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OBJECTIVES: The aim of this study was to evaluate the factors associated with non-invasive mechanical ventilation (NIMV) failure in acute cardiogenic pulmonary edema (ACPE) diagnosed in the emergency department. METHODS: This study was prospectively conducted at the Ege University Faculty of Medicine ED between February 19, 2021 and December 01, 2021. Patients who received NIMV with ACPE were included. Patients' clinical and laboratory parameters, treatments, NIMV mode, and settings were recorded. The primary endpoint was NIMV failure (intubation within 24 h). Secondary endpoints were early NIMV failure, early mortality (within 24 h), and in-hospital mortality. Early NIMV failure was defined as follows: if the patient had a respiratory rate of more than 25 per minute, oxygen saturation below 90%, PaCO2 >50 mmHg in blood gas, and pH <7.35, 1 h after starting NIMV. RESULTS: Out of 347 patients in this study, 34 (10.7%) of them intubated within 24 h. Female sex percentage was 48.7%. Median age was 73 years. Risk factors for NIMV failure were respiratory rate >40.5, systolic blood pressure <122.5 mmHg, Glasgow Coma Score <14, pH <7.21, lactate level >5.2 mmol/L, base excess <−4.5 mmol/L, B-type natriuretic peptide level >3007 pg/mL (respectively area under the curve values; 0.723, 0.693, 0.739, 0.721, 0.690, 0.698, and 0.616). CONCLUSION: Signs of hypoperfusion such as low systolic blood pressure (<122.5 mmHg) and high lactate (lactate level >5.2 mmol/L) are risk factors for NIMV failure. Evaluation of initial vital signs and arterial blood gas parameters is significantly important for prediction of NIMV success in ED. [ABSTRACT FROM AUTHOR]

Objective: The overcrowding of emergency departments, insufficient bed capacity in these units, lack of integrated radiology units and the distance of other departments and intensive care units from the emergency department make it inevitable to transport patients within the hospital for either short-term or long-term purposes. Patients can be transported at least once for diagnostic and treatment procedures to radiology units, operating rooms, or intensive care units for admission. However, even during short-term patient transport in critical situations, complications may arise. Materials and Methods: This study evaluates the data obtained prospectively by examining the transport information of 588 patients who met the study criteria in an eight-month period in the emergency department of a university hospital in 2020. The study is designed to assess survival, disability, and the safe transport process of critically ill patients transported from the emergency department to hospital imaging, interventional procedures, surgery and admission units. For statistical analysis of the data, independent sample t-test was used for normally distributed variables, Mann-Whitney U test when the normality assumption was not met and chi-square, ANOVA tests were used for the comparison of categorical variables. The significance level for all hypothesis tests was set at 0.05. Results: Of the 588 patients included in the study, 36.9% were female and 63.1% were male, with an average age of 61.9 years. The average transport time for patients transferred for examination, admission or interventional procedures was 18.5 minutes. 63.3% of the transferred patients sought medical attention during the night shift. During transport, 51.7% of patients experienced problems. Among the issues encountered during transport, 48.3% were related to the system, 27% were related to equipment and 24.7% were related to human factors. The most common problem, accounting for 23.0%, was waiting in radiology units or corridors for radiology examinations and interventional procedures. Conclusion: In critically ill patients in the emergency department, the most common transport problems occur when planned examinations take place outside the emergency department. Therefore, the necessity of these requests should be carefully evaluated to reduce complications that may occur during transfer. The physical organization of emergency departments should be designed to facilitate the transfer of critical patients as quickly as possible to prevent problems that arise due to prolonged transfer times. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim: Trauma-related injuries constitute an important part of emergency department admissions. In order to provide appropriate health services to these patients, the readiness of physicians, especially those with limited clinical experience, should be increased in terms of knowledge and skills. In this study, it was aimed to evaluate an asynchronous e-learning module, which was prepared in order to increase the knowledge and skill levels of physicians who do not have sufficient experience in the evaluation of trauma patients, before starting to serve patients in a supervised manner, with student feedback. Methods: This research is a retrospective study in which the course feedback data of 28 students out of 39 students studying in the Emergency Medicine Specialization Training program, to whom the e-learning module on trauma was applied, were analyzed descriptively. The students' opinions were collected through an electronic questionnaire consisting of 18 likert-type and 2 open-ended questions. Results: The findings of the study showed that the asynchronous e-learning module on trauma was found to be effective in providing a flexible and accessible learning environment for students. The students found the content of the module easy to understand and evaluated it as a positive feature that they could access the content repeatedly. Conclusion: Asynchronous e-learning is a flexible, learner-centered and effective method adopted by learners for teaching theoretical content in emergency medicine residency education, while also providing more time for practical training in clinical settings for trainers and learners. [ABSTRACT FROM AUTHOR]

Background: The hallucinogenic tryptamine analog 5-methoxy-N-methyl-N-isopropyltryptamine (5-MeO-MiPT) causes social problems worldwide. There are several studies on the metabolism; however, not more studies were found in the literature on acute toxicity. Aims: To report the acute toxicity of 5-MeO-MiPT in mice, followed by quantitative toxicological analysis of blood and organs, hystotoxicological and immunohistochemical analysis of tissues and cells. Study design: Animal experiment Methods: In vivo experiments were performed using CDl adult female mice (n=26). Animals were caged in 4 groups randomly. First group was a control (n=3). Second group was vehicle control (n=3) and injected 150 µL of blank solution (50% dimethyl sulfoxide in saline /0.9% of NaCl). While for acute toxicity experiments, 5-MeO-MiPT was added to a blank solution in order to obtain a dose of 0.27 mg/kg in 150 µL injection (n=10) and the last group were injected 2.7 mg/kg 5-MeO- MiPT in a 150 µL injection (n=10). Quantitative toxicological analysis, hystotoxicological and immunohistochemical analysis were performed. Results: In the toxicological analysis, 5-MeO-MiPT was found negative in biological samples which were control, vehicle control, and 0.27 mg/kg dose mice groups. 5-MeO-MiPT was found 2.7-13.4 ng/ mL in blood, 11-29 ng/g in kidney, 15.2-108.3 ng/g in liver, and 1.540.6 ng/g in the brain in 2,7 mg/kg injected group. In a low dose of the 5-MeO-MiPT liver section, compared with normal tissues, the difference in staining was statistically significant (p<0.0001). In highdose of 5-MeO-MiPT, H-score showed that the increase in the number of Caspase-3 positive cells was significant compared to the control (p<0.05). In high-dose of 5-MeO-MiPT, intense Caspase-3 immunore-activity was observed and the increase in the number of Caspase-3 positive cells compared to the control was statistically significant (p<0.05). In brain section, the statistics of the results obtained from the H-score showed that the increase in the number of Caspase-3 positive cells was significant compared to the control (p=0.0183). In vehicle control liver section, there were few Caspase-8 positive cells characterized by a light brown appearance (p=0.0117). In the high-dose 5-MeO-MiPT group, the numbers of positive cells at low and high doses of 5-MeO-MiPT group were statistically significant compared to the control (p<0.05). In the high-dose 5-MeO-MiPT group, Caspase-8 immunoreactivity was detected in the glomerular structures. Compared to control, the increase in Caspase-8 immunoreactivity was found to be statistically significant (p<0.05). Conclusion: Low-dose 5-MeO-MiPT did not cause any serious histo-pathological effects on the liver, kidney, and brain. High doses induce apoptotic cell death through caspase activity. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction Amitriptyline is a tricyclic antidepressant. In general, toxicity effects develop within 30 min of overdose and peak from 2 h to 6 h. Anticholinergic effects predominate in cases of low dose ingestion. In cases of high dose ingestion, marked depression of the central nervous system is coupled with cardiotoxicity, seizures and hypotension. Patients and methods Amitriptyline-intoxicated patients admitted to the emergency department (ED) of Dicle University Hospital were evaluated between January 2005 and April 2007. Social and demographic status, clinical and laboratory findings, treatments and outcomes were recorded. Age, sex, marital status, time of hospital admission, consciousness levels, ECG findings, requirement for respiratory support, follow-up periods and antidepressant overdose risk assessment (ADORA) criteria were analysed using SPSS software. Results A total of 110 cases of overdose by amitriptyline was evaluated. Suicide attempts by amitriptyline overdose in adult single women were the commonest finding. The commonest symptoms seen during initial examinations were sinus tachycardia (66.3%), altered mental state (78.1%) and hypotension (7.3%). Mechanical ventilatory support was required in 9.1% of cases. Most patients (n=76, 69.1%) were treated in the ED (p=0.001). 60 (54.5%) patients were discharged from the ED within 24 h after admission (p<0.0001). Conclusion Most of the patients were young single women. Altered mental state and tachycardia were the commonest symptoms. The initial symptoms of amytriptyline overdose patients may be life threatening, but effective supportive treatments were helpful. There was high correlation between ADORA criteria and the dose ingested. [ABSTRACT FROM PUBLISHER]

Copyright of Journal of Academic Emergency Medicine / Akademik Acil Tip Olgu Sunumlari Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background/aim: To describe seasonal variations in epidemiology, management, and short-term outcomes of patients in Europe presenting to an emergency department (ED) with a main complaint of dyspnea., Materials and Methods: Anobservational prospective cohort study was performed in 66 European EDs which included consecutive patients presenting to EDs with dyspnea as the main complaint during 3 72-h study periods. Data were collected on demographics, comorbidities, chronic treatment, prehospital treatment, mode of arrival of patient to ED, clinical signs at admission, treatment in the ED, ED diagnosis, discharge from ED, and in-hospital outcome., Results: The study included 2524 patients with a median age of 69 (53–80) years old. Of the patients presented, 991 (39.3%) were in autumn, 849 (33.6%) were in spring, and 48 (27.1%) were in winter. The winter population was significantly older (P < 0.001) and had a lower rate of ambulance arrival to ED (P < 0.001). In the winter period, there was a higher rate for lower respiratory tract infection (35.1%), and patients were more hypertensive, more hypoxic, and more hyper/hypothermic compared to other seasons. The ED mortality was about 1% and, in hospital, mortality for admitted patients was 7.4%., Conclusion: The analytic method and the outcome of this study may help to guide the allocation of ED resources more efficiently and to recommend seasonal ED management protocols based on the seasonal trend of dyspneic patients., Competing Interests: none declared, (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Background: This study aimed to investigate the role of computed tomography (CT) in identifying missed unstable blunt cervical injuries., Methods: Patients admitted to the emergency department between June 2014 and June 2018 with a diagnosis of blunt cervical trauma were included in this study. All participants underwent cervical magnetic resonance imaging (MRI) after an initial cervical CT investigation. All imaging results were reviewed, and decisions were taken by the consensus of a team consisting of an emergency medicine specialist, a neuroradiologist, and a neurosurgeon. Other variables included age, sex, the Glasgow Coma Scale, medical comorbidities, multi-trauma, neurological deficits, accompanying intracranial hemorrhage, extremity fractures, and the mechanism of the injury., Results: Data for 195 patients were analyzed. The mean (±standard deviation) age of the participants was 47.34±21.90 years, and 140 (71.8%) were males. Eighteen patients (9.2%) were below age <18. The most frequent mechanism of injury was fall from height (n=100; 51.3%). Using MRI as the gold standard, the sensitivity of CT in diagnosing unstable cervical injury was 77.7% (95% CI [67.1-86.1]), while its specificity was 100.0% (95% CI [59.0-100.0])., Conclusion: Although computed tomography is relatively good in diagnosing unstable cervical injuries, its sensitivity in detecting positive cases is not as successful. Thus, the use of MRI in patients with an unstable injury seems to be warranted.

Background: Hypericum perforatum (HP) (St. John's Wort-Kantaron) has been used widely for the treatment of burn injuries for many years in traditional Turkish medicine. The aim of study was to investigate HP treatment in experimental thermal burns and compare it with silver sulfadiazine (SS) treatment., Methods: Thirty-five rats were randomly assigned to one of the five groups, 7 rats in each. A second-degree thermal burn was created on the dorsal sites of rats by exposing an area of 4×4 cm to 100 °C boiled water for 10 seconds. All groups were provided with irrigation for three (3) minutes with 50 cc saline solution (SS). Group 1 (Control Group) was not administered any treatment. Group 2 (Burn Control Group) was administered only irrigation, Group 3 (topical silver sulfadiazine [SS]) was administered SS twice a day, Group 4 (the Topical HP Group) was administered HP four times a day (every six hours), Group 5 (treatment with agent -gel-) was administered other topical material used for the preparation of HP four times a day (every six hours). Wound site healing on the skin was histopathologically evaluated., Results: It was found that collagen discoloration of the HP treatment group was localized in the lower part of the epidermal layer and did not go up to the depth of dermis compared to the other groups, and epidermis, hair follicles and sebaceous glands remained protected compared to the groups administered burn, gel and SS in every hour of the experiment and it was the group closest to the control group structurally. It was determined that the epidermal thickness and the number of vessels of the HP Group were significantly higher compared to the other groups (p<0.05), which was the group closest to the control group in terms of these parameters and these numbers did not show any difference within hours (p>0.05). The number of degenerated hair follicles in the HP Group was significantly less than the other groups (p <0.05), and it was determined that the total number of hair follicles significantly increased in the twenty-fourth (p<0.05) and this number did not differ by the control group (p>0.05)., Conclusion: Administration of HP four times a day within the first 24 hours is clearly effective in wound healing in the experimental thermal second degree burn modality and is significantly superior to SS treatment.