Background Personal protective equipment (PPE) are equipment that protect healthcare workers from harmful agents and organisms. The importance of these equipment was noticed again with the Covid-19 pandemic. Objectives In this study, we investigated the effect of different masks used as PPE on resuscitation quality and rescuer fatigue. Methods Participants applied chest compression without a mask, with a surgical mask, a filtering face-piece respirator (FFR) mask, and a half-face mask with active P3 filter. A smart watch was worn on the left wrists of the participants during chest compression in each condition. They were requested to rate their fatigue on the Visual Analogue Scale (VAS). Results Statistically higher average pulse rates were found in the FFR mask and half-face mask conditions. FFR mask and half-face mask resulted in statistically worse results than surgical mask and no-mask conditions in the number of compression per minute, compression depth, and compression effectiveness. Further, half-face mask and FFR mask caused more fatigue in participants. Conclusion Protective masks used as PPE other than surgical masks increase rescuer fatigue in CPR and negatively affect the quality of chest compressions.

Introduction:Approximately 50,000 patients per year present at emergency departments (EDs) because of carbon monoxide (CO) intoxication. The hypothesis of this study was that the half-life of CO and the regression period of complaints could be reduced more rapidly by applying oxygen with the Continuous Positive Airway Pressure (CPAP) modality using a non-invasive mechanical ventilator.Methods:The patients were divided into Group 1 and Group 2 in terms of the treatment method applied. Patients in Group 1 received FiO2 1.0 15 l/minute oxygen at room temperature for at least 30 minutes with a non-rebreather mask. Patients in Group 2 received FiO2 1.0 oxygen at 12 cmH2O pressure with non-invasive mechanical ventilation for at least 30 minutes with an oronasal mask in the CPAP modality.Results:The median values (interquartile range) of carboxyhemoglobin (COHb) levels at zero and 30 minutes of patients were 19% (8) and 14% (6) in Group 1 and 22% (8) and nine percent (3) in Group 2; a median difference of six percent (2) was detected in Group 1 and of 13% (4) in Group 2 in the first 30 minutes (P <.001). When the symptoms of the patients were examined, the median values of Group 1 and Group 2 at zero minutes were both eight units and at 30 minutes were five and three units, respectively. A decrease of five units was determined in the median of Group 2 in the first 30 minutes, and a decrease of two units in the median of Group 1 (P <.001).Conclusion:The use of CPAP was determined to more rapidly reduce COHb level as opposed to high-flow oxygen therapy. It is also thought that it may enable earlier discharge by reducing the duration of the emergency follow-up since it provides a faster improvement in the symptoms of the patients.

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ÖzetGiriş: Kardiyopulmoner resüsitasyon (CPR) uygulamalarında göğüs kompresyonunun etkinliğinin önemi son Amerikan kalp derneğinin (AHA) kılavuzunda da vurgulanmıştır. Ancak etkili göğüs kompresyonun uygulama standardı halen tartışmalıdır. Ayrıca göğüs kompresyonları sırasında kurtarıcı yorgunluğu ile CPR etkinliği arasında ki ilişki, üzerinde tartışılan bir başka konudur. Biz bu çalışmamızda kardiyak arrest vakalarında göğüs kompresyonlarının sayı ve derinliğinin metronom ile standart hale getirilip, getirilemeyeceğini ve metronom kullanımının kurtarıcı yorgunluğu üzerine etkisini araştırdık. Gereç ve yöntem: Çalışmaya güncel TYD uygulamasını bilen 40 sağlık personeli alınmıştır. Çalışmaya katılan personele CPR uygulama mankeni üzerinde ikişer dakikalık turlardan oluşan ve her turdan sonra 2 dk dinlenerek 5 tur boyunca güncel AHA klavuzun da göre CPR uygulaması yapması söylenmiştir. (1.grup). Uygulamadan en az bir gün geçtikten sonra aynı uygulayıcılara metronom eşliğinde metronomun hızı 100/ dk. olacak şekilde ayarlandıktan sonra 2'şer dakikalık turlardan oluşan ve her turdan sonra 2 dk dinlenerek 5 tur boyunca, CPR uygulaması yapmaları söylenmiştir (2.grup). Uygulayıcıların dakikadaki göğüs kompresyon bası sayısı ve derinliğine ilişkin veriler her 2dk' lık turdan sonra o tura ait ortalama değerler bilgisayara bağlı uygulama mankeni üzerinden alınarak kaydedilmiştir. Uygulayıcıların yorgunluğuna ait veriler hazırlanmış olan sıfatsal skala eşliğinde her turun başında uygulayıcıya sözel olarak sorularak elde edilmiştir. Verilerin değerlendirilmesinde Mann Whitney U, Ki Kare ve t testi istatiksel analizleri uygulanmış olup, p<0,05 istatiksel olarak anlamlı kabul edilmiştir. Bulgular: 1.grup ve 2.grubun dakikadaki göğüs kompresyon ortalamaları sırasıyla 130/dk. ve 103,405/dk bulunmuştur (p<0,001). Kompresyon derinliği ortalamaları 55,5 ve 50,3 mm.'dir (p<0,001). Uygulama sonu yorgunluk değeri ortalamaları sırasıyla 3,9 (çok yoruldum) ve 2,6 (az yoruldum)'dır (p<0,001). Sonuç: Çalışmamız sonucunda CPR sırasında metronom kullanımının dakikadaki göğüs kompresyon sayısını standart hale getirilebileceğini, uygulayıcıların yorgunluklarını azalttığını ve ortalama kompresyon derinliğini azaltmasına rağmen güncel kılavuzlarda önerilen değerlere uygunluk gösterdiğini tespit ettik.Anahtar Kelimeler : Temel yaşam desteği, metronom, kardiyopulmoner, resüsitasyon, yorguluk.Gündüz AF, Bora S, Çağlar B, Parlak İ. Kardiyopulmoner resüsitasyon uygulaması esnasında metronom kullanımının etkinliğinin manken üzerinde araştırılması. Pam Tıp Derg 2019;12:49-54. AbstractIntroduction: Importance of effective chest compression during cardio pulmonary resuscitation has been emphasized on the latest AHA guideline but standardization of effective chest compression still remains to be a controversy. On the other hand effects of fatigue on basic life support (BLS) remains to be another argument. In our study we aimed to address if number of cardiac compressions and depth could be standardized on cardiac arrest patients, and show the effects of p...

It is important to exclude the diagnosis of acute coronary syndrome quickly and accurately. This study aims to exclude the diagnosis of acute myocardial infarction (AMI) with a single troponin value in patients with appropriate clinical evaluation and electrocardiography (ECG) Materials and Methods: Among the patients who were followed up with a pre-diagnosis of AMI and for whom a HEART score was calculated, patients whose high sensitive troponin I result was found below the limit of detection (LoD) value and who were discharged is included in study. All patients were contacted on the 30th day of discharge. The status of "major adverse cardiac events" (MACE-30) in the last 30 days was questioned. Results: The HEART score of 122 patients (73.1%) in the study was found to be at low risk while 45 (26.9%) as moderate. MACE-30 developed in only 5 patients (3%). Of the 5 patients who developed Mace; The HEART score of 3 (60%) was determined as 5, whereas the heart score of 2 (40%) was 6. p <0.001. It was observed that no mace was detected in any patient with a low risk HEART score (p <0.001). The cut off value for the heart score was found to be ≤4 (p<0,001) while the cut off value for age was found to be ≤69 (p<0,001). Conclusion:We think that patients presenting to the emergency with chest pain, a troponin value below LoD and a low HEART score can be discharged from the emergency department with a single troponin.

Aim: Methanol intoxication is rare and it can be fatal. This case report aimed to describe the radiological findings in acute methanol intoxication complicated with intracranial hemorrhage in a young patient. Case Report: A 32 year-old man applied to emergency department with a major complaints of nausea, vomiting, double vision, and confusion. Glascow coma score (GCS) was 7 at the initial referral. Laboratory tests showed high anion gap metabolic acidosis. Acute methanol intoxication was diagnosed by aid of the patient anamnesis. Diffusion-weighted MRI (DW-MRI) showed similar diffusion restriction lesions in the putamen and cingulate gyrus of both cerebral hemispheres. The patient had a cardiac arrest during follow-up in the emergency department. He was converted to sinus rhythm with the interventions, intubated, and taken to the intensive care unit. GCS reduced to 3 during follow- up at the 4th day. Cerebral intraparanchimal hemorrhage at the level of left basal ganglia was observed in the brain computed tomography (CT). He was operated however remained comatose after the operation and died at the 8th day of admission. Conclusion: Possibility of methanol intoxication should be included in the differential diagnosis in patients with altered consciousness, vision disturbances and a high anion gap admitted to the emergency service. DW-MRI may be helpful in diagnosis by detecting symmetrical diffusion restrictions at the basal ganglia. Additionally radiologic methods like CT can be used to determine complications such as bleeding that may occur during the follow-up of the cases.

The purpose of this study was to determine the factors affecting mortality in geriatric patients presenting with non-traumatic abdominal pain at the emergency department. Materials and Method: This cross-sectional, retrospective study included patients aged ≥65 years who presented with non-traumatic abdominal pain at the emergency department. The demographic characteristics, laboratory test results, and in-hospital course of the patients were examined. The relationship between mortality and the data obtained was analyzed at a 95% confidence level and with a p value of<0.05 considered statistically significant. The study was conducted following the approval of the ethics committee. Results: A total of 1110 patients were included and comprised 619 (55.8%) women; 719 (64.8%) were admitted to the general surgery clinic and 211 (19%) were operated on. Of those admitted to the general surgery clinic, 106 (9.5%) cases resulted in mortality. The cutoff value of age for mortality was 73 years [73.6% sensitivity, 40.4% specificity, and receiver operating characteristic-area under the curve (ROC-AUC) 0.581)]. A high lactate value (cut-off value 2.4) was associated with mortality (with 78.2% sensitivity, 68.8% specificity, and ROC-AUC 0.786). The most common predictors of mortality were perforation [odds ratio (OR)=20.7], ileus (OR=17.9), high lactate (OR=7.6), and hypocalcemia (OR=3.9). Conclusion: In geriatric patients who presented with abdominal pain at the emergency department, mortality, which increased at the age of over 73 years, was determined mainly by electrolyte and lactate values.