The Effect of Different Personal Protective Equipment Masks on Health Care Workers' Cardiopulmonary Resuscitation Performance During the Covid-19 Pandemic.

BACKGROUND: Personal protective equipment (PPE) is equipment that protects health care workers from harmful agents and organisms. The importance of this equipment was noticed again with the Coronavirus Disease 2019 (COVID-19) pandemic. OBJECTIVES: In this study, we investigated the effect of different masks used as PPE on resuscitation quality and rescuer fatigue. METHODS: Participants applied chest compression without a mask, with a surgical mask, a filtering face-piece respirator (FFR) mask, and a half-face mask with active P3 filter. A smart watch was worn on the left wrists of the participants during chest compression in each condition. They were requested to rate their fatigue on a visual analogue scale. RESULTS: Statistically higher average pulse rates were found in the FFR mask and half-face mask conditions. FFR mask and half-face mask resulted in statistically worse results than surgical mask and no-mask conditions in the number of compressions per minute, compression depth, and compression effectiveness. Further, half-face mask and FFR mask caused more fatigue in participants. CONCLUSION: Protective masks other than surgical masks used as PPE increase rescuer fatigue in CPR and negatively affect the quality of chest compressions.

Diagnostic Performance of One-hour Delta High Sensitive Troponin in Acute Coronary Syndrome.

OBJECTIVE: To determine the impact of an increase in the level of high sensitivite (HS) troponin-I between the time of Emergency Department (ED) arrival and one-hour after arrival (0h-1h), and between the time of ED arrival and three hours after arrival (0h-3h), upon the diagnostic performance of HS troponin-I to correctly diagnose AMI. STUDY DESIGN: Descriptive, analytical study. PLACE AND DURATION OF STUDY: Fethi Sekin City Hospital, Elazig, Turkey from January to June 2019. METHODOLOGY: Patients presenting with chest pain were included in the study. The delta HS Troponin I (0h-1h) and delta HS Troponin I (0h-3h) values of the patients were calculated as percentage changes. These values were statistically compared between those who were diagnosed with acute myocardial infarction (AMI). RESULTS: The evaluation was performed on 114 patients. Delta HS Troponin I levels were examined, a change of >20% was observed in 48 patients (42.1%) for the 0-1 hr interval. Of the 20 patients ultimately diagnosed with an AMI, 16 (80%) had such a change at this time (p <0.001). For 0-3 hr interval, a change of HS Troponin-I of >20% was observed in 52 patients (45.6%); and 17 of 20 AMI patients with an AMI were detected by such a change (p<0.001). CONCLUSION: Delta HS troponin I value in the first hour was nearly as sensitive for detection of an AMI as was delta HS Troponin I third-hour value. Key Words: Troponin, Myocardial infarction, Acute coronary syndrome.

The Effect on Video Laryngoscope on Intubation Process During Ambulance Transport.

OBJECTIVE: To compare the effects of VL and DL on intubation time and ease of operation in an ambulance, which is moving in real urban traffic. DESIGN: Comparative experimental manikin study. PLACE AND DURATION OF STUDY: Urla City Hospital, Izmir, Turkey, from January to May 2019. METHODOLOGY: The paramedics were asked to intubate a standard intubation manikin and manikin with cervical collar with DL and VL in an ambulance that moving in real urban traffic. Intubation time, incisor tooth injury, and the ease of operation data were recorded. RESULTS: There was a statistically significant difference between the median values of DL and VL intubation times DL:18s / VL:15s in standard manikin and DL:28 s / VL:21 s in manikin with cervical collar (p<0.001). When the ease of operation was evaluated, the median scores of the DL and VL Likert 5 scale were determined in the standard manikin as DL:3 / VL:5 and the manikin with collar as DL:2 / VL:4 Conclusion: VL significantly decreased the intubation time compared to DL in both normal and difficult airways. The ease of operation provided by VL reduces the negative environmental factors brought by the out-of-hospital environment and ambulance movement for healthcare workers. The use of VL in limited conditions and time, reduces the intubation time and increases the ease of operation compared to DL. Key Words: Resuscitation, Video Laryngoscope, Transport.

The Impact of Treatment with Continuous Positive Airway Pressure on Acute Carbon Monoxide Poisoning.

INTRODUCTION: Approximately 50,000 patients per year present at emergency departments (EDs) because of carbon monoxide (CO) intoxication. The hypothesis of this study was that the half-life of CO and the regression period of complaints could be reduced more rapidly by applying oxygen with the Continuous Positive Airway Pressure (CPAP) modality using a non-invasive mechanical ventilator. METHODS: The patients were divided into Group 1 and Group 2 in terms of the treatment method applied. Patients in Group 1 received FiO2 1.0 15 l/minute oxygen at room temperature for at least 30 minutes with a non-rebreather mask. Patients in Group 2 received FiO2 1.0 oxygen at 12 cmH2O pressure with non-invasive mechanical ventilation for at least 30 minutes with an oronasal mask in the CPAP modality. RESULTS: The median values (interquartile range) of carboxyhemoglobin (COHb) levels at zero and 30 minutes of patients were 19% (8) and 14% (6) in Group 1 and 22% (8) and nine percent (3) in Group 2; a median difference of six percent (2) was detected in Group 1 and of 13% (4) in Group 2 in the first 30 minutes (P <.001). When the symptoms of the patients were examined, the median values of Group 1 and Group 2 at zero minutes were both eight units and at 30 minutes were five and three units, respectively. A decrease of five units was determined in the median of Group 2 in the first 30 minutes, and a decrease of two units in the median of Group 1 (P <.001). CONCLUSION: The use of CPAP was determined to more rapidly reduce COHb level as opposed to high-flow oxygen therapy. It is also thought that it may enable earlier discharge by reducing the duration of the emergency follow-up since it provides a faster improvement in the symptoms of the patients.

An evaluation of the effect of ertapenem in rats with sepsis created by cecal ligation and puncture.

BACKGROUND: Intra-abdominal adhesions are still a major problem which is expected to be reduced by the provision of bacterial decontamination. Various antibiotics have been used to prevent the formation of adhesion in the septic abdomen. This study aims to investigate the efficacy of ertapenem in sepsis of rats induced by cecal ligation and puncture. METHODS: Twenty-eight Wistar rats were divided into four groups randomly. In all groups, bacterial peritonitis was created by cecal ligation and puncture method. Group 1 was considered as sham group. Groups 2, 3 and 4 were given, respectively, saline, a single dose of ertapenem and a dose of ertapenem intraperitoneally every day. Intra-abdominal adhesions were assessed seven days after surgery by histopathological examination. Microbiological examination was performed through the ascites obtained. TNF-α was measured from blood taken from rats. RESULTS: Adhesion score decreased significantly by the application of ertapenem (p<0.001) and fibrosis scores were found to be significantly lower (p=0.005). Among all groups, the relationship between the decrease in the number of colonies and antibiotics application was not statistically significant (p=0.109). No statistically significant difference was found between the group given a single dose of ertapenem and the group given multiple ertapenem (p=1). CONCLUSION: Peritoneal lavage with ertapenem appears to be effective in preventing the adhesion in the septic abdomen. As no difference was detected at the end of a single dose and multiple-dose administration of antibiotics in the adhesion scores, a single dose after surgery seems to be enough. The findings suggest that the results should be evaluated in a clinical trial.

A comparison of carotid doppler ultrasonography and capnography in evaluating the efficacy of CPR.

INTRODUCTION AND PURPOSE: The end-tidal carbon dioxide (ETCO2) measurement is accepted as the gold standard method for assessing cardiopulmonary resuscitation (CPR) efficacy. In recent studies, the use of Carotid Doppler Ultrasonography has become widespread in showing CPR efficacy. In the present study, the carotid blood flow measurement was compared with ETCO2 measurement and an evaluation was made of whether this method could be used as an alternative method to capnography in the assessment of CPR efficacy. MATERIAL AND METHOD: This study was conducted on patients who presented at the Emergency Department (ED) with non-traumatic arrest or began to suffer from arrest during emergency service follow-up. The main carotid artery peak systolic velocity (PSV), end diastolic velocity (EDV) and time-dependent mean flow velocity (MNV), and ETCO2 values were measured and recorded after the 100th chest pressure of the CPR cycle and the results were statistically analyzed. RESULTS: The mean age of the patients was 54.5±12.3years and 65.6% of the patients were male. The mean values of patients measured from the carotid artery during the CPR were PSV 67.1±17.3, EDV 16.3±4.5, MNV 25.5±8.1 and ETCO2 22.2±8.1. A significant difference was found between in-hospital and out-of-hospital arrests in terms of patient outcome (return of spontaneous circulation (ROSC) and death) (p<0.05). The mean ETCO2 values of those who died were found to be lower than those of the ROSC group (p<0.05). Although there was a positive and low-level of correlation between the ETCO2 values and PSV values, and a positive and very low-level of correlation between the EDV and MNV values of all patients, these correlations were not statistically significant. (p>0.05). CONCLUSION: A low correlation was found between the PSV and ETCO2 values. With effective CPR, the results close to carotid blood flow in normal healthy individuals were obtained. However, the study showed that carotid blood flow measurement results during CPR were not as valuable as ETCO2 in demonstrating CPR efficacy.

The accuracy of bedside USG in the diagnosis of nasal fractures.

A comparison of the sensitivity and specificity of bedside ultrasonography with conventional radiography for the evaluation of nasal fractures. INTRODUCTION - PURPOSE: There is increasing use of ultrasonography in the Emergency Dept (ED) and other areas. The purpose of the present study was to evaluate the sensitivity and specificity of bedside ultrasonography with conventional radiographs in the evaluation of nasal fractures in the ED. METHOD: Patients admitted to ED with maxillofacial trauma were evaluated in this prospective study. Ultrasonography scans of the patients were taken by the emergency physician at the bedside. The images were obtained from both laterals and parallel to the nasal dorsum. The nasal radiography scans were evaluated by an experienced radiologist blinded to the study. The ultrasonography and radiography results were compared statistically. RESULTS: The study included 103 patients. In showing the presence of nasal fracture, the sensitivity of ultrasonography was determined to be 84.8% (95% CI 71.13%-93.66%), specificity was 93.0% (95% CI 83.00%-98.05%), positive predictive value (PPV) was 90.7% (95% CI 77.86%-97.41%), negative predictive value (NPV) was 88.3% (95% CI 77.43%-95.18%). CONCLUSION: Ultrasonography can be used in ED as an alternative method to conventional radiography with high rates of sensitivity and specificity in the evaluation of nasal fractures.