In this article, subarachnoidal hemorrhage developing in a case with Covid-19-related pneumonia was evaluated. In the presence of respiratory system infection signs such as cough and weakness in patient who present with sudden loss of consciousness, performing lung imaging as well as performing brain computerized tomography scan can allow the detection of an underlying Covid-19 infection.

No abstract

No abstract

SUMMARY OBJECTIVE: This study aims to determine the demographic characteristics of cancer patients admitted to an emergency department and determine the relationship between the frequency of admission to the emergency department and oncological emergencies and their effect on mortality. METHODS: This observational, prospective, diagnostic accuracy study was performed in the ED of a tertiary care hospital. Patients over the age of 18 who were previously diagnosed with cancer and admitted to the emergency service for medical reasons were included in the study. We recorded baseline characteristics including age, gender, complaints, oncological diagnosis, metastasis status, cancer treatments received, the number of ED admissions, structural and metabolic oncological emergency diagnoses in the ED, discharge status, length of hospital stay, and mortality status. RESULTS: In our study, 1205 applications related to the oncological diagnosis of 261 patients were examined. 55.6% of the patients were male, and 44.4% were female. The most common metabolic oncological emergency was anemia (19.5%), and the most common structural oncological emergency was bone metastasis-fracture (4.6%.) The mean score of admission of patients to the emergency department was four times (min: 1 max: 29) during the study period. A total of 49.4% (n: 129) of the patients included in the study died during follow-up, and the median time of death was 13 days after the last ED admission. CONCLUSION: The palliation of patient symptoms in infusion centers that will be established in the palliative care center will contribute to the decrease in the frequency of use of emergency services.

Objective: To investigate whether high-flow nasal cannula oxygen therapy could reduce the rate of endotracheal intubation and improve arterial blood gas values, vital signs, and clinical outcomes of patients with hypoxemic acute respiratory failure as compared with conventional oxygen therapy alone. Methods: This retrospective, observational study was performed in the 15-month study period and included adult patients with tachypnea and hypoxemia, whose vital signs and arterial blood gas were monitored. The high-flow nasal cannula oxygen group consisted of patients admitted to the emergency department with acute respiratory failure when high-flow nasal cannula oxygen treatment was available in the hospital, while the conventional oxygen therapy group consisted of patients who have presented to the emergency department with acute respiratory failure in the absence of high-flow nasal cannula oxygen device in the hospital. The primary outcome of the study was improvement in vital signs and arterial blood gas values within first and fourth hours of the treatment. The second outcome was the need for intubation in the emergency department, length of hospital stay, and hospital mortality. Results: The decrease in the pulse and respiratory rate of high-flow nasal cannula oxygen–treated group was significantly greater than the conventional oxygen therapy group on the first and fourth hours of treatment (p < 0.001). PaO2 values were significantly higher in the high-flow nasal cannula oxygen group at the first and fourth hours of treatment (p ⩽ 0.001). Likewise, mean SaO2 levels of patients receiving high-flow nasal cannula oxygen treatment was significantly higher than those of patients in the conventional oxygen therapy group (p = 0.006 at 1 h and p < 0.001 at 4 h). In the hypercapnic patients, the decrease in PaCO2 and increase in pH and PaO2 values were significantly greater in high-flow nasal cannula oxygen group (p < 0.001). The difference between the groups regarding the need for invasive mechanical ventilation was not statistically significant (p = 0.179). Conclusion: High-flow nasal cannula oxygen treatment has been associated with favorable effects in vital signs and arterial blood gas values in patients with acute respiratory failure. High-flow nasal cannula oxygen might be considered as the first-line therapy for patients with hypoxemic and/or hypercapnic acute respiratory failure.

Öz Purpose: In this study; we aimed to compare the effectiveness of the two types of polyvalent snake antivenom and to determine the possible local and systemic reactions in patients who admitted to the emergency department with snake bite. Materials and Methods: We performed this retrospective study on 30 patients who complained of snakebite. We grouped the patients according to the antivenom type (PoliseraTM or Polivalan TM) which they received. Demographic characteristics of the patients, vital signs, local tissue findings, and laboratory parameters were recorded in the standard data form. The following data were also recorded; the number of vials of snake antivenom used in each group, additional doses of venom were administered, and whether any local or systemic reaction to antivenom has developed or not. Results: Thirty patients were included in the study. 16 patients were administered PoliseraTM (Group 1) snake antivenom and 14 patients were administered Polivalan TM (Group 2) snake antivenom. Patients in Group 1 were given an average of 9.1±7.3 vials, while patients in Group 2 were given an average of 11.6±12.7 vials. More allergic reactions-urticaria, fever, and cellulite were observed in the group receiving PolivalanTM antivenom. Conclusion: Different methodologies arising from the production of antivenom, pyrogen contamination, and differences in packaging can cause different effects and side effects even in products with the same dose and antivenom content. Amaç: Bu çalışmada; acil servise yılan ısırması ile başvuran hastalarda kullanılan iki tip polivalan yılan antivenomun etkinliğinin karşılaştırılması ve olası lokal ve sistemik yan etkilerin belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Bu retrospektif çalışmaya yılan ısırması şikayeti olan 30 hasta dahil edildi. Hastalar aldıkları antivenom tipine (PoliseraTM veya PolivalanTM) göre gruplandırıldı. Hastaların demografik özelliklerinin yanı sıra, vital bulguları, lokal doku bulguları ve laboratuvar parametreleri standart veri formuna kaydedildi. Her grupta kaç vial yılan anti serumu kullanıldığı, kaç kez ek doz venom ihtiyacı olduğu; antivenoma karşı herhangi bir reaksiyon gelişip gelişmediği kaydedildi. Bulgular: Çalışmaya 30 hasta dahil edildi. 16 hastaya Polisera TM (Grup 1) yılan antivenomu, 14 hastaya PolivalanTM (Grup 2) yılan antivenomu verildi. Grup 1'deki hastalara ortalama 9.1±7.3 vial antivenom verilirken, Grup 2'deki hastalara ortalama 11.6±12.7 vial verildi. PolivalanTM antivenom alan grupta daha fazla alerjik reaksiyon-ürtiker, ateş ve selülitgözlendi. Sonuç: Pirojen kontaminasyonu, üretimden kaynaklanan farklı metodolojiler ve ambalaj farklılıkları aynı doz ve içeriğe sahip antivenom ürünlerinde bile farklı etkilere ve yan etkilere neden olabilir.

Background: The objective of this study is to investigate the power of CRP/Albumin ratio, NRS-2002, mNUTRIC scores to predict nutritional needs and mortality in patients over 65 years of age diagnosed with acute abdominal syndrome in the emergency department and then transferred to the surgical intensive care unit. Material and Method: CRP/Albumin ratio, APACHE II, SOFA, NRS-2002 and mNUTRIC scores were calculated. The analysis of the data was conducted in IBM SPSS Statistics Base 22.0 package program. Results: In the analytical evaluation made for nutritional needs, AUC value for mNUTRIC was found to be: 0,683, 95% CI 0,611-0,755, p < 0.001. It was found out that mortality of patients had a statistically significant and moderate correlation with mNUTRIC score (r = 0.537; p < 0.001). In the analytical evaluation made for mortality, mNUTRIC's AUC value (AUC: 0.808, 95% CI 0.736-0.880, p < 0.001) was found to be the highest. When the cutoff value determined to predict mortality was taken as 3.5 for mNUTRIC score, sensitivity was 75.9% and specificity was 69.4%. Conclusion: The evaluation of the risk of malnutrition through nutritional risk tools in intensive care patients over 65 years of age with acute abdominal syndrome can also predict nutritional needs in the early period besides mortality. Based on our data, the fact that mNUTRIC score cutoff value in older patients hospitalized in intensive care is 3.5 and higher may be a predictor for ICU mortality.

Hypocalcemia is one of the common electrolyte disorders which can be encountered in the emergency department. It has a wide clinical range from asymptomatic cases to severe life-threatening cases 1 .One of the risk factors leading to prolonged QT interval is hypocalcemia 2 . When cardiac abnormalities related to hypocalcemia are examined, prolongation of QT interval is reported to be the most common 3 . Cases showing that prolonged QT interval associated with hypocalcemia causes fatal ventricular arrhythmias such as Torsades de Pointes are known 4,5 .There are multiple electrocardiography (ECG) measurements associated with ventricular repolarization and are associated with a risk of ventricular arrhythmia. These measurements are QT and QTc interval, QT and QTc dispersion and T wave peak and end interval (Tpe interval). Among these parameters, QT and QTc are indicative of ventricular depolarization in addition to repolarization. However, Tp-e is more predictive of ventricular repolarization and may be more meaningful especially in the evaluation of repolarization. The obtained Tp-e/QT and Tp-e/QTc ratios are related to ventricular transmural dispersion during repolarization 6 .