In the field of critical care medicine, substantial research efforts have focused on identifying high-risk patient groups. This research has led to the development of diverse diagnostic tools, ranging from basic biomarkers to complex indexes and predictive algorithms that integrate multiple methods. Given the ever-evolving landscape of medicine, driven by rapid advancements, changing treatment strategies, and emerging diseases, the development and validation of diagnostic tools remains an ongoing and dynamic process. Specific changes in complete blood count components, such as neutrophils, lymphocytes, monocytes, and platelets, are key immune system responses influenced by various factors and crucial in systemic inflammation, injury, and stress. It has been reported that indices such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and delta neutrophil index calculated using various ratios of these elements, are important predictors of various outcomes in conditions where the inflammatory process is at the forefront. In this narrative review, we concluded that NLR, PLR, SII, and SIRI show promise in predicting outcomes for different health conditions related to inflammation. While these tests are accessible, reliable, and cost-effective, their standalone predictive performance for a specific condition is limited.

An earthquake measuring 7.7 magnitude on the Richter scale occurred at 04:17am on February 6, 2023 in the Pazarcık district of Kahramanmaraş province Turkey. In the hours following the 7.7 magnitude event in Kahramanmaraş, a second 7.6 magnitude earthquake struck the region and a third 6.4 magnitude earthquake struck Gaziantep, causing extensive damage and death. A total of ten provinces directly experienced the earthquake, including Kahramanmaraş, Hatay, Gaziantep, Osmaniye, Malatya, Adana, Diyarbakır, Şanlıurfa, Adıyaman, and Kilis. The official figures indicate 31,643 people were killed, 80,278 were injured, and 6,444 buildings were destroyed within seven days of the earthquakes (as of 12:00pm/noon on Monday, February 13th). The area affected by the earthquake has been officially declared to be 500km in diameter. This report primarily relies on observations made by pioneer Emergency Physicians (EPs) who went to the disaster areas shortly after the first earthquake (in the early stages of the disaster). According to their observations: (1) Due to winter conditions, there were transportation problems and a shortage of personnel reaching disaster areas on the first day after the disaster; (2) On the second day of the disaster, health equipment was in short supply; (3) As of the third day, health workers were unprepared in terms of knowledge and experience for the disaster; and (4) The subsequent deployment of health personnel to the disaster area was uncoordinated and unplanned on the following days, which resulted in the health personnel working there not being able to meet even their basic needs (such as food, heating, and shelter). During the first week, coordination was most frequently reported as the most significant problem.

Cardiac arrests in hospital areas are common, and hospitals have rapid response teams or "blue code teams" to reduce preventable in-hospital deaths. Education about the rapid response team has been provided in all hospitals in Turkey, but true "blue code" activation is rare, and it is abused by medical personnel in practice. This study aimed to determine the cases of wrong blue codes and reasons of misuse. This retrospective study analyzed the blue code reports issued by our hospital between January 1 and June 1 2012. A total of 89 "blue code" activations were recorded in 5 months. A "blue code" was defined as any patient with an unexpected cardiac or respiratory arrest requiring resuscitation and activation of a hospital alert. Adherence to this definition, each physician classified their collected activation forms as either a true or a wrong code. Then, patient data entered a database (Microsoft Excel 2007 software) which was pooled for analysis. The data were analyzed by using frequencies and the Chi-square test on SPSSv16.0. The patients were diagnosed with cardiopulmonary arrest (8), change in mental status (18), presyncope (11), chest pain (12), conversive disorder (18), and worry of the staff for the patient (22). Code activation was done by physicians in 76% of the patients; the most common reason for blue code was concern of staff for the patient. The findings of this study show that more research is needed to establish the overall effectiveness and optimal implementation of blue code teams.

Background: The aim of this study was to compare the ability of the Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS), and Rapid Acute Physiology Score (RAPS) to predict 30-d mortality in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection aged 65 y and over. Methods: This prospective, single-center, observational study was carried out with 122 volunteers aged 65 y and over with patients confirmed to have SARS-CoV-2 infection according to the reverse transcriptase-polymerase chain reaction (RT-PCR) test, who presented to the emergency department between March 1, 2020, and May 1, 2020. Demographic data, comorbidities, vital parameters, hematological parameters, and MEWS, REMS, and RAPS values of the patients were recorded prospectively. Results: Among the 122 patients included in the study, the median age was 71 (25th-75th quartile: 67-79) y. The rate of 30-d mortality was 10.7% for the study cohort. The area under the receiver operating characteristic curve values for MEWS, RAPS, and REMS were 0.512 (95% confidence interval [CI]: 0.420-0.604; P = 0.910), 0.500 (95% CI: 0.408-0.592; P = 0.996), and 0.675 (95% CI: 0.585-0.757; P = 0.014), respectively. The odds ratios of MEWS (≥2), RAPS (>2), and REMS (>5) for 30-d mortality were 0.374 (95% CI: 0.089-1.568; P = 0.179), 1.696 (95% CI: 0.090-31.815; P = 0.724), and 1.008 (95% CI: 0.257-3.948; P = 0.991), respectively. Conclusions: REMS, RAPS, and MEWS do not seem to be useful in predicting 30-d mortality in geriatric patients with SARS-CoV-2 infection presenting to the emergency department.

Background. Computed tomography (CT) is a vital tool in the workup of patients with closed head trauma. The aim of this study was to investigate the necessity of serial CT scans in patients with blunt head trauma. Methods. This is a retrospective study analyzing trauma patients between January and June 2012. Data were analysed by using frequencies, Kolmogorov-Smirnov (K-S), and Chi-square tests. Results. Of the total 351 control Head CTs, it was seen there were no different in 346 (98.6%). In CTs of another 3 patients (0.9%), there were increasing or new, in the other 2 (0.6%) there was a decrease in the pathology present. Of 24 (6.8%) patients who had a hemorrhage in the first CT, there was an increase in the hemorrhage in one of them, a decrease of the pathology in 2 of them. Of 27 (7.7%) patients who had fracture in first CT, 2 had a new intracranial hemorrhage. The relation of the results between the first and second CTs were statistically significant (, test). Conclusion. Repeated CT scans after 6 hours in EDs observation rooms are not necessary if first CT is normal in most situations. Special attention may be needed in patients with an underlying chronic disease.

Introduction and aim. Acute cholecystitis is one of the most common hepatobiliary emergencies. We aimed to investigate the role of the initial hematological inflammatory index and systemic immuno-inflammation index in predicting short-term mortality in patients with acute cholecystitis. Material and methods. This study with a retrospective observational design was conducted at the emergency department of a tertiary teaching hospital. Patients admitted to our clinic between June 15, 2021, and March 15, 2022, according to the Tokyo criteria were included in the sample. The hematological inflammatory index and systemic immuno-inflammation index were calculated using the hematological test results of the patients evaluated at the emergency department. Survivor and non-survivor groups were formed according to all-cause 30-day mortality. The differences between survivor and non-survivor groups were investigated. Results. A total of 194 patients were included in the final analysis. The median age of the study population was 59 (25th–75th percentiles: 46.75–72) years. The rate of all cause-short-term mortality was 7.7. There were significant differences between the survivor and non-survivor groups in terms of the neutrophil count and the systemic immuno-inflammation index (p=0.007, 0.034, respectively; Mann-Whitney U test). No significant difference was found in the remaining laboratory parameters (lymphocyte count, platelet count, and hematological inflammatory index) (p=0.220, 0.489, 0.367 respectively; Mann-Whitney U test). Conclusion. The systemic immuno-inflammation index was determined to be significantly higher in the non-survivor group than in the survivor group among the patients with acute cholecystitis. However, there was no significant difference between these two groups in relation to the hematological inflammatory index.