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Background This study aims to compare emergency trauma visits' severity, emergency surgical needs, and characteristics between the pandemic and pre-pandemic periods. Methods This retrospective observational study was conducted in a tertiary training and research hospital between 1 and 30 April 2020 (pandemic group) and compared with the previous year's same dates (pre-pandemic group). Trauma patients aged 18 and over were included in the study. Emergency Severity Index (ESI) levels, trauma surgery needs, and injury characteristics were compared. Results A total of 2097 patients (592 pandemic and 1505 pre-pandemic) were included. There was an approximately 60% reduction in total and daily visits. ESI levels 1 (0.2% vs. 1.4%) and 2 (0.8% vs. 1.9%) patients increased during pandemic period. Trauma surgery needs (1.6% vs. 2.2%), intensive care unit (ICU) admission (0.4% vs. 0.2%), and ward admission (6.3% vs. 7.9%) did not change during pandemic period. Conclusion Despite the decrease in the visit frequency of adult trauma patients during the pandemic period, the needs for trauma surgery, ICU, and ward admission did not change. Trauma teams should continue their duties during the pandemic period.

BackgroundDoctors have an important role in increasing the number of organ donors. This study aimed to investigate the changing attitudes of medical students regarding organ donation, from first-year medical students (FYMS) to sixth-year medical students (SYMS) at a university medical school in Turkey.Material/MethodsOne hundred first-year medical students and 100 sixth-year medical students participated in the study. A four-part questionnaire was designed for the study, with a response rate of 66.8%.ResultsCompleted study questionnaires showed that organ donation was considered by 46% of first-year medical students and 60% of sixth-year medical students, but an organ donor card was signed by only 8% and 10%, respectively. Information about organ donation had been sought, mainly from social media, by 72% of first-year medical students, and 55% of sixth-year medical students. Regarding their views on organ donation of their relatives, 78% of first-year medical students and 86% of sixth-year medical students were influenced by the opinions of their families and community. When asked about brain death, 50% of first-year medical students and 12% of sixth-year medical students believed it to be a potentially reversible condition, or were uncertain of the definition.ConclusionsDuring six years of training in a university medical school in Turkey, there was only a slight increase in the number of students who were willing to become organ donors and there was a lack of formal education regarding organ donation. Therefore, urgent improvements are required in the education of doctors and society regarding organ donation.

BACKGROUND: Healthcare institutions are confronted with large numbers of patient admissions during large-scale or long-term public health emergencies like pandemics. Appropriate and effective triage is needed for effective resource use. OBJECTIVES: To evaluate the effectiveness of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 years (CURB-65) score in an emergency department (ED) triage setting. DESIGN AND SETTING: Retrospective study in the ED of a tertiary-care university hospital in Düzce, Turkey. METHODS: PMEWS, STSS and CURB-65 scores of patients diagnosed with COVID-19 pneumonia were calculated. Thirty-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) need and outcomes were recorded. The predictive accuracy of the scores was assessed using receiver operating characteristic curve analysis. RESULTS: One hundred patients with COVID-19 pneumonia were included. The 30-day mortality was 6%. PMEWS, STSS and CURB-65 showed high performance for predicting 30-day mortality (area under the curve: 0.968, 0.962 and 0.942, respectively). Age > 65 years, respiratory rate > 20/minute, oxygen saturation (SpO 2) < 90% and ED length of stay > 4 hours showed associations with 30-day mortality (P < 0.05). CONCLUSIONS: CURB-65, STSS and PMEWS scores are useful for predicting mortality, ICU admission and MV need among patients diagnosed with COVID-19 pneumonia. Advanced age, increased respiratory rate, low SpO 2 and prolonged ED length of stay may increase mortality. Further studies are needed for developing the triage scoring systems, to ensure effective long-term use of healthcare service capacity during pandemics.

Background This study aimed to determine the effect of the COVID-19 outbreak on emergency department (ED) visits and emergency consultations according to the triage levels indicating the patients' urgency. Methods A cross-sectional retrospective study was performed in the ED of a tertiary training and research hospital between 1 April and 31 May 2020 in İstanbul, Turkey. The daily count of emergency visits and the count of the emergency consultations during the study period were recorded. The emergency visits and consultations in the same months of the previous year (1 April-31 May 2019) were included as a control group. Results Approximately 50% reduction in ED visits and a 30% reduction in emergency consultations were detected. A significant decrease was detected in all triage levels of visits and emergency consultations (p < 0.001). Within total ED visits, a significant increase was found in the red (4.32% vs. 4.74%) and yellow (21.66% vs. 33.16%) triage levels visit rates, while the green (74.01% vs. 62.1%) level was decreased. Within total emergency consultations, anesthesiology (0.83% vs. 1.56%) and cardiology (3.17% vs. 3.75%) consultation rates increased, neurology (2.22% vs. 1.15%), orthopedics (3.53% vs. 3.01%), and ophthalmology (2.89% vs. 1.57%) consultation rates decreased, internal medicine (2.45% vs. 2.49%), and general surgery (4.46% vs. 4.64%) consultation rates did not change. Conclusions During the COVID-19 pandemic, ED visits at all triage levels decreased. While the rate of critical patient visits increased, non-emergency patient visit rates decreased. The total count of consultations decreased, while the total consultation rates increased. The management of the COVID-19 pandemic will be easier by using or developing appropriate triage scores, as well as establishing good interdisciplinary coordination.

The Emergency Department (ED) overcrowding is an ongoing problem all over the world. The scoring systems are available for the detection of this problem. This study aims to test the applicability of the National Emergency Department Overcrowding Study (NEDOCS) scoring system, one of the scoring systems that evaluate the ED overcrowding. In this prospective observational study, the survey was applied on on-duty doctors, nurses, paramedics, intern doctors, and ward persons working in a University Adult Emergency Department and agreed to participate in the study, between certain hours during the day and the NEDOCS score was calculated simultaneously. The demographic characteristics of the on-duty staff, overcrowding of ED, and the number of the on-duty staff members were recorded in the questionnaires. During the study, 153 measurements were performed, and 3221 questionnaires were filled. The NEDOCS mean score was determined as 101.59 and the most reached result was “extremely busy but not overcrowded” (32%). The ED was rated mostly as “busy” (33.7%) by the on-duty staff. A significant difference was found between ED overcrowding and NEDOCS score. There is a significant difference between ED overcrowding and on-duty emergency nurse and intern doctor count. The NEDOCS score is not suitable for evaluating ED overcrowding. Accurate determination of the ED overcrowding is very important to avoid the negative consequences of the ED overcrowding. Increasing emergency nurse and intern doctor count will decrease ED overcrowding. Also, there is an urgent need to constitute local hospitals and also public health policies to satisfy the increasingly ED's presentations.

Objective: Local anesthetics (LAs) are starting to be used after the discovery of cocaine, which is used in medical practice. Now LAs are used many procedures in many clinics, especially in emergency departments (EDs). The extensive use of LAs was brought side effects and toxicity. Local anesthetic systemic toxicity (LAST) have been reported from simple allergic conditions to cardiovascular and neurological complications that can be fatal. The study aims to evaluate the level of knowledge and awareness of LAST among emergency medicine residents (EMRs). Methods: This was a questionnaire-based cross-sectional study. The questionnaires were sent to EMRs via e-mail, and responses were collected. The participants who gave informed consent included in the study, and who didn't use LAs in their daily practice were excluded. All of the participants responded all of the questions and responses were analyzed. Results: 92 EMRs were included in the study. The median age of the participants was 29 (24-50) years, and 48.9% were women. In the research, no one could recognize all LAST symptoms, ranging from mild to severe. Only 16.3% of the participants answered all treatment options of the LAST correctly, and 27.2% knew the intravenous lipid emulsion dosage accurately. Conclusions: The level of knowledge and awareness of the EMRs on LAST were insufficient. EMRs training rates on LAs and LAST were found to be low. In addition, it was stated that the patient's informed consent was not appropriately obtained from the vast majority of patients undergoing LA procedure. As the first study on LAST among EMRs, we believe that necessary arrangements should be made regarding the detected deficiencies.

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