ObjectiveWe aimed to determine the prevalence of violence directed at emergency department (ED) physicians in Turkey and confirm the factors influencing such violence.DesignCross-sectional survey study.SettingCountry of Turkey.ParticipantsPhysicians currently practising in EDs in Turkey.Main outcome measuresThe prevalence of violence directed at physicians and factors that may influence it, such as physicians’ personal characteristics, ED characteristics and physicians’ opinions regarding the causes of and suggested methods of preventing violence.ResultsA total of 713 physicians participated. Of these, 78.1% reported being subjected to violence in the past year and 65.9% reported more than one such incident. Being subjected to violence was related to age (p=0.008), working in an ED with a high patient admission rate (p=0.018), current position (p<0.001), working outside regular work hours (p<0.001), working in a state hospital (p<0.001) and level of experience (p<0.001). Gender, type of patient typically seen, region and patient waiting period did not influence subjection to violence. The present safety precautions against violence do not appear to influence the prevalence of violence.ConclusionsOur results indicated that ED physicians’ experience of violence is related to personal characteristics such as age and level of expertise, and hospital and ED characteristics such as high patient admission rates. Presently, no measures taken to reduce this violence have been proven effective.

The predictive value of leukocyte counts has been reported in patients with acute myocardial infarction (AMI). We aimed to evaluate the predictive value of the total leukocyte count and neutrophil-lymphocyte (N/L) ratio for mortality due to AMI. A total of 522 patients with acute ST-elevated MI were included in the study. The study population was divided into tertiles based on admission N/L ratio values. High (n = 174) and low N/L (n = 348) ratio groups were defined as patients having values in the third tertile (>5.77) and lower 2 tertiles (≤ 5.77), respectively. The high N/L ratio group had a significantly higher incidence of in-hospital cardiovascular mortality (13.8% vs 4.6%, P < .001). An N/L ratio >5.77 was found to be an independent predictor of in-hospital cardiovascular mortality (hazard ratio: 3.78, 95% confidence interval: 1.71-8.30, P = .001). A high N/L ratio is a strong and independent predictor of in-hospital cardiovascular mortality of AMI with ST elevation.

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Extreme heat wave increases the number of emergency department (ED) admissions and mortality rates. The purpose of our study is to investigate the effects of the heat wave experienced in Izmir province of Turkey on mortality.During a 9-day period between 17th and 25th June 2016 (study period), air temperature values were higher than the seasonal norms in Izmir, Turkey. In this cross-sectional study, nontraumatic admissions and in-hospital mortality rates were compared this historical interval of the extreme heat wave with the same period of the previous year and the other 21 days of June 2016.The average air temperature between 17th and 25th June 2016, was higher than the average air temperature of the previous year's same period and the average air temperature from the other 21 days of June 2016 (27.8 ± 3.6 °C, (24.5 ± 1.9°C, 24.1 ± 2.1°C, respectively) (P <.01)During the study period, the mean number of ED visits and mortality rates were significantly higher than the previous year's same period (320 ± 30/day vs 269 ± 27/day, [P <.01], and 1.6% vs 0.7%, [P <.01]).Although the admission rate was similar between the study period and the other 21 days of June 2016 (320 ± 30/day vs 310 ± 32/ day, [P = .445]); in-hospital mortality rate was significantly higher during study period (1.6% vs 0.7%, [P <.01]).During the extreme heat waves, ED admissions and in-hospital mortality rates are increased. Precautions should be addressed for adaptation of people to extreme hot weather.

ObjectivesWe investigated the demographic characteristics, clinical and laboratory findings, treatment strategies and clinical outcomes of patients presenting at emergency department (ED) with digoxin levels at or above 1.2 ng/ml.Materials and methodsThe demographic and clinical characteristics of patients with serum digoxin levels at or above 1.2 ng/ml admitted to an ED between January 2010 and July 2011 were investigated in this cross-sectional descriptive study. Patients with ECG and clinical findings consistent with digoxin toxicity and no additional explanation of their symptoms were evaluated for digoxin toxicity.ResultsIn this study 137 patients were included, and 68.6% of patients were women with mean age 76.1 ± 12.2. There was no significant difference between gender and digoxin intoxication. The mean age of intoxicated group was significantly higher than the non-intoxicated group (P = 0.03). The most common comorbidities were congestive heart failure (n = 91) and atrial fibrillation (n = 74). The most common symptoms were nausea, vomiting and abdominal pain. The levels of hospitalization and mortality in this group were significantly higher.ConclusionDigoxin intoxication must be suspected in patients present in the ED, particularly those with complaints that include nausea and vomiting, as well as new ECG changes; serum digoxin levels must be determined.

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ObjectivesWe aimed to compare the procedural success and intervention durations regarding various airway access skills in moving and stationary ambulance simulations.Material and methodsAn ambulance simulator was used to simulate the moving ambulance environment, and a standard manikin was used for airway simulation. The study included 38 paramedics and paramedic students. In stationary and moving environments, a classical endotracheal intubation with a stylet, an intubation with a gum elastic bougie (GEB), a laryngeal mask airway (LMA), and a laryngeal tube (LT) were applied randomly. The cuff inflation duration, the duration until the first ventilation, and the intubation success were assessed.ResultsThere was no difference in terms of success and intubation durations of the four methods in moving and stationary environments. In both environments, the LT and LMA were inserted most rapidly (p < 0.001). There was no difference in the intubation duration and the success among the supraglottic methods. In moving and stationary environments, the intubation with a classic stylet was faster than the intubation with a GEB. The use of a GEB did not increase the intubation success.ConclusionsIn this simulation study, the moving environment did not affect the duration or success of the endotracheal intubation. Supraglottic methods were applied more quickly in both moving and stationary environments. A GEB was used successfully by practioners with no previous experience; however, the duration of the intubation was longer.

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