII), systemic inflammatory response index (SIRI), and pan-immune-inflammation value (PIV)-and the development of biphasic reactions in adult patients presenting to the emergency department with anaphylaxis. Materials and Methods: This retrospective observational study included adult patients diagnosed with anaphylaxis between January 1, 2024, and January 1, 2025, at the emergency department of a tertiary care hospital. Demographic data, clinical findings, laboratory values at presentation, and outcomes were collected. Biphasic reactions were defined as a recurrence of symptoms between 1 and 72 hours after initial improvement. Inflammatory markers were calculated from initial complete blood counts and compared between patients with and without biphasic reactions. Results: A total of 142 patients were included, of whom 14 (9.9%) experienced biphasic reactions. There were no statistically significant differences in NLR, PLR, SII, SIRI, or PIV between the biphasic and non-biphasic groups (p > 0.05 for all). Hypotension was observed more frequently in the biphasic group, but the difference did not reach statistical significance (p = 0.059). Conclusion: Systemic inflammatory markers derived from admission laboratory values were not significantly associated with the development of biphasic anaphylactic reactions. Further prospective studies are warranted to identify reliable biomarkers for early prediction and risk stratification.

Objective: In this study, we aimed to determine end-tidal carbon dioxide (ETCO₂) and deltaCO₂ levels in patients with Coronavirus Disease 2019 (COVID-19) pneumonia and examine the relationship between these two parameters and the severity of disease. Methods: Patients with COVID-19 were included in the study. ETCO₂ values were recorded and deltaCO₂ values were calculated. They were divided into two groups: mild-moderate and severe patients. An analysis was performed to determine the threshold values for ETCO₂ and deltaCO₂ in mild-moderate and severe patient groups. Results: A total of 83 patients were included in our study. Of the patients, 43 (51.8%) patients had mild/moderate disease and 40 (48.2%) had severe disease. The AUC value was 0.910 for ETCO₂ (95% CI; 0.840-0.980, p

Background & Objective: With the increasing prevalence of advanced technology, there has been a notable rise in the use of neuroimaging for patients presenting to the emergency department (ED) with dizziness in recent years. This study aims to investigate the frequency of neuroimaging, the clinical indications for its use, the findings, and the factors influencing these findings in geriatric patients presenting with dizziness to the ED. Methods: The study included patients aged 65 and older who presented to the ED with dizziness between January 1, 2018, and December 31, 2023, and who had undergone brain computed tomography (CT) and/or diffusion-weighted magnetic resonance imaging (DW-MRI), with complete data available. Intracranial masses, acute-subacute ischemic findings, intraparenchymal and subarachnoid hemorrhage, and brain edema detected on brain CT were classified as significant pathologies. Additionally, patients were compared based on the presence of ischemia on DW-MRI with other variables. Results: The study included 508 patients who underwent CT scan and/ or DW-MRI. Significant pathology was detected in 6.3% of those who underwent CT scan. Among the patients who underwent DW-MRI, 9.1% were found to have acute-subacute ischemia. The incidence of significant pathology and ischemia was statistically higher in patients who underwent CT scan and DW-MRI due to indications such as aphasia, focal neurological deficits, vertical nystagmus, ataxia, and dysmetria/dysdiadochokinesia (p<0.05). Conclusion: In geriatric patients, emergency neuroimaging should be performed considering clinical characteristics and risk factors. Limiting the use of CT scan to specific indications rather than routine use, and prioritizing DW-MRI in cases where ischemic events are suspected, may be more appropriate.

PURPOSE:Traditional assessments using carboxyhemoglobin (COHb) levels alone often do not adequately predict clinical course of carbon monoxide (CO) poisoning cases. Perfusion index (PI) and pleth variability index (PVI) offer non-invasive, continuous monitoring of peripheral perfusion, potentially improving patient management. The objective of this study is to evaluate whether perfusion indices can assist in triage and monitoring of patients with CO poisoning. METHODS:All patients aged 18 years and older, diagnosed with CO poisoning were consecutively enrolled in this prospective observational study from January 2019 to May 2023. Perfusion indices, COHb and lactate levels were measured at diagnosis (values denoted by 1) and after 60-min hyperbaric or normobaric oxygen therapy (HBOT or NBOT) (values denoted by 2). RESULTS:PI-1 showed significant moderate negative correlation with COHb-1 levels in all patients and AUC value of PI-1 in predicting the necessity for HBOT was 0.935. Patients requiring HBOT had significantly lower PI-1 and higher COHb-1, lactate-1, and PVI-1 compared to those receiving NBOT. Following treatment, PI increased, and PVI, lactate, and COHb decreased significantly in both treatment groups (p<0.001 for all). CONCLUSIONS:Perfusion indices, especially PI, may reflect changes in COHb levels and could provide additional information to support triage and monitoring in CO poisoning.

Objective: Urinary tract infections (UTIs) are one of the most common infectious diseases encountered in emergency departments (EDs), and increasing antimicrobial resistance has become a significant challenge in managing these infections. This study evaluated the antibiotic resistance patterns of pathogens isolated from urine cultures obtained from patients presenting to the ED between 2020 and 2023 and investigated the changes in resistance rates over time. Materials and Methods: This was a retrospective, single-center study. Urine culture and antibiogram results of patients aged 18 years who presented with a preliminary diagnosis of UTI between January 1, 2020, and December 31, 2023, were reviewed. Data were collected from electronic patient records, and pathogens isolated in cultures were analyzed according to antibiotic susceptibility. Results: A total of 978 patients who had urine cultures requested were included in the study. Growth was detected in 258 (26.4%) patients. The median age of patients with positive cultures was 55.5 years (interquartile range: 35-74.25), and 69.8% were female. The most frequently isolated pathogen was Escherichia coli (61.6%), followed by Klebsiella pneumoniae (19%). Ampicillin (38%), ceftriaxone (32.9%), ciprofloxacin (28.3%), and trimethoprim-sulfamethoxazole (TMP/SMX) (24.4%) had the highest resistance rates. Resistance to antibiotics such as meropenem, amikacin, and gentamicin was also lower. An increase in resistance rates was observed for amoxicillin-clavulanate, ampicillin, and TMP/SMX between 2020 and 2023. Conclusion: Our study shows that the UTI pathogens most commonly isolated from patients presenting to the ED exhibit increasing resistance rates to widely used antibiotics. These findings highlight the need for empirical antibiotic therapy to be guided by local resistance patterns and regularly updated. Continuous monitoring of local antibiogram data is crucial for reducing antibiotic resistance and improving patient outcomes.

BACKGROUND:Although spinal immobilization (SI) in the form of reverse Trendelenburg at a 20-degree angle has been shown to reduce undesirable side effects, such as decreased respiratory function seen with 0-degree SI, concerns exist that SI at 20 degrees might increase pain and discomfort, particularly in the lower body, because of gravity. OBJECTIVE:This study aims to evaluate whether SI at a 20-degree angle results in different levels of pain and discomfort in various body regions compared to SI at a 0-degree angle. METHODS:This experimental study was conducted with healthy adult volunteers aged 25 to 45 years who had no chronic illnesses or obesity (body mass index <30). Each volunteer underwent two separate immobilization sessions on different days: once at a 0-degree angle (0-degree group) and once at a 20-degree angle (20-degree group), each lasting 1 hour. Vital signs and pain/discomfort levels by visual analog scale (VAS) were recorded at baseline, 15, 30, and 60 min. RESULTS:A total of 51 volunteers participated in the study. While a statistically significant increase in pain and discomfort was observed over time in both the 0-degree and 20-degree groups, no statistically significant difference in VAS scores was found between the two groups at any time point. CONCLUSION:Although SI at a 20-degree angle does not reduce the pain and discomfort associated with the 0-degree position, it also does not increase these symptoms.

Aim: Upper gastrointestinal bleeding (UGIB) is a common cause of emergency department presentation. Risk stratification of patients presenting to the emergency department with UGIB is important to predict active bleeding, need for blood transfusion, and mortality. In this study, we aimed to investigate the effect of potassium (K) and ionized calcium (iCa) on disease severity and mortality in UGIB patients. Materials and Methods: This is a retrospective, single-center study. Patients aged 18 years and older who presented to the emergency department with UGIB, underwent blood gas analysis within the first half hour of presentation to the emergency department, were admitted to the hospital by the gastroenterology department, underwent endoscopy, and had complete data records were included in the study. Results: The study included 699 patients. The in-hospital mortality rate was 7.7%. In the ROC analysis performed to determine the cut-off value of the K/iCa ratio for predicting mortality and active bleeding, the area under the curve values were 0.892 [95% confidence interval (CI): 0.845-0.939, p<0.001] and 0.832 (95% CI: 0.792-0.871, p<0.001), respectively. Patients were divided into 2 groups: those with a K/iCa ratio lower than 5.02 and those with a ratio higher than 5.02. This ratio has a high specificity value in terms of mortality prediction. Hemodynamic instability, active bleeding, need for erythrocyte suspension, length of hospital stay, and mortality were higher in the high K/iCa ratio group (p<0.001 for all values). Conclusion: In patients presenting to the emergency department with suspected UGIB, assessment of the K/iCa ratio using blood gas analysis may help to predict the risk of active bleeding and in-hospital mortality as a rapid, inexpensive, and practical assessment method. Patients with a high K/iCa ratio may be candidates for early endoscopy and closer hemodynamic monitoring.