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Aims: There is abundant evidence to suggest that health care staff are increasingly being exposed to violent incidents at their workplace. The purpose of our study was to identify the role of crowding in producing violence that occurs in emergency department as well as to outline the factors that affect the types of violence. Study Design: In this prospective study we collected incidents of violence against emergency staff by patients or their relatives. A survey with 20 questions about the event was completed by emergency staff just after the event. Also information about crowding at that time was recorded as well as the area of the event. Statistical analysis was done with SPSS 16.0. Place and Duration of Study: Department of Emergency Medicine, Marmara University Pendik Training and Research Hospital, Between April 1 and June 1, 2012. Methodology: A total of 116 acts of violence were reported during the 61 days of this study. 79 of 116 cases (68.1%) were verbal, 16 (13.8%) physical, and 21 (18.1%) were both verbal and physical. The information about each event was entered into a database and pooled for analysis. Results: The most common victims of violence were physicians (38.8%) and security personnel (31.0%). The presence of security personnel in the environment increases the risk of physical violence (P=.017). The average total number of patients waiting for examination or results of examinations was 24.9 ± 1.4 (95% CI, 22.3 – 27.5). It was observed that the violence increased when the number of people was close to this number and reduced when the crowding increased above this average. Conclusions: The existence of security personnel alone is not sufficient to prevent violence; new steps should be taken to prevent the entrance of the patients’ relatives to inside of the treatment areas of emergency departments.

Objective/aim We aimed to evaluate the diagnostic utility of the widely used left ventricular hypertrophy (LVH) electrocardiography (ECG) criteria (Cornell Voltage Criteria [CVC], Sokolow-Lyon Index [SLI], Romhilt-Estes [REC], and Peguero-Lo Presti [PLP] Criteria) compared with the left ventricular mass measured by echocardiography. Methods In this prospective diagnostic accuracy study, we screened all consecutive adults (18 to 65 years) who presented to our academic emergency department (ED) with increased blood pressure (≥130/85 mmHg) between January 2016 and January 2017, and we enrolled a convenience sample of 165 patients in our study. The attending emergency physician managed all patients as per their primary complaint. The consulting cardiologist performed a transthoracic echocardiogram (TTE) of the patient and calculated the left ventricular mass (LVM) according to the American Society of Echocardiography (ASE) formula. After completing the patient recruitment phase, researchers evaluated all ECGs and calculated scores for SLI, CVC, REC, and PLP. We used contingency tables to calculate the diagnostic utility metrics of all ECG criteria. Results The prevalence of LVH by TTE was 31.5%. CVC, SLI, REC, and PLP criteria correctly identified (true positive rate) abnormal LVM in only 3.9%, 1.9%, 9.6%, and 19.2% of the patients, respectively. CVC, SLI, REC score and PLP criteria performed poorly with extremely low sensitivities (3.9%, 1.9%, 10%, 19.2%) and poor accuracies (67.3%, 64.9%, 57.7%, 69.7%). Conclusion ECG voltage criteria's clinical utility in estimating LVM and LVH is low, and it should not be used for this purpose.

Introduction: A cluster of atypical pneumonia cases in Wuhan, China, turned out to be a highly contagious disease, swept across most of the countries, and soon after was announced as a pandemic. Therefore we aimed to investigate the demographics and factors associated with the disease outcome. Methods: In this retrospective chart review, we screened patients admitted to the emergency department with severe acute respiratory infection due to coronavirus disease 2019 (COVID-19) between March 15, 2020 and April 30, 2020. Age, gender, symptoms, laboratory data, and radiology data were obtained, as well as outcomes and length of stay. Results: We identified 177 patients (54.8% male). Seventy-eight percent of the cases were admitted into wards whereas 22% of the cases were admitted into the intensive care unit (ICU). Twenty-five percent of the cases needed invasive mechanical ventilation during their hospital stay and median length of hospital slay until death or discharge was eight days (interquartile range (IQR) 5.0 - 16.0). Among 177 patients, overall inhospital mortality rate was 19.8% (n=35; male:female=18:17; p=0.6553). In-hospital mortality rates were statistically significantly higher in patients with higher age (64 vs. 74; p=0.0091), respiratory rate (RR) (28 vs. 36; p=0.0002), C-reactive protein (CRP) (54.7 vs. 104.0; p

Background This study aimed to show whether it is necessary to hospitalize pregnant women who have been involved in traffic accidents. Methods Patients at a hospital in Istanbul, Turkey, who underwent traffic accidents between 2012 and 2018 were studied, and pregnant patients' files were evaluated. Demographic and obstetric features of patients, type of accident, type of trauma, Glasgow Coma Score, whether or not hospitalization were examined, the response of patients to hospitalization, and the obstetric and maternal results of accidents were assessed. Results In the present study, 95 patients were included. Overall, hospitalization was recommended for 50 patients, but of these, 58% refused to be admitted. No patients who refused hospitalization had complications. Preterm labor was seen in 3.2% of patients, while 3.2% had a fetal loss and 5.3% had a placental abruption. Only one mother was lost (1.1%) due to sustaining multiple traumas in a traffic accident. Hospitalization was increasingly indicated with increasing gestational age, but other parameters had no effect on hospitalization. Conclusion The likelihood that hospitalization was recommended for pregnant women involved in traffic accidents increased with gestational age. Patients with minor trauma who refused hospitalization had no complications.

Objectives: Our primary goal is to investigate the hypothesis that in patients with a detectable ventricular wall motion (VWM) in cardiac ultrasonography (US) during cardiopulmonary resuscitation (CPR), survival rate is significantly more than in patients without VWM in US. Material and methods: In our prospective, single center study, 129 adult cardiac arrest (CA) patients were enrolled. Cardiac US according to Focus Assessed Transthoracic Echo (FATE) protocol was performed before CPR. Presence of VWM was recorded on forms along with demographic data, initial rhythm, CA location, presence of return of spontaneous circulation (ROSC) and time until ROSC was obtained. Results: 129 patients were included. ROSC was obtained in 56/77 (72.7%) patients with VWM and 3/52 (5.8%) patients without VWM which is statistically significant (p > 0.001). Presence of VWM is 95% (95% CI: 0.95-0.99) sensitive and 70% (95% CI: 0.58-0.80) specific for ROSC. 43/77 (55.8%) patients with VWM and 1 (1.9%) of 52 patients without VWM survived to hospital admission which was statistically significant (p < 0.001). Presence of VWM was 100% (95% CI: 0.87-1.00) sensitive and 54% (95% CI: 0.43 -0.64) specific for survival to hospital admission. Conclusion: No patient without VWM in US survived to hospital discharge. Only 3 had ROSC in emergency department and only 1 survived to hospital admission. This data suggests no patient without VWM before the onset of CPR survived to hospital discharge and this may be an indication to end resuscitative efforts early in these patients. Copyright (C) 2016 The Emergency Medicine Association of Turkey. Production and hosting by Elsevier B.V. on behalf of the Owner.

Background Ultrasonography (US) is noninvasive, readily available, and cheap. The diameter of inferior vena cava (dIVC) and its respiratory variation were proposed as a good surrogate of the hemodynamic state. However, recent studies have shown conflicting results, and the value of IVC-derived parameters in the estimation of fluid status and hemorrhage remains unclear. Methods This was an observational study of trauma patients who presented to emergency department. dIVC and aorta diameter (dAorta) were measured at the initial US and CT in all patients. The correlation of these measurements and all parameters derived from those measurements along with the initial vital signs and laboratory values of hemorrhage (hemoglobin, hematocrit) and shock (lactate, base excess) were assessed. US and CT values were also compared for accuracy using Bland-Altman analysis. Results The final study population was 140, with a mean age of 38 years and 79.3% were male. dIVC and dAorta did not have any clinically significant correlation with any of the vital signs or laboratory values of hemorrhage or shock when measured by US or CT. A good and significant correlation was observed between dIVC and dAorta measured by US and CT. Conclusion The value of an initial and single measurement of IVC and aorta parameters in the evaluation of trauma patients should be questioned. However, the change in the measured parameters may be of value and should be investigated in further studies.

Introduction: Pneumatosis intestinalis (PI) was reported in hematological malignancies in immunosuppressive patients who were being administered chemotherapy and steroids. However, PI generally has a benign course and is usually conservatively treated in these patients. In this case, we presented a patient who underwent chemotherapy because of testis neoplasm and was admitted to the hospital with abdominal pain, vomiting, and high blood glucose levels, and the patient died because of PI and mesenteric ischemia. Case Report: A 38-year-old man who had type 1 diabetes mellitus and had undergone chemotherapy (bleomycin, etoposide, cisplatin, and corticosteroids) for testis neoplasm presented to the emergency room with abdominal pain. His blood glucose level was 547 mg/dL. In blood gases analyses, pH=7.30, cHCO3=15, and lactate=3.2 and ketone was positive in urine analyses. He had no specific finding on physical abdominal examination. He had undergone diabetic ketoacidosis treatment. Because his abdominal pain persisted, abdominal tomography was performed and diffuse intestinal wall necrosis and gas was observed in the portal system. He was operated and died in the intensive care unit after surgery. Conclusion: In the emergency department, it is important to be aware of mesenteric ischemia (MI), particularly in patients who undergone chemotherapy and who were admitted to the hospital with abdominal pain. Quick and further testing for MI is necessary.

INTRODUCTION: Meperidine is a synthetic opiold analog that is frequently prescribed for acute pain management. Normeperidine, the only active metabolite of meperidine, is neurotoxic and can cause significant central nervous system adverse events. CASE SUMMARY: A 29-year-old woman (height, 170 cm; weight, 85 kg) presented to Marmara University Hospital Emergency Department, Istanbul, Turkey, complaining of low back pain she described as stabbing. Physical examination revealed impaired lower-extremity mobility and normal vital-sign findings. There was no evidence of foot drop, head or other trauma, and systemic physical examination was unremarkable. Other common causes (eg, pyelonephritis, nephrolithiasis, pancreatitis, trauma) of lower back pain were excluded. To achieve analgesia, meperidine 80 mg was administered intravenously in 100 mL of isotonic saline solution for 20 minutes. Within 20 minutes, analgesia was achieved, but the patient developed retrograde amnesia, becoming disoriented to time, location, and persons. Her speech slowed and perceptional changes developed. After the onset of amnesia, a complete physical examination was conducted. It failed to reveal focal neurologic deficit, and laboratory (sodium, potassium, magnesium, phosphorus, serum creatinine, blood urea nitrogen, albumin, billrubin, hemoglobin, and platelet count) and subsequent vital-sign findings (blood pressure, 150/100 mm Hg; heart rate, 100 beats per minute; respiratory rate, 18 breaths per minute; body temperature, 37 degrees C; and pulse oximetry, 99%) were within the normal range. Noncontrast computed tomography did not reveal any abnormality. Initially, the patient's condition was attributed to medication error due to incorrect dosage or infusion rate. Despite a review of medication logs, equipment, and the vital-sign record, the etiology for the phenomenon could not be identified. Meperidine was discontinued and oxygen and intravenous isotonic saline solution were initiated as supportive treatment. Three hours after meperidine administration was discontinued, the amnesia and disorientation spontaneously resolved. CONCLUSION: Meperidine was probably associated with reversible amnesia in this healthy patient after a single therapeutic dose.