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.

Acute myocardial infarction (AMI) is rare during reproductive ages, but is three to four times more common in pregnant women than nonpregnant women. AMI during pregnancy is associated with high maternal and fetal mortality. We present a 22-year-old patient with 28 weeks pregnancy who was admitted to emergency department with chest pain and diagnosed with AMI in her follow-up.

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.