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    Can end-tidal CO2 measurement replace arterial partial CO2 in emergency department respiratory distress management?
    (Elsevier Espana Slu, 2024) Selki, Kudret; Demir, Mehmet Cihat; Senguldur, Erdinc; Erdem, Emre; Guldal, Hatice; Tasdemir, Murat; Kiciroglu, Alp Kaan Furkan
    Objective: To assess the feasibility of using end-tidal carbon dioxide (EtCO2) as a non-invasive substitute for partial pressure of arterial carbon dioxide (PaCO2) in emergency department (ED) triage and follow-up, and to explore the potential of partial pressure of venous carbon dioxide (PvCO(2)) as an alternative to PaCO2. Design: Prospective cross-sectional study. Setting: Tertiary university hospital. Patients or participants: 97 patients presenting with acute respiratory distress to the ED. Interventions: EtCO2, arterial blood gases, and venous blood gases measured at admission (0 min), 60 min, and 120 min. Main variables of interest: CO2 levels. Results: Among 97 patients (mean age: 70.93 +/- 9.6 years; 60.8% male), EtCO2 > 45 mmHg at admission showed strong positive correlations with PaCO2 and PvCO(2) (r = 0.844, r = 0.803; p < 0.001, respectively). Significant positive correlation was observed between 60-min EtCO2 and PaCO2 (r = 0.729; p < 0.001). Strong correlation between PaCO2 and PvCO(2) at 120 min when EtCO2 > 45 mmHg (r = 0.870; p < 0.001). EtCO2 was higher in hospitalized patients compared to discharged ones. Conclusions: EtCO2 appears promising as a substitute for PaCO2 in ED patients with acute respiratory distress within the initial two hours of treatment. Venous blood gas sampling offers a less invasive alternative to arterial sampling, facilitating simultaneous blood tests. (c) 2024 Elsevier Espana, S.L.U. and SEMICYUC. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
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    Can the Fluctuation Observed in the Endotracheal Tube with Compression Applied to the Epigastric Region be Used as a Confirmation Method for Endotracheal Intubation?
    (Bentham Science Publishers, 2025) Boǧan, Mustafa; Alatlı, Tufan; Karakeçili, Ceren; Selki, Kudret; Erdem, Emre; Karakoyun, Salih; Kömürcü, Özkan
    Background: The traditional methods are mostly used to detect tracheal localization and to exclude esophageal localization. Therefore, the aim of this study was to investigate the usefulness of epigastric manual compression in the confirmation of esophageal placement of the tube. Methods: Out-of-hospital ETE was performed by experienced paramedics working in the emergency ambulance service, while ETE in the emergency department was performed by emergency medicine residents or emergency medicine specialists with at least 2 years of emergency department experience. Epigastric compression was performed by applying pressure to the epigastric region at least three times (in 5 sec) with the volar side of the intubated patient while the patient was ventilated with a balloon-valved mask. Immediately after ETI was performed, Ultrasonography (USG) was performed as the gold standard confirmation method. If a double path sign was observed and the pleural sliding motion was not seen, it was considered unsuccessful. Results: A total of 78 patients were included in the study (an equal number of successful and unsuccessful ETE applications). Approximately 59% (n=46) of the patients were female, median age was 73 years (64-80), and 22(28.2%) patients were intubated due to traumatic etiology. The specificity and sensitivity of epigastric fluctuation for esophageal intubations were 83.33% and 60%, respectively. The positive predictive value was 92.31%, and the negative predictive value was 38.46%. Epigastric auscultation airflow sound had a specificity of 86.96% and a sensitivity of 65.45% for esophageal intubation. Conclusion: Although the fluctuation that occurs in the tube with epigastric compression is not as sensitive and specific as USG, it is a better method than lung auscultation. © 2025 Elsevier B.V., All rights reserved.
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    Characteristics of patients leaving the emergency department without being seen by a doctor: The first report from Türkiye
    (Lippincott Williams & Wilkins, 2024) Senguldur, Erdinc; Demir, Mehmet Cihat; Selki, Kudret; Erdem, Emre; Guldal, Hatice
    The presence of patients who leave without being seen (LWBS) by a physician in the emergency department (ED) is an essential indicator of the accessibility and quality of healthcare delivery. A high LWBS rate implies low patient satisfaction. This study aims to analyze the prevalence and characteristics of LWBS patients in T & uuml;rkiye and their ED readmission rate within 3 days. This retrospective, single-center, observational study was conducted in the ED of a Turkish tertiary university hospital. It looked at patients who left without being evaluated by a physician admitted to the ED between June 01, 2021, and June 01, 2023. Data on age, gender, residential area, health insurance status, ED readmission within 3 days, complaints, and hospitalization were obtained through the hospital's electronic record system. The prevalence of LWBS patients was 0.43%. Only 0.6% (n = 5) of LWBS patients had no health insurance. About 12.8% (n = 99) of them were 65 years and older. About 10.2% (n = 79) of LWBS patients were readmitted to the ED within 72 hours. The most common reason for readmission was musculoskeletal system complaints. Statistically, ED readmission was significantly more common in older adults (P = .05). Older LWBS patients are more likely hospitalized upon return visits to the ED (P = .014). LWBS patients are both a result and a consequence of ED crowding. A zero LWBS rate is crucial for older adults' health as they may fall victim to an invisible accident while avoiding ED traffic. Prioritizing older adults and reorganizing waiting areas can reduce ED crowding and cost burden due to delayed treatments.