COVID-19 and ethical problems in emergency departments

Giriş Tıbbın temel etik ilkeleri otonomi, fayda, zarar vermemek, adalet, dayanışma, görev bilinci, güven ve karşılıklılıktır Biz bu çalışmada COVID 19 şüphesi veya tanısıyla acil servise başvuran hastalarda pandemi ilişkili en sık görülen etik sorunları anket formu aracılığıyla sorgulayarak yorumlamayı hedefledik Materyal Metod Çalışmanın evrenini 15 Nisan 2021 15 Mayıs 2021 tarihleri arasında Manisa Merkezefendi Devlet Hastanesi Acil COVID 19 polikliniğine başvuran ateş, boğaz ağrısı, nefes darlığı ve ishal gibi semptomları olan hastalar oluşturdu Bu hastalara anket formu dağıtılarak veri analizi yapıldı Araştırma verileri SPSS 23 0 programı aracılığıyla değerlendirildi Kategorik değişkenlerin karşılaştırılmasında pearson ki kare testi ve fisherin kesinlik testi kullanıldı İstatistiksel anlamlılık düzeyi p< 0 05 olarak belirtildi Bulgular Çalışmaya katılanların yaş ortalaması 45 05 18 1 aralığında olup 134 ’ü erkek 51 0 ve 129 ’u bayan 49 0 idi Çalışmaya katılan 150 57 0 hasta COVID 19 tedavisinde kullanılan ilaçlar hakkında bilgisi olmadığını söylerken, 113 43 0 hasta ilaçlar hakkında yeterli bilgisi olduğunu ifade etti Çalışmaya katılan hastaların 106 ’sı 40 3 COVID 19 tedavisinde kullanılan ilaçların faydasız olduğunu ifade ederken, 19 ’u 7 2 çok faydalı olduğunu vurguladı Çalışmaya katılan 162 61 6 hasta COVID 19 tanısı/şüphesiyle takip edildiği süre içinde yakınlarına ulaşma konusunda zorluk çekmediğini ifade ederken, 90 34 2 hasta aynı konuda zorluk çektiklerini vurguladı Cinsiyet ve COVID 19 aşısı yaptırma, hastaneye yatış oranları ve ertelenen hastalık varlığı arasında kadın cinsiyet lehine anlamlı istatistiksel oran saptandı Sonuç Pandemi döneminde tıp etiğini bilmek acil serviste görülebilecek olası etik sorunların saptanmasında ve yönetiminde kolaylık sağlayacaktır.Giriş Tıbbın temel etik ilkeleri otonomi, fayda, zarar vermemek, adalet, dayanışma, görev bilinci, güven ve karşılıklılıktır Biz bu çalışmada COVID 19 şüphesi veya tanısıyla acil servise başvuran hastalarda pandemi ilişkili en sık görülen etik sorunları anket formu aracılığıyla sorgulayarak yorumlamayı hedefledik Materyal Metod Çalışmanın evrenini 15 Nisan 2021 15 Mayıs 2021 tarihleri arasında Manisa Merkezefendi Devlet Hastanesi Acil COVID 19 polikliniğine başvuran ateş, boğaz ağrısı, nefes darlığı ve ishal gibi semptomları olan hastalar oluşturdu Bu hastalara anket formu dağıtılarak veri analizi yapıldı Araştırma verileri SPSS 23 0 programı aracılığıyla değerlendirildi Kategorik değişkenlerin karşılaştırılmasında pearson ki kare testi ve fisherin kesinlik testi kullanıldı İstatistiksel anlamlılık düzeyi p< 0 05 olarak belirtildi Bulgular Çalışmaya katılanların yaş ortalaması 45 05 18 1 aralığında olup 134 ’ü erkek 51 0 ve 129 ’u bayan 49 0 idi Çalışmaya katılan 150 57 0 hasta COVID 19 tedavisinde kullanılan ilaçlar hakkında bilgisi olmadığını söylerken, 113 43 0 hasta ilaçlar hakkında yeterli bilgisi olduğunu ifade etti Çalışmaya katılan hastaların 106 ’sı 40 3 COVID 19 tedavisinde kullanılan ilaçların faydasız olduğunu ifade ederken, 19 ’u 7 2 çok faydalı olduğunu vurguladı Çalışmaya katılan 162 61 6 hasta COVID 19 tanısı/şüphesiyle takip edildiği süre içinde yakınlarına ulaşma konusunda zorluk çekmediğini ifade ederken, 90 34 2 hasta aynı konuda zorluk çektiklerini vurguladı Cinsiyet ve COVID 19 aşısı yaptırma, hastaneye yatış oranları ve ertelenen hastalık varlığı arasında kadın cinsiyet lehine anlamlı istatistiksel oran saptandı Sonuç Pandemi döneminde tıp etiğini bilmek acil serviste görülebilecek olası etik sorunların saptanmasında ve yönetiminde kolaylık sağlayacaktır

Red Flags in Electrocardiogram for Emergency Physicians: Remembering Wellens’ Syndrome and Upright T wave in V1

We present a case of Wellens’ syndrome together with upright T wave in lead V1 in a man presenting with atypical chest pain, and we discuss the significance of its prompt recognition by the emergency physicians who are involved in the evaluation of patients with coronary artery disease in emergency departments. [West J Emerg Med. 2012;13(2):160–162.

Visualization of Cardiac Thrombus by Bedside Ultrasound

[West J Emerg Med. 2013;14(6):637.

Visualization of Cardiac Thrombus by Bedside Ultrasound

[West J Emerg Med. 2013;14(6):637.

Visualization of Cardiac Thrombus by Bedside Ultrasound

[West J Emerg Med. 2013;14(6):637.

Visual Estimation of Bedside Echocardiographic Ejection Fraction by Emergency Physicians

Introduction: The objective of this study was to determine whether bedside visual estimates of left ventricular systolic function (LVSF) by emergency physicians (EP) would agree with quantitative measurement of LVSF by the modified Simpson’s method (MSM), as recommended by the American Society of Echocardiography.Methods: After limited focused training, 2 trained EPs performed bedside echocardiography (BECH) procedures s between January  and June 2012 to prospectively evaluate patients presenting to the emergency department (ED) with dyspnea. EPs categorized their visually estimated ejection fractions (VEF) as either low or normal. Formal echocardiography were ordered and performed by an experienced cardiologist using the MSM and accepted as the criterion standard. We compared BECH results for each EP using chi-squared testing and performed correlation analysis by Pearson correlation coefficient.Results: Of the 146 enrolled patients with dyspnea, 13  were excluded and 133 were included in the study. Comparison of EPs vs. cardiologist’s estimate of ejection fraction yielded a Pearson’s correlation coefficient of 0.77 (R, p&lt;0.0001) and 0.78 (R, p&lt;0.0001). Calculated biserial correlations using point-biserial correlation and z-scores were 1 (rb, p&lt;0.0001) for both EPs. The agreement between EPs and the cardiologist was 0.861 and 0.876, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and the positive and negative likelihood ratios for each physician were 98.7-98.7%, 86.2-87.9%, 0.902-0.914, 0.980-0.981, 7.153-8.175, 0.015-0.015, respectively.Conclusion: EPs with a focused training in limited BECH can assess LVSF accurately in the ED by visual estimation. [West J Emerg Med. 2014;15(2):221–226.

Effectiveness of Bedside Lung Ultrasound for Clinical Follow-Up of Primary Spontaneous Pneumothorax Patients Treated with Tube Thoracostomy

PubMed ID: 30020274Primary spontaneous pneumothorax (PSP) is a common cause of presentation to emergency departments and subsequent hospitalization. Patients with large PSP are treated with tube thoracostomy (TT) and followed up with x-rays. In this study, we investigated the efficiency of bedside ultrasound and compared it with x-ray imaging for the clinical follow-up of PSP patients treated with TT. This is a prospective observational study. After ethical committee approval and written informed consent were obtained, patients who were treated with TT because of PSP were screened. In the follow-up of these patients, a bedside lung ultrasound (BLUS) was performed before every chest x-ray by an emergency physician experienced in performing BLUSs. The performance of BLUSs in detecting free air in the pleural cavity was compared statistically with that of x-rays. Sixty-two patients were enrolled in the study. In total, 166 BLUSs and x-rays were compared. The sensitivity of BLUS was 95.65% (85.20-99.50), specificity was 100% (79.40-100.00), positive predictive value was 100% (92-100), negative predictive value was 88.90% (65.30-98.60), and the area under the curve was 0.99 (0.974-1.000; P = 0.001) for detecting air in the pleural cavity. These results showed that there was no statistically significant difference between BLUS and x-ray methods for detecting air in the pleural cavity. Our study revealed that BLUS can be safely used for the follow-up of PSP patients treated with TT to determine if air is present in the pleural cavity. Further studies are needed. © Wolters Kluwer Health, Inc. All rights reserved

Visual Estimation of Bedside Echocardiographic Ejection Fraction by Emergency Physicians

Introduction: The objective of this study was to determine whether bedside visual estimates of left ventricular systolic function (LVSF) by emergency physicians (EP) would agree with quantitative measurement of LVSF by the modified Simpson’s method (MSM), as recommended by the American Society of Echocardiography.Methods: After limited focused training, 2 trained EPs performed bedside echocardiography (BECH) procedures s between January  and June 2012 to prospectively evaluate patients presenting to the emergency department (ED) with dyspnea. EPs categorized their visually estimated ejection fractions (VEF) as either low or normal. Formal echocardiography were ordered and performed by an experienced cardiologist using the MSM and accepted as the criterion standard. We compared BECH results for each EP using chi-squared testing and performed correlation analysis by Pearson correlation coefficient.Results: Of the 146 enrolled patients with dyspnea, 13  were excluded and 133 were included in the study. Comparison of EPs vs. cardiologist’s estimate of ejection fraction yielded a Pearson’s correlation coefficient of 0.77 (R, p&lt;0.0001) and 0.78 (R, p&lt;0.0001). Calculated biserial correlations using point-biserial correlation and z-scores were 1 (rb, p&lt;0.0001) for both EPs. The agreement between EPs and the cardiologist was 0.861 and 0.876, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and the positive and negative likelihood ratios for each physician were 98.7-98.7%, 86.2-87.9%, 0.902-0.914, 0.980-0.981, 7.153-8.175, 0.015-0.015, respectively.Conclusion: EPs with a focused training in limited BECH can assess LVSF accurately in the ED by visual estimation. [West J Emerg Med. 2014;15(2):221–226.