A profile of individuals accompanying patients in the emergency department: An analysis of 5046 cases.

BACKGROUND: There has been no comprehensive study on identifying the sociocultural characteristics and the factors affecting the number of relatives and/or friends accompanying patients. The purpose of this study was to identify these sociocultural characteristics and the factors affecting this. MATERIALS AND METHODS: The research was designed as a cross-sectional, one-to-one interview study. A study population representing one in three patients aged over 18 years and presenting consecutively to the emergency department over a 1-month period was constituted with systematic sampling. A sample size of at least 4483 patients was planned with a 1% margin of error and 90% power. RESULTS: Two thousand nine hundred and fifty (58.5%) of the 5046 patients included in the study were male. Patients' mean age was 38.4 ± 17.4 years (median 34 years). At least one friend or relative accompanied 3690 (73.1%) patients, and the mean number of accompanying individuals was 1.50. A higher level of accompaniment and a higher mean number of accompanying individuals were determined in patients presenting to the emergency department outside working hours, with altered mental state, attending hospital for the first time, with chronic disease, requiring hospitalization, in illiterate patients, in patients who had not studied at university, in patients aged 65 or over, and in patients presenting to hospital and the emergency department for the first time compared to other parameters (<0.01 for all). CONCLUSION: The number of people accompanying patients increases with sociocultural factors such as gender, age, literacy, and education level. In addition, similar increase can be observed with patients coming to emergency department by ambulance or having a chronic disease or arrive with lost consciousness.

Effect of exhaust emissions on carbon monoxide levels in employees working at indoor car wash facilities.

BACKGROUND: Exhaust emissions from motor vehicles threaten the environment and human health. Carbon monoxide (CO) poisoning, especially the use of exhaust gas CO in suicidal attempts is well known in the literature. Recently, indoor car wash facilities established in large shopping malls with closed parking, lots is a new risk area that exposes car wash employees to prolonged periods of high level CO emissions from cars. The aim of this study was to investigate how carboxyhemoglobin (COHb) blood levels of employees get affected in confined areas with relatively poor air circulation. METHODS: Twenty male volunteers working in indoor parking car wash facilities were included in the study. Participants were informed about the aim of this study and their consent was obtained. Their pulse COHb levels were measured twice, at the beginning and at the end of the working day using Rad-57 pulse CO-oximeter device, allowing non-invasive measurement of COHb blood levels to compare the changes in their COHb levels before and after work. RESULTS: The mean age of the male volunteers was 29.8 ± 11.9 (range 18-55). While the mean COHb levels measured at the start of the working day was 2.1 ± 2.0 (range 0-9), it was increased to 5.2 ± 3.3 (range 1-15) at the end of work shift (Wilcoxon test, p <0.001). There was a statistically significant difference in COHb levels between the beginning and the end of the work shift in smoker subjects, while the difference was not significant in the non-smoking group (Wilcoxon test, p=0.001, p=0.102, respectively). CONCLUSION: The COHb blood levels of indoor car wash facility employees is directly impacted and gets elevated by motor vechile exhaust emissions. For the health of the employees at indoor parking car wash facilities, stricter precautions are needed and the government should not give permit to such operations.

Comparison of transcutaneous, arterial and end-tidal measurements of carbon dioxide during laparoscopic cholecystectomy in patients with chronic obstructive pulmonary disease.

OBJECTIVE: Transcutaneous, arterial and end-tidal measurements of carbon dioxide were compared in patients (American Society of Anesthesiology physical status classes II and III) with chronic obstructive pulmonary disease (COPD) who underwent laparoscopic cholecystectomy with carbon dioxide insufflation. METHODS: General anaesthesia was performed in all patients. The Sentec(®) system was used for transcutaneous monitoring of the partial pressure of carbon dioxide (TcPCO(2)). TcPCO(2) and arterial partial pressure of carbon dioxide (PaCO(2)) were recorded preoperatively, after induction of anaesthesia, during insufflation and postoperatively; end-tidal carbon dioxide (ETCO(2)) was recorded after induction and during insufflation. RESULTS: PaCO(2) increased during insufflation and reached a maximum at extubation. It declined within 20 min postoperatively but did not return to preoperative levels during this time. TcPCO(2) levels followed a similar pattern. ETCO(2) was significantly lower than PaCO(2) after induction and during insufflation. CONCLUSION: TcPCO(2) was a valid and practical measurement compared with ETCO(2). In patients with COPD undergoing laparoscopic cholecystectomy, TcPCO(2) and ETCO(2) could be used instead of arterial blood gas sampling.

A retrospective analysis of antidepressant poisonings in the emergency department: 11-year experience.

Between 1993 and 2004, patients with antidepressant poisoning admitted to an emergency department (ED) were analysed retrospectively with regard to demographics, clinical findings and treatment attempts. Age, gender, suicide attempts, classification of antidepressants, Glasgow Coma Scale (GCS) score, ECG findings, need for endotracheal intubation, follow-up period and Antidepressant Overdose Risk Assessment (ADORA) criteria were analysed by SPSS software. A total of 356 antidepressant poisoning cases were evaluated. Tricyclic antidepressants (TCA), especially opipramol and amitriptyline, were the most common agents (58.4%). The most frequent ECG finding was sinus tachycardia (40.7%, n=145). Endotracheal intubation was required in 9.6% of cases. Patients with TCA ingestion had a longer observation time in the ED, abnormal ECG findings, abnormal physical examination findings and more ADORA criteria, than patients who ingested selective serotonin re-uptake inhibitors (SSRI) (P = 0.008, P = 0.008, P < 0.001, P < 0.001). It was found that the patients who ingested TCA (P = 0.001), poisoned with amitriptyline (P = 0.001), patients with GCS scores of 8 and less (P = 0.001), patients with two or more ADORA criteria (P = 0.001), with seizures (P = 0.001), with abnormal ECG (P = 0.012), and patients with a history of two or more suicide attempts were intubated more frequently. Suicide attempts, classification of the antidepressant, ECG findings, seizure, GCS score and number of detected ADORA criteria affect the need for intubation in patients with antidepressant poisoning.

Succinylcholine or rocuronium? A meta-analysis of the effects on intubation conditions.

This meta-analysis was undertaken to compare the effects of succinylcholine (SCH) and rocuronium (RCR) on endotracheal intubation (ETI) conditions. Eligible randomised controlled trials (RCTs) were identified via medline and a manual search of references. The frequencies of excellent and unacceptable ETI conditions in subjects receiving SCH 1.0-1.5 mg/kg and RCR 0.6-1.2 mg/kg were determined using standard statistical methods. Inclusion criteria were met by 16 RCTs, representing 1362 subjects. SCH was associated with a 17.7% increase (95% CI = 13-22) in the frequency of excellent ETI conditions and a 5.1% decrease (95% CI = -7.3 to -2.9) in the frequency of unacceptable ETI conditions, when compared with RCR. In the subgroup undergoing true rapid sequence intubation, SCH was associated with a 19.1% increase (95% CI = 13.7-24.5) in the frequency of excellent ETI conditions. SCH appears to be superior to RCR in creating excellent ETI conditions and avoiding unacceptable ETI conditions.

Painless aortic dissection with bilateral carotid involvement presenting with vertigo as the chief complaint.

A 63 year-old woman was admitted to the emergency department with vertigo, nausea, and vomiting. On arrival, she was fully oriented and cooperative. She denied any pain in her chest, neck, back, or abdomen. A bruit was heard on both sides of her neck. Cranial computed tomography (CT) revealed no abnormality, while thoracic CT disclosed dissection in the ascending aorta, aortic arch, and bilateral common carotid arteries. After several hours, the patient underwent vascular surgery. She had an uneventful course and was discharged without any sequelae after 10 days. Vertigo is a rare presentation of aortic dissection with carotid involvement. Elderly patients presented with vertigo and nausea/vomiting should be evaluated for the condition and carotid dissection should be ruled out. Carotid bruit may be a clue to the diagnosis.

Anxiety disorder in patients with non-specific chest pain in the emergency setting.

OBJECTIVES: Many patients who have been discharged from the emergency department (ED) with a diagnosis of "non-specific chest pain" (NSCP) have anxiety disorder (AD), a commonly missed entity in acute care. The objective of this study was to delineate characteristic properties that could enhance recognition of AD in ED patients admitted with NSCP. METHODS: All patients between 18 and 65 years of age diagnosed with NSCP were enrolled. The Hospital Anxiety and Depression Scale (HADS) anxiety subscale was used as a screening test for AD. The patients with high HADS scores (> or = 10) were evaluated by a psychiatrist for AD. RESULTS: In total, 157 patients were enrolled in the study. HADS scores were found to be "high" (> or = 10) in 49 patients (31.2%). Patients with high HADS scores had a higher frequency of associated symptoms (p = 0.004). Dizziness or lightheadedness, chills or hot flushes, and fear of dying were found to have been reported more frequently by patients with high anxiety scores. Of the group with high score, 33 patients (67.3%) were interviewed by a psychiatrist, and 23 (69.7%) of these patients were diagnosed with AD. Associated symptoms were described by 21 patients with AD (91.3%). Of those with AD, 18 (78.3%) had been previously admitted to the ED with chest pain. Atypical chest pain was described by 21 patients (91.3%). CONCLUSIONS: Physicians should always consider AD in patients presenting to the ED with chest pain after ruling out organic aetiology. Patients' definition of atypical pain, recurrent admissions to ED, and presence of associated symptoms such as dizziness, chills or hot flushes, and fear of dying could aid in considering AD.

Impact of Ramadan on demographics and frequencies of disease-related visits in the emergency department.

Summary The objective of this study was to determine whether Ramadan is changing frequencies and demographics of visits due to certain diseases. Data obtained from the charts of the adult patients admitted into the emergency department (ED) due to 10 predetermined entities between 2000 and 2004 were analysed. Demographic variables analysed separately for certain entities visiting the ED in Ramadan were not found to be different from visits in other times of year. Visit frequencies for hypertension and uncomplicated headache in Ramadan were significantly higher than in non-Ramadan months (chi(2) test, p = 0.015 for hypertension, p < 0.001 for uncomplicated headache). Mean age of the patients admitted to the ED due to diabetes-related conditions in Ramadan was significantly lower than in pre- and post-Ramadan months (59.91 +/- 14.60 and 62.11 +/- 14.61, respectively) (Mann-Whitney U-test, p = 0.032). The patients with diabetes presenting in Ramadan were found significantly younger than their peers in the rest of the year. For other diseases, Ramadan does not appear to be a risk factor.

Analysis of factors affecting pain in intravenous catheter placement: a survey of 925 patients.

The aim of the study was to determine some factors affecting pain during intravenous (i.v.) catheter placement in an emergency department (ED). A cross-sectional, observational study was conducted at an academic ED. Nine hundred and twenty five adult patients who had a 20 gauge i.v. catheter placed were enrolled the study. Patients were excluded for the following conditions: more than one i.v. attempt, altered mental status, head trauma, lack of contact due to visual impairment, hearing or speech disorder, intoxication, distracting injury or physical abnormality at the i.v. site. The magnitude of pain of i.v. catheter placement was not related to age, sex, experience of the individual placing the i.v. catheter, site of i.v. catheter insertion and use of analgesic or antidepressive drugs (p > 0.05). Patients with a history of depression reported significantly higher pain than non-depressive patients (p = 0.001). Depressive patients reported higher severity of pain during i.v. catheter placement than nondepressed ones. This may influence the decision on whether or not to use local anaesthesia for catheter insertion.

Factors affecting pain in intravenous catheter placement: role of depression illness.

The aim of the study was to examine factors affecting pain during intravenous (IV) catheter placement in an emergency department. A cross-sectional, observational study was conducted at an academic emergency department. Nine hundred and twenty-five adult patients who had a 20-gauge IV catheter placed were enrolled in the study. Patients were excluded for the following conditions: more than one IV attempt, altered mental status, head trauma, lack of contact due to visual impairment, hearing or speech disorder, intoxication, distracting injury or physical abnormality at the IV site. The magnitude of pain in IV catheter placement was not related to age, sex, experience of the individual placing the IV catheter, site of IV catheter insertion and use of analgesic or antidepressant drugs (p > 0.05). Patients with a history of depression reported significantly higher pain than non-depressed patients (p = 0.001). Depressed patients reported higher severity of pain during IV catheter placement than non-depressed ones. This may influence the decision on whether or not to use local anaesthesia for catheter insertion.