Comparison of body mass index level by triage level in the emergency department

INTRODUCTION: Obesity is a high cause of death in both non-communicable and communicable diseases such as COVID-19. The aim of this study is to increase the awareness of emergency department (ED) managers and employees about this problem by showing obesity rates according to triage level in patients admitted to the ED.MATERIAL AND METHODS: BMI levels and complaints of 1246 patients admitted to the ED according to the 3-level triage were re-evaluated with the 5-level ESI (Emergency Severity Index) triage for this study.RESULTS: The mean BMI of 1246 patients was found to be 27.25 ± 5.88 (overweight). 26% of the ED patients were found to be obese and 37.7% of them were overweight. While the mean BMI score of the 6–11 age group was found to be class 1 obesity, the other pediatric and adult age groups were found to be overweight. The highest mean BMI according to both the 3-stage triage system and the 5-stage ESI triage system was found in triage 1 patients (28.8011 ± 7.98; 28.18 ± 6.78, respectively). Obese patients mostly applied to the ED with orthopedic problems and trauma (26.5%). Also, of the patients with class 3 severe obesity, 50% presented with trauma.CONCLUSIONS: The higher the BMI, the higher the triage severity level. BMI levels should be evaluated in the field of triage together with vital signs, especially in trauma patients, and obesity should be considered in ED and hospital management

ANALYSIS OF ADULT PATIENTS WITH PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA IN THE EMERGENCY DEPARTMENT: A CASE SERIES

Amaç: Acil serviste erişkin paroksismal supraventriküler taşikardili (PSVT) hastaların demografik ve klinik özelliklerini ve normal sinüs ritmine (NSR) dönüşü etkileyen etkenleri belirlemektir. Yöntem: Bu retrospektif, tanımlayıcı çalışmada iki yıl içinde acil serviste SVT tanısı alan hastalar incelendi. Hastaların dosyalarından, yaş, cinsiyet, acile başvuru yakınmaları, vital bulguları, başvuru zamanı, tedavi girişimleri, NSR'e dönüş, komplikasyonlara ilişkin bilgiler tarandı. Analizde, ki-kare ve t-testi Fisher-Exact ve Mann-Whitney U testleri kullanıldı. Bulgular: Acil serviste PSVT tanısı alan toplam 104 hasta (55 kadın, %52,9) çalışmaya alındı. Hastaların yaş ortalaması 49 (aralık; 18-86) idi. En sık başvuru yakınması çarpıntı idi (%89,4). Diğer yakınmalar göğüs ağrısı ve huzursuzluk (%20,2), halsizlik (%6,8) ve istirahat dispnesi (%5,8) idi. Vital bulguları; kan basıncı ortalaması 127/88 mmHg, nabız ortalaması 176 atım/dakika, oksijen saturasyonu ortalama %96 idi. Vital bulgu bozuklukları; takipne (n=28, %28,9), hipertansiyon (n=6, %5,8) ve hipotansiyon (n=5, %4,8) idi. Acil servise en sık başvuru saati 16.00-24.00 arasında (n=44, %42,3) idi. Saat 08.00-16.00 arasında 39 (%37,5) olgu ve 24.00-08.00 arasında 21 (%20,2) olgu başvurmuştu. NSR'e dönüş zamanı kaydedilmiş 33 hastanın ortalaması 37,7 dakika idi. NSR'e dönen 90 hastanın dönüş anında kan basıncı ortalaması 116/75 mmHg idi. Sonuç: PSVT olguları acil servise benign semptomlar ve stabil vital bulgularla başvurmaktadır. Antiaritmik ilaç uygulamadan önce Valsalva manevrası yapılan hastalarda karotis sinüs masajı yapılan hastalara göre NSR'e dönüş oranının daha yüksek olduğu görülmüştür. İlk kez PSVT atağı ile başvuran ve Valsalva manevrası yapılmayan hastalarda NSR'e dönüş oranı daha düşük olmuştur. Objective: To describe demographic characteristics and clinical presentation of patients with paroxysmal supraventricular tachycardia (PSVT) and factors affecting conversion to the sinus rhythm in the emergency department (ED). Methods: All consecutive adult patients who were diagnosed to have SVT in the ED within two-year period were enrolled in this retrospective, descriptive study. The charts were reviewed regarding the age, complaints on admission, vital signs, time of admission, time taken to convert to normal sinus rhythm (NSR), complications and mode of disposition.The data were analyzed using chi-square, t-test, Fisher's exact test and Mann-Whitney U test. Results: A hundred and four cases (55 females, 52.9%) diagnosed to have SVT were enrolled. The mean age was 49 (range 18-86). Palpitation was the most common complaint reported by the patients (89.4%), followed by chest discomfort and pain (20.2%), faintness (6.8%) and resting dyspnea (5.8%). Abnormalities of vital signs included tachypnea (23.0%), hypotension (4.8%), and hypertension (5.8%). Mean blood pressure values were 127/ 88 mmHg, mean pulse was 176 bpm and mean SaO2 was 96%. The distribution of the cases' presentation to the ED was as follows: 44 cases between 16.00 and 24.00 hours (42.3%) 39 cases between 08.00 and 16.00 hours (37.5%) and 21 cases between 24.00 and 08.00 hours (20.2%). The number of patients successfully converted to NSR was 33 (%31.7). Mean time taken to conversion was 37.7 minutes. Mean blood pressures of the 90 patients who were successfully converted to sinus rhythm was 116/75 mmHg. Conclusion: Cases with PSVT may present into the ED with a broad range of symptoms that are associated with stable vital signs and clinical appearance. Patients subjected to Valsalva maneuver before receiving antiarrhythmic medications had a higher percentage of conversion to NSR than others. Conversion rate was lower in those with first attack of PSVT and those who had not undergone Valsalva maneuver than in other

Toxicity following unintentional DDT ingestion

Introduction: Dichlorodiphenyltrichloroethane (DDT) ingestion is an uncommon cause of poisoning worldwide. To date, no cases of renal impairment after oral intake of DDT in humans have been reported. We describe the clinical course and management of two patients presenting after DDT ingestion, one of whom developed acute oliguric renal failure. Case Report: A father and son mistook DDT powder for flour while preparing fish for a meal, and after eating they developed symptoms compatible with acute organochlorine insecticide poisoning. Both were intubated endotracheally due to recurrent convulsions and loss of consciousness followed by admission to the intensive care unit. Both cases developed severe metabolic acidosis. Acute oliguric renal failure (ARF) was diagnosed in the son in the second day, with a blood urea nitrogen level of 47 mg/dl and creatinine 6.4 mg/dl. Urinalysis disclosed abundant RBCs on the third day. Vigorous fluid resuscitation and strict monitoring helped reverse its clinical course by the tenth day. Both patients recovered within two weeks and were discharged without sequelae. Conclusion: Clinicians should not overlook the possibility of DDT poisoning in the differential diagnosis of acute renal failure and seizures. More strict measures should be taken to prohibit misidentification of DDT and similar products, particularly in the developing world

Comparison of anxiety levels among healthcare workers with beck anxiety inventory during COVID-19 pandemic

INTRODUCTION: The COVID-19 pandemic is one of the disasters that has caused the highest number of healthcare worker (HCW) deaths recently. The aim of this study is to determine the anxiety levels of HCWs who are actively working during the COVID-19 pandemic. MATERIAL AND METHODS: The study was conducted online with 177 HCWs (127 doctors, 31 nurses, 15 paramedics, and 4 health technicians) due to the pandemic. Beck Anxiety Inventory (BAI) was used for anxiety levels. RESULTS: Anxiety levels of HCWs were found to be 48% ‘minimal’, 23.7% ‘mild’, 17.5% ‘moderate’ and 10.7% ‘severe’. The mean BAI score of other HCWs was higher than the mean BAI score of doctors (15.94 ± 12.776 vs. 9.53 ± 8.868). The highest level of anxiety was found in nurses (19.64 ± 13.370), (p < 0.001). The mean BAI score of female HCWs was found higher than the mean BAI of male HCWs (14.07 ± 10.899 vs. 7.61 ± 8.681) and the mean BAI score of HCWs without children was found to be higher than the mean BAI score of those with children (13.77 ± 11.713 vs. 9.66 ± 9.260). The mean BAI score of HCWs who live with their relatives over 65 years of age or live with a relative with a chronic disease was found to be higher than the others (14.11 ± 9.752 vs. 10.44 ± 9.752), (p < 0.05). CONCLUSIONS: During the COVID-19 epidemic, which has caused the highest number of HCW deaths in recent years, it has been determined that both the BAI score and anxiety levels of HCWs are high. Anxiety levels of nurses, women, those who do not have children, those who live with their relatives over 65 years of age, and those who live with chronic patients were found to be higher than the others

A case report of an unusual sternal fracture

Most sternal fractures are transverse, and a lateral chest radiograph is diagnostic. We report a case of vertical sternal fracture that was not seen on plain radiographs but was revealed using computed tomography (CT). Thoracic CT with coronal reformatted images can also demonstrate sternal fracture lines, supernumerary synchondrosis, and costosternal joint abnormalities

Evaluation of New-Onset Diabetes in Patients Presenting Emergency Service with a Diabetic Ketoacidosis Attack

Aim: The aim of this study was to investigate the rate of new-onset diabetes mellitus (DM) in patients presenting to our emergency department with diabetic ketoacidosis. Methods: We retrospectively evaluated hospital records of patients who presented to the Emergency Department at Istanbul Goztepe Research and Training Hospital between 01 April 2009 and 01 April 2011 and were diagnosed with diabetic ketoacidosis. 57 patients having complete clinical data were included in the study. Results: 45.6%of patients had type 1 DM, 33.3%- type 2 DM, and 21%of them were with new-onset DM. No statistically significant difference was found between type 1 DM, type 2 DM and new-onset DM patients with respect to arterial blood pH and HCO3 levels and serum sodium, potassium and plasma glucose levels at presentation as well as time of presentation (p>0.05), while HbA1c levels showed statistically significant difference in new-onset DM patients. Conclusion: No statistically significant difference was found between types of DM in patients diagnosed with diabetic ketoacidosis except for precipitating factors, age and HbA1c. Detecting high blood glucose levels in patients presenting to emergency room for reasons other than DM is not a rare condition. Cautious evaluation and recognition of these patients in emergency room for the possibility of undiagnosed DM is important for prevention of future diabetic ketoacidosis episodes. (The Medical Bulletin of Haseki 2013; 51: 168-72