Objective: The human body cannot withstand intense mechanical forces generated by an earthquake. The shaking effect of an earthquake, as the human body absorbs it, produces both visible and invisible injuries. Therefore, it is essential to provide accurate triage in the process of mass casualties. Hence, this study aims to characterize green triage patients of the 2023 Kahramanmaraş, Turkey, earthquake and emphasize the need to reconsider mass casualty triage. Methods: A retrospective cross-sectional study was conducted on green triage patients who did not receive first-aid medical attention and attended the emergency department (ED) of a tertiary care hospital. The development of crush syndrome (CS), the receipt of renal replacement therapy (RRT), and associated injuries were considered. Results: Among 295 individuals, CS occurred in 32.2%, and RRT was required in 7.1% of cases. In addition to the traditional markers of CS, non-trapped green triage patients developed both CS and required RRT, as well as sustained injuries. Whether trapped or not, CK levels emerged as a significant predictor of CS. Conclusions: Green triage patients may acquire CS even in the absence of obvious injuries or entrapment. Accurate triage can be life-saving even in the absence of obvious injuries.

En tr Pneumomediastinum is the presence of air in the mediastinum. It can be divided into two as spontaneous and skonder pneumomediastinum. Spontaneous pneumomediastinum is a self-limitting rare clinical entity with good prognosis without an apparent cause. It occurs in young male patients most frequently. It is a benign disease with symptoms such as chest pain, dyspnea, coughing, odinophagia, subcutaneous emphysema, swelling of neck. Chest pain and subcutaneous emphysema are most common symptoms. Most of the patients admit to emergency department (ED) with chest pain. Plain chest radiogram is often adequate for diagnosis but computarized tomography (CT) is golden standard. We aimed to present the patient that admitted to ED with chest pain, whose chest radiogram was clear but thorax CT was performed because of clinical suspicion and diagnosed with pneumomediastinum. Pnömodiastinum mediastende serbest hava bulunmasıdır. Spontan ve sekonder pnömomediastinum olarak ikiye ayrılır. Spontan pnömomediastinum presipite edici bir faktör olmaksızın gelişen iyi seyirli ve kendini sınırlayıcı nadir görülen bir hastalık olarak tanımlanır. Genç erkek hastalarda daha sık görülmektedir. Benign seyirli bir hastalık olup, semptomları arasında göğüs ağrısı, dispne, öksürük, odinofaji, subkutan amfizem, boyunda şişlik vardır. Semptomlardan göğüs ağrısı ve boyunda subkutan amfizem en sik görülenidir. Hastaların çoğu ise acil kliniğine göğüs ağrısı şikâyeti ile başvuruda bulunurlar. Genellikle göğüs direkt grafisi ile tanı koyulsa da bilgisayarlı tomografi tanıda altın standarttır. Olgumuzda sadece göğüs ağrısı şikâyeti ile acil servise başvurup, akciğer grafisinde patoloji tesbit edilmese de klinik şüphe doğrultusunda çekilen toraks bilgisayarlı tomografide pnömomediastenium tesbit ettiğimiz hastayı sunmayı hedefledik.

Objective: Rapid assessment of early treatment-related physiological improvement in emergency department (ED) patients with respiratory failure (RF) remains challenging. Blood gas analysis is informative but invasive and not ideal for repeated use. The vertical displacement index (VDI), an ultrasound-derived parameter based on pleural motion, may provide dynamic bedside information on early physiological change. This study evaluated whether changes in VDI are associated with early physiological improvement in ED patients with RF. Methods: This prospective observational study was conducted in the EDs of two tertiary care hospitals. Adult patients presenting with dyspnea and clinical evidence of RF were included. VDI was measured by lung ultrasound at baseline and 30 min after initial treatment. The primary endpoint was the change in VDI 30 min after the initial treatment, calculated as the difference between pre-treatment and post-treatment VDI. The expected direction was a post-treatment decrease in VDI, with greater VDI reduction expected to be associated with greater early physiological improvement. Secondary analyses included comparisons of VDI changes across oxygen saturation and diagnostic groups, as well as correlations between ΔVDI and physiological changes. Patients were grouped by admission oxygen saturation (<80%, 80–90%, and ≥90%). Results: Seventy-nine patients were included. Pre-treatment VDI differed significantly between oxygen saturation groups, with the highest values in the most hypoxemic patients (p = 0.028). VDI decreased significantly after treatment in all groups (p < 0.001 for all), with the greatest reduction in the <80% group. By diagnosis, VDI decreased significantly in pulmonary edema, COPD/asthma, and pneumonia, but not in pulmonary embolism (p = 0.138). VDI reduction correlated positively with improvements in oxygen saturation (r = 0.27, p = 0.016) and pH (r = 0.24, p = 0.037), but not with CO₂. Conclusions: VDI may be explored as a practical ultrasound-derived bedside parameter associated with early physiological improvement in ED patients with RF.

Background/Objectives: Sepsis-associated acute kidney injury (SA-AKI) involves complex disturbances in renal microcirculation that may precede overt biochemical evidence of renal dysfunction. This study aimed to characterize early renal perfusion patterns during the emergency department (ED) phase of sepsis, as assessed by the renal resistive index (RRI) and the semiquantitative power Doppler ultrasonography score (SPDUS), and to explore their relationship with subsequent SA-AKI trajectories. Methods: In this prospective observational study, adult ED patients who met the Sepsis-3 criteria were enrolled. Renal perfusion was evaluated using the RRI and SPDUS at ED admission and repeated at the fourth hour. SA-AKI was classified as transient or non-transient based on renal recovery patterns. Trajectory comparisons were performed to identify early physiological differences. Receiver operating characteristic (ROC) analyses were conducted for descriptive and exploratory assessment of perfusion pattern separation between injury trajectories. Results: Fifty-four patients were included, with 35 classified as transient and 19 as non-transient SA-AKI. Patients with non-transient injury exhibited lower baseline SPDUS₀ grades and higher RRI₀ values compared with those with transient injury. These differences were evident at ED presentation, prior to the initiation of advanced organ support, and persisted at the fourth hour, with the non-transient group continuing to show lower SPDUS₄ and higher RRI₄ values than the transient group. These findings reflect distinct early renal microcirculatory perfusion patterns across SA-AKI trajectories. Sensitivity, specificity, and cut-off values are reported for descriptive and exploratory purposes only and should not be interpreted as validated clinical thresholds. Conclusions: Early alterations in renal microcirculatory perfusion are detectable during the ED phase of sepsis and differ between transient and non-transient SA-AKI trajectories. Baseline RRI and SPDUS values provide physiological insight into early renal perfusion abnormalities and evolving microcirculatory dysfunction in sepsis, but should not be interpreted as predictive tools.

Purpose: To evaluate the prognostic utility of two widely used maxillofacial trauma scoring systems (MFTSs) -the Facial Injury Severity Score (FISS) and Maxillofacial Injury Severity Score (MFISS)- in adult multiple trauma patients in the emergency department (ED). Methods: This prospective observational study was conducted in the ED of a tertiary care hospital between 01.08.2020 and 01.08.2021. A total of 124 MFT patients aged ≥ 18 years with at least one concomitant injury to another organ system were included. FISS and MFISS were calculated for each patient. The associations between scores and coexisting injuries, intensive care unit (ICU) admission, and mortality were analyzed. Predictive performance for mortality was assessed using receiver operating characteristic (ROC) curve analysis. Results: Higher FISS scores were significantly associated with intracranial injuries, including subarachnoid hemorrhage (SAH), cranial fractures, and pneumocephalus (all p < 0.01), as well as with pneumothorax, rib fractures, ICU admission, and mortality (all p ≤ 0.004). MFISS scores were significantly higher in patients with SAH, while a negative association was observed between MFISS and abdominal injuries ( p = 0.043). ROC analysis demonstrated good predictive performance for mortality, with areas under the curve of 0.820 for FISS and 0.758 for MFISS (both p < 0.01). Conclusions: FISS and MFISS are associated with clinically meaningful outcomes and may serve as practical tools for early risk stratification and prognostic assessment in the ED among adult multiple trauma patients with maxillofacial injuries.