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Öğe Knowledge of Local Anesthetic Systemic Toxicity among Emergency Medicine Physicians: A Cross-Sectional Study(Mre Press, 2020) Ilhan, Bugra; Demir, Mehmet CihatBackground: Local anesthetics (LAs) are widely used in medical practice. The prevalence of LAs used has attracted attention with increasing reports of toxicity. To our knowledge, there is no study that surveyed emergency medicine physicians (EMPs) about local anesthetic systemic toxicity (LAST). We aimed to assess EMPs' knowledge and awareness of LAST. Methods: This was a cross-sectional questionnaire-based study. EMPs working in the emergency department of a variety of hospitals (university, training and research, public, private) in Turkey participated in the study via e-mail. EMPs who did not use LAs and residents were excluded. The questionnaire was sent to physicians via e-mail, and responses were analyzed. Results: A total of 178 EMPs participated in the study and 20.8% and 22.5% of respondents recognized all the symptoms and treatment options of LAST respectively. About 4% had no knowledge on intravenous lipid emulsion (ILE) treatment, 41.6% used ILE treatment, and 42.1% were correct in the treatment dose of ILE. A significant correlation was found between the type of hospital and related training and the correct response of the ILE dose. Participants working at a university hospital had significantly higher correct answers (58.3%) on the treatment dose of ILE, but the correlation was weak (r: 0.165). Conclusion: Although LAST might have high mortality and morbidity in emergency patients, the level of EMPs' knowledge and awareness of LAST is poor. The current training about LAs should be increased and standardized. EMPs should be encouraged to use ILE if indicated.Öğe Local Anesthetic Systemic Toxicity Knowledge of Emergency Medicine Residents: A Cross-Sectional Study(Duzce Univ, 2020) Ilhan, Bugra; Demir, MehmetObjective: Local anesthetics (LAs) are starting to be used after the discovery of cocaine, which is used in medical practice. Now LAs are used many procedures in many clinics, especially in emergency departments (EDs). The extensive use of LAs was brought side effects and toxicity. Local anesthetic systemic toxicity (LAST) have been reported from simple allergic conditions to cardiovascular and neurological complications that can be fatal. The study aims to evaluate the level of knowledge and awareness of LAST among emergency medicine residents (EMRs). Methods: This was a questionnaire-based cross-sectional study. The questionnaires were sent to EMRs via e-mail, and responses were collected. The participants who gave informed consent included in the study, and who didn't use LAs in their daily practice were excluded. All of the participants responded all of the questions and responses were analyzed. Results: 92 EMRs were included in the study. The median age of the participants was 29 (24-50) years, and 48.9% were women. In the research, no one could recognize all LAST symptoms, ranging from mild to severe. Only 16.3% of the participants answered all treatment options of the LAST correctly, and 27.2% knew the intravenous lipid emulsion dosage accurately. Conclusions: The level of knowledge and awareness of the EMRs on LAST were insufficient. EMRs training rates on LAs and LAST were found to be low. In addition, it was stated that the patient's informed consent was not appropriately obtained from the vast majority of patients undergoing LA procedure. As the first study on LAST among EMRs, we believe that necessary arrangements should be made regarding the detected deficiencies.Öğe NEDOCS: is it really useful for detecting emergency department overcrowding today?(Lippincott Williams & Wilkins, 2020) Ilhan, Bugra; Kunt, Mehmet Mahir; Damarsoy, Filiz Froohari; Demir, Mehmet Cihat; Aksu, Nalan MetinThe Emergency Department (ED) overcrowding is an ongoing problem all over the world. The scoring systems are available for the detection of this problem. This study aims to test the applicability of the National Emergency Department Overcrowding Study (NEDOCS) scoring system, one of the scoring systems that evaluate the ED overcrowding. In this prospective observational study, the survey was applied on on-duty doctors, nurses, paramedics, intern doctors, and ward persons working in a University Adult Emergency Department and agreed to participate in the study, between certain hours during the day and the NEDOCS score was calculated simultaneously. The demographic characteristics of the on-duty staff, overcrowding of ED, and the number of the on-duty staff members were recorded in the questionnaires. During the study, 153 measurements were performed, and 3221 questionnaires were filled. The NEDOCS mean score was determined as 101.59 and the most reached result was extremely busy but not overcrowded (32%). The ED was rated mostly as busy (33.7%) by the on-duty staff. A significant difference was found between ED overcrowding and NEDOCS score. There is a significant difference between ED overcrowding and on-duty emergency nurse and intern doctor count. The NEDOCS score is not suitable for evaluating ED overcrowding. Accurate determination of the ED overcrowding is very important to avoid the negative consequences of the ED overcrowding. Increasing emergency nurse and intern doctor count will decrease ED overcrowding. Also, there is an urgent need to constitute local hospitals and also public health policies to satisfy the increasingly ED's presentations.Öğe Performance of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age >= 65 (CURB-65) score among patients with COVID-19 pneumonia in an emergency department triage setting: a retrospective study(Associacao Paulista Medicina, 2021) Demir, Mehmet Cihat; Ilhan, BugraBACKGROUND: Healthcare institutions are confronted with large numbers of patient admissions during large-scale or long-term public health emergencies like pandemics. Appropriate and effective triage is needed for effective resource use. OBJECTIVES: To evaluate the effectiveness of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age >= 65 years (CURB-65) score in an emergency department (ED) triage setting. DESIGN AND SETTING: Retrospective study in the ED of a tertiary-care university hospital in Duzce, Turkey. METHODS: PMEWS, STSS and CURB-65 scores of patients diagnosed with COVID-19 pneumonia were calculated. Thirty-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) need and outcomes were recorded. The predictive accuracy of the scores was assessed using receiver operating characteristic curve analysis. RESULTS: One hundred patients with COVID-19 pneumonia were included. The 30-day mortality was 6%. PMEWS, STSS and CURB-65 showed high performance for predicting 30-day mortality (area under the curve: 0.968, 0.962 and 0.942, respectively). Age > 65 years, respiratory rate > 20/minute, oxygen saturation (SpO(2)) < 90% and ED length of stay > 4 hours showed associations with 30-day mortality (P < 0.05). CONCLUSIONS: CURB-65, STSS and PMEWS scores are useful for predicting mortality, ICU admission and MV need among patients diagnosed with COVID-19 pneumonia. Advanced age, increased respiratory rate, low SpO(2) and prolonged ED length of stay may increase mortality. Further studies are needed for developing the triage scoring systems, to ensure effective long-term use of healthcare service capacity during pandemics.
