Turkthoracj, Turkish Thoracic Journal

Amaç: Geriatrik travma hastalarındaki demografik özellikleri, travma şiddet skorları, travmanın oluş mekanlarını, hastalara istenen konsültasyonları ve sonlanış şekillerini tespit etmeyi hedefledik. Aynı zamanda olayın oluşu ile acil servise başvuru arasında geçen sürenin ve travma skorlarının mortalite ile ilişkisini ortaya çıkarmayı amaçladık. Gereç ve Yöntem: Bu çalışma retrospektif olarak 01.01.2011-31.12.2011 tarihleri arasında Erciyes Üniversitesi Tıp Fakültesi Acil servisine 65 yaş ve üzeri başvuran 250 hasta ile yapılmıştır. Cinsiyet, yaş, travmadan sonra geçen süre, travma mekanizması, tanılar, istenilen konsültasyonlar, yaralanma bölgesi, GKS, ISS ve sonlanış şekilleri araştırılmıştır. Bulgular: Bu hastaların %51,6’sı kadın, %48,4’ü erkektir. Hastaların yaş ortalaması 73,3’tür. Hastaların %32,4’ü ilk 1 saatlik zaman diliminde iken %11,2’si ilk 24 saatlik zaman dilimi sonrası acil servise müracaat etmiştir. Hastalarda sırasıyla en çok yumuşak doku travması (%36,4) saptanmışken travma bölgelerine de bakıldığında en sık %51,6 oranla ekstremite olduğu da tespit edilmiştir. Hastaların 86’sına herhangi bir branştan konsultasyon istenmezken; 79 hastaya ortopedi, 44 hastaya beyin cerrahi konsültasyonu istenmiştir. Çalışmadaki hastaların %54,8’i acil servisten tedavi sonrası taburcu olmuş, %28,4’ü servise yatmış, %12’si yoğun bakım şartlarında takibe alınmış ve %4,8’i yani 12 hasta exitus olmuştur. Hastaların acil servise başvuru süreleri, GKS ve ISS puanları ile acil serviste sonlanışları kıyaslanmış ve istatistiksel olarak anlamlı ilişki tespit edilmiştir. Sonuç: Geriatrik travma hastaları genç hastalara göre daha mortal ve morbid seyretmektedir. Yaşlılığa bağlı olarak genellikle medikal ek problemleri de mevcuttur. Tedavi süreçleri daha zahmetli ve emek istemektedir. Bu nedenle hastalar daha dikkatli ve multisistemik olarak değerlendirilmelidir.

Aim: In this study, it was examined whether the anamnesis taken by pre-hospital paramedics and the physical examination performed in a limited time were effective as intended in non-trauma patients brought to a secondary level district state hospital by ambulance. In addition, it was evaluated whether appropriate preliminary diagnoses were made during the evaluations and these preliminary diagnoses were compared with the definitive diagnoses made after the examinations performed in the emergency room. Methods: Between 01.01.2023 and 30.06.2023, patients brought to a State Hospital by ambulance were retrospectively analyzed. All age groups brought from the field for non-traumatic reasons were included in the study. Patients referred from another hospital, admitted to another ward for hospitalization and brought to the emergency department with cardiopulmonary arrest were not included in the study. Results: During the study period, all patients brought to our emergency department by ambulance were examined. The mean age of the patients was 66. More than half of the cases were female (57.7%). When we compared which system in the body the symptoms and preliminary diagnoses considered by the paramedics belonged to and which system the definitive diagnoses made in the emergency department belonged to, it was observed that there was a statistically moderate level of agreement between the pathologies considered by the 112 teams and the pathologies considered by the emergency department physicians in all body systems except genitourinary system pathologies (Kappa 0.558). Conclusion: It was observed that the preliminary diagnosis or symptom stated in the case form by ambulance workers working in prehospital emergency health services was similar to the definitive diagnostic systems in the emergency department.However, it was determined that 74.9% of the case forms stated symptoms instead of preliminary diagnosis. This may be due to paramedics not wanting to take responsibility by stating a more general approach to patient handover.

Objective: In December 2019, the respiratory disease caused by a coronavirus group virus, first seen in Wuhan, China, was named "coronavirus disease" (COVID-19). As a result of various decisions taken around the world to keep the disease under control, to provide healthcare services to diseases other than COVID-19, and to protect healthcare personnel from transmission, there have been some disruptions in healthcare service delivery. Methods: In this study, the daily number of patients admitted to the emergency department of a state hospital during the pandemic period, the number of patients hospitalized and the referred to another hospital were examined. These data were compared with the pre-pandemic and post-pandemic period. Applications made between January 01, 2019 and December 31, 2022 were examined retrospectively. Monthly data were collected on the number of patients admitted to the emergency department, the number of hospitalized patients and referred to another institution during the four-year period. The effects of the pandemic period on the total number of admissions, referrals and hospitalizations were compared before and after the pandemic. Although the number of patients admitted to the emergency department decreased significantly during the pandemic period, the total number of patients hospitalized and referred from the emergency department did not decrease at a similar rate Results: Considering the significant decrease in patient admissions seen with the pandemic, it would be appropriate to examine whether the emergency department is used properly by patients outside the above-mentioned group (without hospitalization or referral) in order to ensure effective and quality health services.

Foreign body impaction in the esophagus is a common emergency, particularly among children; however, unusual presentations in geriatric patients are rarely encountered. The clinical manifestation may vary depending on the type and location of the foreign body and the patient’s underlying condition. We report the case of a 79-year-old bedridden male patient with Alzheimer’s disease who presented to the emergency department with shortness of breath and audible wheezing. Initial evaluation and imaging studies revealed no acute pulmonary pathology. A lateral neck X-ray demonstrated an image consistent with a foreign body at the cervical level, which was later confirmed by computed tomography to extend along the esophagus. Under sedation with fentanyl and ketamine, the foreign body—a sock—was successfully removed using a laryngoscope and long forceps. The patient recovered uneventfully and was discharged after clinical stabilization. This case is remarkable due to the atypical presentation and the unusual nature of the ingested object. While most esophageal foreign bodies in adults are accidental or intentional, this case resulted from unconscious behavior related to Alzheimer’s disease. Emergency physicians should maintain a high index of suspicion when evaluating elderly or cognitively impaired patients presenting with atypical respiratory symptoms, as early recognition and prompt intervention can be lifesaving.

Aim: This study aims to investigate the association between Creactive protein (CRP) levels and outcomes such as hospitalization, discharge, readmission, and mortality in geriatric patients (aged 65 and over) presenting to the emergency department for nontraumatic reasons. Material and Methods: CRP levels were retrospectively analyzed from blood tests taken during routine diagnostic and therapeutic processes for patients over 65 years of age who presented to the emergency department of a secondary state hospital for non-traumatic reasons between January 1, 2023, and June 30, 2023. Patients were categorized into five CRP level groups (5-50 mg/L, 51-100 mg/L, etc.) and evaluated for their medical history, complaints, hospitalization status, consultation requests, and mortality. Results: Patients with CRP levels between 5-100 mg/L were more frequently diagnosed with non-infective causes, while CRP levels over 101 mg/L were predominantly associated with infective causes. A statistically significant association was found between elevated CRP levels and increased rates of hospitalization and mortality (p < 0.001). Conclusion: A significant relationship was observed between CRP levels and the rates of consultation and hospitalization in geriatric patients admitted to the emergency department for nontraumatic reasons. Additionally, elevated CRP levels were strongly associated with increased mortality rates among hospitalized patients. The findings indicate that CRP levels exceeding 101 mg/L were associated with infectious diagnoses and poor outcomes, highlighting the need for close monitoring of these patients. CRP levels should be considered an integral part of the decision-making process in geriatric emergency patients